VALUTAZIONE DELLA FUNZIONE DEL VENTRICOLO DESTRO DOPO PLASTICA DELLA VALVOLA MITRALE MEDIANTE ECOGRAFIA BI- E TRIDIMENSIONALE

Background and aim of the study: The aim of the present study was to investigate the importance of the modality of pericardial incision (lateral versus anterior) onto postoperative right ventricular systolic function by comparing echocardiographic parameters in patients undergoing minimally invasive or traditional mitral valve repair Materials and methods: 34 patients (mean age 52\ub112 years; 27 males) with severe mitral regurgitation due to mitral valve prolapse were prospectively and randomly assigned to traditional (sternotomy) operation (Group A, 17 pts) or minimally invasive surgery with right antero-lateral thoracotomy (Group B, 17 pts). The pericardial approach consisted in an anterior reversed T incision for traditional surgery and in a lateral one for mini-invasive surgery. Two-dimensional transthoracic echocardiography was performed pre- and 6 months post surgery to evaluate right ventricular function by tricuspid annular plane systolic excursion (TAPSE). Three-dimensional echocardiography was used for right ventricular volumes, ejection fraction and stroke volume evaluation Results: All patients underwent successful and uncomplicated surgery. Preoperative right ventricular function was normal in all patients. Groups failed to statistically differ in basal right ventricular volumes and function and cross-clamping time. A postoperative TAPSE fall was found in both groups, but mini-invasive patients experienced a statistically significant less marked variation (22.2\ub14.1 post versus 23.5\ub13.4 pre, p=0.06) versus traditional surgery (15.2\ub13.1 post versus 25.8\ub15.2 pre, p<0.0001), p<0.0001. 3D echocardiography retrieved no significant inter-group differences in postoperative changes of end-systolic and end-diastolic right ventricular volumes. In mini-invasive patients, right ventricular stroke volume and ejection fraction slightly augmented after surgery while in Group A both values faintly decreased, but such difference was not statistically or clinically significant Conclusions: Mini-invasive mitral repair with lateral pericardial opening reduces postoperative right ventricular longitudinal function decrease but fails to have significant effect onto ejection fraction modifications evaluated at 3D echocardiography

Surgical Treatment of Atrial Fibrillation

Atrial fibrillation represents the most common supraventricular arrhythmia above all in patients undergoing cardiac surgery and is associated to an augmented risk of thromboembolic stroke, heart failure, and cardiovascular mortality. That is the reason why cardiac surgeons began to address their attention to how to surgically treat fibrillating patients according to pathophysiological models describing mechanisms of arrhythmia induction and maintenance. A new branch of cardiac surgery was born, leading to a progressive development of adapted surgical ablation techniques, applicable both to lone or concomitant arrhythmia treatment. Historical evolution and current available surgical treatment options are described, beginning from the first pure surgical maze, going through all its modifications in source ablation energies and lesion sets and finishing with current mini-invasive hybrid treatment of lone atrial fibrillation. Indications, patients’ selection, technical options with respective advantages and disadvantages, surgical technique details, complications, and results are fully illustrated. Relationship between pathophysiologic arrhythmia mechanisms and the consequent ablation tailored procedure choice is highlighted, allowing a customized procedural offer to every single patient, resulting in a success rate ranging from 60 to 90%

Vascular Complications following Isolated Limb Perfusion for Local Recurrence of Extremity Melanoma: A Case Report and Literature Review

Introduction. To evaluate the role of hyperthermic isolated limb perfusion (HILP) in arterial thrombosis following melanoma-soft tissue sarcoma chemotherapy. Report. Here is presented one case of iliac-common femoral artery subacute thrombosis and a review of the appropriate literature performed using a MEDLINE search. Acute/subacute arterial occlusion is one of the most feared vascular complications of HILP, located nearly always in the external iliac-femoral artery axis, being those vessels cannulated for perfusion. Conclusions. The small number of reported cases indicates either the rarity of this complication or unawareness of its existence. The true incidence of this complication is probably underreported

Modeling for Sustainable Supply Chain Management Level and its Impact on Company’s Performance

