Corona mortis variant of the obturator artery : a systematic study of 300 hemipelvises by means of computed tomography angiography

Purpose: The purpose of the present study is to systematically assess the prevalence and characteristics of the corona mortis (CM) variant of the obturator artery by means of computerised tomography angiography (CTA). Material and methods: A total of 150 consecutive patients (112 males, average age 73 years) referred to CTA for lower limb arterial evaluation were included in this retrospective study. Patient demographics, anastomosis incidence, artery diameter, distance from the symphysis pubis, Kellgren-Lawrence score, and pelvic size were evaluated. Results: In this study 40.6% of patients presented at least one competent CM arterial anastomosis. In the 300 evaluated arteries, 90 arterial anastomoses were found (30%), 40 on the right side (average diameter 1.63 mm) and 50 on the left side (1.78 mm). In 32 cases there was only one anastomosis, while in 29 cases the CM was bilateral. No anastomoses were detected in 89 patients. Mean distance from the symphysis was 50 mm. No relevant association with hip osteoarthrosis was found for CM. Mean pelvic size was 213 mm. Conclusions: The evidence from this study suggests that CM is a common variant that needs to be acknowledged before pelvic intervention

Functional and Biomechanical Effects of the Edge-to-Edge Repair in the Setting of Mitral Regurgitation: Consolidated Knowledge and Novel Tools to Gain Insight into Its Percutaneous Implementation

Mitral regurgitation is the most prevalent heart valve disease in the western population. When severe, it requires surgical treatment, repair being the preferred option. The edge-to-edge repair technique treats mitral regurgitation by suturing the leaflets together and creating a double-orifice valve. Due to its relative simplicity and versatility, it has become progressively more widespread. Recently, its percutaneous version has become feasible, and has raised interest thanks to the positive results of the Mitraclip(\uae) device. Edge-to-edge features and evolution have stimulated debate and multidisciplinary research by both clinicians and engineers. After providing an overview of representative studies in the field, here we propose a novel computational approach to the most recent percutaneous evolution of the edge-to-edge technique. Image-based structural finite element models of three mitral valves affected by posterior prolapse were derived from cine-cardiac magnetic resonance imaging. The models accounted for the patient-specific 3D geometry of the valve, including leaflet compound curvature pattern, patient-specific motion of annulus and papillary muscles, and hyperelastic and anisotropic mechanical properties of tissues. The biomechanics of the three valves throughout the entire cardiac cycle was simulated before and after Mitraclip(\uae) implantation, assessing the biomechanical impact of the procedure. For all three simulated MVs, Mitraclip(\uae) implantation significantly improved systolic leaflets coaptation, without inducing major alterations in systolic peak stresses. Diastolic orifice area was decreased, by up to 58.9%, and leaflets diastolic stresses became comparable, although lower, to systolic ones. Despite established knowledge on the edge-to-edge surgical repair, latest technological advances make its percutanoues implementation a challenging field of research. The modeling approach herein proposed may be expanded to analyze clinical scenarios that are currently critical for Mitraclip(\uae) implantation, helping the search for possible solutions

An Image-Based Computational Fluid Dynamics Study of Mitral Regurgitation in Presence of Prolapse

Purpose: In this work we performed an imaged-based computational study of the systolic fluid dynamics in presence of mitral valve regurgitation (MVR). In particular, we compared healthy and different regurgitant scenarios with the aim of quantifying different hemodynamic quantities. Methods: We performed computational fluid dynamic (CFD) simulations in the left ventricle, left atrium and aortic root, with a resistive immersed method, a turbulence model, and with imposed systolic wall motion reconstructed from Cine-MRI images, which allowed us to segment also the mitral valve. For the regurgitant scenarios we considered an increase of the heart rate and a dilation of the left ventricle. Results: Our results highlighted that MVR gave rise to regurgitant jets through the mitral orifice impinging against the atrial walls and scratching against the mitral valve leading to high values of wall shear stresses (WSSs) with respect to the healthy case. Conclusion: CFD with prescribed wall motion and immersed mitral valve revealed to be an effective tool to quantitatively describe hemodynamics in case of MVR and to compare different regurgitant scenarios. Our findings highlighted in particular the presence of transition to turbulence in the atrium and allowed us to quantify some important cardiac indices such as cardiac output and WSS

