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Bicuspid aortic valve (BAV) is the most common congenital valvular anomaly, affecting roughly 1–2% of the population and predisposing to premature aortic stenosis and thoracic aortopathy. Surgical aortic valve replacement (SAVR) remains the standard therapy, while transcatheter aortic valve implantation (TAVI) is increasingly adopted across a broader range of risk profiles due to accumulating evidence and advancements in device technology. Observational registries and early trial data indicate that TAVI is technically feasible in selected BAV anatomies, with device-success rates exceeding 90%. Nonetheless, bicuspid morphology is still technically demanding, with several possible pitfalls during transcatheter procedure and pre-procedural planning compared with tricuspid valve. The rates of moderate-to-severe paravalvular leak (PVL), permanent pacemaker implantation (PPI), and annular complications remain high, especially in the presence of extensive calcifications with raphe or tapered roots, underscoring the importance of meticulous multimodality imaging, dedicated sizing algorithms, and device-specific strategies. Long-term durability signals are encouraging but remain limited, underlining the need for prospective trials with extended follow-up. This review summarizes current knowledge on BAV anatomy and its management, exploring the available evidence supporting the role of transcatheter approach in this challenging and unique scenario.

New-generation transcatheter heart valves have significantly improved technical success and procedural safety of transcatheter aortic valve implantation (TAVI) procedures; however, the incidence of permanent pacemaker implantation (PPI) remains a concern. This study aimed to assess the role of anatomic annulus features in determining periprocedural conduction disturbances leading to new PPI after TAVI using the last-generation Edwards SAPIEN balloon-expandable valves. In the context of a prospective single-center registry, we integrated the clinical and procedural predictors of PPI with anatomic data derived from multislice computed tomography. A total of 210 consecutive patients treated with balloon-expandable Edwards transcatheter heart valve were included in the study from 2015 to 2023. Technical success was achieved in 197 procedures (93.8%), and 26 patients (12.4%) required new PPI at the 30-day follow-up (median time to implantation 3 days). At the univariable logistic regression analysis, preprocedural right bundle branch block (odds ratio [OR] 2.24, 95% confidence interval [CI] 1.01 to 4.97, p = 0.047), annulus eccentricity ≥0.25 (OR 5.43, 95% CI 2.21 to 13.36, p <0.001), calcium volume at annulus of the right coronary cusp >48 mm3 (OR 2.60, 95% CI 1.13 to 5.96, p = 0.024), and prosthesis implantation depth greater than membranous septum length (OR 2.17, 95% CI 1.10 to 4.28, p = 0.026) were associated with new PPI risk. In the multivariable analysis, preprocedural right bundle branch block (OR 2.81, 95% CI 1.01 to 7.85, p = 0.049), annulus eccentricity ≥0.25 (OR 4.14, 95% CI 1.85 to 9.27, p <0.001), and annulusright coronary cusp calcium >48 mm3 (OR 2.89, 95% CI 1.07 to 7.82, p = 0.037) were confirmed as independent predictors of new PPI. In conclusion, specific anatomic features of the aortic valve annulus might have an additive role in determining the occurrence of conduction disturbances in patients who underwent TAVI with balloon-expandable valves. This suggests the possibility to use multislice computed tomography to improve the prediction of post-TAVI new PPI risk. [Display omitted]

Coronary calcific disease represents one of the main challenges for the interventional cardiologist, for whom optimal lesion preparation and percutaneous coronary intervention optimization are paramount for correct management. In this perspective, intravascular imaging using optical coherence tomography (OCT) is becoming an increasingly indispensable tool. This work aims to provide a detailed overview of the complexity of calcified lesions, first analyzing their various morphologies and their clinical impact: spotty calcium seems to be more present in plaques at higher risk of destabilization, while diffuse calcification is typical of stable coronary stenosis; the eruptive calcific nodule is one of the three culprit lesion phenotypes responsible for acute coronary syndromes.In the second part of this review, the available technologies for the treatment of calcified lesions are described, with the aid of illustrative OCT images. Intravascular lithotripsy causes fractures at various levels of the calcified plaque, both circumferentially and longitudinally, with an improvement in vessel compliance; atherectomy acts by modifying the composition of the plaque with selective action on the hard calcific component. OCT, providing a comprehensive overview of lesion characteristics, can guide in the selection of the most appropriate therapeutic strategy, while also offering important information on the effectiveness of the chosen treatment.

