Abstract: Introduction: prevalence of atrial fibrillation (AF) in the population continues to rise steadily due to the rapid aging of the population [1]. The search for the morphological substrate of AF has been going on for more than half a century. Left atrial remodeling has become such an important aspect in the pathogenesis of AF that some authors advocate the definition of atrial cardiomyopathies [3]. Aim: was to examine the impact of various imaging techniques on the detection of atrial fibrosis and their key role in the treatment of atrial fibrillation. Conclusions: currently, radiological imaging techniques are available for clinical practice and provide additional possibilities in the assessment of left anterior segment function in AF. Morpho-functional changes in the left atrium can have a great impact on the global hemodynamic function of the left atrium, and as a consequence, these changes can be a significant predictor of the risk of AF progression and stroke development. Morpho-functional changes in the left atrium can have a great impact on the global hemodynamic function of the left atrium, and as a consequence, these changes can be a significant predictor of the risk of AF progression and stroke development.
Abstract: Introduction: the main methods for diagnosing cardiac neoplasms, allowing to determine the localization, size, involvement of heart structures, to suggest the nature of the pathological process and to plan treatment tactics, are: echocardiography (EchoCG), contrast multispiral computed coronary angiography (MSCT CAG), magnetic resonance imaging (MRI) and positron emission computed tomography (PET CT). At the same time, any additional information about the pathological process can improve the quality of diagnosis and treatment. So, for example, selective coronary angiography (CAG), which in this case can be performed to clarify the coronary anatomy and exclude concomitant coronary atherosclerosis, in hands of attentive and experienced specialist of endovascular diagnostic and treatment methods can make a significant contribution to understanding the nature of blood supply of heart neoplasm, thereby bringing closer the formulation of the correct diagnosis and, ultimately, improving results of surgical treatment. Aim: was to study the nature of blood supply of heart myxoma based on results of a detailed analysis of data of selective coronary angiography in patients with this pathology. Material and methods: since 2005, 20 patients underwent surgery to remove heart myxoma. The average age of patients was 56,6 + 8,0 (43-74) years. According to data of ultrasound examination, sizes of myxomas ranged from 10 to 46 mm in width and from 15 to 71 mm in length (average size ? 25,6 ? 39,1 mm). In 2/3 of all cases (15 out of 20,75%), the fibrous part of the inter-atrial septum (fossa oval region) was the base of myxomas. In 8 of 20 (40%) cases, tumor prolapse into the left ventricle through structures of the mitral valve was noted in varying degrees. In order to exclude coronary pathology, CAG was performed in 14 cases, in the rest - MSCT CAG. Results: of 14 patients with myxoma who underwent selective coronary angiography, 12 (85,7%) patients had distinct angiographic signs of vascularization. In all 12 cases, the sinus branch participated in the blood supply of myxoma, begins from the right coronary artery (RCA) in 10 cases: in 7 case it begins from proximal segment of the RCA and, in 3 cases, from the posterior-lateral branch (PLB) of the RCA. In one case, the source of blood supply of neoplasm was the sinus branch extending from PLB of dominant (left type) circumflex artery of the left coronary artery (PLB CxA LCA). In one case, the blood supply to the neoplasm involved branches both from the RCA and CxA, mainly from the left atrial branch of CxA. Moreover, in all 12 cases, sinus branch formed two branches: branch of sinus node itself and left atrial branch. It was the left atrial branch that was the source of blood supply of myxoma. Analysis of angiograms in patients with myxoma of LA showed that left atrial branch in terminal section formed a pathological vascularization in the LA projection, accumulating contrast-agent in the capillary phase (MBG 3-4). In addition to newly formed vascularization, lacunae of irregular shape were distinguished, the size of which varied from 2 to 8 mm along the long axis. In 8 cases, hypervascular areas with areas of lacunar accumulation of contrast-agent showed signs of paradoxical mobility and accelerated onset of venous phase. In two cases, there were distinct angiographic signs of arteriovenous shunt. In 2 cases (when the size of the myxoma did not exceed 15-20 mm according to EchoCG and CT), angiographic signs allowing to determine the presence of LA myxoma were not so convincing: there was no lacunar accumulation of contrast-agent; small (up to 10 mm) hypervascular areas were noticed, the capillary network of which stood out against the general background of uniform contrasting impregnation and corresponded to MBG grade 1-2. Conclusion: according to our data, angiographic signs of vascularization of myxomas are detected in most cases with this pathology (85,7%). The source of blood supply, in the overwhelming majority of cases, is branch of coronary artery, which normally supplies the structure of the heart, on which the basement of the pathological neoplasm is located. The aforementioned angiographic signs characteristic of myxomas deserve the attention of specialists in the field of endovascular diagnosis and treatment and should be described in details in protocols of invasive coronary angiography. References 1. Петровский Б.В., Константинов Б.А., Нечаенко М.А. Первичные опухоли сердца. М.: Медицина, 1997; 152. Petrovskiy BV, Konstantinov BA, Nechaenko MA. Primary heart tumors. M.: Medicina, 1997 [In Russ]. 2. Balci AY, Sargin M, Akansel S, et al. The importance of mass diameter in decision-making for preoperative coronary angiography in myxoma patients. Interact Cardiovasc Thorac Surg. 2019; 28(1): 52-57. https://doi.org/10.1093/icvts/ivy217 3. Omar HR. The value of coronary angiography in the work-up of atrial myxomas. Herz. 2015; 40(3): 442-446. 4. Gupta PN, Sagar N, Ramachandran R, Rajeshekharan VR. How does knowledge of the blood supply to an intracardiac tumour help? BMJ Case Rep. 2019; 12(2): 225900. https://doi.org/10.1136/bcr-2018-225900 5. Marshall WHJr., Steiner RM, Wexler L. Tumor vascularity in left atrial myxoma demonstrated by selective coronary arteriography. Radiology. 1969; 93(4): 815-816. 6. Lee SY, Lee SH, Jung SM, et al. Value of Coronary Angiography in the Cardiac Myxoma. Clin Anat. 2020; 33(6): 833-838.
