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To propose a sustainable model of coronary computed tomography angiography (CCTA) use in acute coronary syndrome (ACS) in emergency department (ED) using a partially based teleradiology reporting model. We also analyzed impact of the protocol on short- and long-term patient's outcome.During a 12-month period, 104 consecutive patients admitted to the ED for acute chest pain (ACP) with low-to-intermediate risk of ACS were selected and underwent CCTA. Medical reporting was based on a model combining on-site physician and a remote radiologist supported by a web client-based teleradiology system, covering a 24/7 service. CCTA findings were correlated with the incidence of major adverse cardiovascular events (MACEs) over a 5-year follow-up.CCTA ruled-out CAD in 76 patients (73.1%). Moderate (7.7%) to severe (19.2%) CAD was identified in 28 patients who were directly referred to functional tests or invasive angiography. The mean discharge time was 10.8 ± 5.8 h; patients with absent to mild disease were safely and quickly discharged. Remote reporting using a teleradiology platform was performed in 82/104 cases (78.9%), with slight impact on patient's discharge time (10.4 ± 5.6 vs. 12.1 ± 6.1 h, p: 0.24). MACEs at 6-month and at 5-year follow-up were 0.96% (n = 1/104) and 15.5% (n = 14/90).CCTA assessment of patients with ACP enables to quickly rule-out ACS, avoiding waste of time and resources, to identify patients with obstructive CAD which should be referred to subsequent tests and to stratify the risk of MACEs at short and long time. A partial teleradiology based 24/7 CCTA service is feasible and sustainable, even in small ED.

Cardiac and pericardial involvement by malignant lymphoma is a rare condition. The present case report describes a case of primary cardiac MYC/BCL6 double hit non-Hodgkin lymphoma in the pericardium, and highlights the importance of a prompt diagnosis and aggressive pharmacologic treatment of this disease. In a symptomatic patient, a minimally invasive 3 cm sub-xiphoidal incision was performed under deep sedation with spontaneous ventilation to perform a pericardial biopsy. A 5 cm × 3 cm portion of pericardium was removed from above the right ventricle, thus ameliorating the extrinsic compression on the right chambers. The patient received 6 cycles of immuno-chemotherapy (rituximab plus cyclophosphamide, vincristine, and methylprednisolone), with no complications, achieving complete remission with no symptoms. Malignancies must be excluded in every case of acute pericardial disease with imaging techniques, and lymphomas should be always considered in the differential diagnosis of cardiac tumors. Complete surgical removal of the tumor is not necessary to achieve complete remission, and minimally invasive surgical approaches are an effective tool to confirm diagnosis and allow a precise histologic characterization.

A previously developed poly-l-lactide scaffold releasing granulocyte colony-stimulating factor (PLLA/GCSF) was tested in a rabbit chronic model of myocardial infarction (MI) as a ventricular patch. Control groups were constituted by healthy, chronic MI and nonfunctionalized PLLA scaffold. PLLA-based electrospun scaffold efficiently integrated into a chronic infarcted myocardium. Functionalization of the biopolymer with GCSF led to increased fibroblast-like vimentin-positive cellular colonization and reduced inflammatory cell infiltration within the micrometric fiber mesh in comparison to nonfunctionalized scaffold; PLLA/GCSF polymer induced an angiogenetic process with a statistically significant increase in the number of neovessels compared to the nonfunctionalized scaffold; PLLA/GCSF implanted at the infarcted zone induced a reorganization of the ECM architecture leading to connective tissue deposition and scar remodeling. These findings were coupled with a reduction in end-systolic and end-diastolic volumes, indicating a preventive effect of the scaffold on ventricular dilation, and an improvement in cardiac performance.

