Article exists only in Russian.

Abstract:

Background: clinical case of a rarely encountered pathology (0.1-3.5%) in cardiac surgery, such as the aneurysm of the left coronary artery (LCA), is presented. It was detected and analyzed by coronary angiography and coronary CT angiography

Aim: was to show possibilities of radiation research methods in identifying and evaluating of coronary artery aneurysms.

Materials and methods: a 67-year-old patient was referred to the Federation National Center of Cardiovascular Surgery (Penza) for follow-up examination (coronary angiography) and to decide on the choice of management due to the presence of critical aortic valve stenosis. Performed coronary angiography and subsequent coronary CT angiography for demonstrate the topography of the aneurysm.

Results: according to the data of coronary angiography at the region of trifurcation of the LCA or the anterior descending artery, intermediate and circumflex arteries a large-sized aneurysm is visualized. Due to coronary CT angiography data, the one is located at a distance of 1.0 cm from the entrance of the LCA in the area of trifurcation. It's presented by an aneurysmal dilatation of a rounded shape 1.3 cm in diameter with locally calcific walls.

Conclusion: coronary angiography and coronary CT angiography made it possible to identify anc examine individual morphological features of the anatomy of the coronary artery aneurysm, as well as demonstrate and take apart its topography to clearly, which in turn made it possible to rationally determine the management of the patient.

References

1.      Markis JE, Joffe CD, Cohn PF. et al. Clinical significance of coronary arterial ectasia. Am. J. Cardiol. 1976; 37 (2): 217-222.

2.      Newburger JW, Takahashi M, Gerber MA. et al. Diagnosis, treatment, and longterm management of Kawasaki disease: a statement for health profes sionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Pediatrics. 2004; 114(6): 1708-1733.

3.      Pahlavan PS, Niroomand F. Coronary artery aneurysm: a review. Clin. Cardiol. 2006; 29 (10): 439-443.

4.      Swaye PS, Fisher LD, Litwin P. et al. Aneurysmal coronary artery disease. Circulation. 1983; 67(1): 134-138.

5.      Japanese Ministry of Health and Welfare, Research Committee on Kawasaki Disease. Report of Subcommittee on Standardization of Diagnostic Criteria and Reporting of Coronary Artery Lesions in Kawasaki Disease. Tokyo, Japan: Japanese Ministry of Health and Welfare, 1984.

6.      Hartnell GG, Parnell BM, Pridie RB. Coronary artery ectasia. It’s prevalence and clinical significance in 4,993 patients. Br. Heart J. 1985; 54 (4): 392-395.

7.      Morgagni JB. The seats and causes of diseases investigated by anatomy. Italy: Ex typographia Remondiniana. Venice. 1761. Epis 27. Art 28.

8.      Falsetti HL, Carrol RJ. Coronary artery aneurysm: a review of the literature with a report of 11 new cases. Chest. 1976; 69(5): 630-636.

9.      Aqel RA, Zoghbi GJ, Iskandrian A. Spontaneous coronary artery dissection, aneurysms, and pseudoaneurysms: a review. Echocardiography. 2004; 21(2): 175182.

10.    Jha NK, Ouda HZ, Khan JA. et al. Giant right coronary artery aneurysm - case report and literature review. J. Cardiothorac. Surg. 2009; 4: 18.

11.    Alcock R, Naoum C, Ng A.C. Giant right coronary aneurysm: a case of mistaken identity. Eur. Heart J. 2011; 32: 2712.

12.    Topaz O, Rutherford MS., Mackey-Bojack S. et al. Giant aneurysms of coronary arteries and saphenous vein grafts: angiographic findings and histopathological correlates. Cardiovasc. Pathol. 2005; 14: 298-302.

13.    Kato H, Sugimura T, Akagi T. et al. Long-term consequences of Kawasaki disease: a 10- to 21-year follow-up study of 594 patients. Circulation. 1996; 94: 1379-1385.

14.    Williams MJ, Stewart RA. Coronary artery ectasia: local pathology or diffuse disease? Cathet. Cardiovasc. Diagn. 1994; 33(2): 116-119.

15.    Cohen P, O’Gara PT. Coronary artery aneurysms. A review of the natural history, pathophysiology, and management. Cardiol. Rev. 2008; 16(6): 301-304.

16.    Doustkami H, Maleki N, Tavosi Z. Left main coronary artery aneurysm. J. Tehran. Heart Cent. 2016; 11(1): 41-45.

17.    Li D, Wu Q, Sun L. et al. Surgical treatment of giant coronary artery aneurysm. J. Thorac. Cardiovasc. Surg. 2005; 130 (3): 817-821.

18.    Baman TS., Cole JH, Devireddy CM. Risk factors and outcomes in patients with coronary artery aneurysms. Am. J. Cardiol. 2004; 93: 1549-1551.

19.    Alfonso F, Perez-Vizcayno MJ, Ruiz M. et al. Coronary aneurysms after drug-eluting stent implantation: clinical, angiographic, and intravascular ultrasound findings. J. Am. Coll. Cardiol. 2009; 53: 2053-2060.

20.    Slota PA, Fischmann DL, Savage MP, et al. Frequency and outcome of development of coronary artery aneurysm after intracoronary stent placement and angioplasty. Am. J. Cardiol. 1997; 79:1104-1106.

21.    Senzaki H. The pathophysiology of coronary artery aneurysms in Kawasaki disease: role of matrix metalloproteinases. Arch. Dis. Child. 2006; 91 (10): 847-851.

22.    Sharma BK, Jain S, Suri S. et al. Diagnostic criteria for Takayasu arteritis. Int. J. Cardiol. 1996; 54: 141-147.

23.    Hsi DH, Ryan GF, Hellems SO. et al. Large aneurysms of the ascending aorta and major coronary arteries in a patient with hereditary hemorrhagic telangiectasia. Mayo. Clin. Proc. 2003; 78 (6): 774-776.

24.    Onoda K, Tanaka K, Yuasa U. et al. Coronary artery aneurysm in a patient with Marfan syndrome. Ann. Thorac. Surg. 2001; 72 (4): 1374-1377.

25.    Hisham MF. Sherif, Ray A. Blackwell. Successful Coronary Artery Bypass in Ehlers-Danlos Type IV Syndrome Case Report and Review of the Literature. Tex. Heart. Inst. J. 2012; 39 (5): 699-702.

26.    Davis GG, Swalwell CI. Acute aortic dissections and ruptured berry aneurysms associated with methamphetamine abuse. J. Forensic. Sci. 1994; 39 (6): 1481-1485.

