Cardiac resynchronization therapy defibrillator: a de novo implant in a COVID-19 patient by an echo-guided axillary venous approach.

The COVID-19 pandemic has seriously revolutionized the management of patients who need an implanted cardiac implantable electronic device. We report, for the first time, a successful cardiac resynchronization therapy defibrillator implantation procedure in an 82-year-old man affected by COVID-19, recent myocardial infarction, second-degree 2:1 atrioventricular block and left bundle branch block.

Synergistic Effect of N,N-Dimethylformamide and Hydrochloric Acid on the Growth of MAPbI3 Perovskite Films for Solar Cells.

Perovskite solar cells have emerged as a promising next-generation electrical power generating tool. However, imperfections in perovskite films are one of the crucial factors preventing the commercialization of perovskite solar cells. Passivation has proven to be an effective strategy to reduce the density of defect states in perovskite crystals and inhibit ion migration. Although significant work on chloride ion and N,N-dimethylformamide (DMF) has shown that the additives are able to passivate different types of trap defects, systematic studies on the effects of DMF and HCl on perovskite crystallization when used in conjunction with each other are elusive. Here, we systematically investigated the synergistic effect of DMF and hydrochloric acid (HCl) on methylammonium (MA+)-based perovskite films with the two-step spin-coating method. As a Lewis base, DMF coordinates well with Pb2+ to facilitate a decrease in the number of defects, thereby improving the carrier separation and transport, while HCl improves the overall perovskite film morphology. Addition of 20 µL HCl/20 µL DMF to 10 mL of methylammonium iodide/isopropyl alcohol solution afforded ca. 500 nm thick perovskite films with no observable defects within the grains. The process allowed fabrication of devices with an active area of 0.16 cm2, which produced power conversion efficiencies up to 18.37% with minimal hysteresis.

Cardiac arrest in type II Kounis syndrome after oral intake of amoxicilline.

BACKGROUND: Kounis syndrome (KS) is defined as the occurrence of an acute coronary syndrome related to allergic or hypersensitivity reaction. KS is currently classified into three variants, based on coronary arteries status. This syndrome is often neglected or misdiagnosed in clinical practice. METHODS AND RESULTS: We described a type II KS case. This acute coronary syndrome (ACS) began with cardiac arrest (an uncommon clinical expression for KS) immediately after oral intake of amoxicilline. Coronary angiography revealed coronary arteries stenoses which were considered unsuitable for revascularization. Optimization of medical therapies was the goal of the management for this patient. Follow-up visits revealed normal echocardiographic findings and no malignant arrhythmias at ECG Holter monitoring. CONCLUSIONS: KS can be a rare case for ACS, sometimes occurring with sudden cardiac arrest. Physicians should pay attention to the history of the patients in order to identify the correct cause of ACSs.

Ultrasound-guided venipuncture for implantation of cardiac implantable electronic devices: A single-center, retrospective study.

BACKGROUND: The venous access for the insertion of permanent leads of cardiac implantable electronic devices is often achieved by venous cutdown of the cephalic vein, or by "blind" puncture of the subclavian vein using anatomical landmarks, or by fluoroscopy-assisted methods. METHODS: We have retrospectively analyzed our clinical experience to verify the feasibility, the safety, and efficacy of the adoption of ultrasound-guided puncture/cannulation of the axillary vein for this purpose. RESULTS: Nine hundred eighty-seven leads were placed during 548 consecutive procedures, accessing the axillary vein in the infraclavicular area using real-time ultrasound guidance. Venipuncture was successful in 99.8% of cases. The access time was 11 seconds (range 4-580). We recorded three cases of pneumothorax (0.5%), but no hemothorax and no hemo-mediastinum. The incidence of local hematoma was 2.1% (12 cases). No injury to the brachial plexus or to the phrenic nerve was recorded. In a follow-up of 33 months (range 16-39), we observed no cases of "subclavian crush syndrome" (damage of the leads at the level of the thoracic inlet), and the rate of pocket infection/infective endocarditis was 0.7%. CONCLUSION: In our experience, ultrasound-guided puncture/cannulation of the axillary vein for implantation of permanent leads is feasible, effective, and safe. It might be considered as a first option for this procedure.

[Heart failure in Apulia Region - Italy (Local Health Unit Barletta-Andria-Trani): analysis of the therapeutic pathways, healthcare resource consumption and related costs.] / Lo scompenso cardiaco nella ASL Barletta-Andria-Trani (BT): analisi dei trattamenti farmacologici, del consumo di risorse e relativo costo per il Servizio Sanitario Nazionale.