In the last years, technical innovations in the field of CT angiography (CTA) and magnetic resonance angiography (MRA) have allowed accurate and highly detailed evaluation of peripheral vascular pathologies. This has dramatically changed the diagnostic approach in treatment planning of peripheral arterial obstructive disease and also enabling early identification of treatment failure or treatment-related complications after surgical or endovascular procedures. Although Doppler Ultrasound is the first-line imaging modality during follow-up after treatment, its role is currently diminishing in importance mostly because of the proliferation of high-end CT and MR scanners capable of fast, reproducible, and highly reliable vascular imaging. The aim of this study is to review the various surgical and endovascular procedures for peripheral arterial obstructive disease and to provide CTA and MRA samples of common and uncommon complications related to treatment.

Aims: Postdeployment mutual orientation between the disk and the lobe in patients undergoing left atrial appendage closure with Amplatzer cardiac plug/Amulet device might impact on the risk of residual leak during follow-up. Thus, we evaluated in an exploratory, pilot study whether the degree of intradevice misalignment, measured by cardiac computed tomography (CT), discriminates the occurrence of peridevice leak in those patients. Methods: All patients (N = 15) undergoing percutaneous left atrial appendage closure with those specific devices between April 2013 and January 2015 were prospectively included. All patients received follow-up evaluation by cardiac CT at 6 months after the intervention to calculate the angle of misalignment within the device and to detect presence of residual peridevice leak. Results: The angle of misalignment between the disk and the lobe of the device significantly discriminated between patients with and without peridevice leak (area under the curve 0.96, 95% confidence interval 0.88–1.0; P = 0.003), with an angle more than 20° being associated with nine-fold higher risk of residual leak. This angle of intradevice misalignment calculated by cardiac CT was significantly correlated with that measured by two-dimensional transesophageal echocardiography or X-rays in the cath lab after the device deployment (r = 0.943 and r = 0.938, respectively). Conclusion: A marked intradevice misalignment after Amplatzer cardiac plug/Amulet device implantation significantly predicts the occurrence of postprocedural leak in patients with atrial fibrillation; if confirmed by larger studies, these findings may impact on practice patterns.

Purpose Diagnostic challenges are common in clinical practice and diagnostic or classification criteria for musculoskeletal conditions cannot overshadow clinical skills. Methods We present the case of a young man who complained of prolonged articular pain and mild swelling of the right ankle in the absence of other remarkable data. Apparently fulfilling the Budapest diagnostic criteria for complex regional pain syndrome, the patient was treated accordingly, but the pain increased over time. Then the patient underwent an additional diagnostic workup including synovial and bone biopsies in 2 separate occasions with the second one demonstrating diffuse lymphoid infiltrate compatible with lymphoma. Results The conclusive diagnosis of primary diffuse large B-cell lymphoma of the talus was made and adequate treatment initiated. Conclusions The diagnostic difficulties as well as the importance of a multidisciplinary approach for complex cases are highlighted in this report.

Objectives This study sought to evaluate whether a strategy with a 600-mg clopidogrel load and a short-term, high-dose atorvastatin reload would improve outcomes in clopidogrel-naive, statin-treated patients undergoing protected carotid stenting. Background Optimal clopidogrel loading dose during carotid stenting has not been investigated; in addition, statin neuroprotection in this setting has not been described. Methods A total of 156 patients were randomized using a 2 × 2 factorial design to receive either a 600-mg (n = 78) or 300-mg (n = 78) clopidogrel load given 6 h before intervention and either a atorvastatin reload (n = 76; 80 mg + 40 mg initiating 12 h before the procedure) or no statin reload (n = 80). The primary endpoint was the 30-day incidence of transient ischemic attack/stroke or new ischemic lesions on cerebral diffusion-weighted magnetic resonance imaging performed at 24 to 48 h. Results Occurrence of the primary outcome measure was significantly lower in the 600-mg clopidogrel arm (18% vs. 35.9% in the 300-mg group; p = 0.019) and in the atorvastatin reload arm (18.4% vs. 35.0% in the no statin reload group; p = 0.031). High-dose clopidogrel also significantly reduced the transient ischemic attack/stroke rate at 30 days (0% vs. 9%, p = 0.02, secondary endpoint), without an increase in bleeding risk. Conclusions In patients undergoing carotid stenting, a strategy using both a 600-mg clopidogrel load and a short-term reload with high-dose atorvastatin protects against early ischemic cerebral events. These results, obtained along with routine mechanical neuroprotection, provide new evidence of the optimization of drug therapy before percutaneous carotid intervention. (Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting [ARMYDA-9 CAROTID]; NCT01572623 )

