Coronary arterial fistulas

ABSTRACT: A coronary arterial fistula is a connection between one or more of the coronary arteries and a cardiac chamber or great vessel. This is a rare defect and usually occurs in isolation. Its exact incidence is unknown. The majority of these fistulas are congenital in origin although they may occasionally be detected after cardiac surgery. They do not usually cause symptoms or complications in the first two decades, especially when small. After this age, the frequency of both symptoms and complications increases. Complications include 'steal' from the adjacent myocardium, thrombosis and embolism, cardiac failure, atrial fibrillation, rupture, endocarditis/endarteritis and arrhythmias. Thrombosis within the fistula is rare but may cause acute myocardial infarction, paroxysmal atrial fibrillation and ventricular arrhythmias. Spontaneous rupture of the aneurysmal fistula causing haemopericardium has also been reported. The main differential diagnosis is patent arterial duct, although other congenital arteriovenous shunts need to be excluded. Whilst two-dimensional echocardiography helps to differentiate between the different shunts, coronary angiography is the main diagnostic tool for the delineation of the anatomy. Surgery was the traditional method of treatment but nowadays catheter closure is recommended using a variety of closure devices, such as coils, or other devices. With the catheter technique, the results are excellent with infrequent complications. DISEASE NAME AND SYNONYMS: Coronary arterial fistulas Coronary arterial fistulas or malformation

The Effectiveness of Levosimendan on Veno-Arterial Extracorporeal Membrane Oxygenation Management and Outcome: A Systematic Review and Meta-Analysis

Objectives: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides a temporary support system for patients with cardiogenic shock refractory to conventional medical therapies. It has been reported that levosimendan may facilitate VA-ECMO weaning and improve survival. The primary objective of this review was to examine the effect of levosimendan use on VA-ECMO weaning and mortality in critically ill patients on VA-ECMO.Design: MEDLINE, EMBASE, and CENTRAL were searched. A pair of reviewers identified eligible clinical trials. Two reviewers extracted data and independently assessed the risk of bias. A random-effect model was used to combine data. The primary outcome was the success of weaning from VA-ECMO.Measurements and Main Results: Seven studies of observational design, including a total of 630 patients, were selected in the final analysis. The sample size ranged from ten-to-240 patients, with a mean age between 53 and 65 years, and more than half of them underwent cardiac surgeries. The VA-ECMO durations varied between four and 11.6 days. Overall, levosimendan use was significantly associated with successful weaning compared with control (odds ratio [OR] 2.89, 95% CI, 1.53-5.46; (poverall effect) = 0.001); I-2 = 49%). For survival, six studies (n = 617) were included in the meta-analysis involving 326 patients in the levosimendan group and 291 in the comparator group. Pooled results showed a significantly higher survival rate in the levosimendan group (OR 0.46, 95% CI, 0.30-0.71; (poverall effect) = 0.0004; I-2 = 20%).Conclusions: Levosimendan therapy was significantly associated with successful weaning and survival benefit in patients with cardiogenic or postcardiotomy shock needing VA-ECMO support for severe cardiocirculatory compromise. To date, there is limited literature and absence of evidence from randomized trials addressing the use of levosimendan in VA-ECMO weaning. This study may be considered a hypothesis-generating research for randomized controlled trials to confirm its findings. (C) 2021 The Authors. Published by Elsevier Inc

Intermittent levosimendan infusion in ambulatory patients with end-stage heart failure: a systematic review and meta-analysis of 984 patients

We sought to synthesize the available evidence regarding safety and efficacy of intermittent levosimendan (LEVO) infusions in ambulatory patients with end-stage heart failure (HF). Safety and efficacy of ambulatory intermittent LEVO infusion in patients with end-stage HF are yet not established. We systematically searched MEDLINE, EMBASE, SCOPUS, Web of Science, and Cochrane databases, from inception to January 30, 2021 for studies reporting outcome of adult ambulatory patients with end-stage HF treated with intermittent LEVO infusion. Fifteen studies (8 randomized and 7 observational) comprised 984 patients (LEVO [N = 727] and controls [N = 257]) met the inclusion criteria. LEVO was associated with improved New York Heart Association (NYHA) functional class (weighted mean difference [WMD] −1.04, 95%CI: −1.70 to −0.38, p < 0.001, 5 studies, I2 = 93%), improved left ventricular (LV) ejection fraction (WMD 4.0%, 95%CI: 2.8% to 5.3%, p < 0.001, 6 studies, I2 = 9%), and reduced BNP levels (WMD −549 pg/mL, 95%CI −866 to −233, p < 0001, 3 studies, I2 = 66%). All-cause death was not different (RR 0.65, 95%CI: 0.38 to 1.093, p = 0.10, 6 studies, I2 = 0), but cardiovascular death was lower on LEVO (RR 0.34, 95%CI: 0.13 to 0.87, p = 0.02, 3 studies, I2 = 0) compared to controls. Furthermore, health-related quality of life (HRQoL) was improved alongside with reduced LV size following LEVO infusions. Major adverse events were not different between LEVO and placebo. In conclusion, intermittent LEVO infusions in ambulatory patients with end-stage HF is associated with less frequent cardiovascular death alongside with improved NYHA class, quality of life, BNP levels, and LV function. However, the current evidence is limited by heterogeneous and relatively small studies.Scopu

