Aorto-right ventricular fistulas are defects of the aortic wall in the area above the right coronary cusp, where it separates aorta and right ventricular outflowtract. Often, these injuries are due to trauma or infective endocarditis. We report an occasional finding of such a fistula, without these causes. There were no other abnormalities on the aortic valve, root or the ascending aorta.

The calculated incidence of IE of 9.61 cases per 100,000 inhabitants per year was more than five times higher than the one reported in a nation-wide Dutch study of 1992. The present study demonstrates that IE remains a disease with a considerable mortality and complication rate. The majority of the patients with IE had non-cardiac comorbidity. Especially, the prevalence of diabetes mellitus and chronic renal failure in our population of patients with IE is remarkable.

Transdermally delivered nitroglycerin (TTS-NTG) through a rate-controlling membrane yields stable blood levels for 24 h. We studied the effect of TTS-NTG (25 mg per 10 cm2) on exercise induced angina in 10 patients with stable angina pectoris, all in NYHA class III, who were not under treatment with other cardiac drugs. In a pre-study exercise test, all patients had angina pectoris and more than one mm ST depression. The study was placebo controlled and double blind with a randomized cross-over. Exercise tests were carried out on a treadmill according to the Bruce-protocol, 12 to 16 h after administration of TTS-NTG or of an identical placebo. After a 48 h wash-out period, the procedure was repeated after application of a plaster with the alternative content. A significant improvement was seen on TTS nitroglycerin compared with placebo in the total duration of exercise (7.2 +/- 3.6 min (mean +/- SD) vs 6.2 +/- 3.8 min; P less than 0.002). In 7 patients, the time to onset of angina was extended by TTS nitroglycerin. Maximal ST depression (lead V4 and V6) was significantly lower on TTS nitroglycerin (1.85 +/- 1 mm) compared with placebo (2.2 +/- 1 mm; P less than 0.05). It is concluded that 12 to 16 h after administration, transdermally delivered nitroglycerin improves exercise capacity and reduces maximal ST depression in patients with stable angina.

isolated ventricular noncompaction, left ventricular dysfunction, stroke, transoesophageal echocardiographyA 51-year-old male, with a medical history of diabetes mellitus and alcohol abuse, was admitted to the hospital because of a cerebrovascular insult.During work-up for stroke, transthoracic echocardiography documented a previously unknown dilated cardiomyopathy with severely diminished left ventricular systolic function,

We describe a patient with oedema of the legs and ascites due to right atrial (RA) inflow obstruction, caused by atrial septal aneurysm (ASA) and an elongated Eustachian valve (EV). Both structural abnormalities created a narrow inflow channel to the free RA cavity. RA inflow obstruction is usually related to constrictive pericardial disease and pericardial tamponade. Other cardiac causes of RA inflow obstruction are rare and include lipomatous hypertrophy of interatrial septum, tumour or thrombus in the right atrium (RA). Reports, describing inflow obstruction in the RA as a consequence of an elongated EV or an ASA, are extremely rare.