27.    Villines TC, Avedissian LS, Elgin EE. Diffuse non-atherosclerotic coronary aneurysms. Cardiol. Rev. 2005; 13: 309-311.

28.    Nazareth J, Weinberg L, Fernandes J, et al. Giant right coronary artery aneurysm presenting with non-ST elevation myocardial infarction and severe mitral regurgitation: a case report. J. Med. Case Rep. 2011; 5: 442.

29.    Manginas A, Cokkinos DV. Coronary artery ectasias: imaging, functional assessment and clinical implications. Eur. Heart J. 2006; 27 (9): 1026-1031.

30.    Sokmen G, Tuncer C, Sokmen A. et al. Clinical and angiographic features of large left main coronary artery aneurysms. Int. J. Cardiol. 2008; 123 (2): 79-83.

31.    Topaz O, DiSciascio G, Cowley MJ. et al. Angiographic features of left main coronary artery aneurysms. Am. J. Cardiol. 1991; 67 (13): 1139-1142.

32.    Mata KM, Fernandes CR, Floriano EM. et al. Coronary artery aneurysms: an update. Novel Strategies in Ischemic Heart Disease. Rijeka, Croatia: In. Tech. 2012; 381-404.

33.    Tunick PA, Slater J, Kronzon I. et al. Discrete atherosclerotic coronary artery aneurysms: a study of 20 patients. J. Am. Coll. Cardiol. 1990; 15: 279-282.

34.    Bhindi R, Testa L, Ormerod OJ, Banning A.P. Rapidly evolving giant coronary aneurysm. J. Am. Coll. Cardiol. 2009; 53 (4): 372.

35.    Chia HM, Tan KH, Jackson G. Non-atherosclerotic coronary artery aneurysms: two case reports. Heart. 1997; 78 (6): 613-616.

36.    LaMotte LC, Mathur VS. Atherosclerotic coronary artery aneurysms: 8-year angiographic follow-up. Tex. Heart Inst. J. 2000; 27 (1): 72-73.

37.    Kim WY, Danias PG, Stuber M, et al. Coronary magnetic resonance angiography for the detection of coronary stenoses. N. Engl. J. Med. 2001; 345 (26): 1863-1869.

38.    Mavrogeni S, Markousis-Mavrogenis G., Kolovou G. Contribution of cardiovascular magnetic resonance in the evaluation of coronary arteries. World J. Cardiol. 2014; 6 (10): 1060-1066.

Abstract:

Aim: was to establish methods of coronary artery bypass graft (CABG) with use of internal thoracic artery (ITA), that influenced high risk of continued diaphragmatic dysfunction in early post-operative period, on the base of analysis of dynamics of diaphragmatic dysfunction after operation.

Materials and methods: the retrospective study included 880 patients in the early period after CABG with use of ITA. The mobility of diaphragm domes was estimated on 2,8±0,88 day after the surgery, when transferred from the intensive care unit to the in-patient department and again on 7,7±1,9 day when transferred to the rehabilitation department. Patients were divided into 3 groups. The first group with normal diaphragm mobility with an initial study of 529(60,1%) patients. The second group with diaphragmatic dysfunction in the initial study and the restored mobility of the diaphragm in a re-examination of 249(28,3%) patients. The third group with diaphragmatic dysfunction, which persists in the re-examination of 102(11,6%) patients. The criterion for diaphragmatic dysfunction was the amplitude of the diaphragm's movement ess than 10 mm. Using the model of logistic regression, the influence of the CABG methods on the probability of maintaining diaphragmatic dysfunction at the end of the early postoperative period was determined. Two CABG methods were included in the model: «in situ» and autograft.

Results: in the primary study, 39,9% of patients had diaphragmatic dysfunction, 21,1% left-sided, 8,0% right-sided, and 10,8% bilateral. The prevalence of diaphragmatic dysfunction during the early postoperative period decreases threefold, from 39,9% to 11,5%, and was persisted more often as a unilateral lesion: left-sided in 7,2% of patients or right-sided in 3,4%, Less often, bilateral dysfunction persists in 0,9% of patients. Restoration of the function of the diaphragm during repeated examination was observed in 71,2% of cases of initial dysfunction. A different effect was established on the persistence of unilateral and bilateral diaphragmatic dysfunction by the end of the early postoperative period, depending on methods of CABG with use of ITA and their combination. High likelihood conservation diaphragmatic dysfunction by the right harvest of ITA was observed after bypass «in situ» (OR 4.4; CI 2,2-8,9) and by the harvest of ITA left after bypass graft (OR 4.1; CI 1,6-10,6). Other methods of grafting either did not have an effect on the preservation of dysfunction on the part of the ITA harvest, or the effect was traced, but was statistically insignificant.

Conclusion: dysfunction of the diaphragm acquired after CABG with use of ITA is reversible. During the early postoperative period, 71,2% of patients undergo full restoration of diaphragm mobility, the prevalence of diaphragmatic dysfunction decreases three-fold, the frequency of bilateral diaphragm dysfunction decreases by 10 times. Methods of CABG with use of ITA, «insitu» and autograft, affect the likelihood of the dysfunction of the diaphragm retained during the early postoperative period by surgical manipulation. Results of the study indicate that chances of maintaining diaphragmatic dysfunction were 4,4 times higher by grafting the right ITA «in .situ» and 4,1 times by grafting the left ITA with a graft. While the likelihood of maintaining diaphragmatic dysfunction was low by grafting the right ITA with a graft and was absent from the grafting of the left ITA «in situ».

References

1.      Paramonova T.I., Vdovkin A.V., Pal'kova V.A. Factors, influencing the development of diaphragmatic dysfunction in the early postoperative period after cardiac surgery. Diagnosticheskaya I interventsionnaya radiologia. 2016; 10(2):11-16.

2.      Canbaz S, Turgut N, Halici U, et al. Electrophysiological evaluation of phrenic nerve in-jury during cardiac surgery - a prospective, controlled, clinical study. BMC Surgery. 2004, 4:2

3.      Deng Y Byth K, Paterson HS. Phrenic nerve injury associated with high free right internal mammary artery harvesting. Ann Thorac Surg. 2003; 76(2):459-463

4.      Bazylev V.V., Paramonova T.I., Vdovkin A.V., i soavt. Ocenka faktorov, vliyayushchih na razvitie dispnoeh v rannem posleoperacionnom periode posle kardiohirurgicheskih vmeshatel'stv. [Factors affecting the development of dyspnea in the early postoperative period after cardiac surgery] Diagnosticheskaya i intervencionnaya radiologiya. 2016; 10(4):19-27.