Abstract: Introduction: incidence of aortic valve stenosis is 3rd in the group of cardio-vascular diseases. Most important questions of aortic valve replacement (AVR) are: prosthesis effective orifice area (EOA) sufficiency for certain patient and need of posterior aortoplasty (PA). Each prosthesis of certain number has technical data and size. Reasonable frequency of posterior aortoplasty is a discussed question. Aim: was to analyze echocardiographic data in two groups: isolated AVR and AVR + PA in order to study the reasonable frequency of posterior aortoplasty application while using stented bioprosthesis NeoCor-21 «UniLine». Materials and methods: 99 patients with bioprosthesis NeoCor-21 «UniLine» implantation were enrolled in study for investigation of problem of aortoplasty need. According to application/absence of posterior aortoplasty patients were divided in two groups. In postoperative period groups were compared in echocardiographic data calculations: left ventricle end-diastolic volume (LV EDV), ejection fraction (LV EF), stroke volume (LV SV), peak and mean valve gradients. Indexes were calculated and compared: stroke volume index (SVI) and prosthesis effective orifice area index (EOAI). Results: the group of AVR + PA consisted of 14 (14,14%) patients. Immediate postoperative echocardiographic calculations revealed no statistic difference between two groups: in left ventricle end diastolic volume (LV EDV), ejection fraction (LV EF), stroke volume (LV SV), peak and mean valve gradients, stroke volume index (SVI) and valve effective orifice area index (EOAI). Group without posterior aortoplasty had slightly higher end diastolic volume (LV EDV), stroke volume (LV SV), peak and mean valve gradients. Opposite patients with posterior aortoplasty had slightly higher ejection fraction (LV EF), stroke volume index (SVI), slightly less peak and mean valve gradients. Left ventricle function was more optimal in the posterior aortoplasty group. Conclusion: in our practice, incidence of posterior aortoplasty in using stented bioprosthesis NeoCor-21 «UniLine» was 14,14%. Echocardiographic calculations of postoperative data demonstrated that this frequency was reasonable. Probably posterior aortoplasty is to be applied more frequently. Conflict of interest: the authors declare no conflict of interest. References 1. Bokeriya LA, Belaya G. Methods of echocardiographic assessment of aortic valve hemodynamics after prosthetics: methods and precautions. Kreativnaya kardiologiya-Creative cardiology. 2012; 6(1): 73-79 [In Russ]. 2. Iqbal A, Panicker VT, Karunakaran J. Patient prosthesis mismatch and its impact on left ventricular regression following aortic valve replacement in aortic stenosis patients. Indian J Thorac Cardiovasc Surg. 2019; 35: 6-14. https://doi.org/10.1007/s12055-018-0706-3 3. Malhotra A. Prosthesis patient mismatch: myth or reality? Indian J Thorac Cardiovasc Surg. 2019; 35: 3-5. https://doi.org/10.1007/s12055-018-0708-1 4. Rashimtoola SH. The problem of valve prosthesis-patient mismatch. Circulation. 1978; 58: 20-24. 5. Sazonenkov MA, Ismatov KhH, Prisyazhnyuk EI, et al. Comparison of the manufacturers technical specification with postoperative results in four types of stented bioprostheses in the aortic position. Actualnye problemy mediciny. 2020; 43(1): 113-123 [In Russ]. 6. Klyshnikov KYu, Ovcharenko EA, Shcheglova NA, Barbarash L.S. Functional characteristics of Uniline bioprostheses. Kompleksnye problemy serdechno-sosudistykh zabolevaniy. 2017; 3: 6-12 [In Russ]. https://doi.org/10.17802/2306-1278-2017-6-3-6-12 7. Manufacturers information. ZAO «NeoCor» 1978-2020 [In Russ]. https://neocor.ru/aortalnyyklapan-3 8. Nicks R, Cartmill T, Bernstein L. Hypoplasia of the aortic root. The problem of aortic valve replacement. Thorax. 1970; 25(3): 339-346. 9. Rittenhouse EA, Sauvage LR, Stamm SJ, et al. Radical enlargement of the aortic root and outflow tract to allow valve replacement. Ann Thorac Surg. 1979; 27(4): 367-73. 10. Clinical guidelines: Aortic stenosis. Association of Cardiovascular Surgeons of Russia. Moscow 2020 [In Russ]. 11. Manouguian S, Seybold-Epting W. Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. New operative technique. J Thorac Cardiovasc Surg. 1979; 78(3): 402-412. 12. Belov YuV, Charchyan ER, Katkov AI, et al. Influence of the discrepancy between the diameter of the prosthesis and the patient's body surface area on the long-term results of aortic valve replacement. Kardiologiya i serdechno-sosudistaya khirurgiya. 2016; 9 (2): 46-51 [In Russ]. https://doi.org/10.17116/kardio20169246-51 13. Pibarot P, Magne J, Leipsic J, et al. Imaging for Predicting and Assessing Prosthesis-Patient Mismatch After Aortic Valve Replacement. JACC Cardiovasc Imaging. 2019; 12(1): 149-162. https://doi.org/10.1016/j.jcmg.2018.10.020 14. Tam DY, Dharma C, Rocha RV, et al. Early and late outcomes of aortic root enlargement: a multicenter propensity score-matched cohort analysis. J Thorac Cardiovasc Surg. 2020; 160: 908-19. https://doi.org/10.1016/j.jtcvs.2019.09.062 15. Aortic valve replacement with smaller prostheses in elderly patients: does patient prosthetic mismatch affect outcomes? J Card Surg. 2013; 28(4): 341-7. 16. Dumani S, Likaj E, Dibra L, et al. Aortic Annular Enlargement during Aortic Valve Replacement. Open Access Maced J Med Sci. 2016; 15; 4(3): 455-457. https://doi.org/10.3889/oamjms.2016.098 17. S? MP, Zhigalov K, Cavalcanti LRP, et al. Impact of aortic annulus enlargement on the outcomes of aortic valve replacement: a meta-analysis. Semin Thorac Cardiovasc Surg. 2021; 33(2): 316-325. 18. Aortic Root Enlargement Is Safe and Reduces the Incidence of Patient-Prosthesis Mismatch: A Meta-analysis of Early and Late Outcomes. Can J Cardiol. 2019; 35(6): 782-790.
