A rare localization of papillary fibroelastoma

Papillary fibroelastoma is a benign cardiac tumor, generally small and with papillary fronds, third in frequency after cardiac myxoma and lipoma, with a prevalence of about 10% of all cardiac tumors [1, 2]. Its localization, similarly to other benign cardiac tumors, prefers the endothelium of the valve leaflets, most commonly the aortic valve (44% to 59%), less frequently the mitral (13% to 35%) and tricuspid (4% to 15%) valves [3–5]. It is discovered occasionally or following symptoms due to systemic or coronary embolization. Symptoms due to obstruction of the ventricular flow tract are rare. Surgical excision is curative and its recurrence rare if the resection of margins are disease-free

Risk of aortic dissection in patients with ascending aorta aneurysm: a new biological, morphological, and biomechanical network behind the aortic diameter

Thoracic aortic aneurysm represents a deadly condition, particularly when it evolves into rupture and dissection. Proper surgical timing is the key to positively influencing the survival of patients with this pathology. According to the most recent guidelines, ascending aorta size ≥ 55 mm and a rate of growth ≥ 0.5 cm per year are the most important factors for surgical indication. Nevertheless, a lot of evidence show that aortic ruptures and dissections might occur also in small size ascending aorta. In this review, we sought to analyze a new biological and morphological network behind the aortic diameter that need to be considered in order to identify the portion of patients with thoracic aortic aneurysm who are at increased risk of aortic complications, despite current aortic guidelines not advising surgical intervention in this group

Progettazione sismica di tipo prestazionale: l’importanza della scelta dell’input sismico

L’obiettivo principale del Performance Based Seismic Design (PBSD) consiste nella stima probabilistica delle prestazioni di una struttura soggetta all’azione sismica (PSDHA). Questa memoria concerne, in particolare, le procedure atte ad una corretta identificazione degli input dinamici da utilizzarsi in questo tipo di analisi. In dettaglio, (a) viene proposto un quadro generale per una trattazione organizzata e razionale degli ultimi contributi di ricerca finalizzati ad una corretta identificazione degli inputs sismici e (b) viene formulata una proposta per l’utilizzo di un parametro di tipo vettoriale identificativo dei sismi di progetto, composto da Peak Ground Acceleration (PGA) e Peak Ground Velocity (PGV). Vengono inoltre elaborati gli spettri di risposta (di accelerazione e di spostamento, sia elastico lineari che elasto-plastici) ottenuti a partire da gruppi di sismi identificati con la metodologia proposta e confrontati con gli spettri ottenuti da gruppi di sismi identificati in base alla sola PGA (o PGV), come indicato dalle normative vigenti

Identificazione di input sismici riferimento per valutazioni di affidabilità strutturale

Negli ultimi anni il Performance Based Seismic Design (PBSD) è stato l’oggetto di una serie di lavori di ricerca scientifica nel campo dell’ingegneria sismica. L’obiettivo principale del PBSD consiste nella stima probabilistica delle prestazioni di una struttura soggetta all’azione sismica. Questa memoria riguarda principalmente la corretta identificazione degli input dinamici che si devono utilizzare nella PSDHA. Per una data struttura, la PSDHA viene realizzata attraverso l’applicazione di una serie di analisi dinamiche eseguite per diversi livelli sismici di progetto. Per ogni livello sismico di progetto viene eseguito un numero di analisi dinamiche (lineari o non lineari) utilizzando, come inputs dinamici, accelerogrammi storici. L’identificazione del gruppo di accelerogrammi associati ad un dato livello sismico di progetto è ottenuta attraverso l’associazione dell’input sismico ad un dato valore della probabilità di superamento, in un determinato periodo di osservazione T, di uno specifico valore di soglia di un dato ground motion parameter. Si definisce “EPI group” (“Equal-Probability Input group”) un gruppo di n accelerogrammi (Equal-Probability inputs, EP inputs), tutti caratterizzati dallo stesso valore di probabilità (proprietà di Equal-Probability). In dettaglio, questa memoria (a) introduce un quadro generale per una trattazione organizzata e razionale degli ultimi contributi di ricerca per la corretta identificazione dell’EPI group e (b) identifica una proposta pratica per l’effettiva applicazione della metodologia basata sull’utilizzo di un IM vettoriale, composto da Peak Ground Acceleration (PGA) e Peak Ground Velocity (PGV), e di un’altra informazione (NFR, come definita dagli autori), ottenuta anch’essa dalla Hazard Analysis e riferita all’intero EPI group. I risultati presentati sono stati ottenuti con riferimento ad una città del sud Italia