BACKGROUND: Heart failure (HF) is commonly reported, it is estimated to affect 10% of subjects aged over 70 years. Objectives of this study were to describe clinical and demographic characteristics of patients with HF diagnosis, to analyze therapeutic pathways and to estimate healthcare resources consumption. METHODS: Data on patients aged ≥18 years with a hospitalization discharge diagnosis of HF between 01/01/2010 and 31/12/2014 and in treatment with HF-related drugs were extracted from the administrative databases of the Italian Local Health Unit of Barletta-Andria-Trani (BT). We described the pharmacological treatment prescribed and the use of drugs in combination both at the beginning and at the end of the 12-month follow-up period. The costs analysis was conducted with the perspective of the Italian National Health System. RESULTS: A total of 2 669 patients with HF were enrolled in the study, 1 960 as primary and 709 as secondary diagnosis (average age 77.0±10.4/76.5±11.1 years respectively, 49% and 55% were male, respectively). Mortality during 12 months of follow-up was 46% and 43% respectively. Mostly prescribed pharmacological treatments were diuretics (90.4% of patients with primary HF diagnosis and 79.4% of patients with secondary HF diagnosis), beta-blockers (53.7% and 58.8%, respectively) and aldosterone antagonists (57.5% and 42.5%, respectively); moreover, during the follow-up period, half of the patients presented a switch from the original therapy and 10% of the patients required an add-on. Healthcare resource consumption for patients discharged alive was € 11 872.4 for patients with primary diagnosis and € 12 493.7 for patients with secondary diagnosis of HF. Cost for hospitalizations during follow-up was around € 3 800 (32.3% of total costs) and € 3 600 (29.0% of total costs), respectively. CONCLUSIONS: Our findings are in accordance with what already published, both in a National and International context, on mortality rates in HF patients and related costs for the National Healthcare System. Results from the present study highlight the under-prescriptions of ACEi/ARBs, aldosterone antagonists and beta-blockers in HF patients.

Modifying Perovskite Films with Polyvinylpyrrolidone for Ambient-Air-Stable Highly Bendable Solar Cells.

One major drawback that prevents the large-scale practical implementation of perovskites is their susceptibility to performance degradation in humid environments. Here, we achieved uniform, stable perovskite films within a polyvinylpyrrolidone (PVP) polymer frame via mild solution processing in ambient air with over 60% relative humidity. In addition to facilitating film formation, the hydrophobic PVP served to protect the perovskite grains from atmospheric moisture. Use of PVP, coupled with optimization of the deposition parameters, provided for compact, smooth, pinhole-free perovskite films that when incorporated into a photovoltaic device exhibited highly reproducible efficiencies in the range of up to 17%. In the absence of encapsulation, the devices exhibited stable performance characteristics during exposure to humid ambient air for 600 h. Furthermore, on flexible substrates, the 8 wt % PVP-perovskite samples provided for device efficiencies of ca. 15%. The devices retained ca. 73% of their efficiency after bending 1000 times with a bending radius of 0.5 cm.

Histological and ultrastructural evaluation of human decellularized matrix as a hernia repair device.

Recently, interest has been increasing for human decellularized matrices, due to their ability to reduce numerous side effects related to hernia repair. To date, only animal studies investigated the biological interaction post-implant of human decellularized matrices for soft tissue repair. Therefore, the aim of this study was to evaluate the morphological response one year post implant of human decellularized matrix, through morphological analysis of human biopsies. The histological and ultrastructural results revealed a perfect cellular repopulation and neoangiogenesis, with minimal inflammatory response and a well-organized collagen matrix. The results have indicated that this scaffold can be an effective treatment for hernia.

[Conservative treatment of a pseudoaneurysm of the mitral-aortic intervalvular fibrosa: 9 years of follow-up]. / Trattamento conservativo di pseudoaneurisma della fibrosa mitro-aortica: 9 anni di follow-up.

