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Three paracardiac masses (1 thymic cyst, 2 thymomas) were studied by magnetic resonance imaging (MRI) using spin-echo, multi-echo, and gradient-echo sequences (cine-MR). MRI showed: a pedunculate cystic lesion, typical for thymic origin, in Case 1; cardiac and pulmonary infiltration, and 3 intracardiac metastases, in Case 2; cardiovascular compression but not infiltration, in Case 3. In 3/3 cases MRI was superior to transthoracic echocardiography (TTE), and in 2/2 MRI was superior to computed tomography (CT), not performed in Case 2 (allergy to contrast agents). MRI may be considered the most important technique to evaluate cardiovascular involvement by thymic neoplasms. MRI should be performed after TTE and makes CT unnecessary.

Coronary angioplasty is an effective recanalization technique, but is plagued by a high restenosis rate. One of the major effects of balloon dilatation is the stretching of the vessel wall and the subsequent elastic recoil. Although a well known phenomenon, few data have been published on the evaluation of elastic recoil after coronary angioplasty. The purpose of this study was to quantify the acute and short-term elastic recoil after coronary dilatation. Thirty-six patients underwent coronary angioplasty. A digital end-diastolic acquisition of the coronary artery was performed before, immediately after, at 15 min and at 20 hours after dilatation. Elastic recoil was defined as the difference between the diameter of the inflated balloon and the diameter of the vessel after dilatation. It was quantified by a semi-automatic computer-assisted program. Our data show a high elastic recoil immediately after dilatation, equal to 27.9% (p < 0.0001), which continues for the next 20 hours to a final value of 34.1%. No difference was found in the amount of elastic recoil depending on the coronary artery involved, length, severity and eccentricity of the stenosis, time and pressure used during balloon inflation. Elastic recoil was more pronounced (p = 0.002) using balloons with a balloon diameter/vessel diameter ratio > 1.

A cirrhotic patient with inferior cava and right atrium-ventricular invasion by hepatic tumor was studied with transthoracic echocardiography (TTE), computerized tomography (CT) before and after contrast agent bolus iv, ECG-gated magnetic resonance imaging (MRI). Obesity obstacled abdominal echotomographic study; esophageal varices were relative contraindication to transesophageal echocardiography (TEE). The resolutive diagnosis was possible thanks to MRI which documented the spatial continuity among hepatic tumor, intracaval neoplastic thrombus and intracardiac mass. TTE can be considered the first step in case of suspected cardiac masses, but it is sometimes limited by the thorax conformation and not always discriminant. TEE is semi-invasive with important contraindications. CT is limited by the only axial or para-axial scans with low quality reconstructions, worsened in these cases by respiratory and cardiac movements. MRI can be considered the second step in the imaging of cardiac masses, immediately and directly after the echocardiographic techniques.

Restenosis is the major limit of arterial recanalization devices. Directional atherectomy has allowed for the first to remove atheroma samples by a percutaneous approach. A group of patients affected by superficial femoral artery disease who underwent directional atherectomy were studied. The patients were treated for primitive stenosis, restenosis after balloon angioplasty and thermal laser angioplasty. Intimal hyperplasia was the distinctive feature of restenosis and the cells were identified by immunohistochemistry and transmission electron microscopy as smooth muscle cells in an active synthetic phenotype. No differences were found in the restenosis process after balloon angioplasty and laser thermal angioplasty. Directional atherectomy is a useful tool to ameliorate our knowledge in the restenosis process after invasive procedure of recanalization.

Intravascular ultrasound angioscopy allows to better define the structure of arterial wall and the effect of angioplasty. We report the case of a patient previously treated by coronary angioplasty, who underwent peripheral angioplasty for a stenosis of the left iliac artery. Intravascular ultrasound imaging performed before and after balloon dilatation clearly identified the plain of dissection and the partial resolution of the stenosis in a better way compared to digital angiography.

Aim of this study is to define the hemodynamic effects of magnesium (Mg) in patients with ischemic heart disease. Thus, the effects of 1 g of Mg pidolate injected over 3 min iv were evaluated in 10 patients by analysis of pressure data from a micromanometer catheter in the left ventricle and of volume data derived from Doppler and 2-dimensional echocardiography. Recordings were made before and immediately after the injection, at 3, 5, and 8 min. At 5 min, Mg induced a significant reduction in left ventricular peak systolic pressure (from 132.4 +/- 19.4 to 122.7 +/- 17.5 mmHg, p = 0.015, with early filling notably augmented (E wave of Doppler curve; from 39.4 +/- 8.5 to 43.9 +/- 9.7 cm/s, p = 0.013) and a slight increase in cardiac output (from 6.23 +/- 1.4 to 6.9 +/- 1.7 l/min, p = 0.092). Heart rate increased (from 75.9 +/- 9.6 to 78.13 +/- 8.4 b/min, p = 0.062) and the constant of isovolumetric pressure decay decreased (from 48.9 +/- 13.2 to 45.7 +/- 14.9 ms, p = 0.065), probably as a final effect of aortic pressure reduction. The diastolic pressure-volume relationship was insignificantly displaced downward (p = 0.11) and to the right (p = 0.62). In conclusion, Mg unloads the ischemic left ventricle through a reduction of systemic aortic pressure, with a secondary increase in early filling; this increase may derive from a rise in the atrioventricular diastolic gradient, subsequent to an improvement in ventricular emptying. Active relaxation is improved, and passive diastolic properties are not affected, in spite of the reported calcium-antagonist action of the drug.