5.      Bonacchi M, Prifti E, Giunti G, et al. Respiratory dysfunction after coronary artery bypass grafting employing bilateral internal mammary arteries: the influence of intact pleura. Eur J Cardiothorac Surg. 2001; 19:827-833.

6.      Matsumoto M., Konishi Y, Miwa S., et al. Effect of different methods of internal thoracic artery harvest on pulmonary function. Ann Thorac Surg. 1997; 63: 653-655.

7.      Uzun K, Kara H, Ugurlu D. The Effects Of Internal Mammary Artery Harvesting Techniques On Pulmonary Functions. Ko§uyolu Kalp Dergisi. 2011; 14(3):76-78.

8.      Diehl JL, Lofaso F, Deleuze P, et al. Clinically relevant diaphragmatic dysfunction after cardiac operations. J Thorac Cardiovasc Surg. 1994; 107:487-498

9.      Bazylev V.V., Paramonova T.I., Vdovkin A.V. Analiz polozheniya i podvizhnosti diafragmy u vzroslyh s normal'noj funkciej legkih do i posle kardiohirurgicheskih operacij. [Analysis of position and mobility of the diaphragm in adults with normal lung function before and after cardiac surgery.] Luchevaya diagnostika i terapiya. 2017;(1):53-63.

10.    Davison A., Mulvey D. Idiopathic diaphragmatic weakness. BMJ 1992; 304:492-494

11.    McCool F.D., McCool G.E. Dysfunction of the Diaphragm. N Engl J Med. 2012; 366:932-942

12.    Kim WY Suh HJ, Hong SB, et al. Diaphragm dysfunction assessed by ultrasonography: Influence on weaning from mechanical ventilation. Critical Care Medicine. 2011; 12:2627-2630.

13.    Bazylev V.V., Nemchenko E.V., Karnahin V.A., i soavt. Floumetricheskaya ocenka koronarnyh shuntov v usloviyah iskusstvennogo krovoobrashcheniya i na rabotayushchem serdce. [Flowmetric estimation of coronary grafts in conditions of extracorporeal circulation and on a working heart.] Angiologiya i sosudistaya hirurgiya. 2016; 22(1):67-72.

14.    Rankin JS, Tuttle RH, Wechsler AS. et al. Techniques and benefit of multiple internal mammary artery bypass at 20 year of follow up. Ann Thorac Surg. 2007; 83:1008-1015.

15.    Buxton BF, Tatoulis J, Fuller JA. The right internal thoracic artery: the forgotten conduit - 5,766 patients and 991 angiograms. The Annals of Cardiothoracic Surgery. 2011; 92: 9-17.

16.    Lytle BW, Blackstone EH, Sabik JF. et al. The effect of bilateral internal thoracic artery grafting on survival during 20 postoperative years. Ann Thorac Surg 2004;78(6):2005-2014.

17.    Tripp HF., Sees DW, Lisagor P.G, et al. Is phrenic nerve dysfunction after cardiac surgery related to internal mammary harvesting? J Card Surg. 2001, 16(3):228-231

18.    Calafiore AM, Di Giammarco G., Teodori G, et al. Bilateral internal thoracic artery grafting with and without cardiopulmonary bypass: six-year clinical outcome. J Thorac Cardiovasc Surg. 2005; 130(2):340—345.

19.    Cygel'nikov S.A. Vnutrennyaya grudnaya arteriya v hirurgicheskom lechenii ishemicheskoj bolezni serdca: varianty i taktika ispol'zovaniya, rezul'taty. [Internal thoracic artery in the surgical treatment of ischemic heart disease: options and tactics of use, results.] Avtoreferat Dis. dok. med. nauk. M., 2010; 49.

20.    Buxton BF, Ruengskulrach P, Fuller J, et al. The right internal thoracic artery graft - benefits of grafting the left coronary system and native vessels with a high-grade stenosis. The European Journal of Cardio-Thoracic Surgery. 2000; 18:255-261.

21.    Bazylev V.V., Nemchenko E.V., Pavlov A.A., i soavt. Sravnitel'nye rezul'taty revaskulyarizacii bassejna pravoj koronarnoj arterii s ispol'zovaniem bimammarnogo Y- grafta i autoveny. [Comparative results of revascularization of right coronary artery basin using bimammary Y-graft and autovein.] Grudnaya i serdechno-sosudistaya hirurgiya. 2014; 5:11-18.

22.    Vecherskij YU.YU., Andreev S.L., Zatolokin V.V. Taktika ispol'zovaniya pravoj vnutrennej grudnoj arterii «in situ» pri koronarnom shuntirovanii. [Tactics of using the right internal thoracic artery «in situ» in CABG surgery.] Angiologiya isosudistaya hirurgiya. 2015; 1(21):148-154.

23.    O'Brien JW, Johnson SH, VanSteyn SJ, et al. Effects of internal mammary artery dissection on phrenic nerve perfusion and function. Ann Thorac Surg. 1991; 52: 182-188.

24.    Sharma AD, Parmley CL, Sreeram G, et al. Peripheral nerve injuries during cardiac surgery: risk factors, diagnosis, prognosis, and prevention. Anesth Analg. 2000; 91(6):1358

25.    Wilcox PG, Pardy RL. Diaphragmatic weakness and paralysis. Lung. 1989; 167:323-341

26.    Buxton BF, Hayward PA. The art of arterial revascularization - total arterial revascularization in patients with triple vessel coronary artery disease. The Annals of Cardiothoracic Surgery. 2013; 2: 543-551.

27.    Paterson HS, Naidoo R., Byth K, et al. Full myocardial revascularization with bilateral internal mammary artery Y grafts. The Annals of Cardiothoracic Surgery. 2013; 2: 444-452.

28.    Akchurin R. S., Shiryaev A. A., Brand YA. B., i soavt. Hirurgiya koronarnyh arterij - krajnosti i algoritmy revaskulyarizacii. [Surgery of coronary arteries - extremes and algorithms of revascularization.] Grudnaya i serdechno-sosudistaya hirurgiya. 2001; 2:13-17

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

1.      Salem M. A.; Abd El-Razek M. A.; Bassiouny M. I. et al. Diagnostic Value of Cardiac MRI in Aortic Valve Stenosis in Comparison with Echocardiography. Med J Cairo Univ., 2016; 84 (2):271-278.

2.      Sondergaard L., Hildebrandt P., Lindvig K., et al. Quantification by magnetic resonance velocity mapping. Am Heart J., 1993; 26(5):156-1164.

3.      Bellenger N.G., Burgess M.I., Ray S.G. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionucleide ventriculography and cardiovascular magnetic resonance. Are they interchangeable?. Eur Heart J., 2000; 21:1387-1396.

