Myocardial Perfusion and Coronary Physiology Assessment of Microvascular Dysfunction in Patients Undergoing Transcatheter Aortic Valve Implantation-Rationale and Design.

The prevalence of coronary artery disease (CAD) in patients with severe aortic stenosis (AS) is 30-68%. Nevertheless, there is still not enough evidence to use invasive assessment of lesion severity, because the hemodynamic milieu of AS may impact the fractional flow reserve (FFR) and non-hyperemic indices. Therefore, the aim of the study is two-fold. First, to measure acute and long-term changes of FFR, index of microvascular resistance (IMR), and coronary flow reserve (CFR) in patients undergoing TAVI procedure. Second, to compare the diagnostic accuracy of intracoronary indices with myocardial perfusion measured by cadmium-zinc-telluride single-photon emission tomography (CZT-SPECT) and find cut-off values defining significant stenosis. We plan to enroll 40 patients eligible for TAVI with intermediate stenosis (30-70%) in the left anterior descending (LAD) coronary artery. In each patient FFR, CFR, and IMR will be measured in addition to myocardial blood flow calculated by CZT-SPECT before and either immediately after TAVI (acute cohort) or in 6 months (late cohort) after the procedure. FFR, CFR, and IMR will be matched with the results of myocardial perfusion measured by CZT-SPECT in the area of LAD. As a result, cut-off values of FFR, CFR, and IMR defining the decreased blood flow will be found.

Laser produced streams of Ge ions accelerated and optimized in the electric fields for implantation into SiO2 substrates.

Ge crystals were prepared by means of laser-induced ion implantation technique. A Nd:YAG pulsed laser (repetition rate: 10 Hz; pulse duration: 3.5 ns; pulse energy: ∼0.5 J) was used both as an ion source and to carry out the ablation processes. The optimization of the laser-generated ion beam parameters in a broad energy and current density range has been obtained controlling the electrostatic field parameters. Numerical simulations of the focusing system, performed adopting an OPERA 3D code, and an investigation of the ion characteristics, using the ion time-of-flight method, have allowed to optimize the preparation parameters. The structural properties of the samples were investigated by means of x-ray photoelectron, micro-Raman spectroscopies, and scanning electron microscopy techniques. Experimental results show that, by appropriately varying the ion implantation parameters and by a post-preparation annealing treatment, it is possible to achieve the development of a micrometer-sized crystalline Ge phase and∕or an amorphous one.