Balloon Aortic Valvuloplasty as Bridge-to-Decision in High Risk Patients with Severe Aortic Valve Stenosis

Background. A sizable group of patients with symptomatic aortic stenosis (AS) can undergo neither surgical aortic valve replacement (AVR) nor transcatheter aortic valve implantation (TAVI) because of clinical contraindications. The aim of this study was to assess the potential role of balloon aortic valvuloplasty (BAV) as a “bridge-to-decision” in selected patients with severe AS and potentially reversible contraindications to definitive treatment. Methods. We retrospectively enrolled 645 patients who underwent first BAV at our Institution between July 2007 and December 2012. Of these, the 202 patients (31.2%) who underwent BAV as bridge-to-decision (BTD) requiring clinical re-evaluation represented our study population. BTD patients were further subdivided in 5 groups: low left ventricular ejection fraction; mitral regurgitation grade ≥3; frailty; hemodynamic instability; comorbidity. The main objective of the study was to evaluate how BAV influenced the final treatment strategy in the whole BTD group and in its single specific subgroups. Results. Mean logistic EuroSCORE was 23.5±15.3%, mean age was 81±7 years. Mean transaortic gradient decreased from 47±17 mmHg to 33±14 mmHg. Of the 193 patients with BTD-BAV who received a second heart team evaluation, 72.5% were finally deemed eligible for definitive treatment (25.4%for AVR; 47.2% for TAVI): respectively, 96.7% of patients with left ventricular ejection fraction recovery; 70.5% of patients with mitral regurgitation reduction; 75.7% of patients who underwent BAV in clinical hemodynamic instability; 69.2% of frail patients and 68% of patients who presented relevant comorbidities. 27.5% of the study population was deemed ineligible for definitive treatment and treated with standard therapy/repeated BAV. In-hospital mortality was 4.5%, cerebrovascular accident occurred in 1% and overall vascular complications were 4% (0.5% major; 3.5% minor). Conclusions. Balloon aortic valvuloplasty should be considered as bridge-to-decision in high-risk patients with severe aortic stenosis who cannot be immediate candidates for definitive percutaneous or surgical treatment.

Astroparticle physics with nuclear track detectors

This thesis is mainly about the search for exotic heavy particles -Intermediate Mass Magnetic Monopoles, Nuclearites and Q-balls with the SLIM experiment at the Chacaltaya High Altitude Laboratory (5230 m, Bolivia), establishing upper limits (90% CL) in the absence of candidates, which are among the best if not the only one for all three kind of particles. A preliminary study of the background induced by cosmic neutron in CR39 at the SLIM site, using Monte Carlo simulations. The measurement of the elemental abundance of the primary cosmic ray with the CAKE experiment on board of a stratospherical balloon; the charge distribution obtained spans in the range 5≤Z≤31. Both experiments were based on the use of plastic Nuclear Track Detectors, which records the passage of ionizing particles; by using some chemical reagents such passage can be make visible at optical microscopes.

Analisi della dinamica e composizione chimica del particolato atmosferico mediante un modello alla mesoscala

The vertical profile of aerosol in the planetary boundary layer of the Milan urban area is studied in terms of its development and chemical composition in a high-resolution modelling framework. The period of study spans a week in summer of 2007 (12-18 July), when continuous LIDAR measurements and a limited set of balloon profiles were collected in the frame of the ASI/QUITSAT project. LIDAR observations show a diurnal development of an aerosol plume that lifts early morning surface emissions to the top of the boundary layer, reaching maximum concentration around midday. Mountain breeze from Alps clean the bottom of the aerosol layer, typically leaving a residual layer at around 1500-2000 m which may survive for several days. During the last two days under analysis, a dust layer transported from Sahara reaches the upper layers of Milan area and affects the aerosol vertical distribution in the boundary layer. Simulation from the MM5/CHIMERE modelling system, carried out at 1 km horizontal resolution, qualitatively reproduced the general features of the Milan aerosol layer observed with LIDAR, including the rise and fall of the aersol plume, the residual layer in altitude and the Saharan dust event. The simulation highlighted the importance of nitrates and secondary organics in its composition. Several sensitivity tests showed that main driving factors leading to the dominance of nitrates in the plume are temperature and gas absorption process. A modelling study turn to the analysis of the vertical aerosol profiles distribution and knowledge of the characterization of the PM at a site near the city of Milan is performed using a model system composed by a meteorological model MM5 (V3-6), the mesoscale model from PSU/NCAR and a Chemical Transport Model (CTM) CHIMERE to simulate the vertical aerosol profile. LiDAR continuous observations and balloon profiles collected during two intensive campaigns in summer 2007 and in winter 2008 in the frame of the ASI/QUITSAT project have been used to perform comparisons in order to evaluate the ability of the aerosol chemistry transport model CHIMERE to simulate the aerosols dynamics and compositions in this area. The comparisons of model aerosols with measurements are carried out over a full time period between 12 July 2007 and 18 July 2007. The comparisons demonstrate the ability of the model to reproduce correctly the aerosol vertical distributions and their temporal variability. As detected by the LiDAR, the model during the period considered, predicts a diurnal development of a plume during the morning and a clearing during the afternoon, typically the plume reaches the top of the boundary layer around mid day, in this time CHIMERE produces highest concentrations in the upper levels as detected by LiDAR. The model, moreover can reproduce LiDAR observes enhancement aerosols concentrations above the boundary layer, attributing the phenomena to dust out intrusion. Another important information from the model analysis regard the composition , it predicts that a large part of the plume is composed by nitrate, in particular during 13 and 16 July 2007 , pointing to the model tendency to overestimates the nitrous component in the particular matter vertical structure . Sensitivity study carried out in this work show that there are a combination of different factor which determine the major nitrous composition of the “plume” observed and in particular humidity temperature and the absorption phenomena are the mainly candidate to explain the principal difference in composition simulated in the period object of this study , in particular , the CHIMERE model seems to be mostly sensitive to the absorption process.