The advent of transapical echocardiography-guided mitral valve (MV) repair with implantation of polytetrafluoroethylene neochordae (NeoChord, St. Louis Park, Minnesota) has identified some critical aspects of the procedure that require accurate understanding of cardiac anatomy [(1,2)][1]. In

Carotid disease is a major cause of cerebrovascular events. Risk is proportional to the extent and severity of atherosclerosis. Aim of this study was to assess the correlation between 64-multi-detector-row computed-tomography angiography (MDCTA) and Doppler ultrasound peak-systolic-velocity (DUS-PSV) in the quantification of stenosis. 116 consecutive patients were included; it was calculated the degree of carotid stenosis with the North American Symptomatic Carotid Endarterectomy Trial (NASCET) method using MDCTA and DUS-PSV. MDCTA measurements of stenosis ranged from 35% to 95% (mean 67±16%). DUS-PSV ranged from 102 to 600 cm/s (mean 262±112 cm/s). A moderate correlation ( r 2 = 0.427) was found between MDCTA-NASCET stenosis and PSV values. At ROC curve analysis, PSV could significantly discriminate between stenoses ≥70% and 70% stenosis of MDCTA.

Sternal synthesis after median sternotomy, a conventional access practice in thoracic and cardiac surgery, is at the basis of severe complications, often impairing the clinical outcome of surgical interventions. In this work, we propose the use of an acellular biomaterial scaffold, to be interposed across the fracture rime during closure operations, directly exposing the biomaterial to bone marrow, in order to expedite healing process. A rabbit model of median sternotomy was performed and an electrospun scaffold composed of a hydroxyapatite-loaded absorbable biopolymer (poly-L: -lactide), shaped into a fibrillar structure, was used. CT follow-up confirmed a complete healing in the scaffold-treated group 1 week before the control. Histological evaluation demonstrated presence of newly formed bone trabeculae among scaffold fibers showing a higher degree of maturity with respect to the control untreated group. The proposed approach is able to both guide a more rapid healing and modulate inflammatory response across the wound site, resulting in improved healing and tissue remodeling with respect to conventional closure technique.

To compare two different imaging modalities, magnetic resonance (MR), and three-dimensional sonography (3DUS), in order to evaluate the specific role in preoperative work-up of deep infiltrating endometriosis. 33 women with endometriosis underwent 3DUS and MR followed by surgical and histopathological investigations. Investigators described the disease extension in the following sites: torus uterinus and uterosacral ligaments (USL), vagina, rectovaginal-septum, rectosigmoid, bladder, ovaries. Results were compared with surgical and histopathological findings. Ovarian and deep pelvic endometriosis were found by surgery and histology in, respectively, 24 (72.7%) and 22 (66.6%) of the 33 patients. Sensitivity and specificity values of 3DUS for the diagnosis of endometrial cysts were 87.5% and 100%, respectively; those of MRI were 96.8% and 91.1%, respectively. Sensitivity and specificity of 3DUS for the diagnosis of deep infiltrating endometriosis in specific sites were: USL 50% and 94.7%; vagina 84% and 80%; rectovaginal-septum 76.9% and 100%; rectosigmoid 33.3% and 100%; bladder 25% and 100%. Those of MR were: USL 69.2% and 94.3%; vagina 83.3% and 88.8%; rectovaginal-septum 76.4% and 100%; restosigmoid 75% and 100%; bladder 83.3% and 100%. MR accurately diagnoses deep infiltrating endometriosis; 3DUS accurately diagnoses deep infiltrating endometriosis in specific locations.