Abstract: Background: pulmonary hypertension not only aggravates the course of myocardial infarction, but also significantly worsens the prognosis, increasing disability and mortality due to the steadily progressing course. The need to predict the development of pulmonary hypertension in patients with myocardial infarction is not in doubt, since a clear clinical picture manifests itself only in the late stages of the disease, when the effectiveness of the treatment reduces and its cost increases. Aim: was to define most significant factors, influencing the development of pulmonary hypertension in the subacute period of myocardial infarction to elaborate a model for predicting this pathological condition. Material and methods: study included 451 men aged 18-60 y.o. with a verified diagnosis of myocardial infarction. All patients underwent a standard diagnostic algorithm, including a comprehensive echocardiographic examination - in first 48 hours and at the end of the third week of the disease. The study group included 84 patients with pulmonary hypertension, which had occurred at the end of the third week of the disease at an initially normal level of mean pressure in the pulmonary artery. Control group consisted of 367 patients with a normal level of mean pulmonary artery pressure in both phases of the study or normalization of this indicator at the end of the subacute period of the disease. Using multivariate analysis of variance from the analytical base, we selected parameters associated with levels of mean pulmonary artery pressure, the proportion of patients with firsttime pulmonary hypertension at the end of the subacute Ml. Then, with step-by-step and binary logistic regressions, most sensitive of them were selected for the prognostic model. Results: study established a number of significant for the development of pulmonary hypertension in the subacute period of myocardial infarction clinical and anamnestic (heart rate, diastolic blood pressure, the presence of pulmonary edema and chronic lung diseases), laboratory (concentrations of the sodium, potassium, chloride; glucose, some parameters of lipid concentration in the blood plasma) and instrumental (the value of left atrium, end-diastolic size of the right ventricle, values of indices of end-systolic and end-diastolic left ventricular volumes, cardiac index, total pulmonary resistance, the presence of regurgitation at the aortic valve) parameters. Final prognostic model included mean pulmonary artery pressure, heart rate and the presence of aortic valve regurgitation of the second degree and higher in first 48 hours of myocardial infarction. Characteristics of the resulting model allow us to recommend it for practical use. Conclusions: using a combination of these predictors, as well as prognostic modeling, makes it possible to distinguish among men under 60 years, a high-risk group for the development of pulmonary hypertension in the subacute period of the disease in order to conduct timely additional diagnostic and therapeutic measures. References 1. Galie N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology and the European Respiratory Society: Endorsed by: Association for European Pediatric and Congenital Cardiology, International Society for Heart and Lung Transplantation. Eur Heart J. 2016;37(1): 67-119. PMID:26320113. https://doi.org/10.1093/eurhearti/ehv317 2. Haeck ML, Hoogslag GE, Boden H, et al. Prognostic Implications of Elevated Pulmonary Artery Pressure After ST-Segment Elevation Myocardial Infarction. Am J Cardiol. 2016; 118(3): 326-31. PMID: 27265675. https://doi.orq/10.1016/i.amicard.2016.05.008 3. Thygesen K, Alpert JS, Jaffe AS, et al. Task Force for the Universal Definition of Myocardial Infarction. Fourth Universal Definition of Myocardial Infarction (2018). J Am Coll Cardiol. 2018;72(18):2231-2264. PMID: 30153967. https://doi.org/10.1016/i.iacc.2O18.08.1038 4. Lang RM, Badano LP, Mor-AviV, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015; 16(3): 233-70. PMID: 25712077. https://doi.org/10.1093/ehici/iev014 5. Erlikh AD. Novel score for mortality risk prediction 6 months after acute coronary syndrome. Russian Journal of Cardiology. 2020;25(2):3416 [In Russ]. https://doi.org/10.15829/1560-4071 -2020-2-3416 6. Sotnikov AV, Epifanov SYu, Kudinova AN etal. Predictors of recurrent ischemic damages in men under 60 years of age with myocardial infarction. Science of the young (Eruditio Juvenium) 2019; 7(4): 565-574 [In Russ]. http://doi.org/10.23888/HMJ201974565-574 7. Panev Nl, FilimonovSN, Korotenko OYu et al. System for predicting the probability of developing respiratory failure in chronic mechanic bronchitis. Medicine in Kuzbass. 