Research in the field of sustainable supply chain management (SSCM) has grown rapidly but focuses mainly on the economic and environmental aspects and rarely considers the social aspect. This research will discuss recent literature review on SSCM and propose a model to measure the impact of institutional pressures on company’s SSCM level and the influence of that level on company’s performance. SSCM level will be measured from five variables: orientation, continuity, collaboration, risk management, and proactivity; whereas company’s performance will be measured from three variables of sustainable development: economic, social, and environment. Furthermore, we propose seven indicators to assess institutional pressures, fourteen indicators to assess SSCM level, and nine indicators to assess company’s performance

Pemodelan Sustainable Lifestyle terhadap Kesiapan Menghadapi ASEAN Economic Community dengan Structural Equation Modeling (Studi Kasus: Kota Surabaya)

Penelitian ini bertujuan untuk mengetahui pengaruh penerapan sustainable lifestyle terhadap kesiapan masyarakat dalam menghadapi ASEAN Economic Community (AEC). Kedua hal tersebut adalah sesuatu yang tidak bisa diukur secara langsung, sehingga penelitian diawali dengan perumusan indikator pengukur untuk kedua hal tersebut. Didapatkan 10 indikator untuk merefleksikan penerapan sustainable lifestyle dan 15 indikator untuk merefleksikan kesiapan masyarakat dalam menghadapi AEC, ke-15 indikator ini dikelompokkan menjadi dua kelompok variabel yaitu kemampuan individual dan daya saing produk lokal. Pengumpulan data melalui kuisioner yang melibatkan 202 responden menunjukkan bahwa penerapan sustainable lifestyle tergolong tinggi dengan nilai sebesar 3,40 (dari nilai maks. 5), dan tingkat kesiapan masyarakat menghadapi AEC tergolong sedang yaitu sebesar 3,29 (dari nilai maks. 5). Dengan menggunakan Partial Least Square – Structural Equation Modeling (PLS – SEM), didapatkan bahwa penerapan sustainable lifestyle signifikan mempengaruhi kesiapan masyarakat dalam menghadapi AEC dengan koefisien korelasi 0,47. Tingkat kesiapan menghadapi AEC dapat direfleksikan oleh variabel “Kemampuan Individual” sebesar 51% dan oleh variabel “Daya Saing Produk Lokal” sebesar 70%, dengan dua indikator yang memiliki nilai pengaruh yang terbesar dan sekaligus merupakan kelemahan masyarakat yang memerlukan perbaikan adalah perlunya peningkatan pengembangan bakat dan ketrampilan pribadi serta perlunya peningkatan kesadaran para produsen lokal untuk melakukan penyesuaian diri daam hal manajemen untuk menghadapi AE

Current and future options for adult biventricular assistance: a review of literature

In cardiogenic shock various short-term mechanical assistances may be employed, including an Extra Corporeal Membrane Oxygenator and other non-dischargeable devices. Once hemodynamic stabilization is achieved and the patient evolves towards a persisting biventricular dysfunction or an underlying long-standing end-stage disease is present, aside from Orthotopic Heart Transplantation, a limited number of long-term therapeutic options may be offered. So far, only the Syncardia Total Artificial Heart and the Berlin Heart EXCOR (which is not approved for adult use in the United States unlike in Europe) are available for extensive implantation. In addition to this, the strategy providing two continuous-flow Left Ventricular Assist Devices is still off-label despite its widespread use. Nevertheless, every solution ensures at best a 70% survival rate (reflecting both the severity of the condition and the limits of mechanical support) with patients suffering from heavy complications and a poor quality of life. The aim of the present paper is to summarize the features, implantation techniques, and results of current devices used for adult Biventricular Mechanical Circulatory Support, as well as a glance to future options

Postoperative Echocardiographic Reduction of Right Ventricular Function: Is Pericardial Opening Modality the Main Culprit?