4.      Bellenger N.G., Francis J.M., Davies L.C. et al. Establishment and performance of a magnetic resonance cardiac function clinic. J Cardiovasc Magn Reson. 1999; 1(4):323-330.

5.      Bernard Y, Meneveau N., Boucher S. et al. Lack of agreement between left ventricular volumes and ejection fraction determined by two-dimensional echocardiography and contrast cineangiography in postinfarction patients. Echocardiography. 2001;18:113-122.

6.      Darasz K.H., Underwood S.R., Bayliss J. et al. Measurement of left ventricular volume after anterior myocardial infarction: comparison of magnetic resonance imaging, echocardiography, and radionuclide ventriculography. The Int J of Cardiovasc Imaging. 2002;18(2):135-142.

7.      Gardner B., Bingham S., Allen M. et al. Cardiac magnetic resonance versus transthoracic echocardiography for the assessment of cardiac volumes and regional function after myocardial infarction: an intrasubject comparison using simultaneous intrasubject recordings. The J of Cardiovasc ultrasound. 2009;7:38-44.

8.      Li C., Lossnitzer D., Katus H.A. et al. Comparison of left ventricular volumes and ejection fraction by monoplane cineventriculography, unenhanced echocardiography and cardiac magnetic resonance imaging. Int J Cardiovasc Imaging. 2012; 28(5):1003-1010.

9.      Malm S., Frigstad S., Sagberg E.; et al. Accurate and reproducible measurement of left ventricular volume and ejection fraction by contrast echocardiography a comparison with magnetic resonance imaging. J Am Coll Cardiol. 2004; 44(5):1030-1035.

10.    Ozaki S. Pathophysiology of calcification of bioprosthetic heart valves: an experimental investigation. LeuvenUniversity Press. 2001;238.

11.    Ozaki S., KawaseI., Yamashita H., et al. A total of 404 cases of aortic valve reconstruction with glutaraldehyde-treated autologous pericardium. J. Thora Cardiovasc Surg. 2014; 147(1):301-306.

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].

13.    Ozaki S., Kawase I., Yamashita H., et al. Aortic Valve Reconstruction Using Autologous Pericardium for Aortic Stenosis. Circ J. 2015; 79(7):1504-1510.

14.    Izgi C. MRI evaluation of aortic stenosis: flow evaluation. https://www.escardio.org/Education/PracticeTools/ EACVI-toolboxes/Valvular-Imaging/Atlas-of-valvular-imaging/Aortic-stenosis/MRI-evaluation-of-aortic- stenosis-flow-evaluation

15.    La Manna A., Sanfilippo A., Capodanno D. et al. Cardiovascular magnetic resonance for the assessment of patients undergoing transcatheter aortic valve implantation: a pilot study. J Cardiovasc Magn Reson. 2011;13: 82-90.

16.    Rajani R., Hancock J., Chambers J.B. The art of assessing aortic stenosis. Heart. 2012;98(4):14-22.

17.    Oosterhof T, Mulder B.J.M., Vliegen H.W. et al. Cardiovascular magnetic resonance in the follow-up of patients with corrected tetralogy of Fallot. American Heart J. 2006;151:265-272.

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.

References

1.     Albarran J. Retention renale par periureterite. Liberation externe de l’uretrne. Assoc. Fr. Urol. 1905; 9: 511-517.

2.     Ormond J.K. Bilateral ureteral obstruction due to envelopment and compression by an inflammatory retroperitoneal process. J. Urol. 1948; 59: 1072-1079.

3.     Kottra J.J., Dunnick N.R. Retroperitoneal fibrosis. Radiol. Clin. North. Am. 1996; 34(6): 1259-75.

4.     McDougal W.S., MacDonell R.C. Treatment of idiopathic retroperitoneal fibrosis by immunosuppression. J. Urol. 1991; 145(1): 112-4.

5.     Dedeoglu F. et al. Successful treatment of retroperitoneal fibrosis with tamoxifen in a child. J. Rheumatol. 2001; 28(7): 1693-5.

6.     Keith D.S., Larson T.S. Idiopathic retroperitoneal fibrosis. J. Am. Soc. Nephrol. 1993; 3: 1748-52.

7.     Jones J.H. et al. Retroperitoneal fibrosis. Am. J. Med. 1970; 48: 203-8.

8.     Vaglio A. et al. Evidence of autoimmunity in chronic periaortitis: a prospective study. Am. J. Med. 2003; 114:.454-462.

9.     Katz S.M. et al. Immune complex glomerulonephritis in a case of retroperitoneal fibrosis. Am. J. Clin. Pathol. 1977; 67(5): 436-9.

10.   Parums DV, et al. Serum antibodies to oxidized low-density lipoprotein and ceroid in chronic periaortitis. Arch. Pathol. Lab. Med. 1990; 114(4): 383-7.

11.   Neild G.H. et al. Hyper-IgG4 disease: report and characterisation of a new disease. BMC Med. 2006; 4: 23.

12.   Pryor J.P. et al. Do beta-adrenoceptor blocking drugs cause retroperitoneal fibrosis? Br. Med. J. 1983; 287: 639-641.

13.   Higgins P.M., Aber G.M. Idiopathic retroperitoneal fibrosis - an update. Dig Dis. 1990; 8(4): 206-22.

14.   Uibu T. et al. Asbestos exposure as a risk factor for retroperitoneal fibrosis. Lancet. 2004; 363(9419): 1422-6.

15.   Katz R. et al. Primary and postoperative retroperitoneal fibrosis? experience with 18 cases. Urology. 2002; 60: 780-783.

16.   Mitchinson M.J. Chronic periaortitis and periarteritis. Histopathology. 1984; 8(4): 589-600.

17.   Parums D.V. The spectrum of chronic periaortitis. Histopathology. 1990; 16: 423-31.

18.   Lepor H., Walsh P.C. Idiopathic retroperitoneal fibrosis.J. Urol. 1979; 122(1): 1-6.

19.   Vaglio A. et al. Retroperitoneal fibrosis: evolving concepts. Rheum. Dis. Clin. North. Am. 2007; 33(4): 803-17.

20.   Moussavian B., Horrow M.M. Retroperitoneal fibrosis. Ultrasound Q. 2009; 25(2): 89-91.

21.   Arrive L. et al. Malignant versus nonmalignant retroperitoneal fibrosis: differentiation with MR imaging. Radiology. 1989; 172 (1): 139-43.