2017;16(3): 52-56 [In Russ]. 8. Bax JJ, Di Carli M, Narula J, Delgado V. Multimodality imaging in ischaemic heart failure. Lancet. 2019;393(10175):1056-1070. PMID: 30860031. https://doi.org/10.1016/S0140-6736(18)33207-0 9. Sheludko EG, Naumov DE, Prikhodko AG, Kolosov VP. Clinical and functional peculiarities of comorbid obstructive sleep apnea syndrome and asthma. Bulletin Physiology and Pathology o f Respiration. 2019; (71): 23-30 [In Russ]. http://doi.org/10.12737/article_5c88b5e86b9c18.75963991 10. Chistyakova MV, Govorin AV, Radaeva EV. Opportunities for prediction of pulmonary hypertension development in patients with viral liver cirrhosis. Russian Journal of Cardiology. 2017;(4):70-74 [In Russ]. https://doi.org/10.15829/1560-4071-2017-4-70-74 11. Agapitov LI. Diagnostics and treatment of childish pulmonary arterial hypertension. Diagnostics and treatment of childish pulmonary arterial hypertension. Lechaschi Vrach Journal. 2014; 4: 50 [In Russ]. 12. Laletin DA, Bautin AE, Rubinchik VE, Mikhailov AP. Right ventricle contractility during early postoperative period after coronary artery bypass grafting with cardiopulmonary bypass. Circulation Pathology and Cardiac Surgery. 2014; 18(3): 34-38 [In Russ]. 13. Kirillova W. Early ultrasound detection of venous congestion in pulmonary circulation in patients with chronic heart failure. Russian Heart Failure Journal. 2017; 18(3):208-212 [In Russ].
Abstract: Introduction: development of software and hardware capabilities of modern computing systems has enabled three-dimensional (3D) modeling and 3D printing technology (medical prototyping) to become available for a wide range of healthcare specialists. Commercial software used for this purpose remains unavailable to private physicians and small institutions due to the high cost. However, there are freeware applications and affordable 3D printers that can also be used to create medical prototypes. Aim: was to describe stages of creating of physical 3D models based on medical imaging data and to highlight main features of specialized software and to make an overview of main types of 3D printing used in medicine. Material and methods: article describes process of creation of medical prototype, that can be divided on three main stages: 1) acquisition of medical imaging, obtained by ‘volumetric’ scanning methods (computed tomography (CT), magnetic-resonance imaging (MRI), 3D ultrasound (3D US)); 2) virtual 3D model making (on the basis of visualisation data) by segmentation, polygonal mesh extraction and correction; 3) 3D printing of virtual model by the chosen method of additive manufacturing, with or without post-processing. Conclusion: medical prototypes with sufficient precision and physical properties are necessary for understanding of anatomical structure and surgical crew training and can be made with use of freely available software and inexpensive 3D printers.
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Abstract: A clinical case of right atrial diverticulum in a 34-year-old patient is presented, which was suspected during echocardiography and confirmed during magnetic resonance imaging of the heart. Main main features of the anomaly and clinical and radiation features of the atrial diverticulum are presented in discussion. References 1. Podzolkov VP, Cheban V N, Kokshenev IV, Katsadze NG, Serov RA. Congenital giant aneurysm of the right atrium. Thoracic and cardiovasc. surg. 2012; 4: 44-47 [In Russ]. 2. Soroka NV, Shelestova IA, Kosmacheva ED, Porkhanov VA. Case report of a giant aneurysm of the right atrium in a patient of seventy-eight years. Pathology of blood circulation and cardiac surgery. 2014; 18(2): 66-68 [In Russ]. 3. Binder TM, Rosenhek R, Frank H.et al. Congenital malformations of the right atrium and the coronary sinus: an analysis based on 103 cases reported in the literature and two additional cases. Chest. 2000; 117(6): 1740-1748. 4. Hofmann S.R., Heilmann A., Hдusler H. J., Dahnert I. et all Congenital idiopathic dilatation of the right atrium: antenatal appearance, postnatal management, long-term follow-up and possible pathomechanism. Fetal Diagn. Ther. 2012; 32: 256-261. 5. Sanchez-Brotons J.A., Lуpez-Pardo F. J., Lуpez-Haldуn J. E., Rodmguez-Puras M. J. Giant Right Atrial Diverticulum: Utility of Contrast-enhanced Ultrasound. Rev. Esp. Cardiol. 2013; 6(03): 222-223.