The left atrial appendage (LAA) is the main source of thromboembolism in patients with non-valvular atrial fibrillation (AF). As such, the LAA can be the target of specific occluding device therapies. Optimal management of patients with AF includes a comprehensive knowledge of the many aspects related to LAA structure and thrombosis. Here we provide baseline notions on the anatomy and function of the LAA, and then focus on current imaging tools for the identification of anatomical varieties. We also describe pathogenetic mechanisms of LAA thrombosis in AF patients, and examine the available evidence on treatment strategies for LAA thrombosis, including the use of non-vitamin K antagonist oral anticoagulants and interventional approaches. The left atrial appendage (LAA) is the main source of thromboembolism in patients with non-valvular atrial fibrillation (AF). As such, the LAA can be the target of specific occluding device therapies. Optimal management of patients with AF includes a comprehensive knowledge of the many aspects related to LAA structure and thrombosis. Here we provide baseline notions on the anatomy and function of the LAA, and then focus on current imaging tools for the identification of anatomical varieties. We also describe pathogenetic mechanisms of LAA thrombosis in AF patients, and examine the available evidence on treatment strategies for LAA thrombosis, including the use of non-vitamin K antagonist oral anticoagulants and interventional approaches.

Background The aims of our study were to quantify cartilage thickness at the minimum and maximum diameters of the radial head circumference and to investigate its influence on the size and shape of the proximal radius. Methods We analyzed high-definition magnetic resonance imaging scans of 78 healthy elbows in 19 men and 20 women, with a mean age of 28 (21-32) years. All measurements were estimated in the axial plane just distal to the fovea radialis. Maximum and minimum bone diameters, maximum and minimum total diameters (including cartilage thickness), and cartilage thickness were calculated. Cartilage thickness was measured at 4 different points: (1) at the articular side of the maximum diameter (point A), (2) at the nonarticular side of the maximum diameter (point B), (3) at the medial side of the minimum diameter (point C), and (4) at the lateral side of the minimum diameter (point D). Pearson correlation and t test were used for the statistical analysis. Results Mean maximum and minimum bone diameters and maximum and minimum total diameters were 22.2, 21.5, 24.0, and 23.2 mm, respectively. All differences between diameters were statistically significant. Mean cartilage thickness at points A, C, and D was 1.7, 0.8, and 0.8 mm, respectively. No measurable cartilage thickness was found at point B. No significant correlation was found between bone diameters and cartilage thickness. Conclusions Cartilage surface significantly increases and modifies the size and shape of the radial head. The observation that cartilage thickness varies between subjects and does not correlate with bone parameters suggests that the diameters of the radial head cannot be inferred from indirect measurements of dry bones or radiographs.

The authors describe the abnormal confluence of the right internal iliac vein into a left common iliac vein compressed by the overlying right common iliac artery. The prevalence of this combination of abnormalities, evaluated in cadavers and in living subjects by CT, was 0.9%. The possible obstacle to venous pelvic return by these anomalies is pointed out.

Background To study the degree of coverage provided by the greater sigmoid notch (GSN) to the humeral trochlea, as well as the contribution of the olecranon and coronoid process cartilage tips to this angle, and its variations. Methods We recruited 39 healthy volunteers, comprising 19 women and 20 men, with a mean age of 28 years (range, 21-32 years). High-definition magnetic resonance images were obtained for the right and left elbows. Four angles were measured on the sagittal plane passing through the coronoid and olecranon tips: angle A, identified by 2 lines from the trochlea center to the olecranon bone–cartilage junction and olecranon cartilage tip; angle B, identified by 2 lines from the trochlea center to the olecranon and coronoid bone–cartilage junction; angle C, identified by 2 lines from the trochlea center to the coronoid bone–cartilage junction and coronoid cartilage tip; and GSN coverage angle (GSN-ca), defined as the sum of angles A, B, and C. Pearson correlation tests, t tests, and intraclass correlation coefficients were used for statistical analyses. Results The mean angle A, angle B, and angle C values were 6° (range, 2°-12°), 182° (range, 153°-204°), and 9° (range, 2°-16°), respectively. No correlations were found between these 3 angles. The mean GSN-ca was 198° (range, 167°-222°), and the GSN-ca was less than 180° in 8% of the cases. No significant differences emerged for side or gender or for total length of the ulna. Conclusion The GSN showed significantly different shapes on the sagittal plane that we defined as closed type when the GSN-ca was greater than 180° (92%) and as open type when the GSA-ca was less than 180° (8%). The cartilage tip contribution varied and was not correlated with that of bone.