22.   Mikhaylov S.Kh. Retroperitoneal'nyy fibrozbolezn’ Ormonda. Avtoreferat....kand. med. nauk, Moskva.1981: 19 [In Russ].

23.   Inaraja L. et al. CT findings in circumscribed upper abdominal idiopathic retroperitoneal fibrosis. J. Comput. Assist. Tomogr. 1986; 10 (6): 1063-4.

24.   Hulnick D.H. et al. Retroperitoneal fibrosis presenting as colonic dysfunction: CT diagnosis. J. Comput. Assist. Tomogr. 1988; 12 (1):159-61.

25.   Khan A.N. et al. Retroperitoneal Fibrosis. 2004. http://emedicine.medscape.com/article/380772-overview.

26.   Dixon A.K. et al. Computed tomographic observations in periaortitis: a hypothesis. Clin. Radiol. 1984; 35(1):39-42.

27.   Ozgen A., Cila A. Renal involvement in multifocal fibrosclerosis: CT and MRI. J. Comput Assist Tomogr. 1999; 23(6): 937-8.

28.   Ayuso J.R. et al. Atypical retroperitoneal fibrosis: MRI findings. Eur. Radiol. 1999; 9(5): 937-9.

29.   Elsayes K.M. et al. Retroperitoneal masses: magnetic resonance imaging findings with pathologic correlation. Curr. Probl. Diagn. Radiol. 2007; 36(3): 97--106.

Abstract:

Aim: was to reveal factors, influencing high cnance of dysfuntion of diaphragm domes in further patient examination by estimation of dynamics of acqired diaphragmatic dysfunction after different cardiac surgical interventions.

Material and methods: research included 642 patients after different cardiac surgical interventions. We estimated mobility of diaphragm domes at the moment of patients discharge from intensive care unit and secondly before transporting to rehabilitation center. All patients were devided into 3 groups. 1st group: patients with normal mobility of diaphragm at initial examination - 395 (61,5%). 2nd group - diaphragmatic dysfunction at initial examination and recovered mobility at further examination - 173 patients (26,9%). 3rd group - patients with diaphragmatic dysfunction at both stages of examination - 74 (11,5%). Criteria for diaphragmatic dysfunction - mobility amplitude of domes less than 10 mm. We estimated chances of extant dysfunction, under the influence of complex of clinical and surgical factors.

Results: at initial examination diaphragmatic dysfunction was revealed at 38,5%, left dome - 18,2%, right dome - 10,3%, bilateral dysfunction - 10,0%. At further examination diaphragmatic dysfunction persisted in 11,5% of patients, left-sided - 7,5%, right-sided - 3,9%, bilateral - in one case. Recovery of diaphragmatic function was achieved in 70% of initial dysfunction. High and statistically significant chances of extant dysfunction were evaluated only in case of unilateral separation of internal thoracic artery (ITA). Other surgical and clinical factors had no statistically sugnificant influence.

Conclusions: aquired diaphragmatic dysfunction after different cardiac surgical interventions ir 70% of cases is reversible. Recovery of diaphragm mobility was full. Prevalence of diaphragmatic dysfunction decreases for 5 days from 38,5% to 11,5% and persists usually unilateral: left-sided - 7,5%, right-sided - 3,9%.

The only statistically significant surgical factor, influencing high risk of appearance and extantion of post-operative domes dysfunction is unilateral separation of ITA. 

References

1.    Bazylev V.V., Paramonova T.I., Vdovkin A.V. Ocenka faktorov, vlijajushhih na razvitie dispnoje v rannem posleoperacionnom periode posle kardiohirurgicheskih vmeshatel'stv. [Factors affecting the development of dyspnea in the early postoperative period after cardiac surgery.] Diagnosticheskaja i intervencionnaja radiologija. 2016;10(4):19-27 [In Russ].

2.    Davison A., Mulvey D. Idiopathic diaphragmatic weakness. BMJ 1992; 304:492-494.

3.    McCool F.D., McCool G.E. Dysfunction of the Diaphragm. N Engl J Med. 2012; 366:932-942.

4.    Canbaz S., Turgut N., Halici U., et al. Electrophysiological evaluation of phrenic nerve injury during cardiac surgery - a prospective, controlled, clinical study. BMC Surgery. 2004, 4:1-5.

5.    Diehl J.L., Lofaso F., Deleuze P., et al. Clinically relevant diaphragmatic dysfunction after cardiac operations. J Thorac Cardiovasc Surg. 1994; 107:487-498.

6.    McCool F.D., Mead J. Dyspnea on immersion: mechanisms in patients with bilateral diaphragm paralysis. Am Rev Respir Dis. 1989; 139:275-276.

7.    Steier J., Jolley C.J., Seymour J., et al. Sleep-disordered breathing in unilateral diaphragm paralysis or severe weakness. Eur Respir J. 2008; 32:1479-1487.

8.    Kim W.Y, Suh H.J., Hong S.B., et al. Diaphragm dysfunction assessed by ultrasonography: Influence on weaning from mechanical ventilation. Critical Care Medicine. 2011;12:2627-2630.

9.    Deng Y, Byth K., Paterson H.S. Phrenic nerve injury associated with high free right internal mammary artery harvesting. Ann Thorac Surg. 2003; 76(2):459-463.

10.  Mazzoni M., Solinas C., Sisillo E., et al. Intraoperative phrenic nerve monitoring in cardiac surgery. Chest. 1996; 109(6):1455-1460.

11.  Tripp H.F., Sees D.W., Lisagor P.G., et al. Is phrenic nerve dysfunction after cardiac surgery related to internal mammary harvesting? J Card Surg. 2001; 16(3): 228-231.

12.  Metzner A., Rausch P., Lemes C., et al. The incidence of phrenic nerve injury during pulmonary vein isolation using the second-generation 28 mm cryoballoon. J Cardiovasc Electrophysiol. 2014; 25(5):466-470.

13.  Merino-Ramirez M.A., Juan G., Rair^n M., et al. Electrophysiologic evaluation of phrenic nerve and diaphragm function after coronary bypass surgery: prospective study of diabetes and other risk factors. J Thorac Cardiovasc Surg. 2006; 132:530-536.

14.  Paramonova T.I., Vdovkin A.V. Faktory, vlijajushhie na razvitie diafragmal'noj disfunkcii v rannem posleoperacionnom periode posle kardiohirurgicheskih vmeshatel'stv [Factors, influencing the development of diaphragmatic dysfunction in the early postoperative period after cardiac surgery.] Diagnosticheskaja i intervencionnaja radiologija. 2016; 10(2): 11-16 [In Russ].