Pseudoaneurysm of the mitral-aortic intervalvular fibrosa (MAIVF-P) is one of the rare complications of endocarditis or, more rarely, of surgical trauma. This condition is characterized by a pseudoaneurysm in the intra-annular area between the mitral valve and the aortic valve communicating with the outflow tract of the left ventricle, between the coronary or noncoronary left aortic valve and the front flap of the mitral valve. Nowadays, surgery is recommended to avoid further growth and complications. We hereby describe the case of a patient with MAIVF-P as a consequence of a surgical trauma and early appearance of MAIVF-P. During the long echocardiographic and clinical follow-up, the patients showed stable clinical and hemodynamic conditions despite the increase in size of the MAIVF-P. A conservative treatment based on a medical follow-up can represent an alternative in patients refusing surgery, in high-risk surgical patients as well as in patients showing a stable echocardiographic and clinical picture regardless of the MAIVF-P size.

Isolated Congenital Left Ventricular Diverticulum: A Case Report and Differential Diagnosis.

We describe a case of an incidental finding of diverticulum in a patient presented to the Emergency Department for atypical chest pain, and we analyze the challenging differential diagnosis with aneurysm, pseudoaneurysm, and ventricular cleft.

[Isolated pulmonary valve endocarditis]. / Endocardite isolata della valvola polmonare.

We report a case of isolated pulmonary valve endocarditis evaluated with real-time three-dimensional echocardiography in a previous intravenous drug user. Although right-sided infective endocarditis is common in this population, the involvement of the pulmonary valve without infection of the tricuspid valve is a rare condition.

Membranes of left atrial appendage: real appearance or "pitfall".

The membranes of left atrial appendage (LAA) cavity are very rare entity. To date, only five cases of a membrane involving LAA have been described. In this report, we describe two different cases: in Case 1, we show image of a "real" nonobstructive membrane within the body of LAA, but in Case 2 we show a linear image, mimicking a membrane within the body of LAA. It really is a "pitfall" of transesophageal echocardiography (TEE).

The incidence and clinical course of caseous calcification of the mitral annulus: a prospective echocardiographic study.

BACKGROUND: Mitral annular calcification (MAC) is a common echocardiographic finding. Caseous calcification of the mitral annulus (CCMA) is, on the other hand, a less known, rarely described variant, seen as a round mass with a central echolucent area composed of a puttylike admixture of fatty acids, cholesterol, and calcium. The aims of this study were to assess the prevalence of CCMA, assess its morphologic changes over the course of time, and evaluate the patients' characteristics and clinical outcome on follow-up. METHODS: Between January 2002 and December 2004, 20,468 consecutive patients, referred for transthoracic echocardiography, were included in the study. All patients underwent echocardiographic examinations. Four echocardiographic laboratories participated in the registry. CCMA was defined as a large, round, echodense mass with smooth borders located in annular region, without acoustic shadowing and with central areas of echolucencies resembling liquefaction. RESULTS: A total of 2169 (10.6%) patients were given the diagnosis of MAC by 2-dimensional echocardiography. A total of 14 patients (0.64% of all MACs, 0.068% of all studies) were given the diagnosis of echocardiographic findings compatible with CCMA. Six (43%) patients underwent transesophageal echocardiography (TEE) to better evaluate the nature of the mass. A complete TEE examination was performed using 2-dimensional and color flow Doppler, and the best visualizations of the mass were performed by midesophageal 4-chamber view, midesophageal 2-chamber view, and midesophageal long-axis view. More detailed imaging of the masses, above all a better visualization of the central areas of echolucency, the assessment of the posterior mitral leaflet motion, and the assessment of the correct location of the mass was achieved by TEE views. All calcifications were confined to the mitral annulus. The most common symptom was palpitation, which occurred in 43% of the patients. During a mean follow-up of 3.4 +/- 1.2 years, one patient died. The cause was unrelated to the annular mass; it was the result of neoplasm. During the follow-up period, in 6 (43%) cases, the studies changed, in regard to the features of CCMA, in comparison with baseline studies, thus likely suggesting a changeable condition. CONCLUSIONS: This study confirms prior observations that CCMA is a rare and benign condition. It illustrates the potential role of TEE in confirming the precise location of the lesion and in more clearly defining the extent of the involvement of the posterior mitral leaflet. There were no typical clinical characteristics in patients with CCMA although the absolute number of patients with CCMA was too small to be statistically significant. However, CCMA does tend to occur in older patients and all 14 patients with CCMA in this study had hypertension. CCMA may be a dynamic process based on the observation that 3 patients with MAC progressed to CCMA and 3 patients with CCMA reverted back to MAC during the study period. To avoid diagnostic mistakes such as tumor, abscess, or thrombus among echocardiographers, it is important for us to consider a more widespread knowledge of this rare lesion.