Post-mortem imaging is increasingly used in forensic field in cases of natural deaths related to cardiovascular diseases, which represent the most common causes of death in developed countries. While radiological examination is generally considered to be a good complement for conventional autopsy, it was thought to have limited application in cardiovascular pathology. The aim of this study was to investigate the role of post-mortem multidetector coronary artery computed tomography in cases of sudden death in adults.We have enrolled 11 cases, all of whom were negative for macroscopic extra-cardiac lethal findings after standard autopsy procedure. Later, from the same individuals, isolated single-organ post-mortem computed tomography coronarography (PMCTA), using an iodinated non-ionic contrast medium, was achieved. After computed tomography examination, all the isolated hearths were carried to the forensic pathologist, and a conventional histology assessment was performed on them.In 7 out of 11 of cadavers, a final diagnosis of myocardial infarction was made after a complete autopsy and histology procedures. Isolated hearts underwent PMCTA scanning and was confirmed in 6/11 cases, with the autopsy findings showing the presence and the localization of occlusions or severe stenoses and the extension of the myocardial hypoxic area by the extravasation of contrast medium as well.Isolated single-organ PMCTA could be considered a valid and useful tool in addition to traditional autopsy investigation (macroscopic sections and histology) in identifying the cause of death by recognizing the presence and degree of coronary artery disease and myocardial infarction area visualization.

In October 2012, an asymptomatic 54-year-old man, with a body mass index (BMI) of 50 kg/m2, smoking habits, hypertension, dyslipidaemia and family history of coronary artery disease (CAD) presented to us for a clinical work out. Since these conditions indicate high risk of CAD,1 he underwent exercise/rest sestamibi gated single-photon-emission cardiac tomography (G-SPECT). This procedure documented submaximal exercise test and inconclusive anterior wall perfusion defect. A reduced exercise capacity and tissue attenuation characterise obesity and determine doubtful SPECT results (figure 1). A 64-slice cardiac tomography (CT) detected calcium deposits over the anterior descending (LAD) and first diagonal (D1) coronary …

In July 2012, a 63-year-old man presented with effort angina occurring in a predictable fashion. He worked as a porter and when carrying heavy loads, angina with palpitations and feeling loss of consciousness, suggested prodromal symptoms of syncope owing to arrhythmia. Stress/rest thallium-201 single-photon emission cardiac tomography (SPECT) revealed inferior and septal wall reversible defects (ischaemia) without ST-depression at peak during a bicycle maximal exercise test. Cardiac CT documented an anomalous origin of the left circumflex coronary artery (ACXCA) arising from the right sinus of Valsalva with an extramural course between the …

Electrostimulation represents a well-known trophic factor for different tissues. In vitro electrostimulation of non-stem and stem cells induces myogenic predifferentiation and may be a powerful tool to generate cells with the capacity to respond to local areas of injury. We evaluated the effects of in vivo electrostimulation on infarcted myocardium using a miniaturized multiparameter implantable stimulator in rats. Parameters of electrostimulation were organized to avoid a direct driving or pacing of native heart rhythm. Electrical stimuli were delivered for 14 days across the scar site. In situ electrostimulation used as a cell-free, cytokine-free stimulation system, improved myocardial function, and increased angiogenesis through endothelial progenitor cell migration and production of vascular endothelial growth factor (VEGF). In situ electrostimulation represents a novel means to stimulate repair of the heart and other organs, as well as to precondition tissues for treatment with cell-based therapies.

Steno-occlusive diseases of mesenteric and renal vessels depend on a great number of pathological conditions. The most common are: atherosclerosis, collagen vascular disease, vasculitis, fibromuscular dysplasia, trauma, and neoplastic encasement.

