[Diagnosis of ventricular localization by studying the septal forces in dextrocardia].
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Biomedical subjects
Publications and source records attributed to G Thiene.
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Lung specimens of 27 patients under six months of age with complete transposition of the great arteries (TGA), obtained at autopsy, were studied histologically. No evidence of hypertensive pulmonary vascular disease was found in patients under four months of age (23 patients), while obstructive intimal proliferations were seen in 2 patients, aged four and five months, with TGA and VSD. Since pulmonary vascular lesions in transposition with VSD appear early in infancy, timely palliative procedures, such as banding of the pulmonary artery, are strongly indicated when the radical corrective operation is to be postponed.
ECG and cinecoronary angiography of two patients with Prinzmetal's variant angina are reported. A pathologic study was performed on both. In one case, a transient luminal obstruction of the left circumflex coronary artery became apparent during selective coronary arteriography. Histologic examination of the corresponding coronary segment revealed a severe concentric atherosclerotic process with a normal-sized muscular layer, so that the angiographic transient occlusion might be attributed to an arterial spasm. In the second case no angiographic narrowings were demonstrated by cinecoronary angiography. Nevertheless, histologic examination revealed significant obstructive atherosclerotic narrowing in some coronary segments. It is suggested that atherosclerotic disease may be present also in cases with variant angina who have apparently normal coronary angiograms.
Two cases are reported of truncus arteriosus communis arising entirely from the right ventricle and associated with interruption in one case and tubular hypoplasia of the aortic arch in the other. A haemodynamic hypothesis of preferential blood flow is proposed to explain this rare association.
Anatomically corrected malposition of the great arteries is defined as a trunco-conal malformation characterized by an aorta arising anteriorly from a morphologically left ventricle and by the presence of a subaortic muscular conus. This malalignment determines a conotruncal-ventricular discordance: d-loop and l-position or l-loop and d-position of the aorta. Two additional cases of this very rate lesion are reported, both associated with left juxtaposition of the atrial appendages, tricuspid atresia, ventricular malrotation and destrocardia in situs solitus with d-loop. Because of the high frequency of this association, observed also in the majority of the previously published cases, its morphogenetic significance and implications are discussed.
A case of myocellular necrosis by cathecholamines in a patient presenting pheocromocytoma is reported. Death was due to cerbral apoplexy. The histological findings are quite specific and show myofibrillar degeneration with substitution of the normal striation by coarse sarcomeric transversal bands. The possible role of necrosis by catecholamines in sudden deaths and non-coronary myocardiosclerosis is emphasized.
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A correct clinical diagnosis in end-stage patients undergoing cardiac transplantation may have important prognostic and therapeutic implications. A retrospective clinico-pathologic study was carried out in 257 patients who had undergone cardiac transplantation at the University of Padua. A discrepancy between clinical and pathological diagnosis was found in 20 cases (8%). Among 126 patients with the clinical diagnosis of dilated cardiomyopathy, seven were found eventually to have ischemic heart disease (IHD), five myocarditis, one arrhythmogenic right ventricular cardiomyopathy (ARVC), and one non-compacted myocardium. Among the 87 patients with clinical diagnosis of IHD, three turned out to be dilated cardiomyopathy and one granulomatous myocarditis. Among the 10 patients with the clinical diagnosis of hypertrophic-restrictive cardiomyopathy, one had ARVC and one had cardiac fibroma. Altogether, only 24.5% underwent endomyocardial biopsy (EMB) and 75% coronary angiography before transplantation. Missed diagnosis of myocarditis occurred in patients in whom EMB was not carried out. EMB and coronary angiography might be indicated routinely in patients with apparent dilated cardiomyopathy, before proceeding to cardiectomy.
We report two cases of spontaneous superior mesenteric artery dissection diagnosed by CT. In both cases lamination of the arterial wall and enhancement of both true and false lumina were the key to the diagnosis.
From 1978 to 1993 in the Veneto region, we collected 200 cases of sudden death in the young (</=35 years). Sudden death was cerebral in 15 cases (7.5%), respiratory in 10 (5%), and cardiovascular in 163 (81.5%), whereas it remained unexplained in 12 cases (6%). Among cardiovascular sudden death, obstructive coronary atherosclerosis accounted for 23% of cases, arrhythmogenic right ventricular cardiomyopathy for 12.5%, mitral valve prolapse for 10%, conduction system abnormalities for 10%, congenital coronary artery anomalies for 8.5%, myocarditis for 7.5%, hypertrophic cardiomyopathy for 5.5%, aortic rupture for 5.5%, dilated cardiomyopathy for 5%, nonatherosclerotic-acquired coronary artery disease for 3.5%, postoperative congenital heart disease for 3%, aortic stenosis for 2%, pulmonary embolism for 2%, and other causes for 2%. Cardiac arrest remained unexplained in 6% of the cases. Specific pathology and pathogenetic mechanisms of each disease were investigated and correlated with clinical signs and symptoms in detail. A large spectrum of cardiovascular disorders, both congenital and acquired, may represent the organic substrate of sudden death in the young. The underlying abnormality is frequently concealed and discovered only at postmortem examination. Most of the diseases, although asymptomatic, are potentially detectable during life with proper imaging tests.