Abstract: Aim: was to evaluate the prognostic effectiveness of the method of cardiac magnetic resonance imaging (MRI) in patients with ischemic heart disease (IHD) with dysfunctional myocardium after endovascular interventions Materials and methods: a total of 114 patients were included in the study Inclusion criteria: myocardial infarction in previously; myocardial ischemia according to stress tests; occlusion or subtotal stenosis of one or more coronary arteries according to digital angiography (SYNTAX score <32); viable myocardium in the zone of the occluded/stenotic artery; heart failure of I-III functional class (NYHA); left ventricular ejection fraction (LVEF) less than 50%. Patients were randomized into 2 equivalent groups: in the I group, myocardial viability was determined by cardiac magnetic resonance imaging (MRI) with delayed contrast, in the II group - by stress-echocardiography with dobutamine. All patients underwent stenting of coronary arteries in the zone of the viable myocardium with drug-eluting stents. Long-term results of treatment were followed to 12 months after endovascular intervention in all patients. Results: all patients had a significant improvement in the local contractility of the myocardium after performed endovascular myocardial revascularization. After 12 months, a significant decrease in the mass fraction of ischemic viable myocardium in the peri-infarction zone was noted among patients from group I, compared with preoperative data (32.8 ± 2.4 and 24,3±2,3%, respectively, p<0.05). Thus, in I group the volume of ischemic myocardium decreased by 26%. In all studied groups, there was a significant increase in LVEF, compared with data obtained when the patient was discharged from the hospital. Survival in the I group was 100%, whereas in the II group - 97.3% (p> 0.05). The incidence of non-fatal MI was 0.88 and 3.5% in groups I and II, respectively (p <0.05). Conclusion: cardiac MRI with delayed contrast is more effective and sensitive for diagnosis of myocardial viability and patient prognosis after endovascular intervention, compared with stress echocardiography with dobutamine. References 1. Mironkov A.B. Revaskulyarizatsiya miokarda v lechenii patsientov s sistolicheskoi disfunktsiei levogo zheludochka: sostoyanie problemy. [Myocardial revascularization in the treatment of patients with left ventricular systolic dysfunction: the state of the problem]. Vestnik transplantologii i iskusstvennykh organon 2013; XV(2): 156-163 [In Russ]. 2. Katritsis D.G., loannidis J.P. Percutaneous coronary intervention versus conservative therapy in non-acute coronary artery disease: a meta-analysis. Circulation. 2005; 111(22):2906-2912. 3. Pitt M., Dutka D., Pagano D. The natural history of myocardium awaiting revascularisation in patients with impaired left ventricular function. Eur Heart J. 2004; 25: 500 -507. 4. Saidova, M.A., Belenkov Yu.N., Akchurin R.S. Diagnosticheskaya tsennost i prognosticheskie vozmozhnosti dobutaminovoi stress-ekhokardiografii i prefuzionnoi stsintigrafii miokarda v vyyavlenii zhiznesposobnogo miokarda u bol'nykh ishemicheskoi bolezn'yu serdtsa s vyrazhennoi disfunktsiei levogo zheludochka i otbore patsientov na khirurgicheskuyu revaskulyarizatsiyu. [Diagnostic value and prognostic possibilities of dobutamine stress echocardiography and myocardial perfusion scintigraphy in the detection of viable myocardium in patients with coronary heart disease with severe left ventricular dysfunction and selection of patients for surgical revascularization]. Kardiobgiya. 1999; (8):4-12 [In Russ]. 5. Vorozhtsova I.N., Bukhovets I.L., Bezlyak V.V. et al. Sopostavlenie rezultatov stress-ekhokardiografii i stsintigrafii miokarda s 99m-tekhnetrilom i probe s sublingval'nym priemom nitroglitserina v otsenke zhiznesposobnosti miokarda u bol'nykh s postinfarktnym kardiosklerozom. [Comparison of results of stress echocardiography and myocardial scintigraphy with 99m-technetril and a sample with sublingual nitroglycerin intake in assessing the viability of the myocardium in patients with postinfarction cardiosclerosis]. Patologiya krovoobrashcheniya i kardiokhirurgiya. 2001;(3):15-20 [In Russ] 6. Shinkel A.F., Bax J.J., Poldermans D. et al. Hibernating myocardium: diagnosis and patient outcomes. Curr. Probl. Cardiol. 2007; (32):375-410. 7. Saurabh J., Scott D.F., Deborah H.K. Revascularization in heart failure in the post-STICH era. Curr. Heart Fail. 2013; (10):365-372. 8. Kwon D.H., Hachamocitch R., Popovic Z.B. et al. Survival in patients with severe ischemic cardiomyopathy undergoing revascularization versus medical therapy: association with end-systolic volume and viability. Circulation. 2012; (126):3-8. 9. Windecker S., Kolh P., Alfonso F. et al. 2014 ESC/EACTS Guidelines on myocardial revascularization. Eur Heart J. 2014; (35):2541-2619. 10. Dickstein K., Cohen-Solal A., Filippatos G.,et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology: Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur. Heart. J. 2008; 29: 2388-2442. 11. Got'e S.V., Mironkov A.B., Sakhovskii S.A. Sostoyanie problemy revaskulyarizatsii miokarda u patsientov s vyrazhennoi sistolicheskoi disfunktsiei levogo zheludochka [The state of the problem of myocardial revascularization in patients with severe left ventricular systolic dysfunction.] Vestnik transplantologii i iskusstvennykh organov. 2017; 19(1): 103-110 [In Russ]. 12. Camici P.G., Kumak S.P., Rimoldi O.E. Stunning, Hybernating and Assesment of Myocardial Viability. Circulation. 2008; (117):103-114. 13. Trufanov G.E., Rud' S.D., Zheleznyak S.E. MRT v diagnostike ishemicheskoi bolezni serdtsa: ucheb.posobie. [MRI in the diagnosis of coronary heart disease: education guidance]. SPb.: Izd-vo «ELBI-SPb». 2012;. 63s [In Russ]. 14. West A.M., Kramer C.M. Cardiovascular magnetic resonance imaging of myocardial infarction, viability and cardiomyopathies. Curr. Probl. Cardiol. 2010; (35): 176-220. 15. Kramer C.M., Schulz-Menger J., Bluemke D.A., et al. Standardized cardiovascular magnetic resonance imaging (CMR) protocols, society for cardiovascular magnetic resonance: board of trustee's task force on standardized protocols. J. Cardiovasc. Magn. Reson. 2013; 15(1): 35. 16. Wellnhofer E., Olariu A., Klein C. Magnetic resonance low-dose dobutamine test is superior to SCAR quantification for the prediction of functional recovery. Circulation. 2004; 109(18): 2172-4. 17. Gerber B.L., Rousseau M.F., Ahn 18. Bax J.J., Poldermans D., Elhendy A., et al. Sensitivity, specificity, and predictive accuracies of various noninvasive techniques for detecting hibernating myocardium. Current Problems in Cardiology. 2001; 26 (2): 141-186. 19. Underwood S.R., Bax J.J., vom Dahl J., et al. Imaging techniques for the assessment of myocardial hibernation: report of a Study Group of the European Society of Cardiology. European Heart Journal. 2004; 25(10): 815836. 20. Romero J., Xue X., Gonzales W. et al. CMR imaging assessing viability in patients with chronic ventricular dysfunction due to coronary artery disease: a meta-analysis of prospective. JACC Cardiovasc. Imaging. 2012; 5(5): 494-508.
