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To evaluate the effects of uncomplicated revascularization surgery on resting global and regional left ventricular function we studied 34 patients, enrolled consecutively, by radionuclide angiocardiography. After surgery, we found no significant change in global left ventricular ejection fraction; this was true even in the subgroup of 14 patients who developed paradoxical septal motion. This finding indicates that the development of paradoxical septal motion after uncomplicated cardiac surgery does not compromise global left ventricular function. Both in the subgroup of patients with paradoxical septal motion and in the subgroup without paradoxical septal motion regional ejection fraction calculations showed the same postoperative pattern consisting of increase of the proximal and distal posterolateral regional ejection fraction, increase in the inferoapical regional ejection fraction and unchanged proximal and distal septal regional ejection fraction. In our patients paradoxical septal motion is not due to pericardial effusion, conduction disturbance, septal ischemia or infarction. Our data suggest that the anteromedial translation of the entire heart during systole, due to surgical removal of constraints, may account for both the false improvement of posterolateral and inferoapical regional wall motion and the development of paradoxical septal motion.

Partial monosomy of 22q, resulting from a de novo unbalanced translocation t(X;22)(q28;q11) was detected in a newborn female with manifestations of the DiGeorge anomaly including multiple anomalies, type I truncus arteriosus, T-cell abnormalities, thymic aplasia and parathyroid hypoplasia noted on postmortem examination. Although DiGeorge anomaly is causally heterogeneous, our patient, together with 18 previously known cases, confirm that partial monosomy of the proximal long arm of chromosome 22 is the single most common cause of this polytopic developmental field defect.

Two new cases of anatomically corrected malposition of great arteries (A-V concordance or discordance; V-GA concordance; subaortic conus) are reported. One of these has been studied from the autoptic specimen and is in situs solitus with A-V concordance (SDL), which is the most common form of such alteration. The second case, studied by angiography, is in situs inversus with A-V concordance (ILD). This form has been described only once in the literature, but some Authors still consider it "possible" such an anormally rather than reported as yet. Finally the anomalies most frequently associated to the MACGA and the possible morphogenesis are valuated.

A 5 year old child, previously diagnosed as having tetralogy of Fallot, was admitted to hospital in severe congestive heart failure. The electrocardiogram showed left anterior hemiblock and incomplete right bundle-branch block, neither of which was previously present. The child died in intractable congestive heart failure and the necropsy showed a double outlet right ventricle with complete spontaneous closure of the subaortic ventricular septal defect by fibrous tissue. The possible mechanism involved in the production of this unusual complication of double outlet right ventricle is discussed, together with an explanation for the electrocardiographic changes.

Choledochoscopy is complementary to peroperative cholangiography in exploration of the main biliary way. Transcystic access is proposed in choledocholithiasis. The cystic duct, in fact, is frequently transitable owing to the dilatation produced by the migration of gallstones and because of the increasing miniaturisation of instruments. This examination of the MBW is less traumatic and risky than transcholedochotomic choledochoscopy.

In 64 consecutive subjects (age range 17-69 years) we compared the antero-posterior (A-P) size of the left atrium estimated by M-mode and wide-angle two-dimensional echocardiography (short and long axis parasternal views). M-mode A-P diameter correlated both with short (r = 0.82) and with long (r = 0.76) axis A-P diameter. Subsequently we quantitatively analysed by two-dimensional echocardiography A-P, cranio-caudal (C-C) and latero-lateral (L-L) left atrial dimensions in 20 patients with mitral valve disease (age range 24-66 years) and in 24 normal subjects of comparable age range. Subjects with mitral valve disease had significantly higher A-P (P less than 0.001), C-C (P less than 0.02) and L-L (P less than 0.001) left atrial dimensions than normal controls. Both in normals and in mitral valve disease patients C-C was the view that showed the largest atrial diameter. Left atrial shape was however more spherical in mitral valve patients. Of these 7/20 (35%) had abnormal A-P diameter compared to the normal subjects. Patients with abnormal L-L and C-C left atrial dimensions were 9/20 (45%) and 7/20 (35%). Five of the patients with increased L-L size had a normal A-P diameter. Our results demonstrate the usefulness of wide-angle two-dimensional echocardiography in the assessment of the left atrial enlargement, especially in patients with negative or borderline M-mode echocardiographic data.

Ninety consecutive patients with atrioventricular canal were studied to identify the association between left-sided obstructive lesions and Down's syndrome. Three groups were recognized: Group I, 76 patients with atrioventricular canal and no left-sided obstructions; Group II, nine patients with atrioventricular canal and left-sided inlet obstructions; Group III, five patients with atrioventricular canal and left-sided outlet obstructions. Of the 90 patients studied, 47 had Down's syndrome and only one of these had a left-sided obstructive lesion. Of 43 without Down's syndrome, 13 or 30% had left-sided obstructive lesions with predominating lesions at the inlet level caused by right ventricular dominance.