Article exists only in Russian.

Abstract:

Aim: was to assess the consistency of measurements of anatomic and functional parameters performed with EchoCG and MRI and to determine the possibility of MRI to visualize the coaptation of valve leaflets after reconstruction of the aortic valve (AV) using the Ozaki technique.

Material and methods: the study included 124 patients who underwent MRI of the heart anc transthoracic EchoCG, 9,3±4,0 days after the Ozaki operation. With EchoCG and MRI, EDV and LV EF were calculated. Dopplerography determined the area of AV opening and the transaortal pressure gradient. At MRI, the area of AV opening was planetically measured, and the transoortal pressure gradient was calculated from results of phase contrast study To assess the consistency of measurement results, the Blend-Altman method was used.

Results: mean values obtained with EchoCG and MRI were statistically significantly different (p<0,001) only when measuring LV EDV The greatest accordance between measurements of EchoCG and MRI was observed in the evaluation of the transaortal pressure gradient (0,04±3,7 mm Hg). Less coordinated were measurements of the opening area of AV (0,22±0,79 cm2) and LV EF (0,22±8,9%). Less consistency was in measurement of EDV (26,4±33,0 ml). The mean value of the difference was statistically significantly different from zero when measuring the opening area of AV (p=0,180) and the transaortal pressure gradient (p=0,120). The article presents 5 clinical examples of visual evaluation of leaflets coaptation after AV reconstruction by the Ozaki method.

Conclusions: differences in consistency in the assessment of the opening area of the AV and the transaortal pressure gradient in echocardiography and MRI are not clinically significant, indicating that these measurement methods can be used interchangeably after AV reconstruction using the Ozaki technique.

Results of measurements of EDV size and LV EF in EchoCG and MRI are less consistent and not interchangeable, therefore, measurement results should be interpreted in the context of the specific method

MRI should be a part of the diagnostic algorithm after Ozaki surgery, but its use in the early postoperative period may be limited to cases of poor quality or inconsistent Echocardiography

References

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12.    Rossejkin E.V., Bazylev V.V., Batrakov P.A. i dr. Neposredstvennye rezul'taty protezirovanija stvorok aortal'nogo klapana autoperikardom po metodike Ozaki [Immediate results of aortic valve leaflets replacement with auto pericardium due to Ozaki technique]. Patobgija krovoobrashhenija i kardiohirurgija. 2016; 20(2):44-48 [ In Russ].

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18.    Bazylev V.V., Paramonova T.I., Vdovkin A.V., Pal'kova V.A. Pri kakom razmere KDO u bol'nyh s sistolicheskoj disfunkciej levogo zheludochka predpochtitel'no vypolnenie magnitno-rezonansnoj tomografii [What dimensions of EDV in patients with systolic dysfunction of the left ventricle is preferable to perform MRI?.]. Diagnosticheskaja i intervencionnaja radiologija. 2017;11(2):30-37 [In Russ].

19.    Bazylev V.V., Paramonova T.I., Vdovkin A.V., Karpuhin V.G., Pal'kova V.A. Soglasovannost' JehoKG i MRT v ocenke mitral'noj regurgitacii i KDO u bol'nyh s dilataciej levogo zheludochka [Accordance of MRI and EchoCG in estimation of mitral regurgitation and EDV in patients with left ventricle dilatation]. Luchevaja diagnostika i terapija. 2017;1 (8): 64-68 [ In Russ].

Abstract:

Retroperitoneal fibrosis (RPF) is a relatively rare disease which shows enlarged periaortic adipose in the retroperitoneal area. The diagnosis of RPF is a challenge for the clinicians. The symptoms and signs associated with RPF are nonspecific, and diagnosis requires a high degree of suspicion. A definitive diagnosis can only be made based on biopsy findings, although US, CT scanning or MRI are essential for evaluating the disease process, for determination whether the retroperitoneal mass is due to idiopathic or secondary RPF. Article presents 2 cases of idiopathic RPF occurring in patients who was suspected of abdominal aortic aneurysm.

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Abstract:

Aim: was to show possibilities of magnetic resonance imaging (MRI) in the detection and characterization of neoplasms of the heart.

Materials and methods: we retrospectively studied clinical cases of heart neoplasms, diagnosed and operated in Federal National Center of Cardiovascular Surgery (FNCCS) (Penza) since 2008 tc 2014. All patients on admission underwent echocardiography, after which, in some cases to clarify the topography of neoplasms and features of individual anatomy - MRI was performed. In postoperative follow-up period, control studies were conducted. In all cases, the diagnosis was histologically verified. All operated patients were discharged in satisfactory condition. We made a search and analysis of scientific literature on beam diagnostics of space-occupying lesions of heart.