Abstract: The aim of the study was to assess the powers of complex ultrasonography in different stages of endovascular closure of atrial septal defects (ASD). 31 patients 13-56 years old (mean age 23,65 ±5,2 years) with septal defects were included into the study. Ultrasound (US) monitoring performed during the procedure of endovascular closure, and as a follow-up. There were prevalence (35,4%) of the patients with central ASD with rims of 5 mm and more. Abcence of anterio-superior or aortic rim, or its deficiency, noted in 19,2% of cases. Patent foramen ovale (PFO) registered in 25,81% of patients. Incidence of multiple ASDs and ASD in aneurysm occurred to be similar and was as high as 9,67%. In 2 cases of multiple ASDs, and 2 cases of PFO, transseptal puncture was used as an approach to left atrium, for the reason of complex anatomy of the septum. After the closure, transthoracic US showed reliable decrease of the right atrium, right ventricle, and pulmonary artery (PA) size. The majority of patients (64%) showed normalization of PA pressure and left ventricle enlargement in a week after the procedure. Two-dimensional echocardiography (EchoCG) with color Doppler mapping (CDM) is the key method for ASD imaging and assessing its suitability for endovascular closure. Transesophageal EchoCG can help in verification of the ASD anatomy and refinement of the ASD rims. Ultrasound guidance during the procedure of endovascular closure allows optimal positioning of the device, immediate assessment of the homodynamic effects, and timely diagnosis of complications. Reference 1. Банкл Г. Врожденные пороки сердца икрупных сосудов. М.: Медицина, 1980; 312. 2. Белоконь Н.А., Подзолков В.П.Врожденные пороки сердца. М.: Наука, 1991; 351. 3. Kannan B.R., Francis E., Sivakumar K., AnilS.R., Kumar R.K. Transcatheter closure ofvery large (> or = 25 mm) atrial septal defectsusing the Amplatzer septal occluder. Catheter.Cardiovasc. Interv. 2003; 59 (4): 522-527. 4. Maron B.J., Bonow R.O. et al. Hyperterophic cardiomyopathy: interrelations of clinicalmanifestations, pathophysiology and therapy. New. Engl.J. Med. 1987; 316: 844-852. 5. Бокерия Л.А. Эндоваскулярная иминимально инвазивная хирургия сердца исосудов у детей. М. 1999; 226-233. 6. Дземешкевич С.Л., Синицин В.Е., КоролевС.В., Мершина Е.А., Пустовойтова Т.С.,Фролова Ю.В., Терновой С.К., АкчуринР.С. Септальные дефекты у взрослых:современная диагностика и лечебнаятактика. Грудная и сердечно-сосудистая хирургия. 2001; 2: 40-45. 7. Пурецкий М.В., Иванов А.С., Тараян М.В.,Балоян Г.М., Плотицин А.А., РодионовА.С., Аксюк М.А., Ревуненков Г.В. Опытиспользования Amplatzer septal occluderдля закрытия дефектов межпредсерднойперегородки. Хирургия. 2008; 2: 10-14. 8. Mazic U., Gavora P., Masura J. The role of transesophageal echocardiography in transcatheter closure of secundum atrial septal defects by the Amplatzer septal occluder. Am. Heart J. 2001; 142 (3): 482-488. 9. Belkin R.N., Pollak B.D., Ruggiero M.L., et al. Comparison of esophageal and transthoracic echocardiography with contrast and color flow Doppler in the detection of patent foramen ovale. Amer. heart J. 1994; 128 (3): 520-525. 10. Droste D.W., Lakemeier S., Wichter T., Stypmann J., Dittrich R., Ritter M., Moeller M., Freund M., Ringelstein E.B. Optimizing the technique of contrast transcranial Doppler ultrasound in the detection of right-to-left shunts. Stroke. 2002; 33 (9): 2211-2216. 11. Hofer C.K., Furrer L., Matter-Ensner S., Maloigne M., Klaghofer R., Genoni M., Zollinger A. Volumetric preload measurement by thermodilution: a comparison with transoesophageal echocardiography. Br.J. Anaesth. 2005; 94 (6): 748-755. 12. Augoustides J.G., Weiss S.J., Ochroch A.E., WeinerJ., Mancini J., Savino J.S., Cheung A.T. Analysis of the interatrial septum by transesophageal echocardiography in adult cardiac surgical patients: anatomic variants and correlation with patent foramen ovale. J. Cardiothorac. Vasc. Anesth. 2005; 19 (2): 146-149. 13. Augoustides J.G., Weiss S.J., Weiner J., Mancini J., Savino J.S., Cheung A.T.Diagnosis of patent foramen ovale with multiplane transesophageal echocardiography inadult cardiac surgical patients.J. Cardiothorac.Vasc. Anesth. 2004; 18 (6): 725-730. 14. Carlson K.M., Justino H., O'Brien R.E.,Dimas V.V., Leonard G.T., Pignatelli R.H.,Mullins C.E., Smith E.O., Grifka R.G.Transcatheter atrial septal defect closure:modified balloon sizing technique to avoid 18.overstretching the defect and oversizing theAmplatzer septal occluder. Catheter.Cardiovasc. Interv. 2005; 66 (3): 390-396. 15. Chen C.Y., Lee C.H., Yang M.W., Chung H.T., Hsieh I.C., Ho A.C. Usefulness of transesophageal echocardiography for transcatheter closure of ostium secundum atrial septum defect with the amplatzer septal occluder. Chang. Gung. Med.J. 2005; 28 (12): 837-845. 16. Dewhirst W.E., Stragand J.J., Fleming B.M. Mallory-Weiss tear complicating intraoperative transesophageal echocardiography in a patient undergoing aortic valve replacement. Anesthesiology. 1990; 73 (4): 777-778. 17. Mehta R.H., Helmcke F., Nanda N.C., Hsiung M., Pacifico A.D., Hsu T.L. Transesophageal Doppler color flow mapping assessment of atrial septal defect. J. Am. Coll. Cardiol. 1990; 16(4): 1010-1016. 18. Radhakrishnan S., Marwah A., Shrivastava S. Non surgical closure of atrial septal defect using the Amplatzer septal occluder in children-feasibility and early results. Indian Pediatr. 2000; 37 (11): 1181-1187.