15.  Chetta A., Rehman A.K., Moxham J., et al. Chest radiography cannot predict diaphragm function. Respir. Med. 2005; 99:39-44.

16.  O'Brien J.W., Johnson S.H., VanSteyn S.J., et al. Effects of internal mammary artery dissection on phrenic nerve perfusion and function. Ann Thorac Surg. 1991; 52: 182-8

17.  Sharma A.D., Parmley C.L., Sreeram G., et al. Peripheral nerve injuries during cardiac surgery: risk factors, diagnosis, prognosis, and prevention. Anesth Analg. 2000; 91(6):13

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.  

References 

1.    Centofanti P, Rosa E.Di., Deorsola L. et al. Primary cardiac tumors: carly and late results of surgical treatment in 91 patients. Ann. Thorac. Surg. 1999; 68(4):1236-1241.

2.    Schaff H.V., Mullany C.J. Surgery for cardiac myxomas. Semin Thorac. Cardiovasc. Surg. 2000; 12:77-88.

3.    Moynihan T. J. Is there such a thing as heart cancer? http: www.mayoclinic.org/heart-cancer/expert-answers/ faq-20058130.

4.    Roberts W.C. Neoplasms involving the heart, their simulators, and adverse consequences of their therapy. Bayl Univ. Med. Cent. 2001; 14:358-376.

5.    Sutsch G., Jenni R., L. von Segesser, Schneider J. Heart tumors: incidence, distribution, diagnosis exemplified by 20,305 echocardiographies. Schweiz. Med. Wochenschr. 1991; 121:621-629.

6.    Goswami K.C., Shrivastava S., Bahl V.K., et al. Cardiac myxomas: clinical and echocardiographic profile intern J. Cardiol. 1998; 63 (3):251-259.

7.    Bogaert J., Dymarkowski S., Taylor A.M. Clinical Cardiac MRI. Springer 2005; 549.

8.    Buckley O., Madan R., Kwong R., et al. Cardiac Masses, Part 1: Imaging Strategies and Technical Consideration. AJR. 2011; 197:837-841.

9.    O’Donnell D.H., Abbara S., Chaithiraphan V., et al. Cardiac Tumors: Optimal Cardiac MR Sequences and Spectrum of Imaging Appearances. AJR. 2009; 193: 377387.

10.  Finn J.P, Nael K., Deshpande V., et al. Cardiac MR imaging: state of the technology. Radiology. 2006; 241:338-354.

11.  Fussen S., De Boeck B.W., Zellweger M.J., et al Cardiovascular magnetic resonance imaging for diagnosis and clinical management of suspected cardiac masses and tumours. Eur. Heart J. 2011; 32(12):1551-1560.

12.  Belenkov Ju.N., Sinicin V.E., Ternovoj S.K. Magnitno-rezonansnaja tomografija serdca i sosudov[MRI of heart and vessels]. Vidar. 1997; 144 р [In Russ].

13.  Bokerija L.A., Malashenkov A.I., Kavsadze V. Je., Serov R.A. Kardioonkologija [Cardiology]. NCSSH im. A.N. Bakuleva RAMN. 2003; 254 р [In Russ].

14.  Burke A., Virmani R. Atlas of Tumor Pathology. Tumors of the Heart and Great Vessels. Armed Forces Institute of Pathology. 1996.

15.  Butany J., Leong S.W., Carmichael K., Komeda M. A 30-year analysis of cardiac neoplasms at autopsy. Can. J. Cardiol. 2005; 21:675-680.

16.  Telen M., Jerbel R., Krejtner K-F., Barkhauzen J. Luchevye metody diagnostiki boleznej serdca [Beam methods of diagnostics of heart diseases]. MEDpress-inform. 2011; 408 р [in Russ].

17.  Hanson E.C. Cardiac tumors: a current perspective. NY State J. Med. 1992; 92:41-42.

18.  Amano J., Kono T., Wada Y, et al. Cardiac myxoma: its origin and tumor characteristics. Ann. Thorac. Cardiovasc. Surg. 2003; 9:215-21.

19.  Araoz PA., Mulvagh S.L., Tazelaar H.D., et al. CT and MR imaging of benign primary cardiac neoplasms with echocardiographic correlation. Radiographics. 2000; 20:1303-19.

20.  Buckley O., Madan R., Kwong R., et al. Cardiac Masses, Part 2: Key Imaging Features for Diagnosis and Surgical Planning. AJR. 2011; 197:842-851.

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. 

References

1.     Angelini P. Normal and anomalous coronary arteries: definitions and classification. Am. Heart J. 1989; 117: 418-434.

2.     Maron B.J. Triggers for sudden cardiac death in the athlete. Cardiol. Clin. 1996; 14: 195-210.

3.     Corrado D., Basso C., Rizzoli G., et al. Does sports activity enhance the risk of sudden death in adolescents and young adults? J. Am. Coll. Cardiol. 2003; 42: 1959-1963.

4.     Jakobs T., Becker C., Ohnesorge B., et al. Multislice helical CT of the heart with retrospective ECG gating: reduction of radiation exposure by ECG-controlled tube current modulation. Eur. Radiol. 2002; 12: 1081-1087.

5.     Wollenek G., Domanig E., Salzer-Muar U., et al. Anomalous origin of the left coronary artery: a review of surgical management in 13 patients. J. Cardiovasc. Surg. 1993; 34: 399-405.

6.     Jurishica A.J. Anomalous left coronary artery; adult type. Am. Heart J. 1957; 54: 429-436.

7.     Kawara T., Tayama E., Hayashida N., et al. Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery: Successful Direct Reimplantation in a 50-year-old Man. Ann.Thorac Cardiovasc Surg. 2003, 9 (3): 197-201.

8.     Williams I.A., Gersony W.M., Hellenbrand W.E. Anomalous right coronary artery arising from the pulmonary artery: a report of 7 cases and a review of the literature. Am. Heart J. 2006; 152(5): 1004-1017.

9.     Maroules C.D., Adams D.Z., Whiting E.D., et al. Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery Evaluation with Use of 64-Slice Multidetector Computed Tomography. Texas Heart Institute Journal. 2013; 40(1): 93-99.

10.   Burakovskij V.I., Sharykin A.S., Garibjan V.A. Anomal'noe othozhdenie pravoj koronarnoj arterii ot legochnoj arterii v sochetanii s defektom mezhzheludochkovoj peregorodki [Anomalous right coronary artery from the pulmonary artery in conjunction with a ventricular septal defect.]. Grudnaja hirurgija. 1981; 2: 1-10 [In Russ].