Turbulent blood dynamics in the left heart in the presence of mitral regurgitation: a computational study based on multi-series cine-MRI

In this work, we performed a computational image-based study of blood dynamics in the whole left heart, both in a healthy subject and in a patient with mitral valve regurgitation. We elaborated multi-series cine-MRI with the aim of reconstructing the geometry and the corresponding motion of left ventricle, left atrium, mitral and aortic valves, and aortic root of the subjects. This allowed us to prescribe such motion to computational blood dynamics simulations where, for the frst time, the whole left heart motion of the subject is considered, allowing us to obtain reliable subject-specifc information. The fnal aim is to investigate and compare between the subjects the occurrence of turbulence and the risk of hemolysis and of thrombi formation. In particular, we modeled blood with the Navier–Stokes equations in the arbitrary Lagrangian–Eulerian framework, with a large eddy simulation model to describe the transition to turbulence and a resistive method to manage the valve dynamics, and we used a fnite element discretization implemented in an in-house code for the numerical solution

COMPLICANZE ASSOCIATE AL POSIZIONAMENTO DI PORT-A-CATH E LORO GESTIONE DA PARTE DI RADIOLOGI INTERVENTISTI

Scopo: Descrivere le complicanze precoci e tardive associate al posizionamento di port-a-cath e la loro gestione da parte di Radiologi Interventisti. Materiali e metodi: Sono stati retrospettivamente analizzati i dati clinici di 742 pazienti sottoposti a posizionamento di port-a-cath presso la nostra Unità di Angiografia tra il 2016 ed il 2019. Le complicanze associate alla procedura sono state distinte in precoci (entro 30 giorni dall’impianto) e tardive (>30 giorni). Risultati: Il follow-up medio è stato di 832 giorni (range, 162-1532 giorni). Il malfunzionamento clinico del port-a-cath è stato riscontrato in 72 pazienti (9.7%). Le complicanze precoci (19/72, 26.4%) hanno incluso: infezione della tasca (31.6%), ematoma sottocutaneo (26.3%), torsione del catetere (15.8%), difficoltà di iniezione da causa indefinita (10.5%), dislocazione del serbatoio (10.5%) e deiscenza della ferita (5.3%); tali complicanze sono state gestite con rimozione del port-acath in 10 casi (52.6%) e con sua revisione (disostruzione meccanica, aspirazione percutanea di raccolta o sutura della tasca) nel 49.1% dei casi. Le complicanze tardive (53/72, 73.6%) hanno incluso: difficoltà di iniezione da causa indefinita (50.9%), infezione della tasca (18.9%), deiscenza della ferita (17%), trombosi venosa (7.5%) e migrazione del catetere (5.7%); le complicanze tardive sono state gestite con rimozione del serbatoio in 30 casi (56.6%) e con revisione del dispositivo (disostruzione meccanica o sutura della tasca) in 23 casi (43.4%). Conclusioni: Il malfunzionamento clinico dei port-a-cath può occorrere in circa il 10% dei casi; è più frequente dopo 30 giorni dall’impianto e può essere gestito senza rimozione del serbatoio in circa il 50% dei casi

Dynamic and quantitative evaluation of degenerative mitral valve disease: A dedicated framework based on cardiac magnetic resonance imaging