Results: for the period of 6 years, in FNCCS were examined and surgical treatment of more than 30 thousand patients, of which neoplasms of the heart were detected in 25(0.08%) cases. Cardiac myxoma was diagnosed in 19(76%) patients, of whom in 2(8%) cases, the echocardiographic picture was mixed, that had required magnetic resonance imaging. MRI has also been used in 2(8%) patients with benign and malignant transformation of mesenchyoma, and in few cases (4%) rhabdomyomas, lipomatous hypertrophy, atrial septum, epithelioid leiomyoma of the uterus in the germinating atrium and metastatic melanoma. Also, in some cases, the use of MRI allowed to rule out malignancy and to identify mural thrombus. In 1 case, MRI gave, a detailed study of the morphology and localization of tumors to evaluate its spatial relationship with neighboring structures, study of three-dimensional and functional parameters of the heart. Dynamic mode (Cine-SSFP), planar and volumetric reconstruction (MPR) demonstrated the topography of tumors. That helped a broad understanding of the pre-operative pathology and surgical simplified decision-making. MRI allowed to analyze results of surgical correction and implement dynamic monitoring during the early and late postoperative period.

Conclusions: MRI in the diagnosis of tumors of the heart significantly complements echocardiography, providing a non-invasive multi-modal visualization, necessary for a comprehensive assessment of the topography of lesions, detection of individual anatomical features of intracardiac and extracardiac structures. MRI should be included in the diagnostic algorithm of tumors of the heart, including to assess occured hemodynamic changes.  

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Abstract:

Aim: was to show capabilities of MDCT-angiography of coronary arteries in the detection and characterization of rare forms of anomalous coronary arteries from the pulmonary artery in adult patients

Materials and methods: we made retrospective study of anomalous coronary arteries from pulmonary arteries in patients who have been examined and operated in our Center for the period of 2008-2013. All patients on admission underwent: echocardiography, selective coronary angiography and MDCT coronarography Postoperatively - echocardiography and MDCT coronarography.

Results: for the period of 5 years about 30,000 patients underwent examination in our center, and congenital anomalous coronary arteries from the pulmonary artery was identified only in 6(0,02 %) cases. 4( 0,013%) of them had «infantile» type - ALCAPA. In adults, anomalous coronary arteries from the pulmonary artery revealed in 2 cases: a 31 year woman had «adult» type ALCAPA (0,003%) and 17-year boy - isolated form ARCAPA (0,003%). Preoperative MDCT provided direct visualization of anomalous coronary arteries from the pulmonary artery, displayed the spatial relationship of coronary vessels in the three-dimensional image that helped to clarify and demonstrate for cardiac surgeons individual characteristics of congenital disorder. Marked dilatation and tortuous course of trunks and branches of coronary arteries, the severity of which declined after surgical correction. Adult patients successfully underwent surgical correction: reimplantation of anomalous coronary arteries in orthotopic position in cardiopulmonary bypass with the creation of two-coronary blood supply of the heart

Conclusions: Even in cases where a definitive diagnosis of anomalous coronary arteries from the pulmonary artery can be diagnosed by echocardiography and coronary angiography, before surgery is recommended to perform MDCT angiography to clarify the anatomy and more specific spatial representation of the topography of the anomalous vessel. In the late postoperative period this method allows to assess in details the condition of coronary flow and effectiveness of coronary intervention. 

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Abstract:

Aim: was to evaluate the influence of factors on the development of diaphragmatic dysfunction ir early periods after cardiac surgery

Materials and methods: study included 830 patients after various cardiac surgery in Federal National Center of Cardiovascular Surgery (Penza, Russian Federation). In the early postoperative period (3,9 ± 0,9 days) all patients underwent chest x-ray while transporting from intensive care unit. We evaluated differences between diaphragm contors in two consecutive shots - with a deep breath and exhale fully In the early postoperative period diaphragmatic dysfunction was detected in 172 cases (20.7%). Patients were divided into 4 groups depending on the presence or absence of a violation of the diaphragm function. The criterion of selection into the group with diaphragmatic dysfunction was size of amplitude motion, less than 10 mm. 1st group with normal mobility of the diaphragm included 658 patients (79.3%). 2nd group with dysfunction of the left dome of the diaphragm - 85 patients(10.2%). 3rd group with dysfunction of the right dome - 58 patients (7%). 4th group with bilateral diaphragmatic dysfunction - 29 patients (3.5%). Logistic regression model included 4 variables, the significance of which is reflected by the published data: preparation of internal thoracic artery (ITA) for graft, valve surgery, the use of radiofrequency ablation, the use of cardiopulmonary bypass. We made a multiple logistic regressive analysis of predictors for the development of diaphragmatic dysfunction.

