1,406 research outputs found
The Use of a Handheld Ultrasound Device to Guide the Axillary Vein Access during Pacemaker and Cardioverter-Defibrillator Implantation. A Feasibility Study
No full textBackground: Although ultrasound guidance for axillary vein (AV) access (USGAVA) has been described as a reliable technique for cardiac implantable electronic device (CIED) implantation, no data is available on the use of handheld ultrasound devices (HUD) in such a setting. Objective: We investigated the feasibility of using a HUD for USGAVA in patients referred to our Institution for CIED implantation. Methods: The procedure details of 80 consecutive patients undergoing USGAVA (Group-1) from June 2020 to June 2021 were prospectively collected and compared to those of an age and sex-matched cohort of 91 patients (Group-2) who had undergone AV access with the traditional venipuncture guided by fluoroscopic landmarks. Results: The two groups were comparable for the success rate of venous access (92.5% versus 93.4%, p = 0.82), complication rate (1.3% versus 0.9%, p = 1.0), and procedure time (71 ± 32 min versus 70 ± 29 min, p = 0.9). However, Group-2 had a longer X-ray exposure time (7.6 ± 8.4 min versus 5.7 ± 7.3 min, p = 0.03). In Group-1, the univariate logistic regression analysis demonstrated that the AV diameter was associated with successful USGAVA (odds ratio = 3.34, 95% confidence interval 1.47–7.59, p < 0.01), with a 3-fold increase of probability of success per each 1 mm increase in the AV diameter. Conclusions: USGAVA using a HUD for CIED implantation is a feasible, effective, and safe technique; moreover, it saves X-ray exposure time without lengthening the implant procedure time
Pitfalls in arrhythmogenic left ventricular cardiomyopathy (ALVC). A review of the literature with considerations on a single case of sudden death in a juvenile athlete
No full textSudden cardiac death (SCD) in young athletes represents a challenging issue in forensic practice. The pathologist is frequently asked to establish the cause of death basing upon anatomical findings and to evaluate the role of the physician in preparticipation evaluation (PPE) and eligibility decision. Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a leading cause of SCD during sport activity. However, in the last few years, forms with predominant or even isolated involvement of the left ventricle (LV) have progressively been correlated with a high risk of SCD. We present a case of SCD in an apparently healthy 19-year-old semi-professional football player. Annual PPEs performed in accordance with international and Italian recommendations, were unremarkable. At autopsy, a 1-cm area of subepicardial fibro-fatty replacement was observed at the postero-lateral wall of the LV. The finding was diagnostic of arrhythmogenic left ventricular cardiomyopathy (ALVC). A review of this rare pathology has been performed under a forensic perspective, focusing on the evaluation of the medico-legal responsibility of the physician in the PPE and on the morphological aspects of the disease. Current diagnostic criteria and recommendations result to be focused on the right ventricular pattern, with a risk of misdiagnosis for isolated LV forms. Furthermore, few detailed autopsies cases concerning ALVC have been published. There is a need, therefore, to study this rare disease with a careful and revised approach
Candida endocarditis and the impact of antifungal treatment on the corrected QT interval: a case report
No full textTreatment of candida endocarditis using isavuconazol
Long-term outcome of catheter ablation for treatment of bundle branch re-entrant tachycardia
No full textAbstract not available.Rajeev K. Pathak, Joe Fahed, Pasquale Santangeli, Matthew C. Hyman, Jackson J. Liang, Maciej Kubala, Tatsuya Hayashi, Daniele Muser, Manina Pathak, Arshneel Kochar, Simon A. Castro, Fermin C. Garcia, David S. Frankel, Gregory E. Supple, Robert D. Schaller, David Lin, Michael P. Riley, Rajat Deo, Andrew E. Epstein, Erica S. Zado, Sanjay Dixit, David J. Callans, Francis E. Marchlinsk
Concealed SARS-CoV-2 interstitial pneumonia unmasked by infarct-like acute myocarditis
No full textNo abstract availabl
An Integrated Approach for Treatment of Acute Type A Aortic Dissection
No full textBackground and objective: We reviewed a single-institution experience to verify the impact of surgery during different time intervals on early and late results in the treatment of patients with type A acute aortic dissection (A-AAD). Materials and Methods: From 2004 to 2021, a total of 258 patients underwent repair of A-AAD; patients were equally distributed among three periods: 2004–2010 (Era 1, n = 90), 2011–2016 (Era 2, n = 87), and 2017–2021 (Era 3, n = 81). The primary end-point was to assess whether through the years changes in indications, surgical strategies and techniques and increasing experience have influenced early and late outcomes of A-AAD repair. Results: Axillary artery cannulation was almost routinely used in Eras 2 (86%) and 3 (91%) while one femoral artery was mainly cannulated in Era 1 (91%) (p p p p = 0.07). Actuarial survival at 3 years is 74%, in Era 1, 78% in Era 2, and 89% in Era 3 (p = 0.05). Conclusions: With increasing experience and a more aggressive approach, including total arch replacement, repair of A-AAD can be performed with low operative mortality in many patients. Patient care and treatment by a specific team organization allows a faster diagnosis and referral for surgery allowing to further improve early and late outcomes
Distal Reoperations after Repair of Acute Type A Aortic Dissection—Incidence, Causes and Outcomes
