Abstract: Introduction: left atrial (LA) volumes measured during different phases of the cardiac cycle can be used for the evaluation of the LA functional properties before and after catheter ablation (CA). Increase of LA ejection fraction (EF) supposed to be early and more sensitive marker of LA reverse remodeling process, than LA volume and can be important for assessing the effectiveness of CA. Aim: was to estimate volumetric parameters and function of LV before and after cryo- and radiofrequency catheter ablation of pulmonary veins in patients with paroxysmal atrial fibrillation. Materials and methods: 21 patients with paroxysmal atrial fibrillation (AF) were included in study. All patients underwent multidetector computed tomography (MDCT) of pulmonary veins (PV) and LA before CA and 12±2 months after CA. 3-dimensional images at phases 0%, 40%, 75% of the cardiac cycle were used to assess LA functional properties. Results: LA maximal volume before CA was increased insignificantly in patients with AF recurrence (124,52±38,22 ml vs. 117,89±23,94 ml, p>0,05). In patients without recurrence after CA, LA volumes decreased slightly (LA max 115,31±20,13 ml, p>0,05, LA min 73,43±14,91 ml, p>0,05), while in patients with recurrence increased (LA max 130,88±25,20 ml, p<0,05, LA min to 94,92±31,75 ml, p<0,05). Global LA ejection fraction was less in patients without recurrence before CA (22,37%±4,69 vs. 31,31%±9,89, p=0,013), but increased significantly after CA, while in patients with recurrence global LA EF was without relevant changes (36,54%±3,27 vs. 28,89%±9,41, p=0,011). Conclusion: improved left atrial mechanical function was demonstrated in patients without any recurrence after ablation. The anatomic and functional reverse remodeling was not significant in patients with atrial fibrillation recurrence.
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Abstract: Arm. In order to improve the quality of severe pelvis fractures' diagnostics, detection of pelvic organs' lesion, preoperative examination and monitoring of treatment, we have made a retrospective analysis of radiological data of 70 patients (46 males, 24 females) aged between 24 and 54 years who were treated in emergency departments of hospital. Results. The diagnostic efficiency of X-rays for injuries of the pelvis in case of lesions of the acetabulum is less than MDCT (specificity - 70.4%, accuracy - 61.3%, sensitivity - 56.3%). At the same time, traditional X-rays should only be used to diagnose fractures without displacement and for the control of metal after the surgery It is established that multidetector CT is the method of choice and the first stage in the diagnosis of associated injuries and hidden pelvic fractures, and has the best indicators of diagnostic value (specificity - 69% accuracy - 95% predictive of a positive result - 90%). Conclusion. It was established that radiography is a method of screening and monitoring of treatment in patients with injuries of the pelvic ring and acetabulum, and in the first place during the provision of urgent specialist care. However, existing X-ray examination methods are not sufficiently informative, particularly in the diagnosis of posterior half-ring damage and hip; early and complete radiodiagnostics of pelvic and intrapelvic organs' injures is the leader in terms of examination of patients. A differentiated approach to the assessment of individual semiotic signs of pelvic fractures with MSCT improves informative value not only from the standpoint of initial diagnostics, but also helps to predict possible complications. References 1. Gumanenko E.K., Shapovalov V. M., Dulaev A.K., Dudykin A.V. Sovremennye podhody k lecheniju postradavshih s nestabil'nymi povrezhdenijami tazovogo kol'ca. [Current approaches to the treatment of patients with unstable pelvic ring injuries] Voenno-med. zhurnal. 2003; 4: 17. [In Russ]. 2. Ratnikov V.A. SYNGO-MR-tehnologija: metodika i vozmozhnosti vizualizacii organov brjushnoj polo- sti i taza na vysokopol'nom (1,5 T) magnitnom tomografe «MAGNETOM SYMPHONY» [SYNGO- MR-Technology: methodology and visualization of the abdomen and pelvis in the 1.5 T magnetic tomography «MAGNETOM SYMPHONY»]. ( V.A. Ratnikov, G.E. Trufanov, S.V. Serebrjakova). Materialy Nevskogo radiologicheskogo foruma «Iz buduwego v nastojawee». SPb, 2003; 343 [In Russ]. 3. Balogh Z., Voros E., Suveges G. Stent graft treatment of an external iliac artery injury associated with pelvic fracture. A case report. J. Borne Joint Surg. Am. 2003; 5: 919-922. 4. Serebrjakova S.V. Spiral'naja komp'juternaja tomografija v diagnostike povrezhdenij vertluzhnoj vpadiny (S.V. Serebrjakova, V. M. Cheremisin, O. F. Pozdnjakova) [Spiral computed tomography in the diagnosis of acetabulum lesions]. Materialy Nevskogo radiologicheskogo foruma «Iz buduwego v nastojawee». SPb, 2003; 113-115 [In Russ]. 5. Djatlov M. M. Luchevaja diagnostika povrezhdenij tazovogo kol'ca v ostrom periode perelomov vert- luzhnoj vpadiny. [Radiological diagnosis of pelvic ring injuries in acute acetabular fractures]. Ortop., travm im Priorova 2003; 3: 72-74 [In Russ]. 6. Miller P. R, Moore P. S., Mansell E., Meredith J. W. С External fixation or arteriogram in bleeding pelvic fracture: initial therapy guided by. Clin. Imaging. 2003; 18(4): 533-536. 7. Loberant N., Goldfeld M. A pitfall in triple contrast CT of penetrating trauma of the flank. Clin. Imaging. 2003; 27(5): 351-352. 8. Tile M. Fracture of pelvis. The Rationale of operative Fracture Care. Spinger Verlag. 1987: 441.