Results: we have found that under the influence of complex predictors, greatest chance of dysfunction was observed in the group with bilateral violation of diaphragm mobility after two-sidec separation of ITA (OR 3.4; CI 1.60, 7.25). High chances of dysfunction were observed in groups with unilateral violation of diaphragm mobility after unilateral separation of ITA. Separation of left ITA had higher chances for diaphragmal dysfunction (OR 2.7; CI 1.36; 5.37) than in case of separation of right ITA (OR 2.0; CI 1.16, 3.47). After valve operations, radiofrequency ablation, and cardiopulmonary bypass chances of diaphragmatic dysfunction was statistically insignificant (p>0.05) in all study groups.

Conclusions: diaphragmatic dysfunction develops in 3.4 times greater in case of bilateral separation of ITA. Unilateral dysfunction of the diaphragm has a great chance in case of separation of ITA: left up to 2.7 times and right up to 2 times. Influence of cardiopulmonary bypass, valve operations and radiofrequency ablation for the development of diaphragmatic dysfunction is statistically insignificant.

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Abstract:

Aim: was to reveal factors that cause dyspnea in the early postoperative period after cardiac surgery.

Materials and methods: the study included 818 patients after cardiosurgical interventions in «F^S» Penza from June 2014 to February 2015, with complaints of shortness of breath at rest. The degree of influence of variables was determined using ROC analysis and logistic regression analysis.

Results: dyspnea was noted in 169 patients (19.4 %). ROC-analysis revealed a very large influence on the occurrence of dyspnoea disturbances of the mobility of the diaphragm, the great influence of the frequency of respiratory movements, the average impact of the height of diaphragm domes and low impact of body mass index. Results of logistic regression analysis showed that odds increase in 327 times at a decreased mobility of the left dome of the diaphragm 49 times in dysfunction of the right dome, 4,4-times elevation in the left dome, 3,5 times at the elevation of the right dome, 3.9 times with tachypnea and 2,6 times for severe obesity, in 1,5 times in chronic heart failure II B degree. Other factors, included in research, didn't influence on dispnea appearance.

Conclusions: a leading factor in the occurrence of dyspnea is dysfunction of the diaphragm, especially when decreased mobility of the left dome. To a lesser extent, reasons can be the elevation of diaphragm domes and tachypnea. Obesity 2 and 3 degree and chronic heart failure II B degree, had a small effect on dyspnea.

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Abstract:

Aim: was to determine what dimensions of an end-diastolic volume (EDV) in patients with reducec left ventricular function (LV) higher chances to measure its value up to 50 ml with Echocardiography compared to MRI.

Materials and methods: the sample consisted of 134 patients with ischemic cardiomyopathy and ejection fraction (EF) less than 35%. A mathematical model that calculates what dimensions of the MLC are more likely to determine its size with an accuracy of up to 50 ml with Echocardiography compared to MRI. Produced logistic regression analysis and calculated odds ratios.

Results: аccording to Echocardiography the EDV was 250.5 ± 67.6 ml, EF was 29.4 ± 5.0 percent. According to MRI, the EDV was 249.3 ± 77.2 ml, EF was 29.9 ± 6.4 percent. Results of the logistic regression analysis showed that EDV to 150 ml have high chances of a consistent measure of EDV with Echocardiography and MRI (OR a 2,5). In groups with EDV more than 150 ml but less than 300 ml had low chances of an accurate measurement of the EDV at the Echocardiography (OR from 0,62 to 0,95). Since EDV is greater than 300 ml, a marked increase chances Echocardiography, to determine EDV up to 50 ml compared to MRI (OR from 2,3 to 4,2).

Conclusions: when EDV to 150 ml, and in dilatation of the left ventricle more than 300 ml MRI has no advantages compared to Echocardiography In these figures there is no need to duplicate echocardiographic study When the EDV of 150 to 300 ml, for determination of volumetric indices it is better to use MRI, because the computations do not depend on the geometric shape of the left ventricle.

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