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A study of left ventricular volume was carried out on ten normal subjects. The average values and the standard deviations of the end-diastolic (EDV) and end-systolic volumes (ESV), the systolic throw and the ejection (EF) are reported. They were obtained by using the single-plane cineventriculography method in the OAdx projection of 30 degrees.

Thirty-two members of a family were studied. Three of them died in their youth and had evidence of arrhythmogenic right ventricular (RV) dysplasia. The other 29 members underwent clinical examination, electrocardiography, chest x-ray and M-mode and 2-dimensional echocardiography. Fourteen patients found to have structural abnormalities of the right ventricle underwent 24-hour ambulatory electrocardiographic recording and symptom-limited bicycle stress testing. Hemodynamic and angiographic studies were performed in 6 of these patients. In this family the arrhythmogenic RV dysplasia showed a wide variation of abnormalities, ranging from mild, local alterations to generalized involvement of the right ventricle. The patients were separated into 3 groups on the basis of both the clinical profile and noninvasive/invasive studies: 3 subjects who died suddenly; 3 subjects who had severe ventricular arrhythmias; and 8 subjects in whom RV impairment was not associated with any significant arrhythmias. There was no close relation between the severity of the RV abnormality and presence of ventricular arrhythmias. The variability of the RV abnormality and the high prevalence of this condition in this family is consistent with a genetic pattern of autosomal dominance with incomplete penetrance.

A case of anomalous origin of the right coronary artery from the main pulmonary artery, in a previously asymptomatic young woman, is presented. Direct transposition into the aortic root of the anomalous vessel was performed. To our knowledge this is the 4th case of this malformation to be successfully corrected.

The authors report seven cases of congenital coronary artery fistula observed in the Cardiology Department of Padua Medical School. The cardiopathy, the anatomo-histological characteristics, evolution and embriology are described. The anamnesic, clinical, electrocardiographic, X-Ray, phonocardiogram, haemodynamic, and contrastographic findings for each case are given. They are discussed and interpreted in the light of the pathophysiology of the disease.

The clinical, surgical and pathological features of 13 patients (3 males, 10 females) with cardiac myxoma are reported. Eleven masses were situated in the left atrium and 2 in the right one. The incidence of signs and symptoms usually ascribed to cardiac myxoma is evaluated. Particular emphasis is given to embolization phenomenon which occurred in 3 patients with villous-surfaced tumors. The results of phonocardiographic, echocardiographic and isotopic angioscintigraphic examination are illustrated and the use of these incruent investigations is highly recommanded. Final diagnosis may be achieved by cardiac catheterization and angiocardiography. Successful surgical excision was carried out in 12 patients. Structural profile of atrial myxoma is discussed. Particular attention is given to the surface of the tumors (smooth or villous), to the pseudovascular structures on the light microscopy and to the endotelial like features, together with secretory activity of the myxoma cells, on the electron microscopy. The morphologic findings support the neoplastic origin of the myxoma. The distinction between embolization and malignant metastasis is underlined.

A new method for evaluating the systolic displacement of the left ventricle profile is proposed. It rests on the definition of an intracardiac axis and the identification of equivalent points on cardiac end-systolic and end-diastolic silhouettes separately. Displacement in then evaluated by means of vector methods. The results in ten normal subjects are reported. Systolic displacement is visualized by means of maps, uhich reflect the geometric properties of left ventricle normal contraction.

One hundred forty-three subjects (107 with coronary artery disease [CAD], 23 without CAD [evaluated by coronary angiography] and 13 athletes) were selected for this study. All subjects underwent exercise testing to evaluate sensitivity, specificity and predictive value of Q wave, QX/QT ratio, QTc interval and ST depression. The Q-wave analysis revealed less sensitivity (49%) and less specificity (83%) than ST depression (71% and 97%, respectively). The QTc criterion had greater sensitivity (80%) than ST depression but less specificity (11%). The QX/QT criterion was no different in sensitivity (74%) but had less specificity (69%). To establish the statistical evaluation of the positive predictive value in CAD, variations in the prevalence of the disease were considered. A 90% prevalence gives the best positive predictive value on all evaluated measurements, between 100% for ST depression and 89% for the QTc criterion. A 5% prevalence, however, gives an acceptable positive predictive value only on ST-segment depression (57%).

One-hundred and eighty-nine patients who underwent cardiac catheterization for suspected ischemic heart disease were assigned to four different groups depending on the number of diseased vessels (0, 1, 2, 3), the dominant artery and the presence of left main coronary stenosis. Among the 45 parameters obtained from history, physical examination, E.C.G., and exercise test multivariate analysis identified (positive stress test, maximal systolic blood pressure, documented myocardial infarction, maximal heart rate, ipercholesterolemia, lateral myocardial infarction, angina during stress test) that were statistically significant. A score system was devised on the basis of the summed-up value of the seven parameters. When the patients were assigned, according to the score, to one of the previously mentioned 4 groups, the classification proved to be correct in 54% of the cases. When we divided the patients in two groups with or without coronary artery disease so that the attribution turned out to be correct in 92% of the cases (sensitivity 94%, specificity 77%), whereas when based on ST segment depression only, the classification was correct in 85% of the cases (sensitivity 84%, specificity 88%).

Coronary artery spasm has rarely been observed in the transplanted, denervated heart. We report two patients who had coronary artery spasm after orthotopic heart transplantation that was documented by coronary angiography while ECG and Holter monitoring showed ischemic changes. Both patients were treated with calcium antagonists with no further evidence of this complication; however, one patient died suddenly at home after calcium antagonists were arbitrarily withdrawn. We believe that coronary artery spasm in heart transplant recipients may occur more frequently than expected. Careful monitoring of 24-hour ECG should be considered routinely in the follow-up of such patients, and when coronary spasm occurs it should be aggressively treated.