Background: Accurate quantification of mitral valve (MV) morphology and dynamic behavior over the cardiac cycle is crucial to understand the mechanisms of degenerative MV dysfunction and to guide the surgical intervention. Cardiac magnetic resonance (CMR) imaging has progressively been adopted to evaluate MV pathophysiology, although a dedicated framework is required to perform a quantitative assessment of the functional MV anatomy. Methods: We investigated MV dynamic behavior in subjects with normal MV anatomy (n=10) and patients referred to surgery due to degenerative MV prolapse, classified as fibro-elastic deficiency (FED, n=9) and Barlow's disease (BD, n=10). A CMR-dedicated framework was adopted to evaluate prolapse height and volume and quantitatively assess valvular morphology and papillary muscles (PAPs) function over the cardiac cycle. Multiple comparison was used to investigate the hallmarks associated to MV degenerative prolapse and evaluate the feasibility of anatomical and functional distinction between FED and BD phenotypes. Results: On average, annular dimensions were significantly (P < 0.05) larger in BD than in FED and normal subjects while no significant differences were noticed between FED and normal. MV eccentricity progressively decreased passing from normal to FED and BD, with the latter exhibiting a rounder annulus shape. Over the cardiac cycle, we noticed significant differences for BD during systole with an abnormal annular enlargement between mid and late systole (LS) (P < 0.001 vs. normal); the PAPs dynamics remained comparable in the three groups. Prolapse height and volume highlighted significant differences among normal, FED and BD valves. Conclusions: Our CMR-dedicated framework allows for the quantitative and dynamic evaluation of MV apparatus, with quantifiable annular alterations representing the primary hallmark of severe MV degeneration. This may aid surgeons in the evaluation of the severity of MV dysfunction and the selection of the appropriate MV treatment

APPROCCIO ENDOVASCOLARE ALL’EMBOLIZZAZIONE NEL RENE TRAPIANTATO: DESCRIZIONE DELLA NOSTRA CASISTICA

Scopo: Descrivere la nostra casistica di pazienti nefrotrapiantati sottoposti ad embolizzazione arteriosa transcatetere. Materiali e metodi: Nel periodo 2016-2019, 7 pazienti (6 uomini, 1 donna; età media 57, range 46-66 anni) sono stati sottoposti ad embolizzazione transcatetere dopo trapianto renale: 3/7 prima dell’espianto chirurgico di un graft malfunzionante, 4/7 per complicanze vascolari insorte nel rene trapiantato (3 pseudoaneurismi, 1 fistola artero-venosa conseguente a biopsia del graft). Risultati: Le procedure pre-espianto sono state eseguite mediante posizionamento di spirali o plug metallici a cavallo dell’anastomosi chirurgica arteriosa. In tutti casi l’espianto chirurgico è stato eseguito senza complicanze emorragiche. Nei pazienti con pseudoaneurismi intrarenali l’embolizzazione è stata eseguita mediante posizionamento di spirali metalliche “a monte” e “a valle” dello pseudoaneurisma, per escluderlo dalla circolazione sistemica; 1 di queste procedure è stata eseguita in regime d’urgenza a causa della rottura dello pseudoaneurisma entro la pelvi renale. Nel paziente con fistola artero-venosa sono state posizionate microspirali metalliche entro l’arteria afferente la fistola. Nel caso eseguito in urgenza è stato necessaria una seconda procedura per il persistere dell’ematuria secondaria ad incompleta esclusione della sacca pseudoaneurismatica. In tutti i casi la procedura di embolizzazione ha determinato la risoluzione della problematica e la preservazione del graft. Conclusioni: Il trattamento endovascolare può essere un valido aiuto tanto nell’embolizzazione pre-espianto di graft renale quanto nel trattamento delle complicanze vascolari. In quest’ultimo caso l’embolizzazione dev’essere più precisa e selettiva possibile, per evitare l’embolizzazione non target con rischio di perdita di funzione del graft