Evasive subspaces

Let V denote an r-dimensional vector space over GF(q^n), the finite field of q^n elements. Then V is also an rn-dimension vector space over GF(q). A GF(q)-subspace U of V is (h,k)_q-evasive if it meets the h-dimensional GF(q^n)-subspaces of V in GF(q)-subspaces of dimension at most k. The (1,1)_q-evasive subspaces are known as scattered and they have been intensively studied in finite geometry, their maximum size has been proved to be the lower integer part of rn/2 when rn is even or n=3. We investigate the maximum size of (h,k)_q-evasive subspaces, study two duality relations among them and provide various constructions. In particular, we present the first examples, for infinitely many values of q, of maximum scattered subspaces when r=3 and n=5. We obtain these examples in characteristics 2, 3 and 5

A methodology for the identification of design earthquake inputs

In recent years, Performance Based Seismic Design (PBSD) has played a central role for research works in the field of seismic engineering. The core idea of the PBSD is the probabilistic assessment of the structural performances due to seismic action [Bertero and Bertero, 2002, Moehle and Deierlein, 2004, Zhang et al., 2004]. From a practical point of view, following the PEER framework [Cornell and Krawinkler, 2000], this assessment can be achieved through an articulated procedure which can be summarized in the following subtasks [Zhang et al., 2004]: · Probabilistic Seismic Hazard Analysis (PSHA) or simply Hazard Analysis (HA); · Probabilistic Seismic Demand Hazard Analysis (PSDHA); · Probabilistic Seismic Capacity Analysis (PSCA) also called Fragility Analysis; · Seismic Reliability Analysis (SRA). This paper focuses mainly on the correct identification of the dynamic inputs (“bins” as defined by [Giovenale et al., 2004] or “EPI groups” as defined hereafter by the authors) to be used in the PSDHA subtask. In detail, the paper introduces a general framework (“methodology for EPI group creation”) for the rationally-organised treatment of the latest contributions in terms of ground motion parameters which have a substantial effect upon the structural response. Among the factors taken into account in the proposed methodology for the correct identification of the EPI group, we mention the use of vector-valued IMs [Baker and Cornell, 2005, Trombetti et al, 2003], the recently proposed parameter “epsilon” (as obtained by disaggregation analysis [Baker and Cornell, 2005]), magnitude “MS”, site to epicentre distance “R” and relative number of near field records

Role of Cachexia and Fragility in the Patient Candidate for Cardiac Surgery

Frailty is the major expression of accelerated aging and describes a decreased resistance to stressors, and consequently an increased vulnerability to additional diseases in elderly people. The vascular aging related to frail phenotype reflects the high susceptibility for cardiovascular diseases and negative postoperative outcomes after cardiac surgery. Sarcopenia can be considered a biological substrate of physical frailty. Malnutrition and physical inactivity play a key role in the pathogenesis of sarcopenia. We searched on Medline (PubMed) and Scopus for relevant literature published over the last 10 years and analyzed the strong correlation between frailty, sarcopenia and cardiovascular diseases in elderly patient. In our opinion, a right food intake and moderate intensity resistance exercise are mandatory in order to better prepare patients undergoing cardiac operatio

Risk of aortic dissection in patients with ascending aorta aneurysm: a new biological, morphological, and biomechanical network behind the aortic diameter

Thoracic aortic aneurysm represents a deadly condition, particularly when it evolves into rupture and dissection. Proper surgical timing is the key to positively influencing the survival of patients with this pathology. According to the most recent guidelines, ascending aorta size ≥ 55 mm and a rate of growth ≥ 0.5 cm per year are the most important factors for surgical indication. Nevertheless, a lot of evidence show that aortic ruptures and dissections might occur also in small size ascending aorta. In this review, we sought to analyze a new biological and morphological network behind the aortic diameter that need to be considered in order to identify the portion of patients with thoracic aortic aneurysm who are at increased risk of aortic complications, despite current aortic guidelines not advising surgical intervention in this group

Bentall Operation: Early Surgical Results, Seven-Year Outcomes, and Risk Factors Analysis