Abstract: At 246 patients with coarctation of the aorta the ultrasonic semiotics of disease has been investigated. Are systematized echocardiographycal attributes of defect: are determined direct and indirect (displays directly reflecting morphology), the estimation of their sensitivity and specificity is lead. The certain combination of the specified attributes has allowed to allocate three variants of a ultrasonic picture coarctation of the Aorta, reflecting various anatomic forms of defect. The semiotics and diagnostic attributes of each ultrasonic variant of defect is described by echocardiography. Reference 1. Шиллер Н., Осипов М. А. Клиническая эхокардиография. М. 1993. 2. Митьков В. В., Сандриков В. А. Клиническое руководство по ультразвуковой диагностике в 5 т. М.: Видар. 1998; 5: 96-297. 3. Бураковский В. И., Бокерия Л. А. Сердечно-сосудистая хирургия (руководство). М.: Медицина.1989; 298-310. 4. Kaine S. E, Smith E. О., Mott A. R. et al. Quantitative echocardiographic analysis of the aortic arch predicts outcome of balloon angioplasty of native coarctation of the aorta. Circulation. 1996; 94 (5): 1056-1062. 5. Фейгенбаум X. Ультразвуковая диагностика. М.: Медицина. 1999; 1123-1145.
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Abstract: The article gives account of coronary stenting impact on the dynamics of left ventricle index. The study covered 94 postinfarction patients, including 80 men and 14 women. Among them 52 patients with Q-forming myocardium infarction and 42 with non-Q myocardium infarction were observed. 1 3 patients that suffered Q-forming myocardium infarction didn't show any segment contractility disorders (group 1), while 39 showed contractility disorders (group 2). The analysis revealed that index improvement of the left ventricle is observed in the 1st group in 77% cases after stenting, while the 2nd group shows no improvements. Among the 2nd group of patients the full recovery is observed in 21% cases, the partial recovery - in 46% and 1 3% didn't overcome any dynamics. The EchoCG study performed on 42 patients revealed that 31 men have no segmental activity disorders (group 3) and 1 1 suffered segmental activity disorder (group 4). Stenting procedure improved the myocardium function in the 3rd group in 65% cases. In the long prospect 1 0 patients of the 4th group fully recovered their myocardium function and only 1 man showed no dynamics in contractility improvement. Taking into consideration what has been said one can be sure that EchoCG proves to be an effective method of valuing the left ventricle function improvement before and after coronary stenting. References 1. Бокерия А.А. Современное общество и сердечно-сосудистая хирургия. Тезисы докладов V Всероссийского съезда сердечно-сосудистых хирургов. М., 1999; 3-6. 2. Чазов Е.И. Проблемы борьбы с сердечно-сосудистыми заболеваниями. Кардиология. 1973; 2: 5-10. 3. Белов Ю.В., Вараксин В.А. Современное представление о постинфарктном ремоделировании левого желудочка. Русский медицинский журнал. 2002; 10: 469-471. 4. Самко А.Н. Применение интракоронарных стентов ДЛЯ лечения больных ишемической болезнью сердца. Русский медицинский журнал. 1998; 6(14): 923-927. 5. Мазур Н.А. Эффективные и безопасные методы лечения больных хронической ишемической болезнью сердца. Русский медицинский журнал. 1998; 6(14): 908-913. 6. Петросян Ю.С., Зингерман Л.С. Классификация атеросклеротических изменений коронарных артерпи. Тезисы докл. 1 и 2 Всесоюзных симпозиумов по современным методам селективной ангиографии и их применение в клинике. М., 1973; 16. 7. Петросян Ю.С., Иоселиани Д.Г. О суммарной оценке состояния коронарного русла у больных ишемической болезнью сердца. Кардиология. 1976; 12(16): 41-46. 8. Петросян Ю.С., Шахов Б.Е. Коронарное русло у больных с постинфарктной аневризмой левого желудочка сердца. Горький. 1983; 17-20. 9. Bourdillon P.D.V, Broderick T.M., Sawada S.G, Armstrong WE, Ryan., Dillon J.C., Fineberg N.S., and Feigenbaum H.: Regional wall motion index for infarct and noninfarct regions after reperfusion in acute myocardial infarction: Comparison with globalwall motion index./. Am. Soc. Echocardiogr. 1989; 2: 398. 10. Фейгенбаум Харви «Эхокардиография». М.: Видар. 1999; 115-119. 11. Otto СМ., Pearlmann A.S. Textbook of clinical echocardiograph.
