Combination of a Giant Dissected Ascending Aortic Aneurysm with Multiple Fistulae into the Cardiac Chambers Caused by Prosthetic Aortic Valve Endocarditis

The combination of a dissected ascending aortic aneurysm (AA) with multiple fistulae to the periaortic root structures is a life-threatening complication that occurs rarely after infective endocarditis of the prosthetic aortic valve. Many risk factors are potentially associated with this complication, including aortic diameter, connective tissue disease of the aortic wall, hypertension and infection. We report a rare case of dissected ascending AA with fistulae to the left atrium and pulmonary artery and a paravalvular leak in a 47-year-old woman with a history of an aortic valve replacement. The patient had presented to the Imam Ali Hospital, Kermanshah, Iran, in January 2015 with clinical features of heart failure. After initially being treated for congestive heart failure, she underwent open-heart surgery via a classic Bentall procedure and double fistula closure. She was discharged 23 days after the operation in good condition. A six-month follow-up showed normal functioning of the composite conduit prosthetic valve and no fistulae recurrence

Powder bed fusion additive layer manufacturing of titanium alloys

Powder bed fusion (PBF) techniques for additive layer manufacturing (ALM) are reviewed with a focus on titanium alloys production. Selective laser melting and electron beam melting are discussed in terms of feedstock production and processing-microstructure relationships. To control the PBF processes, an outline is presented on the computational modelling approaches for simulating process parameters and defects such as residual stresses and porosity at different length scales. It is concluded that by improving powder production techniques, designing new alloys and further developing ALM hardware, PBF techniques can reach commercial maturity. This review was submitted as part of the 2019 Materials Literature Review Prize of the Institute of Materials, Minerals and Mining run by the Editorial Board of MST. Sponsorship of the prize by TWI Ltd is gratefully acknowledged

Right Ventricular Thrombus and Cerebral Artery Aneurysm in a Patient with Behçet’s Disease

We report a 35-year-old woman referred to the Imam Ali Hospital, Kermanshah, Iran, in July 2014 for evaluation of postoperative dyspnoea after neurosurgery performed seven days previously for a ruptured cerebral artery aneurysm. She was known to have Behçet’s disease with a history of recurrent oral and genital aphthous ulcers and uveitis. At referral, her symptoms included vertigo, dysarthria, palpitations and chest pain. Transthoracic echocardiography (TTE) revealed a large thrombus in her right ventricle outflow tract and open-heart surgery was performed eight days after the previous surgery to remove the clot. The postoperative period was complicated by transient acute renal failure, which resolved spontaneously. The patient was discharged 13 days after the cardiac surgery on warfarin, prednisolone, azathioprine and cyclophosphamide. Cyclophosphamide and azathioprine were discontinued after three months as the symptoms had completely resolved; however, prednisolone was continued due to recurrent uveitis. A 10-month follow-up TTE scan revealed no thrombus recurrence and treatment with warfarin and prednisolone was continued

A Tricuspid Valve Mass Attached to Papillary Muscle

BACKGROUND: Cardiac myxoma is the most common benign heart tumor which can arise in any of the cardiac chambers, valves or related great veins. Diagnosis of a myxoma arising from the tricuspid valve apparatus is exceptional. We present a rare case of myxoma in a tricuspid valve attached to papillary muscle.CASE DETAILS: A 45-year-old man was referred to our center for the evaluation dyspnea and chest pain. During work-up by transthoracic echocardiography (TTE), a mass was found on the corda tendinea of the anterior papillary muscle of the tricuspid valve. Coronary angiography revealed normal coronary artery. During open heart surgery, an oval and non-pedunculated mass was detected on tricuspid corda tendinea and resected. Pathological examination revealed the presence of a myxoma.CONCLUSION: This experience illustrates a rare case of myxoma which originated from tricuspid corda tendinea, diagnosed by echocardiography, suggesting fibroelastoma. However, the mass was not clear enough but dyspnea and sign and symptom of probably embolization to lung urged us to treat it surgically. No complications attributable to the mass developed in the postoperative course. In the first year of follow-up, non-recurrence of the mass was detected on TEE, and the patient was asymptomatic.KEYWORDS: Myxoma, Papillary muscle, Tricuspid valv

Empowering human resources of organization and insurance selling network with effective factors approach

When organization and insurance sales network are influenced by intense economic competition, considering the work quality and human resources productivity in organization and their sales network has special importance. Meanwhile, senior management of insurance organizations in order to improve the performance of organization and their respective companies should see their organization with qualitative view and try to maintain the work performance quality of his own organization in optimum level as far as possible, by providing practical strategies. This continuous improvement is essential in today's complex environment to deal with threats and opportunities. This article tries to examine factors affecting the process of empowering human resources of organization and sales networks by examining the available books and resources and analyzing the issues relevant to the topic and also conducted researches and in addition to analyzing the available inefficiencies and barriers will illustrate the practical solutions to solve the relevant problems

Empowering human resources of organization and insurance selling network with effective factors approach

When organization and insurance sales network are influenced by intense economic competition, considering the work quality and human resources productivity in organization and their sales network has special importance. Meanwhile, senior management of insurance organizations in order to improve the performance of organization and their respective companies should see their organization with qualitative view and try to maintain the work performance quality of his own organization in optimum level as far as possible, by providing practical strategies. This continuous improvement is essential in today's complex environment to deal with threats and opportunities. This article tries to examine factors affecting the process of empowering human resources of organization and sales networks by examining the available books and resources and analyzing the issues relevant to the topic and also conducted researches and in addition to analyzing the available inefficiencies and barriers will illustrate the practical solutions to solve the relevant problems

Empowering human resources of organization and insurance selling network with effective factors approach

When organization and insurance sales network are influenced by intense economic competition, considering the work quality and human resources productivity in organization and their sales network has special importance. Meanwhile, senior management of insurance organizations in order to improve the performance of organization and their respective companies should see their organization with qualitative view and try to maintain the work performance quality of his own organization in optimum level as far as possible, by providing practical strategies. This continuous improvement is essential in today's complex environment to deal with threats and opportunities. This article tries to examine factors affecting the process of empowering human resources of organization and sales networks by examining the available books and resources and analyzing the issues relevant to the topic and also conducted researches and in addition to analyzing the available inefficiencies and barriers will illustrate the practical solutions to solve the relevant problems