11.   Burakovskij V.I., Podlozkov V.P., Ragimov F.R. Diagnostika i hirurgicheskoe lechenie defektov aortolegochnoj peregorodki, sochetajushhihsja s drugimi vrozhdennymi porokami serdca [Diagnosis and surgical treatment of defects aorto-pulmonary septum, combined with other congenital heart defects.]. Grudnaja hirurgija. 1982; 6: 13-21 [In Russ].

12.   Kacitadze Z.D. Rezul'taty hirurgicheskogo lechenija anomaij othozhdenija koronarnyh arterij ot legochnoj arterii. Avtoreferat. Diss. kand. med. Nauk [Results of surgical treatment of coronary artery anomalies of divergence from the pulmonary artery.]. M.1998; 28 [In Russ].

13.   Modi H., Ariyachaipanich A., Dia M. Anomalous origin of right coronary artery from pulmonary artery and severe mitral regurgitation due to myxomatous mitral calve disease: a case report and literature review. Journal of Invasive Cardiology. 2010; 2(4): 49-55.

14.   Yao C.T., Wang J.N., Yeh C.N., et al. Isolated anomalous origin of right coronary artery from the main pulmonary artery. Journal of Cardiac Surgery. 2005; 20(5): 487-489.

15.   Angelini P. Coronary artery anomalies-current clinical issues: definitions, classification, incidence, clinical relevance, and treatment guidelines. Tex. Heart Inst. J. 2002; 29: 271-278.

16.   Abbott M.E. Congenital Cardiac disease. Modern Medicine. Philadelphia. 1908.

17.   Abrikossoff A. Aneurysma des linken Herzventrikels mit abnormer Abgangsstelle der linken Koronararterie von der Pulmonalis bei einem funsonatlichen Kinde. Virchows Arch. Pathol. Anat. 1911; 203: 413.

18.   Keith J.D. Diseases of coronary arteries and aorta. in: Keith J.D., Rowe R.D., Vlad P., editors. General cardiac disease. 3rd ed. New York; Macmillan Publishing Co. Inc; 1978.

19.   Bland E.F., White P.D., Garland J. Congenital anomalies of the coronary arteries: report of an unusual case associated with cardiac hypertrophy. Am. Heart J. 1933; 8: 787-801.

20.   Emmanouilides G.C., Riemenschneider T.A., Allen

H.    D., Gutgesell H.P Heart disease in infants, children, and adolescents. 5th edition. Williams and Wilkins (Publishers) Ltd, Baltimore 1995; 776-779.

21.   DeLeval M.R., Yacoub M., Georgakopoulos D.I., et al. Bland-White-Garland Syndrome: Definitive echocardiographic diagnosis of a surgical treatable form of dilatative cardiomyopathy. Hell. J. Cardiol. 1991; 32: 22.

22.   Frescura C., Basso C., Thiene G., et al. Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum. Pathol. 1998; 29: 689-695.

23.   Yau J.M., Singh R., Halpern E.J., Fischman D. Anomalous origin of the left coronary artery from the pulmonary artery in adults: a comprehensive review of 151 adult cases and a new diagnosis in a 53-year-old woman. Clin. Cardiol. 2011; 34: 204-210.

24.   Dodge-Khatami A., Mavroudis C., Backer C.L. Anomalous origin of the left coronary artery from the pulmonary artery: collective review of surgical therapy. Ann. Thorac. Surg. 2002; 74: 946-955.

25.   Brooks H.S.J. Two cases of an abnormal coronary artery of the heart arising from the pulmonary artery: with some remarks upon the effect of this anomaly in producing cirsoid dilatation of the vessels. J. Anat. Physiol. 1885; 20(Pt 1): 26-29.

26.   Mollet N.R., Cademartiri F., van Mieghem C.A., et al. High-resolution spiral computed tomography coronary angiography in patients referred for diagnostic conventional coronary angiography. Circulation. 2005; 112 (5): 2318-2323.

27.   Menahem S., Venables A.W., Anomalous left coronary artery from the pulmonary artery: a 15 year sample. Br. Heart J. 1987; 58: 78-84.

28.   Montaudon M., Latrabe V., Iriart X., et al. Congenital coronary arteries anomalies: Review of the literature and multidetector computed tomography (MDCT)-appearance. Surg. Radiol. Anat. 2007; 29: 343-355.

29.   Brijesh P, Kottayil M., Karunakaran J. et al. Anomalous Origin of Left Coronary Artery From Pulmonary Artery in Older Children and Adults: Direct Aortic Implantation. Ann. Thorac. Surg. 2011; 91: 549-553.

30.   Johnsrude C.L., Perry J.C., Cecchin F. Differentiating anomalous left coronary artery originating from the pulmonary artery in infants from myocarditis and dilated cardiomyopathy by electrocardiogram. Am. J. Cardiol. 1995; 75: 71-79.

31.   King D.H., Danford D.A., Huhta J.C., Gutgesell H.P Noninvasive detection of anomalous origin of the left main coronary from the pulmonary trunk by pulsed Doppler echocardiography. Am.J. Cardiol. 1985; 55: 608-717.

32.   Frommelt M.A., Miller E., Williamson J., Bergstrom S. Detection of septal coronary collaterals by color flow Doppler mapping is a marker for anomalous origin of a coronary artery from the pulmonary artery. J. Am. Soc. Echocardiogr. 2002; 15(3): 259-263.

33.   Schmidt K.G., Cooper M.J., SilvermanN.H., Stanger P Pulmonary artery origin of the left coronary artery: Diagnosis by two-dimensional echocardiography, pulsed Doppler ultrasound and colour flow mapping. J. Am. Coll. Cardiol. 1988; 11: 396-402.

34.   Tavakol M., Ashraf S., Brener S.J. Risks and Complications of Coronary Angiography: A Comprehensive Review. Global Journal of Health Science. 2012; 4(1): 65-93.

35.   Ternovoj S.K., Nikonova M. Je., Akchurin R.S., i dr. Vozmozhnosti mul'tispiral'noj komp'juternoj tomografii (MSKT) v ocenke koronarnogo rusla i ventrikulografii v sravnenii intervencionnoj koronaroventrikulografiej [Possibilities of MDCT in the evaluation of coronary disease and ventriculography in comparison intrvention coronaro ventriculography.]. REJR. 2013; 3(1): 28-35 [InRuss].

36.   Fine J.J., Hopkins C.B., Ruff N., et al. Comparison of accuracy of 64-slice cardiovascular computed tomography with coronary angiography in patients with suspected coronary artery disease. Am. J. Cardiol. 2006; 97: 173-174.