Have been studied 51 patients with aortic incompetency (AI), 46 with mitral insufficiency (MI) and 31 with congestive cardiomyopathy (CM) as example of a primitive myocardial lesion. The mean parametres calculated were: the left ventricular end-diastolic pressure (LVEDP), the ventricular volumes, the ejection fraction (EF), the end-sistolic pressure-volume ratio (Emax) and the eccentricity. In the chronic volume overload, the relationship between the pump performance and the contractility (EF-Emax) is parabolic with an initial plateau (myocardial failure without circulatory failure); the EF-Emax relationship, in the CM, is linear without a plateau. The LVEDP is a limiting factor of the pump-contractility relationship in the AI: for the same value of the contractility, the pump function is greater depressed if the LVEDP is 25 mmHg (loss of the preload modulation); in the MI and CM the depression of the pump performance is a function only of the depressed contractility. The end-systolic eccentricity is correlated with Emax: the changes in the geometrical shape of the left ventricular chamber is due to the depressed contractility.

16 cases of left ventricular-right atrial communication are reported. The most consistent clinical features, suggestive of this condition, were: auscultatory findings of V.S.D., electrocardiographic patterns of right atrial enlargement and biventricular hypertrophy, considerable right atrial enlargement coexisting with signs of left-sided cardiac enlargement and increased polmonary vascularity to Xray examination, echocardiographic fluttering of the tricuspid valve. Cardiac catheterization revealed an increased oxygen content in the right atrial or ventricular blood without the passage of the catheter through an A.S.D. The definitive diagnosis was established by left ventricular angiocardiography which demonstrated immediate opacification of a dilated right atrium through a septal defect; the location of the septal defect in the cardiac septum was attempted. In patients who suffered from a large left to right shunt were recommended for surgical treatment also in view of the relatively bad tolerance of this defect and low operative risk. There were two deaths: one baby died of early congestive failure. 9 cases were operated upon with one immediate postoperative death. The remaining, controlled by clinic follow-up, had good results.

Ten cases of total abnormal pulmonary venous connection are described: 5 cases with supracardiac drainage, 4 with sub-diaphragmatic drainage and one with intracardiac drainage, 3 cases with supradiaphragmatic drainage, and 4 with subdiaphragmatic drainage have undergone surgical treatment. Some developmental, embryological and pathophysiological signs of this malformation are reported. The more significant clinical and instrumental data arising from our personal cases and from review data are discussed. In the clinical description a distinction is made between cases with venous obstruction and those without venous obstruction. The importance of hemodinamic tests, which allow us to identify the type of connection present, and whether or not there are associated malformations, are underlined. The natural history is conditioned by the presence of venous obstruction, by the value of the pulmonary hyper-flow and by the possibility of communication between the two circulatory districts. The prognosis of the cases with marked obstruction, and of those with irreversible cardiac failure is one of rapid deterioration: surgical correction in the first months of life is the only therapeutic possibility, even if the death risk is high. The cases without venous obstruction, and with fairly normal weight and circulation, are corrected surgically at a later age with much more favourable results.

A case of transient tricuspid insufficiency in a newborn is reported. Cardiac catheterization performed at the age of two days because of cyanosis and cardiac failure, showed massive tricuspid incompetence, a normal tricuspid valve, increased diastolic volume of both ventricles valve, increased diastolic volume of both ventricles and depressed left ventricular ejection fractions. The clinical course has been satisfactory and at the age of four months repeated cardiac catheterization showed marked reduction of the size of both ventricles and improved left ventricular function; a small hypokinetic area of the left ventricle and a mild residual tricuspid incompetence, due to incomplete reversibility of the ischemic damage, were also documented. These findings suggest further considerations on therapeutic problems of transient tricuspid insufficiency and its outlook.

60 patients with clinical signs of coronary artery disease who had a hemodynamic examination were studied. The study of the regional dynamics using the deformation as a vectorial time-dependent parameter and the pressure-length loops, was carried out on a total of 420 parietal regions of the left ventricle: the basal ventriculography, the post-extrasystolic potentiation and the ventriculography after nitroglycerin were evaluated. The dynamic regional pattern was correlated with clinical-enzimatic signs of necrosis in the electrocardiogram. The possibility of correlating signs of necrosis with particular patterns of hypokinesia, akinesia, dyskinesia which differ from corresponding "static" forms of asynergy in active pressure development and deformation (even in a brief systolic interval) seems to confirm the physiopathologic interpretation of the regional phenomenon based on the ratio between viable not viable myocardium -- as primary cause.

Aneurysm-like kialations of the membranous septum are described with increasing frequency in association to a ventricular septal defect (VSD). Their etiology may be congenital, though with different pathogenesis and acquired. An anatomical distinction between true aneurysm of the membranous septum and pseudoaneurysm is proposed. The acquired forms may be joined to a decrease of left to right shunt and are regarded as the mechanism of closure of a VSD. Nine cases of aneurysm-like dilation of the membranous septum are presented: an interpretation of their etiology and pathogenesis is discussed, on the basis of the history and clinical and instrumental data.

A radiographic and hemodynamic investigation has been performed in 53 patients with pure isolated aortic regurgitation, in order to evaluate the most reliable method to detect left ventricular enlargement in this condition. Twelve plain chest film measurements have been compared to the end diastolic volume of the left ventricle calculated by left ventricular angiography. The most sensitive detector of left ventricular enlargement was the plain film total heart volume ( r = 0.754); the cardiothoracic ratio, the cardiac perimeter and the frontal area were less sensitive measurements, but still statistically significant (p less than 0.001). The results of our investigation support the conclusion that plain film total heart volume is the most reliable single measurement for evaluating the left ventricular enlargement in patients with isolated pure aortic incompetence.