Recently, multilayer stents for type B aortic dissections (TBAD) have been proposed to decrease false lumen flow, increase and streamline true lumen flow, and retain branch vessel patency. We aimed to provide a protocol with standardized techniques to investigate aortic remodeling of TBAD by multilayer flow modulators (MFM) in static geometric and hemodynamic analyses. Combining existing literature and new insights, a standardized protocol was designed. Using pre- and postoperative CT scans, geometric models were constructed, lumen dimensions were calculated, computational fluid dynamics (CFD) models were composed, and velocity and pressures were calculated. Sixteen TBAD cases treated with MFM were included for analysis. For each case, aortic remodeling was analyzed using post-processing medical imaging software. After 3D models were created, geometrical anatomical measurements were performed, and meshes for finite element analysis were generated. MFM cases were compared pre- and postoperatively; true lumen volumes increased (p < 0.001), false lumen volumes decreased (p = 0.001), true lumen diameter at the plane of maximum compression (PMC) increased (p < 0.001), and false lumen index decreased (p = 0.008). True lumen flow was streamlined, and the overall fluid velocity and pressures decreased (p < 0.001 and p = 0.006, respectively). This protocol provided a standardized method to evaluate the effects of MFM treatments in TBAD on geometric analyses, PMC, and CFD outcomes.
Objectives. This paper assesses the importance and contribution of cardiovascular rehabilitation programs in the short- and long-term outcome following surgical revascularization procedures for patients with coronary artery disease (CAD). Methods. We present the case of a 64-year-old patient who benefited from a coronary artery bypass graft (CABG) procedure for CAD, followed by an individualized cardiac rehabilitation program. The case particularity consisted of the presence of associated peripheral vascular disease that imposed additional challenge in decision-making process regarding surgical therapy. Results and discussion. Immediately after surgery, the patient was included in a phase II residential recovery program, preceded by a ramp effort test. The rehabilitation program consisted of partial toning massage of the lumbosacral spine, and individual physiotherapy. Coronary revascularization procedures often cause lowered exercise capacity and declining physical activity levels. In our case even preoperative assessment showed a limited physical effort capacity, further reduced by the surgical intervention. The physiotherapy plan should be personalized, safe, effective, and must increase the independent mobility of patient soon after open heart surgery. Conclusions. The main contribution of cardiac rehabilitation program should be the improvement of physical and social status of patients undergoing surgical myocardial revascularization. This program should be included in the management of all cardiac heart disease patients who benefit from cardiac surgery procedures. Implementation of CR programs at most hospitals and community centres, as well as awareness about their efficacy, would result in higher participation after coronary revascularization interventions and improvement of functional parameters and quality of life.
Intravenous drug use is associated with infective endocarditis. Besides, it does appear that left-sided infective endocarditis is a feature of general population, whereas right-sided infective endocarditis is common in intravenous drug users. The most common etiology of right-sided infective endocarditis in intravenous drug users is Staphylococcus aureus in about 75% followed by streptococci, Gramnegative bacilli and fungi. In case of intravenous drug users with infective endocarditis, optimal treatment strategies lack a general consensus. Additionally, the best indication and timing of surgery are debatable. To overcome these problems, the early and complete surgical debridement of infected tissue together with microbial therapy assures a good prognosis in the long term.Keywords: endocarditis, drug-associated endocarditis, intravenous drug abuser endocarditis, intravenous drug users, right heart endocarditis Infective Endocarditis 2 the right-sided IE, tricuspid valve is affected in 90% cases [21], whereas pulmonic valve represents about 10% from right-sided IE cases [3,18,24]. Up to now, isolated right-sided IE involving the pulmonary valve, the eustachian valve, interventricular septum, or right ventricular free wall have been described [17,21,25]. MicrobiologyAccording to current evidence, IE among IDUs presents a large spectrum of microbial pathogens (Table 1) [26][27][28][29][30][31].Pathogens as Pseudomonas aeruginosa, other gram-negative microorganisms, fungi, enterococci, streptococci, and polymicrobial infections occur less frequently [16]. Importantly, other pathogens noted in IDUs are oral bacteria such as Prevotella intermedia, Haemophilus parainfluenzae, S. constellatus, and E. corrodens [32][33][34][35][36].The most common etiology of right-sided IE in IDUs is Staphylococcus aureus (S. aureus) in about 75% [1,4,6,[37][38][39] followed by streptococci, Gram-negative bacilli, and fungi [40]. In fact, published data supports the involvement of S. aureus among IDUs in 40-74% cases of IE [38,41,42]. S. aureus is the most common cause of tricuspid valve endocarditis regardless of associated risk factors in IDUs [1,4,16,18,43].The incidence of negative blood cultures is reported as 2.5-31% and is associated with delayed diagnosis and treatment [44], with large vegetations [45], and with highest morbidity and mortality [16,45,46].Regarding HIV, a prevalence of HIV as high as 60% among IDUs has been reported by centers from Europe and the USA [11,40]. HIV is more common among IDUs with right-sided IE than left-sided IE [47].Polymicrobial endocarditis is characteristically for IDUs [48] and may involve microorganisms such as Bartonella spp., Candida spp., or Tropheryma whipplei [49]. The presence of E. corrodens should aware the likelihood of polymicrobial IE with embolic complications and relapses. In fact, there is a synergism between streptococci and E. corrodens [50][51][52].
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