Aim: To analyze early and mid-term outcomes of the Bentall operation. Methods: Two hundred and seventeen patients (mean age 65.6 ± 15.9 years, males/females 172/45) underwent Bentall operation in a 7-year period (January 2015–December 2021), on average, 30 Bentall operations occurred per year, using biological (n = 104) or mechanical (n = 113) valved conduits for the treatment of ascending aorta–aortic root aneurysms. Associate procedures were performed in 58 patients (26.7%); coronary artery bypass grafting (CABG) in 35 (16%). Mean follow-up was 55.2 ± 24 (median 60.2) months. Cox model analysis was used to assess risk factors, Kaplan–Meier and log-rank tests were used to assess different survival rates. Results: Operative mortality was 1.38%. At 7 years, survival, freedom from cardiac death, and event-free survival were 93% ± 2%, 99% ± 1%, and 81% ± 5%. NYHA class (p < 0.0001), trans-aortic valve mean (p < 0.0001) and maximum (p < 0.000) gradients, left ventricular hypertrophy (p < 0.05), and pulmonary arterial pressure (p = 0.002) significantly improved vs. preoperative values. Concomitant CABG during Bentall operation independently affected late outcomes (HR 1.9–2.3; p-values < 0.05). Late survival was affected by concomitant CABG (84% ± 8% vs. 95% ± 2%, p = 0.04), preoperative myocardial infarction (91% ± 9% vs. 97% ± 2%, p = 0.02), and biological vs. mechanical prostheses valved conduits (91% ± 9% vs. 95% ± 3%, p = 0.02). Event-free survival also was affected by concomitant CABG (62% ± 14% vs. 85% ± 5%, p = 0.005) and biological prostheses (78% ± 8% vs. 84% ± 6%, p = 0.06). Freedom from endocarditis–redo operation was 83% ± 9% for biological prostheses vs. 89% ± 6% for mechanical prostheses (p = 0.49). Conclusions: Low rates of operative mortality and late complications make Bentall operation the gold standard for the treatment of ascending aorta–aortic root aneurysms. Coronary ischemic disease affects late outcomes. Biological prostheses should be preferred for the elderly

Early and mid-term results in patients undergoing primary CABG in comparison with patients with PCI prior to CABG

Aim: We evaluated the impact of prior percutaneous coronary intervention (PCI) on early and mid-term results in patients undergoing coronary artery bypass grafting (CABG).Methods: Between 2015 and 2020, 938 consecutive patients (mean age 67.4 ± 9.11 years) underwent CABG with prior PCI (n = 121) or primary CABG (n = 817). The mean follow-up was 37 ± 25 (median 36) months. Kaplan-Meier estimates were used to assess survival rates, while Logistic and Cox model analysis regressions assessed the risk of prior PCI and other variables.Results: Six-year survival including in-hospital mortality was 79% ± 6% in CABG with prior-PCI patients vs.88% ± 2% in primary CABG (P = 0.002). As compared with primary CABG, in prior-PCI patients, clinical presentation (acute coronary syndrome, reduced left ventricular ejection fraction, and previous myocardial infarction, P ≤ 0.01, for all comparisons) was worse, comorbidity increased (Euroscore-2, severe chronic renal dysfunction, P < 0.01), and in-hospital mortality was higher (6.6% or 8 patients vs. 1.6% or 13 patients, P < 0.001). Prior PCI was found to be an independent predictor of mortality (HR = 4.23; P = 0.01). Six-year freedom from late all-cause death and cardiac death were 84% ± 6% vs. 90% ± 2% (P = 0.2) and 96% ± 2% vs. 96% ± 1% (P = 0.5), respectively. Independent predictors of all-cause death were advanced age at the operation (P < 0.0001), reduced left ventricular ejection fraction (P = 0.01), severe chronic renal dysfunction (P = 0.02), prior PCI (P = 0.03), and Euroscore-2 (P = 0.05). Prior PCI did not negatively affect late cardiac death (P = 0.5).Conclusion: Patients undergoing CABG after prior PCI have worse perioperative outcomes. Mid-term reduced survival in the prior-PCI patients is mainly due to the concomitant presence of worse clinical presentation and increased comorbidity. Freedom from cardiac death is comparable and satisfactory in both cohorts, highlighting the positive protective effect of CABG over time