No abstract

High-grade AV block requiring PPM implantation is a common complication following TAVI and could be predicted by a deeper implantation of the prosthesis. Patients with preexisting RBBB also seem to be at risk for the development of high-grade AV block and subsequent pacemaker implantation.

One third of patients required PPM after TAVI and full recovery of advanced conduction abnormalities seems unlikely. Unfavorable aortic root orientation may hinder the deployment of the valve and contribute to the continued impairment of the conduction system. Porcelain aorta was a strong predictor of pacemaker dependency.

Vascular access site complications are frequent in patients undergoing TF TAVI. SIFAR was the only independent predictor of access site complications and therefore should be systematically assessed during pre-procedural imaging study.

In this paper the Amazon Basin is presented and its hydrology and natural environment are described. Monitoring this large river basin is necessary and becomes more and more important when different scientific institutions show alarming forecasts of increase in temperature and decrease in precipitation in the basin as a result of climate change. The monitoring scheme developed by Brazil and its neighbours shows the importance of this activity and its role as a mechanism to improve co-operation among countries in the basin. The institutional mechanism for transboundary river basin management is the Amazon Basin Co-operation Treaty, signed by the nine countries of the basin. This treaty is described and can serve as a good example of how this type of problem can be tackled in other regions of the world.