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Fifty-seven patients underwent aortic valve replacement with a stentless glutaraldehyde-fixed bioprosthesis; 27 received a porcine aortic valve and 30 had a bovine pericardial valve. Two groups of 30 patients each who had aortic valve replacement with a tilting-disc mechanical valve or a stented porcine bioprosthesis served as controls. There were no differences in sex, body surface area, valve lesion, and valve size among the four groups. Results were assessed on a Doppler-based determination of maximum velocity across the valve, aortic valve area, and degree of valve regurgitation. Velocity across the valve was significantly less with stentless pericardial valves than with stentless porcine valves, stented bioprostheses, and mechanical valves. Stentless valves had a significantly larger aortic valve area when compared with stented valves. Mild central aortic insufficiency was detected more often with stentless pericardial than with stentless porcine bioprostheses (p = 0.04). Stentless valves showed a higher incidence of complete atrioventricular block when compared with stented valves (p = 0.04). Long-term studies are now warranted to assess the durability of both types of stentless valves.

Objectives and Design: In order to assess the current behavioural status of patients receiving emergency cardiological treatment and the emergency services in the Piedmont Region, our Division carried out a survey of the Region's DEA and first aid centres based on the compilation of a questionnaire for each patient who passed through these structures over a 5-month period. The study included only patients hospitalised within 12 hours of symptoms' onset. The questionnaire aimed to assess the time the patient took to reach a decision, the eventual call for a home visit, the type of doctor called, the time spent by the doctor, the use of either a private vehicle or of an ambulance for transport to hospital, the time taken to get to the hospital, and the overall time taken to admit the patient to the emergency cardiological ward. The statistical analysis of data was carried out using both single and multiple variables. The selection of prognostic variables was carried out using a stepwise method., Results: Data presented in this study refer to 1705 records, collected in 39 Piedmontese hospitals (75% of those with DEA or First Aid Center). Patients with acute myocardial infarction were 970 (57%). A doctor was requested at home in nearly half of the cases (49.3%). There was no correlation between the type of emergency and the request for a home visit, whereas the latter varied in relation to the different geographical areas and to the patients' age. A small majority of patients used personal transport to get to the hospital (55.5%) in comparison to those using an ambulance (44.5%) (p less than 0.001). Time taken to reach a decision was related to the type of pathology (acute pulmonary edema less than acute myocardial infarction less than arrhythmia) and to geographical area; mean decision time in the overall sample was 125 +/- 158 minutes. The mean duration of doctors' intervention at home was 74 +/- 82 minutes. The mean time taken to reach the hospital using private transport was 22 minutes, and the time taken using ambulance was the same, but this should be added to the time taken for the ambulance to reach the patient (a mean total time of 15 minutes). Overall mean hospitalisation time was 192 minutes., Conclusions: The critical factors causing delay in hospitalisation time are the poor levels of health education of the population in general, and the poor activation capacity of certain peripheral parts of the National Health Service. In particular, it is worth drawing attention to the delay due to the intervention of the family doctor in the current organisational model. Doctors called from first aid stations are able to provide a more rapid intervention, but are currently unable to meet the requirements of patients needing emergency cardiological treatments. These data confirm the rationale for intervention projects in cardiological emergencies, considering on one hand that a fleet of special vehicles be created, and on the other that doctors from first aid stations be specifically trained and increasingly involved.

An assessment was made of the ability of an ergometric test to detect coronary patients in evaluating the reliability of the effort test, which is mainly important when it gives the percentage of coronary patients that can be discovered at an early stage during screening. The concept of sensitivity and specificity is analysed with respect to the diagnostic criteria employed. Blood pressure, heart rate and oxygen consumption are discussed in their rôle of leading parameters and the appraisal made of the diagnostic significance of a below-normal ST level in the literature is examined. Junctional falls in level and depression of the J point are also discussed. Cases in which a below-normal ST segment level is not associated with coronary disease are examined.

The historical development of the stress-test in the diagnosis of coronary insufficiency has been examined from the first observations about 1930 regarding changes in the repolarization phase during effort in coronary patients, up to modern tests with the ergometer bicycle and treadmill. Starting from the consideration that Master's Test is still the most commonly used in clinical practice, the limitations of tests of this type are highlighted and the discussion also covers the techniques and parameters now considered of greatest importance in cardiopathy diagnosis and evaluated by means of modern maximal stress tests. The results of a first period of work involving tests using the treadmill are reported. The methodology is discussed and the symptoms or ECG data that had suggested the test be used are related to the patient's origin (out-patient or hospitalized) and with the test's positivity or negativity. The high incidence of unstable ST syndrome, especially in the female sex, is also stressed. If this is not thoroughly investigated functionally (hyperventilation, Valsalva, etc.) it could be the cause of a large number of false positives. The lack of danger in the maximal stress test, even in cardiopaths, is confirmed together with the extreme ease with which nearly all patients manage to perform the test on the treadmill. Stress is also laid on the fact that the stress test is functional, unlike coronarography which is purely morphological, and the two examinations are thus complementary in the diversity of information they provide.