Leflunomide-induced pulmonary arterial hypertension: Case report and review of literature.

Unlabelled: Leflunomide, an isoxazole derivative, is a disease-modifying antirheumatic drug, that has successfully been used for the treatment of rheumatoid arthritis and psoriatic arthritis as a feasible alternative to methotrexate. Among side effects, pulmonary arterial hypertension (PAH) has been described in a few case reports.We present a 55-year-old woman treated with leflunomide for psoriatic spondyloarthritis who consulted our hospital because of progressive exertional dyspnea.

[Appropriateness in echocardiography and clinical priority classification criteria: a proposal from the Italian Society of Cardiovascular Echography].

One of the main tasks of a scientific society is to define the theoretical bases and appropriate management strategies with the aim to maintain a high-quality diagnostic and therapeutic standard. As far as echocardiography is concerned, the task of the Italian Society of Cardiovascular Echography is to provide appropriate, complete, and useful echocardiographic tests for clinical application, as well as procedural, technological, organizational and economic indications to be adopted in clinical practice. In addition, there is an increasing need for regulating access to echocardiographic assessment according to clinical priority, because of the huge proportion of patients who should undergo a first or follow-up echocardiographic evaluation.

[Permanent atrial fibrillation and heart failure: radiofrequency ablation of atrioventricular junction and cardiac resynchronization therapy: review of the literature and of the new techniques for echocardiographic assessment].

Radiofrequency ablation of atrioventricular junction plus pacing therapy ("ablate and pace") is an effective non-pharmacological therapy in patients with medically refractory permanent atrial fibrillation and heart failure. However, the chronic right ventricular pacing may result in regional wall motion abnormalities and adverse hemodynamic effects. These findings imply that patients with permanent atrial fibrillation who undergo "ablate and pace" may benefit from cardiac resynchronization therapy.

Real-time three-dimensional echocardiography: technological gadget or clinical tool?

The complex anatomy of cardiac structures requires three-dimensional spatial orientation of images for a better understanding of structure and function, thereby improving image interpretation. Real-time three-dimensional echocardiography is a recently developed technique based on the design of an ultrasound transducer with a matrix array that rapidly acquires image data in a pyramidal volume. The simultaneous display of multiple tomographic images allows three-dimensional perspective and the anatomically correct examination of any structure within the volumetric image.

[Selection of patients undergoing cardiac resynchronization therapy: role of echocardiography].

Patients with heart failure, marked systolic dysfunction and dys-synchronous myocardial contraction are at increased risk for exacerbated pump failure and arrhythmias, and suffer higher mortality rates. In these patients, cardiac resynchronization therapy (CRT), achieved by a biventricular pacing, can lead to clinical improvement, reverse left ventricular remodeling and prolonged survival, although a substantial subset of non-responders has been reported. The electrocardiographic QRS width does not predict long-term CRT benefit, while direct measures of mechanical dyssynchrony obtained by various ultrasound techniques have been shown to have a better predictive value.

Improved delineation of morphological features of arrhythmogenic right ventricular cardiomyopathy with the use of contrast-enhanced echocardiography.

A case of an already diagnosed arrhythmogenic right ventricular cardiomyopathy in which the use of contrast improved the echocardiographic characterization of morphologic abnormalities of the right ventricle is reported.

Clinical and hemodynamic implications of supra-annular implant of biological aortic valves.

The use of stented bioprostheses in elderly patients with degenerative aortic stenosis, despite being desirable, raises concerns about the harmful effects of residual obstruction to left ventricular outflow. To overcome this limitation new stented and stentless bioprostheses have been designed for supra-annular implant. However, the actual hemodynamic advantage of supra-annular implant over the intra-annular one remains incompletely understood.

Stented bioprosthetic valve hemodynamics: is the supra-annular implant better than the intra-annular?

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.