Correction to

The article “Intermittent levosimendan infusion in ambulatory patients with end‑stage heart failure: a systematic review and meta‑analysis of 984 patients”, written by Hagar Elsherbini, Osama Soliman, Casper Zijderhand, Mattie Lenzen, Sanne E. Hoeks, Rasha Kaddoura, Mohamed Izham5, Abdulaziz Alkhulaifi, Amr S. Omar, and Kadir Caliskan, was originally published electronically on the publisher’s internet portal on 11 April 2021 without open access. With the author(s)’ decision to opt for Open Choice the copyright of the article changed on 10 June 2021 to</p

Progetto del Team KNOW-HOWse, competizione internazionale Solar Decathlon Middle East 2018, Dubai

Team Sharjah is composed of the University of Sharjah (UOS), leader institution, and Sharjah Investment and Development Authority (SHUROOQ). UOS is an academic institution with a distinctive learning style and a global vision. It is a pioneer in academia, scientific research and arts in the UAE. The Architectural Engineering Department (AE) will coordinate the team thanks to its expertise in design and construction management. SHUROOQ will assist with technical issues and connecting with potential sponsors. The team comprises also a scientific third-party, Architettura&gt;Energia Research Centre (University of Ferrara, Italy) and two sponsors: Bee’ah and X-lam Dolomiti S.r.l. Key members and third parties will cooperate in synergy to meet the SDME goals. The extended team is currently involved in research, design consultancy, projects, and training services for public administrations, companies, and privates, in the fields of energy efficiency and environmental quality of buildings and urban spaces. These activities include: accredited energy assessment; membership of GBC and LEED Scientific Committee; energy consultancy for architecture and engineering companies; research and application of BiPV. Project Goal. Know-Howse is an educational program. The SDME prototype house will be a showcase for innovation and energy efficiency practices that will educate society to sobriety. Nowadays, UAE is responsible for one of the largest residential energy consumption in the world. Such unaware habit is the result of lacking education on resources consumption, but is also implicitly supported by the local policies on the (low) tariffs for electricity and water. The education program aims at increasing environmental awareness by rediscovering a new dimension of “living small but comfortably”. Yet, Know-Howse represents just one tile of a larger framework that involves society, economics, and urbanism. To this regard, the prototype house is conceived as a test-unit extracted form an innovative apartment building that combines occupants’ comfort with environmental goals such as reducing land-use and resource consumption

Progetto del Team KNOW-HOWse, competizione internazionale Solar Decathlon Middle East 2018, Dubai

Team Sharjah is composed of the University of Sharjah (UOS), leader institution, and Sharjah Investment and Development Authority (SHUROOQ). UOS is an academic institution with a distinctive learning style and a global vision. It is a pioneer in academia, scientific research and arts in the UAE. The Architectural Engineering Department (AE) will coordinate the team thanks to its expertise in design and construction management. SHUROOQ will assist with technical issues and connecting with potential sponsors. The team comprises also a scientific third-party, Architettura>Energia Research Centre (University of Ferrara, Italy) and two sponsors: Bee’ah and X-lam Dolomiti S.r.l. Key members and third parties will cooperate in synergy to meet the SDME goals. The extended team is currently involved in research, design consultancy, projects, and training services for public administrations, companies, and privates, in the fields of energy efficiency and environmental quality of buildings and urban spaces. These activities include: accredited energy assessment; membership of GBC and LEED Scientific Committee; energy consultancy for architecture and engineering companies; research and application of BiPV. Project Goal. Know-Howse is an educational program. The SDME prototype house will be a showcase for innovation and energy efficiency practices that will educate society to sobriety. Nowadays, UAE is responsible for one of the largest residential energy consumption in the world. Such unaware habit is the result of lacking education on resources consumption, but is also implicitly supported by the local policies on the (low) tariffs for electricity and water. The education program aims at increasing environmental awareness by rediscovering a new dimension of “living small but comfortably”. Yet, Know-Howse represents just one tile of a larger framework that involves society, economics, and urbanism. To this regard, the prototype house is conceived as a test-unit extracted form an innovative apartment building that combines occupants’ comfort with environmental goals such as reducing land-use and resource consumption