Balloon pulmonary angioplasty in chronic thromboembolic pulmonary hypertension: experience of four years in a single centre

Background: Balloon pulmonary angioplasty (BPA) has recently been developed as an alternative and less- invasive treatment strategy for chronic thromboembolic pulmonary hypertension (CTEPH), but therapeutic efficacy and technical safety of the technique have to be established. Aim: effects of BPA on patients with inoperable disease or residual pulmonary hypertension (PH) after pulmonary endarterectomy (PEA). Methods: From June 2015 to September 2019 we enrolled symptomatic (NYHA ≥ II) inoperable CTEPH patients and patients with residual PH after PEA. At baseline, immediately before the first BPA session and 3-6 months after last BPA session all patients underwent clinical evaluation, six-minute walking distance and right heart catheterization. For comparisons Friedman test (with Bonferroni post-hoc pairwise analysis) was used. Survival curves were done with Kaplan Meier method. Results: Forty-seven patients [male 45%, median age 68 (51-74) years, 40 inoperable and 7 with residual PH after PEA] were treated for a total of 136 sessions (median number of sessions for each patient: 2); during each session we treated 2 (2-3) vessels; BPA significantly improved symptoms (NYHA III-IV from 85 to 42%), exercise capacity (from 425 to 446 m) and hemodynamic profile (reduction of mean pulmonary arterial pressure from 41 to 35 mmHg and of pulmonary vascular resistance from 7.1 to 4.7 WU). Five pulmonary artery dissection and 2 hemoptysis with clinical impairment were documented; 33 patients had lung injury (radiographic opacity with/without hemoptysis and/or hypoxemia), 7 patients had access site complications. Five patients died during follow-up (none within 30 days from the procedure) because of sepsis (1), heart failure (1), cancer (1), arrhythmic storm (1) and sudden death in a patient with severe coronary atherosclerosis (1). Conclusions: BPA is a safe and effective treatment able to improve symptoms and hemodynamic profile in inoperable CTEPH patients and in patients with residual PH after PEA.

Analysis of the main phenomena affecting solid rocket motors internal ballistics

In solid rocket motors, the absence of combustion controllability and the large amount of financial resources involved in full-scale firing tests, increase the importance of numerical simulations in order to asses stringent mission thrust requirements and evaluate the influence of thrust chamber phenomena affecting the grain combustion. Among those phenomena, grain local defects (propellant casting inclusions and debondings), combustion heat accumulation involving pressure peaks (Friedman Curl effect), and case-insulating thermal protection material ablation affect thrust prediction in terms of not negligible deviations with respect to the nominal expected trace. Most of the recent models have proposed a simplified treatment to the problem using empirical corrective functions, with the disadvantages of not fully understanding the physical dynamics and thus of not obtaining predictive results for different configurations of solid rocket motors in a boundary conditions-varied scenario. This work is aimed to introduce different mathematical approaches to model, analyze, and predict the abovementioned phenomena, presenting a detailed physical interpretation based on existing SRMs configurations. Internal ballistics predictions are obtained with an in-house simulation software, where the adoption of a dynamic three-dimensional triangular mesh together with advanced computer graphics methods, allows the previous target to be reached. Numerical procedures are explained in detail. Simulation results are carried out and discussed based on experimental data.