Endovascular repair of the dissected descending thoracic aorta can be performed in patients with Marfan syndrome with a low risk of death or major complications. In case of staged procedures, stent graft treatment can be considered a possible alternative to open reoperation. Long-term durability remains to be determined.

The endovascular approach was a safe and flexible procedure in traumatic aortic rupture and allowed us to fit the operative timing to every patient's clinical and imaging findings. In the presence of an inadequate proximal landing zone, conventional open surgical intervention still remains a favorable option as an alternative to endovascular procedures if a surgical revascularization of the left subclavian artery, carotid artery, or both is necessary.

Aortic malformations may be associated with other congenital heart abnormalities or may present independently, as incidental findings in asymptomatic patients. For more than 30 years, conventional imaging techniques for detection and assessment of congenital anomalies of the aorta have been chest X-ray, echocardiography and angiography. In recent times, considerable interest in congenital aortic diseases has been shown, due to technical progresses of noninvasive imaging modalities. Among them, magnetic resonance imaging (MRI) almost certainly offers the greatest advantages, especially in young patients in which a radiation exposure must be avoided as much as possible. MRI provides an excellent visualization of vascular structures with a wide field of view, well suited for evaluation of the thoracic aorta malformations. With the implementation of magnetic resonance angiography (MRA) it is also possible to depict any relationship with supra-aortic or mediastinal vessels. Phase contrast technique allows identification of the hemodynamic significance of the aortic alteration. Some technical considerations, which include fast spin-echo, gradient-echo and, especially, MRA techniques with phase-contrast and contrast enhanced methods, are discussed and applied in the evaluation of congenital thoracic aorta diseases.

Relaying and diversity methods improve wireless communications by jointly exploiting the benefits of node cooperation, multiple-channel reception, and distributed processing. We develop a framework for design and analysis of relay-assisted diversity communications accounting for: 1) node positions; 2) link characterization; 3) diversity methods; 4) distributed coding and constellation signaling; and 5) power allocation. The framework is built on a simple model for assessing the frame error probability (FEP) as a function of radio-link characteristics, and it enables a clear understanding of how the aforementioned aspects affect the performance. A novel FEP-optimal power allocation is developed and compared with other allocation techniques such as uniform, destination-balanced (D-balanced), and relay-balanced (R-balanced) power allocations. Results show the effectiveness of the novel power allocation technique for various distributed codings and provide insights into the operation of relay-assisted diversity systems

Acute aortic dissection continues to be one of the most catastrophic cardiovascular events. While there is a general consensus on immediate surgical repair when the ascending aorta is involved, the optimal treatment strategy for type B aortic dissection (B-AD) remains controversial. Recently, endovascular treatment with percutaneous stent-graft implantation, originally used for aortic aneurysm exclusion, has acquired an important role in the treatment of B-AD. Imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI) and angiography have a fundamental role in the search for the anatomic details necessary to tailor the stent graft and in evaluating the most suitable anatomy for stent graft. Transesophageal echocardiography is fundamental during the procedure to monitor the correct release of the stent graft and evaluate the result of the procedure expressed by immediate thrombosis out of the stent-graft. Again, imaging techniques, more notably CT, have a fundamental role in the postoperative followup after stent-graft placement. The risk of endoleaks may compromise the result of endovascular repair and increase the risk of aortic rupture. Several reports and a few trials attesting to technical feasibility and safety of stent-graft implantation procedures for B-AD have been reported so far. Also, a randomised trial comparing type B aortic stent-graft placement with medical therapy is currently underway. According to the investigators, new therapeutic indications are likely to emerge also in uncomplicated B-AD.

A 71-year-old man with a history of hypertension and dyslipidemia underwent emergency department due to dyspnea and chest discomfort. Chest radiography revealed cardiomegaly and signs of pulmonary congestion, whereas the ECG was consistent with recent myocardial injury (antero-septal and lateral). Cardiac catheterization showed a huge right coronary artery (RCA) with left coronary artery collateralization.The multidetector computed tomography scan showed an anomalous origin of left coronary artery from the pulmonary trunk, with a tortuous and dilated RCA and right-to-left collateralization. The patient refused surgical correction.Bland-White-Garland syndrome, also known as ALCAPA (anomalous origin of left coronary artery from the pulmonary artery), is a rare but serious congenital coronary anomaly that affects 1 in 300 000 births. Approximately 90% of patients with this malformation die within the first year of life as the result of fatal intractable heart failure and ischemia. Very few patients reach adulthood, and survival beyond infancy depends on the development of adequate collaterals from the RCA. Significant RCA dilation has been seen in adults.These images (Figure 1) were taken of a 71-year-old man, which is the oldest one reported in medical literature. Multidetector computed tomography is very helpful for detection and anatomic definition of coronary anomalies, especially if complex, as shown in this case. DisclosuresNone. Figure.A, Chest radiograph shows cardiomegaly and signs of pulmonary congestion. B through D, Coronary angiography images show the absence of left coronary artery (missing left main [LM]) and a huge RCA. E through H, Multidetector computed tomography images show an anomalous origin of the left coronary artery from the pulmonary trunk, with a tortuous and dilated RCA, which provides 2 collateral branches, from the posterior descending artery (PD) to the left anterior descending coronary artery (LAD) and from the postero-lateral artery (PL) to the obtuse marginal branch. CX indicates circumflex coronary artery; OM, obtuse marginal branch; AO, aorta; PA, pulmonary artery.

Relay assisted communications exploit cooperative diversity to efficiently extend area coverage or improve the performance in wireless channels. We propose a mathematical framework to analyze the frame error probability (FEP) at the destination depending on distributed coding, nodes spatial distribution, and power allocation among source and relay nodes. We evaluate the impact of cooperative links characterization on the overall FEP at the destination by considering simple approximations on the link FEP which depend on the signal-to-noise ratio and diversity. We consider a number of power allocation techniques such as uniform, ideal power control, outage-optimal, and FEP-optimal. Results are given for a case study in which pragmatic space-time codes are employed as distributed coding technique. Analytical results are confirmed by simulations that are given to serve as a benchmark for the considered cases. The framework enables the system designer to allocate power and individuate the best relay position to minimize the FEP

The substantial advances in the medical and surgical treatment of congenital heart diseases have dramatically improved patients' life expectancy, as well as increased the number of those needing lifelong monitoring to identify complications and residual defects. Magnetic resonance imaging (MRI) is an ideal imaging modality for the follow-up of these young patients owing to its noninvasiveness, high reproducibility and morphological and functional accuracy. This paper describes the most appropriate MRI techniques and sequences for the study of cardiovascular heart diseases on the basis of an analysis of MRI studies carried out between January 2003 and June 2006 on 274 patients affected by all of the main congenital cardiovascular malformations, as well as a review of the literature. The advantages of MRI with respect to other imaging techniques, the problems encountered and the main clinical applications and indications of MRI, with special reference to the most common disease entities, are then discussed to define the role, the utility and the future perspectives of this imaging technique in the study of congenital heart diseases.