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Abstract: Noncompaction of the left ventricular myocardium is a rare and unclassified cardiomyopathy that remains frequently overlooked, even by experienced echocardiographers. This fact may be due to non-optimal imaging of the lateral and apical myocardium, and/or insufficient disease awareness by echocardiographers. We report a case of a young man with heart failure and severe left ventricular dysfunction, previously diagnosed of ischemic etiology, in which the contrast enhancement of left ventricular endocardium allowed us to reach the correct diagnosis of isolated left ventricular noncompaction. [Copyright &y& Elsevier]

The article presents two images of ehocardiographic and intraoperative display of ring thrombosis following minimally invasive mitral valve repair in a patient without thrombotic risk factors such as thrombophilic disorders and atrial fibrillation.

Cardiac sonographers play a key role in the management of echo-laboratories in anglo-saxon countries. In Italy, and generally in "latin" countries nearly all echocardiographic studies are performed by cardiologists. However, because of the increasing demand for echocardiography, this practice will no longer be feasible (medical schools do not graduate enough cardiologists!), and cost-effective (the cost of echocardiography performed by cardiologists only is becoming too high!). Introduction of cardiac sonographers in Italian echo-laboratories may represent a feasible and cost-effective solution to the ever increasing demand for echocardiography. In order to contribute to the debate, we report the experience of our echo-laboratory that employs cardiac sonographers since 1984.

Background and Aim of the Study: The use of stented bioprostheses for aortic valve replacement (AVR) in elderly patients with a small aortic annulus may result in unsatisfactory hemodynamic performance of the prosthesis. To overcome this limitation, new bioprostheses have been designed for complete supra-annular implantation, but the actual hemodynamic advantage of the supra-annular implant over the intra-annular has not been fully investigated. Accordingly, the hemodynamic performance of the same stented bioprosthesis (except for sewing ring design) implanted in the supra-annular and conventional intra-annular seating was compared., Methods: Twenty-two patients received an intra-annular implant, and 38 a supra-annular implant. Age (74 +/- 5 versus 76 +/- 5 years, p = 0.54), gender (55% versus 50% males, p = 0.79) and body surface area (1.74 +/- 0.2 versus 1.81 +/- 0.2 m2, p = 0.13) were similar in both subgroups, who underwent echocardiography at 8 +/- 2 and 6 +/- 2 months after surgery, respectively (p = 0.09)., Results: The two patient subgroups had similar preoperative left ventricular outflow tract diameters (2.06 +/- 0.2 and 2.1 +/- 0.2 cm; p = 0.62), average size of implanted prosthesis (21.0 and 21.3 mm; p = 0.44) and mean transprosthetic flow rate (246 +/- 70 and 218 +/- 58 ml/s; p = 0.12). Mean (8 +/- 3 and 19 +/- 8 mmHg, p < 0.0001), and peak (17 +/- 6 and 40 +/- 13 mmHg; p < 0.0001) transprosthetic gradients were lower, and mean effective orifice area (EOA) (1.78 +/- 0.4 and 1.45 +/- 0.5 cm2, p = 0.006) was higher in patients with supra-annular implants than in those with intraannular. The incidence of patient-prosthesis mismatch (EOA index < 0.85 cm2/m2) decreased from 50% to 34% (p < 0.0001), with no case of severe mismatch using the supra-annular implant. During follow up, a left ventricular mass reduction occurred in patients with supra-annular implants (from 225 +/- 110 to 173 +/- 59 g/m2; p < 0.03), but not in patients with intra-annular implants (173 +/- 62 and 186 +/- 64 g/m2; p = 0.87), Conclusion: The study results showed that, compared to intra-annular implantation, supra-annular implantation of bioprosthetic stented valves in the aortic position was associated with a significantly better hemodynamic performance of the prosthesis and significant regression of left ventricular hypertrophy.