La malattia coronarica calcifica rappresenta una delle principali sfide per il cardiologo interventista, per la cui corretta gestione è preponderante la preparazione ottimale delle lesioni e l’ottimizzazione del risultato finale dell’angioplastica. In questa prospettiva, l’imaging intravascolare mediante tomografia a coerenza ottica (OCT) rappresenta uno strumento sempre più imprescindibile. Questo lavoro mira a fornire una panoramica dettagliata sulla complessità delle lesioni calcifiche, analizzandone innanzitutto le varie morfologie e il loro impatto clinico: il calcio spotty sembra essere maggiormente presente in placche più a rischio di destabilizzazione, la calcificazione diffusa è invece tipica di stenosi coronariche stabili; il nodulo calcifico eruttivo costituisce uno dei tre fenotipi di lesione culprit responsabili delle sindromi coronariche acute. Nella seconda parte di questa rassegna viene evidenziato, con l’ausilio di immagini OCT esemplificative, il meccanismo d’azione delle diverse tecniche di modifica del calcio. La litotrissia intravascolare provoca fratture a vari livelli della placca calcifica sia circonferenziali che sul piano longitudinale con miglioramento della compliance dei vasi; l’aterectomia agisce modificando la composizione della placca con un’azione selettiva sulla componente dura calcifica. L’OCT, fornendo una panoramica completa delle caratteristiche delle lesioni, può guidare nella selezione della strategia terapeutica più appropriata offrendo, al contempo, importanti informazioni sull’efficacia del trattamento scelto.

Time-synchronised high-speed imaging and electrical signal measurements are performed in near-real erosion conditions to analyse the feasibility of determining spark location based on its electrical signals in die-sinking electrical discharge machining (EDM). Using this novel research platform, a correlation between the discharge voltage and the geometric location of a discharge on an electrode has been established. Through the derived understanding, a microsecond level spark location adaptive process control has been conceptualised and demonstrated. The parameter control of each spark according to its probabilistic location on the electrode results in low wear of micro- to macroscale electrode features, higher material removal rate and higher form precision despite of electrode complexity. Reduction in the required number of electrodes achieved through the novel spark location adaptive process control increases the economic and energy efficiency of die-sinking EDM.

Pharmaceutical formulations suitable for dysphagic patients are not always commercially available, motivating caregivers to crush tablets or open capsules to facilitate swallowing. Since this action may modify the characteristics of the medicine, it should be considered potentially inappropriate. This paper is the first to focus on how hospitalization affected the rate of potentially inappropriate prescriptions (PIPs) and the incidence of dosage form-related PIPs in elderly patients with dysphagia. Data was collected by reviewing patient medical records in the Italian National Research Center on Aging of Ancona. The therapy at admission and discharge was analysed in terms of: inappropriate drug associations, inappropriate drugs for dysphagic patients, inappropriate dosage forms and inappropriate dosage form modifications. Forty-one dysphagic patients with an average age of 88.3 years were included in the study and 451 prescriptions were analysed. PIPs were widespread at admission, and hospitalization did not improve the situation in a statistically significant manner. The most common PIPs identified (>80%) were related to dosage form selection and modification. This study highlights a clear need for continuing medical education about prescription appropriateness and modification of solid dosage forms in patients with dysphagia.

Zinc is a relevant nutritional factor for the whole life of an organism because it affects the inflammatory/immune response and antioxidant activity, leading to a healthy state. Despite its important function, the dietary intake of zinc is inadequate in elderly. Possible interventions include food fortification because it does not require changes in dietary patterns, the cost is low and it can reach a large portion of the elderly population, including very old subjects. Studies evaluating the impact of Zn-fortified foods on functional parameters in elderly, in particular, in very old individuals, are missing. The objective of this study was to evaluate the efficacy of consumption of a zinc-fortified drinking skim milk (Zn-FMilk) for a period of 2 months in comparison to standard non-fortified milk (No-FMilk) on some biochemical parameters, zinc status, inflammatory/immune response and on a key parameter of the T cell-mediated immunity (thymulin hormone) in healthy very old subjects. The treatment with zinc-fortified milk (Zn-FMilk) is a good omen to increase the cell-mediated immunity in very old age represented by thymulin activity and some cytokine (IL-12p70, IFN-γ) release. At clinical level, a good healthy state occurs in 70 % of the subjects with no hospitalization after 1 year of the follow-up in comparison to very old control subjects that did not participate to crossover design. In conclusion, the Zn-FMilk can be considered a good functional food for elderly, including older people. It might be a good replacement to the zinc tablets or lozenges taking into account the attitude of old people to uptake milk as a preferential food.