No full textBackground and Aim of the Study: In patients with acute type A aortic dissection (A-AAD) whether initial repair should include also aortic arch replacement is still debated. We aimed to assess if extensive aortic repair prevents from reoperations patients with A-AAD. Methods: Outcomes after distal reoperation following repair of A-AAD (n = 285; 1977 to 2018) were analysed in 22 of 226 who underwent ascending aorta/hemiarch replacement (Group 1R) and 7 of 59 who had ascending aorta/arch replacement (Group 2R). Results: Distal reoperation was more common in Group 1R (n = 22) than in Group 2R (n = 0) (p < 0.001) while thoracic endovascular stenting was more frequent in Group 2R (7 vs 3, p < 0.001). Indications for reoperation were pseudoaneurysm at distal anastomosis (n = 4, 18%) and progression of aortic dissection (n = 18, 82%) in Group 1R. Indication for thoracic endovascular stenting was progressive aortic dissection in 3 patients of Group 1R and in 6 of Group 2R. Second reoperation was required in 2 patients from Group 1R (2%) during a mean follow-up of 5 years. Median follow-up was 4 years in Group 1R and 7 years in Group 2R (p = 0.36). Hospital mortality was 14% in Group 1R and 0% in Group 2R (p = 0.3). Actuarial survival is 68 ± 10%, and 62 ± 11% for Group 1R and 100% for Group 2R at 5 and 10 years (p = 0.076). Conclusions: Distal reoperations after A-AAD repair have an acceptable mortality. An extensive initial repair has lower rate of reoperation and better mid-term survival and should be indicated especially for young patients in experienced centers
Unsupervised phenotypic clustering of cardiac MRI data reveals distinct subgroups associated with outcomes in ischemic cardiomyopathy
No full textIschemic cardiomyopathy (ICM) shows significant heterogeneity in clinical outcomes, challenging traditional risk stratification methods. Cardiac magnetic resonance (CMR) imaging offers detailed insights into myocardial structure and function, yet integrating this multidimensional data remains complex. Aim of the current study was to assess whether unsupervised machine learning could help identify distinct phenotypic subgroups and enhance prognostic accuracy. This study included 319 clinically stable ICM patients. CMR-derived variables, including left ventricular ejection fraction (LVEF), ventricular volumes, and myocardial scar burden, were analysed using KAMILA clustering algorithm. The optimal number of clusters was determined through silhouette analysis, within-cluster sum of squares, and gap statistics. Principal Component Analysis (PCA) visualized the clustering results, and prognostic value was assessed using Cox regression and Kaplan-Meier survival analysis. SHAP (SHapley Additive exPlanations) values were used to evaluate feature importance. Two distinct phenotypic clusters were identified. Cluster 1 (n = 219) demonstrated better cardiac function, with higher LVEF, smaller ventricular volumes, and lower scar burden. Cluster 2 (n = 100) indicated advanced disease, with lower LVEF, larger volumes, higher scar burden, and greater midwall fibrosis. PCA confirmed clear separation between clusters, explaining 62.6% of the variance. After a median follow-up of 13 months, the composite endpoint was observed in 37 (12%) patients. Patients in Cluster 2 had a significantly higher risk of experiencing the composite outcome (HR = 3.96, p < 0.001). SHAP analysis identified ischaemic scar burden, sphericity index, and midwall fibrosis as key predictors of outcomes. Unsupervised clustering of CMR-derived variables identified distinct ICM phenotypes with important prognostic implications. This method improves risk stratification and could help tailor personalised treatment plans, highlighting the potential of machine learning in understanding ICM heterogeneity
Perspettiva ridotta a perfezione: Glimpses of Daniele Barbaro’s Perspective Theory
No full textThis contribution is intended to identify some textual elements, apparently
secondary in Daniele Barbaro’s treatise on perspective, which either foreshadow
unprecedented developments in the discipline of representation or have
constituted complex critical nodes in the field of perspective. The first of these
is introduced in part V: anamorphosis (though never so called by the author, since
the term was not yet in use), suggesting a quick method to deform any flat image
by means of shadows. Finally, the author mentions two other ‘eccentric’ elements
of interest for the future developments of perspective that originated in Daniele
Barbaro’s text: an optical-projective device first introduced by Giovanni Battista
Vimercato, later developed by Jean François Niceron in his Thaumaturgus
opticus (1646), and the camera obscura
INTRUSION AND PRESENCE OF THE AUTHOR IN SAMUEL BECKETT’S “THE UNNAMABLE” AND B. S. JOHNSON’S “ALBERT ANGELO”
No full textThis article explores the intricate relationship between B.S. Johnson’s novel “Albert Angelo” and Beckett’s “The Unnamable”, both dealing with the issue of the possible presence of the author in his own text. The point of departure for such comparison is Johnson’s incorporation, as an epigraph, of a passage taken from Beckett’s novel. Such passage, intended rather literally by the British author, is employed as a justification not only for the central device at the heart of his novel, but also in support of a larger aesthetic project which will characterise a great part of his oeuvre – which famously stresses the importance of ‘truth’, as opposed to fabulation, and the necessity of the author’s direct presence in his texts. This contribution, in particular, tries to reconstruct the history of Johnson’s involvement with Beckett’s work, demonstrating how Johnson has in fact distorted the master’s message – perhaps intentionally – in order to produce a rather different model of literature, despite moving from very similar premises
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