At present, both CTA and MRA allow to obtain datasets formed by a large amount of bi-dimensional images acquired through a spatial axis (x, y, z); however, in consideration of the very thin intervals between contiguous partitions of each dataset, the acquisition as a whole can be considered a true volume formed by basic three-dimensional components (voxels) rather than a stack of independent slices with bi-dimensional properties.

A 44-year-old woman had a transient ischemic attack in 2010 and a subsequent ischemic stroke (while on a regimen of aspirin therapy) in May 2012 with evidence of an ischemic cerebral lesion at magnetic resonance imaging. Thrombophilic screening tests showed factor V Leiden homozygosis.

A 77-year-old man presented to us with atypical chest pain, hypertension, hypercholesterolaemia and ST changes on the ECG lateral leads and negative cardiac enzymes. The presence of an intermediate pretest probability of coronary artery disease suggested performing a coronary tomography (CT). The scan documented calcium lesions in the left descending (Lad) and left circumflex coronary arteries and a saccular coronary artery aneurysm (CAA) adjacent to a calcium lesion in the Lad (figure 1, video 1). An invasive coronary angiography (ICA) demonstrated …

In February 2012, a 60-year-old man presented to us with a positive exercise test for ST-depression, which was performed before beginning sports activity. Rest/stress thallium-201 single-photon emission cardiac tomography (SPECT) revealed inferior and lateral wall reversible defects (ischaemia) and a painless ST-depression at peak during a bicycle maximal exercise test. Cardiac tomography (CT) documented an anomalous origin of the right coronary artery (ARCA) arising from the left sinus of Valsalva with an extramural …

This study sought to evaluate whether a strategy with a 600-mg clopidogrel load and a short-term, high-dose atorvastatin reload would improve outcomes in clopidogrel-naïve, statin-treated patients undergoing protected carotid stenting.Optimal clopidogrel loading dose during carotid stenting has not been investigated; in addition, statin neuroprotection in this setting has not been described.A total of 156 patients were randomized using a 2 × 2 factorial design to receive either a 600-mg (n = 78) or 300-mg (n = 78) clopidogrel load given 6 h before intervention and either a atorvastatin reload (n = 76; 80 mg + 40 mg initiating 12 h before the procedure) or no statin reload (n = 80). The primary endpoint was the 30-day incidence of transient ischemic attack/stroke or new ischemic lesions on cerebral diffusion-weighted magnetic resonance imaging performed at 24 to 48 h.Occurrence of the primary outcome measure was significantly lower in the 600-mg clopidogrel arm (18% vs. 35.9% in the 300-mg group; p = 0.019) and in the atorvastatin reload arm (18.4% vs. 35.0% in the no statin reload group; p = 0.031). High-dose clopidogrel also significantly reduced the transient ischemic attack/stroke rate at 30 days (0% vs. 9%, p = 0.02, secondary endpoint), without an increase in bleeding risk.In patients undergoing carotid stenting, a strategy using both a 600-mg clopidogrel load and a short-term reload with high-dose atorvastatin protects against early ischemic cerebral events. These results, obtained along with routine mechanical neuroprotection, provide new evidence of the optimization of drug therapy before percutaneous carotid intervention. (Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting [ARMYDA-9 CAROTID]; NCT01572623).

Alla base delle principali patologie dei vasi splancnici e delle arterie renali possono esservi numerosi eventi eziopatogenetici. I piu frequenti sono: condizioni patologiche quali collagenopatie, vasculiti e displasia fibromuscolare; lesioni in corso di traumi addominali; infiltrazione neoplastica.

We describe the case of a patient with situs viscerum inversus totalis in whom we performed percutaneous closure of a patent foramen ovale. This case report may represent a further contribution to illustrate instrumental and interventional issues to consider in patients with situs viscerum inversus; it is also an example in which a background in embryology and congenital heart disease may aid cardiologists for the well-tolerated and effective diagnosis and treatment of adult patients with cardiac anomalies.

