Non invasive assessment of right ventricle in patients with operated tetralogy of Fallot

The objective of this study was to evaluate right ventricular function in patients with right ventricular volume overload in patients with (tetralogy of Fallot, and pulmonary atresia + VSD ) underwent corrective surgery; with echocardiography measure that can be easily applied; and to study the relationship between ProBNP and the contractile function of the right ventricle, dilated right atrium, and the consequences of pulmonary insufficiency . Methods: The study included 50 patients (50% males, mean age 30.64 ± 13.30 years) with prior cardiac surgical intervention of TDF (90%) or pulmonary atresia + VSD (10%). (49 pz) have performed a cardiac MRI and clinical evaluation, (47 pz) echocardiogram, (48 pz) ECG, (34 pz) a cardiopulmonary exercise testing, (29 pz) a dosage of ProBNP. Results: The S-wave velocity (p <0.0001), the TAPSE (p <0.0001) correlated significantly with RVEF estimated by cardiac MRI. The VO2 max was 27.93 ± 12.91 ml / kg / min, 15% of patients had VE/VCO2 The peak> 35. ProBNP correlated positively and significantly with the area of the right atrium (p = 0.0001), and negative and significant with VO2 max (p = 0.04). Those who have increased pulmonary insufficiency (PVR fraction> 30%) have a significantly increased RVED volume (p = 0.01), reduced VO2 max (p = 0.04), and lower ejection fraction of LV (p = 0.02) than the group of patients with PVR ≤ 30. Conclusion: The TAPSE and S-wave velocity are fundamental and may become the technique of choice for routine assessment of RV systolic function in adult patients with TOF. The monitoring of the Pro BNP is probably a choice, given the simplicity and their information that correlate with the test cardiopulmonary. In view of the ventricular-ventricular interaction, so measures to maintain or restore the functioning of the pulmonary valve could preserve biventricular function.

Hierapolis-Castabala: The Urban Development in A.D. 1st to 3rd Centuries

The goal of the present dissertation is to explore the urbanization process in Castabala in A.D. 1st to 3rd centuries, along with the factors affecting the urbanization of the city and the impact of Romanization on this process, by making use of the buildings that are proven or assumed to date back to this period. A further goal is to provide a general assessment of these buildings based on the finds and findings revealed by the excavations in Castabala, which first started in 2009, and use these as evidence for proposing new dating for buildings that have not been fully dated.

Left Ventricle Modification After Endovascular Aortic Repair

INTRODUCTION Endograft deployment is a well-known cause of arterial stiffness increase as well as arterial stiffness increase represent a recognized cardiovascular risk factor. A harmful effect on cardiac function induced by the endograft deployment should be investigated. Aim of this study was to evaluate the impact of endograft deployment on the arterial stiffness and cardiac geometry of patients treated for aortic aneurysm in order to detect modifications that could justify an increased cardiac mortality at follow-up. MATHERIALS AND METHODS Over a period of 3 years, patients undergoing elective EVAR for infrarenal aortic pathologies in two university centers in Emilia Romagna were examined. All patients underwent pre-operative and six-months post-operative Pulse Wave Velocity (PWV) examination using an ultrasound-based method performed by vascular surgeons together with trans-thoracic echocardiography examination in order to evaluate cardiac chambers geometry before and after the treatment. RESULTS 69 patients were enrolled. After 36 months, 36 patients (52%) completed the 6 months follow-up examination.The ultrasound-based carotid-femoral PWV measurements performed preoperatively and 6 months after the procedure revealed a significant postoperative increase of cf-PWV (11,6±3,6 m/sec vs 12,3±8 m/sec; p.value:0,037).Postoperative LVtdV (90±28,3 ml/m2 vs 99,1±29,7 ml/m2; p.value:0.031) LVtdVi (47,4±15,9 ml/m2 vs 51,9±14,9 ml/m2; p.value:0.050), IVStd (12±1,5 mm vs 12,1±1,3 mm; p.value:0,027) were significantly increased if compared with preoperative measures.Postoperative E/A (0,76±0,26 vs 0,6±0,67; p.value:0,011), E’ lateral (9,5±2,6 vs 7,9±2,6; p.value:0,024) and A’ septal (10,8±1,5 vs 8,9±2; p.value0,005) were significantly reduced if compared with preoperative measurements CONCLUSION The endovascular treatment of the abdominal aorta causes an immediate and significant increase of the aortic stiffness.This increase reflects negatively on patients’ cardiac geometry inducing left ventricle hypertrophy and mild diastolic disfunction after just 6 months from endograft’s implantation.Further investigations and long-term results are necessary to access if this negative remodeling could affect the cardiac outcome of patient treated using the endovascular approach.