Arterial tortuosity syndrome in two Italian paediatric patients

<p>Abstract</p> <p>Background</p> <p>Arterial tortuosity syndrome (ATS) (OMIM #208050) is a rare autosomal recessive connective tissue disorder characterized by tortuosity and elongation of the large and medium-sized arteries, propensity to aneurysms formation, vascular dissection, and pulmonary arteries stenosis. ATS is caused by mutations in <it>SLC2A10 </it>gene, encoding for the facilitative glucose transporter 10 (GLUT10). So far, 17 <it>SLC2A10 </it>mutations have been reported in 32 families, two of which were Italian with a total of five patients. Here we present the clinical and molecular characterization of two novel Italian paediatric ATS patients.</p> <p>Methods</p> <p>The exons and intronic flanking regions of <it>SLC2A10 </it>gene were amplified and direct sequencing was performed.</p> <p>Results</p> <p>In both patients, the involvement of major- and medium-sized arteries was characteristic; the nonvascular connective tissue manifestations were mild and not pathognomic of the disorder. Both patients, born from non-consanguineous parents, were heterozygous for two different <it>SLC2A10 </it>mutations, three of which were recurrent and one was novel (p.Arg231Trp). This mutation is localized at the endofacial loop between the transmembrane domains 6 and 7 of GLUT10.</p> <p>Conclusion</p> <p>Two novel ATS patients were characterized at clinical and molecular level. Overall, four ATS unrelated families are known in Italy so far. Though ATS clinical delineation improved in the last years, further works in the comprehension of disease presentation and complications onset, particularly in paediatric age, and on ATS molecular basis are needed to add new insights for diagnosis and prevention strategies for related complications.</p

ESCLUSIONE ENDOVASCOLARE DI PSEUDOANEURISMI IN FEGATO TRAPIANTATI: VIRTUTE DUCE, COMITE FORTUNA

Scopo: Presentare due casi di trattamento endovascolare di pseudoaneurismi in pazienti sottoposti a trapianto epatico. Materiali e metodi: Gli pseudoaneurismi sono stati identificati incidentalmente in corso di follow-up dopo trapianto epatico ortotopico. Il paziente 1, nel quale era stata confezionata una bilio-digiuno anastomosi, presentava uno pseudoaneurisma pre-anastomotico dell’arteria epatica, con trombosi dell’arteria a valle ed opacizzazione dei rami intraepatici apparentemente attraverso esili circoli collaterali di pertinenza dell’arteria epatica comune e del circolo mesenterico. Il paziente 2 presentava uno pseudoaneurisma intraepatico, probabile conseguenza di biopsia eseguita sul donatore. Risultati: In entrambi i casi lo pseudoaneurisma è stato escluso dal circolo sistemico edil graft è stato preservato. Nel paziente 1 una delle spirali metalliche utilizzate per l’esclusione dello pseudoaneurisma con tecnica “sandwich“ si è dislocata trombizzando l’arteria epatica comune prossimale; fortunatamente, grazie a verosimili fenomeni di neoangiogenesi indotti dalla presenza della bilio-digiuno anastomosi, le branche arteriose intraepatiche permanevano pervie, anche in corso di follow- up. Nel paziente 2 si è scelto di utilizzare la tecnica “jailing“, con posizionamento di spirali a rilascio controllato attraverso le maglie di uno stent a celle aperte posizionato nel lume dell’arteria coinvolta dallo pseudoaneurisma; nonostante una parziale occlusione dello stent, le diramazioni a valle permanevano pervie in corso di follow-up. Conclusioni: Nel fegato trapiantato il circolo arterioso è importante quanto quello portale. Il trattamento endovascolare in tali casi è una procedura ad elevato rischio, poichè l’embolizzazione non target può portare a perdita di parenchima con malfunzionamento del graft

Affidabilità dell'agobiopsia percutanea di noduli polmonari di piccole dimensioni eseguiti con guida TC a fascio conico

Valutare l’affidabilità e il tasso di complicanze delle agobiopsie dei noduli polmonari di piccole dimensioni eseguite mediante guida TC a fascio conico con braccio “a C”