Para-valvular leaks represent a relevant post-operative complication of cardiac valve replacement, often causing heart failure or severe hemolysis. We report a case of a 72 year-old woman with aortic and mitral mechanical prostheses who developed hemolytic anemia because of a para-prosthetic mitral leak. Chest tomography in such patient unexpectedly documented inferior vena cava interruption with azygos continuation into superior vena cava. Given the high surgical risk, the venous anomaly and the presence of the aortic valve prosthesis, transcatheter leak closure via antero-lateral mini-thoracotomy and transapical approach was performed.

Invasive strongyloidiasis is a rare event occurring in patients aving a deficient cellular immunity, as in hematologic maligancies; digestive tract is frequently involved as secondary ocalization in cases of systemic invasive aspergillosis, but priary aspergillosos of digestive tract is a very rare. We describe a ase of severe unrecognized strongyiloidiasis associated to primary spergillosis of the upper gastrointestinal tract occurring during nduction treatment of a patient with T-cell acute lymphoblastic eukemia (T-ALL).

In this study, we tested in vivo effectiveness of a previously developed poly-l-lactide/poly-e-caprolactone armored vascular graft releasing heparin. This bioprosthesis was designed in order to overcome the main drawbacks of tissue-engineered vascular grafts, mainly concerning poor mechanical properties, thrombogenicity, and endothelialization. The bioprosthesis was successfully implanted in an aortic vascular reconstruction model in rabbits. All grafts implanted were patent at four weeks postoperatively and have been adequately populated by endogenous cells without signs of thrombosis or structural failure and with no need of antiplatelet therapy. The results of this preliminary study might warrant for further larger controlled in vivo studies to further confirm these findings.

In March 2013, a 72-year-old male patient presented with angina during strenuous effort (SE), a left bundle branch block, type 2 diabetes and hypertension. He was undergoing treatment with valsartan, metformin and aspirin. Dipyridamole infusion on thallium-201 single-photon emission cardiac tomography (SPECT) detected a septal-inferior reversible defect (figure 1). Coronary tomography revealed the presence of an anomalous left main coronary artery (ALMCO) originating from the opposite sinus of Valsalva and coursing between the aorta (AO) and the pulmonary artery (PA). The right coronary artery (RCA) arose at an acute angle from the same orifice of the ALMCO1 …

In May 2012, a 73-year-old man presented with effort dyspnoea and chest discomfort, negative exercise test for ST depression and ventricular ectopy after exercise. He had a history of Sjogren's syndrome, diabetes, dyslipidemia, hypertension, chronic obstructive pulmonary disease and was under methotrexate treatment for rheumatoid arthritis. Such diseases imply a severe dysfunctional burden, tend to develop accelerated atherosclerosis, endothelial dysfunction and ischaemic heart disease (IHD).1 ,2 A functional assessment was thus provided with an exercise/rest technetium-99 m tetrofosmin-gated …

An asymptomatic 65-year-old woman was transferred to our hospital with a hook-wire breast marker migrated into the chest. PA Chest X-Ray film ( Panel A ) shows a small linear structure projecting on the right ventricle (curved arrow); on the lateral film ( Panel B ) a linear opacity is appreciable projecting on the …

In 2012 December, a 68-year-old man presented with mild effort dyspnoea, paroxysmal atrial fibrillation and type 2 diabetes. The ECG was within normal limits. Echocardiography documented septal and inferior left ventricle (LV) hypokinesia. Stress/rest technetium-99m sestamibi (MIBI)-gated, single-photon emission, cardiac tomography revealed septal and inferior wall defects with mild reversibility (figure 1) and reduced contractility. The submaximal exercise test was negative.1 ,2 Cardiac tomography documented an anomalous origin in the left circumflex artery (AOLCX) arising from the right coronary artery and coursing between the aorta and the left atrium (figures 2⇓–4). Direct angiography excluded the presence of atherosclerotic disease. The systolic compression of the AOLCX produced …