Echocardiographic reduction of RV function, measured using TAPSE, is a well described phenomenon after cardiac surgery. The aim of the present study was to investigate the relation between the modality of pericardial opening (lateral versus anterior) and the postoperative right ventricular systolic function by comparing echocardiographic parameters in patients undergoing minimally invasive or traditional mitral valve repair. 34 patients with severe mitral regurgitation due to mitral valve prolapse underwent traditional (sternotomy) operation (Group A) or minimally invasive surgery with right anterolateral thoracotomy (Group B). A postoperative TAPSE fall was found in both groups. Group A experienced a significant postoperative TAPSE fall versus Group B with p<0.0001

The impact of pericardial approach and myocardial protection onto postoperative right ventricle function reduction

Background The reduction of RV function after cardiac surgery is a well-known phenomenon. It could persist up-to one year after the operation and often leads to an incomplete recovery at follow-up echocardiographic control. The aim of the present study is to analyze the impact of different modalities of pericardial incision (lateral versus anterior) and of myocardial protection protocols (Buckberg versus Custodiol) onto postoperative RV dynamic by relating two- and three-dimensional echocardiographic parameters in patients undergoing mitral valve repair through minimally invasive or traditional surgery approach. Methods We have analyzed 44 consecutive patients with severe degenerative mitral regurgitation who underwent mitral reparation with different surgical approach and cardioplegia type: Group 1 (17 pts): sternotomy with Buckberg cardioplegia protocol; Group 2 (10 pts): sternotomy with Custodiol cardioplegia; Group 3 (17 pts): mini-invasive surgery with Custodiol cardioplegia. Two-dimensional transthoracic echocardiography was performed pre- and 6 months post-surgery to evaluate RV function by tricuspid annular plane systolic excursion (TAPSE). Results All patients underwent successful and uneventful. A postoperative TAPSE reduction was found in all groups. However, mini-invasive patients experienced a significant reduced variation versus traditional surgery. Conclusions Mini-invasive mitral repair, with lateral incision of pericardium, reduces postoperative TAPSE fall, while cardioplegia protocol fails to have an impact onto longitudinal RV function. In our study, the RV seems to experience a clinically irrelevant geometrical modification too, whose entity appears to be less evident in case of lateral pericardial approach. These results could strengthen the use of minimally invasive approach also to preserve RV function

Management of pregnancy in autoimmune rheumatic diseases: maternal disease course, gestational and neonatal outcomes and use of medications in the prospectiveItalian P-RHEUM.it study

Objectives To investigate pregnancy outcomes in women with autoimmune rheumatic diseases (ARD) in the Italian prospective cohort study P-RHEUM.it. Methods Pregnant women with different ARD were enrolled for up to 20 gestational weeks in 29 Rheumatology Centres for 5 years (2018-2023). Maternal and infant information were collected in a web-based database. Results We analysed 866 pregnancies in 851 patients (systemic lupus erythematosus was the most represented disease, 19.6%). Maternal disease flares were observed in 135 (15.6%) pregnancies. 53 (6.1%) pregnancies were induced by assisted reproduction techniques, 61 (7%) ended in miscarriage and 11 (1.3%) underwent elective termination. Obstetrical complications occurred in 261 (30.1%) pregnancies, including 2.3% pre-eclampsia. Two cases of congenital heart block were observed out of 157 pregnancies (1.3%) with anti-Ro/SSA. Regarding treatments, 244 (28.2%) pregnancies were treated with glucocorticoids, 388 (44.8%) with hydroxychloroquine, 85 (9.8%) with conventional synthetic disease-modifying anti-rheumatic drugs and 122 (14.1%) with biological disease-modifying anti-rheumatic drugs. Live births were 794 (91.7%), mostly at term (84.9%); four perinatal deaths (0.5%) occurred. Among 790 newborns, 31 (3.9%) were small-for-gestational-age and 169 (21.4%) had perinatal complications. Exclusive maternal breast feeding was received by 404 (46.7%) neonates. The Edinburgh Postnatal Depression Scale was compiled by 414 women (52.4%); 89 (21.5%) scored positive for emotional distress. Conclusions Multiple factors including preconception counselling and treat-to-target with pregnancy-compatible medications may have contributed to mitigate disease-related risk factors, yielding limited disease flares, good pregnancy outcomes and frequency of complications which were similar to the Italian general obstetric population. Disease-specific issues need to be further addressed to plan preventative measures