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Abstract: We performed echocardiographic evaluation of 149 women with congenital and acquired heart defects prior to their pregnancy and during the 3d trimester of gestation, as the hemodynamic load reached its peak. It was shown that in patients with surgically corrected cardiac anomalies, echocardiographic findings could stay within physiological limits, otherwise we saw inadequate hemodynamic response and structu-ralchanges. References 1. Абрамченко В.В. Беременность и роды высокого риска. М.: «МИА». 2004; 212. 2. Дидина Н. М., Ефимочкина В.И. Структура заболеваний сердца у беременных в современных условиях. Сб. науч. трудов «Эктрагенитальная патология и беременность».М. 1996; 26-29. 3. Егорян Д.С. Оптимизация подходов к ведению беременных, страдающих врожденными пороками сердца. Автореф. дис. канд.мед. наук. Ростов-на-Дону. 2006; 22. 4. Макацария А.Д., Беленков Ю.Н., Бейлин А.Л. Беременность и врожденные пороки сердца. М.: Руссо. 2001; 305. 5. Lieber S. et al. Eisenmengers syndrome and pregnancy. Acta Сardiol. 2003; 40: 421-424. 6. Затикян Е.П. Оценка нарушений гемодинамики у беременных и родильниц с врожденными пороками сердца. Акуш. и гин. 1998; 4: 64-66. 7. Алексеева Л. Л. Особенности адаптации кардиореспираторной системы у беременных низкого акушерского риска. Дис. канд. мед. наук. Иркутск. 2004; 190. 8. Елисеев О.М. Сердечно-сосудистые заболевания у беременных. М.: Медицина. 1994; 246. 9. Жигунова И.А. Оценка неспецифических адаптационных механизмов у женщин в III триместре беременности. Автореф. дис.канд. мед. наук. Рязань. 2002; 15. 10. Затикян Е.П. Врожденные и приобретенные пороки сердца у беременных. М.: Триада-Х. 2004; 294. 11. Гриффин Б., Тополь Э. Кардиология. М.:Практика. 2008; 673. 12. Кулавский В.А., Огий Т.И. Физиология и патология сердца у беременных. Уфа. 2000; 198. 13. Тетелютина Ф.К. Прогнозирование, доклиническая диагностика и профилактика перинатальной патологии у беременных с пороками сердца. Дис. Д-ра мед. наук (Казанская государственная медицинская академия). 2002; 176.
Abstract: Aim: was to estimate possibilities of two-dimensional and three-dimensional transesophageal echocardiography (TEE) in the diagnosis of atrial septal defects (ASD). Material and methods: 52 patients with atrial septal defect underwent TEE. In 32 cases - 3D TEE, 20-2D TEE. 44 patients further underwent endovascular closure of ASD, 8 underwent cardiac surgical correction of ASD with extracorporeal circulation. Results: 3D TEE allows to make more accurately and correctly measure of ASD, to determine its location, shape, and number of defects and to quantify all edges, including top, and to measure the length of the partition in three standard areas and additional-caval from lower to upper edge. Conclusions: 3D TEE gives the most correct estimation of localization, shape and size of the defect, as well as contributes the proper determination of the optimal tactics of surgical correction of the defect. References 1. Tkachev I.V., Kondrabulatova S.S., Tarasov D.S. Rol' trehmernoj jehokardiografii v predoperacionnoj ocenke defektov mezhpredserdnoj peregorodki[The role of 3D echocardiography in preoperative estimation of atrial septal defects] Patologija krovoobrashhenija i kardiohirurgija. 2014; 1:58-61 [In Russ]. 2. Klinicheskaja kardiologija: diagnostika i lechenie v treh tomah [Clinical cardiology: diagnostics and treatment in 3 volumes. Under edition of L.A. Bokeria, E.Z.Golukhov]. T 1. ( pod redakciej L.A. Bokerija., E.Z. Goluhova) M.: NCSSH im. A.N. Bakuleva RAMN. 2011; 518-52[ In Russ]. 3. Narcyssova G.P., Malahova O.Ju., Osiev A.G. Ul'trazvukovye kriterii otbora pacientov s defektom mezhpredserdnoj peregorodki na jendovaskuljarnuju korrekciju sistemoj AMPLATZER i ocenku rezul'tatov - medicinskaja tehnologija. [Ultrasound criteria for selection of patients with atrial septal defect for endovascular correction with AMPLATZER system and the evaluation of results.] Novosibirsk. 2012; 10-11 [In Russ] 4. Prakticheskaja jehokardiografija[Practical echocardiography (under edition Frank A. Flaksamph, translation from 5. Tkacheva A.V. Diagnostika i jendovaskuljarnoe zakrytie vtorichnogo defekta mezhpredserdnoj peregorodki ustrojstvom «AMPLATZER» [Diagnosis and endovascular closure of secondary atrial septal defect with «AMPLATZER» device] Avtoreferat. Diss. kand. med. nauk. M. 2008; 24 [In Russ].