37.   Leschka S., Alkadhi H., Plass A., et al. Accuracy of MSCT coronary angiography with 64-slice technology: first experience. Eur. Heart J. 2005; 26: 1482-1487.

38.   de Jonge G.J., van Ooijen PM., Piers L.H., et al. Visualization of anomalous coronary arteries on dualsource computed tomography. Eur. Radiol. 2008; 18: 2425-243

39.   Nambi P, Sengupta R., Cheong B.Y Multislice computed tomography of a repaired anomalous left coronary artery arising from the pulmonary artery. Tex. Heart. Inst. J. 2008; 35: 485-486.

40.   Su C.S., Tsai I.C., Lin W.W., et al. Usefulness of multidetector-row computed tomography in diagnosis of anomalous origin of left coronary artery arising from the pulmonary artery. J. Chin.Med. Assoc. 2010; 73: 492-495.

41.   Schmitt R., Froehner S., Brunn J., et al. Congenital anomalies of the coronary arteries: imaging with contrastenhanced, multidetector computed tomography. Eur. Radiol. 2005; 15(6): 1110-1121. 

Abstract:

Aim: was to study influence of surgical reconstruction of left ventricular (LV) in patients with postinfarction LV aneurysm, on dynamics of stroke volume (SV) and determine basic predictors of its decreasement.

Materials and Methods: retrospective study included patients with various types of surgical reconstruction of post-infarction LV aneurysm who underwent cardiac MRI before surgery, and subsequent control study by the same method in the postoperative period (mean 17,6 ± 4,7 days ) from March 2010 to February 2014. For statistical analysis, patients were divided into 2 groups according to the postoperative increase or decrease of SV Performed statistical analysis of baseline and post-operative structure - geometric and functional parameters of LV A mathematical model, based on which the multivariate analysis was performed using an automated method of linear modeling tc identify the most important predictor of subsequent risk assessment and its impact on postoperative decrease SV

Results: the left ventricular reconstruction surgery in the early postoperative period leads to reduce of left ventricular end diastolic (LVED) and end-systolic volume (LVES), respectively 22,41% and 21,85% (p <0,001), and an increase in ejection fraction (EF) at 21,76% (p <0,001), that seemingly indicates improvement in the pumping function of the heart. But, however, pointed out that the stroke volume, which more accurately reflects the feature after reconstruction LV increases less than half of patients (42.6%), an average of 11,2±1,6%, (p <0,001) and the majority (57,4%) decreases in average 21,0 ± 1,6%. (p <0,001). Groups with a postoperative increase or decrease in the value of SV differed except its dynamics (p <0,001), for the volume reduction of LVES (p = 0.25) increase in EF (p <0,001), a decrease INLS (p = 0.006). Found that the most important predictor of postoperative dynamics affecting the SV is the surgical reduction of LV volume (LVED). With a decrease in LV volume more than 25% of the original LVED risk reduction SV becomes high (OR 0,53; 95% CI 0,35, 0,79). When surgical volume reduction ratio greater than 35% chance of postoperative improvement SV maximally reduced (RR 4,74; 95% CI 1,27; 17,73; p = 0,042).

Conclusion: after surgical reconstruction of postinfarction LV aneurysms in the early postoperative period increase SV occurs in less than half of patients (42.6%), despite an increase in ejection fraction and decreased LVED. Leading predictor of postoperative determining the dynamics of the SV, is surgical reduction of left ventricular volume. Reduction of the volume of the left ventricle during the operation of surgical correction of left ventricular aneurysm more than 25% of the original LVED increases the risk of postoperative decrease in stroke volume, and more than 35% reduces chances of his promotion. 

References

1.     Borisov N.A., Popov L.V., Bletkin A.N. Hirurgicheskoe lechenie postinfakrtnoj anevrizmy levogo zheludochka [Surgical treatment of postinfarction aneurysm of left ventricular]. Annaly hirurgii. 2002; 3:14-19 [ in Russ].

2.     Cooley D.A. Surgical restoration of left ventricular aneurysm. Oper. Tech. Cardiac. Thorac. Surg. 1997; 2:151-161.

3.     Otsuji Y, Handschumacher M.D., Liel-Choen N., et al Mechanism of ischemic mitral regurgitation with segmental left ventricular dysfunction: Three-dimensional echocardiographic studies in models of acute and chronic progressive regurgitation. J. Am. Coll. Cardiol. 2001; 37:641-648.

4.     Kalon K., Ho. L., Pinsky J.L., Karmd W.B., Levy D. The epidemiology of heart failure: the Framingham Study. J. of AmericanCollege of Cardiology. 1993; 22:6A-13A.

5.     Grigioni F., regurgitationEnriquez-Sarano M., Zehr K.J. et al. Ischaemic mitral. Circulation. 2001; 103: 1759-1764.

6.     Athanasuleas C.L., Buckberg G.D., Stanley A.W., et al. RESTORE group. Surgical ventricular restoration in the treatment of congestive heart failure due to post-infarction ventricular dilation. J. Am.Coll. Cardiol. 2004; 44:1439-1445.

7.     Di Donato M., Fantini F., Toso A., Castelvecchio S., Menicanti L., Annest L., Burkhoff D. Impact of surgical ventricular reconstruction on stroke volume in patients with ischemic cardiomyopathy. J. Thorac. Cardiovasc. Surg. 2010; 140:1325-1331

8.     Menicanti L., Castelvecchio S., Ranucci M., et al. Surgical therapy for ischemic heart failure: Single-center experience with surgical anterior ventricular restoration. J. Thorac. Сardiovasc. Surg. 2007; 134: 433-441.

9.     Annest L., Burkhoff D., JordeU., Wechsler A.S. Stroke volume alterations in patients undergoing left ventricular reconstructive surgery: a meta-analysis of 2131 cases. J. Card. Fail. 2007; 3:118.

10.   Cirillo M., Amaducci A., Brunelli F., et al. Determinants of postinfarction remodeling affect outcome and left ventricular geometry after surgical treatment of ischemic cardiomyopathy. J. Thorac. Cardiovasc. Surg. 2004; 127:1648-1656.

11.   Di Donato M., Toso A., Dor V., et al. Surgical ventricular restoration improves mechanical intraventricular dyssynchrony in ischemic cardiomyopathy. Circulation. 2004; 109:2536-2543.

12.   Menicanti L., Di Donato M. The Dor procedure: what has changed after fifteen years of clinical practice? J. Thorac. Cardiovasc. Surg. 2002; 124:886-890.

13.   O’Neill J.O., Starling R.C., McCarthy P.M., et al. The impact of left ventricular reconstruction on survival in patients with ischemic cardiomyopathy. Eur. J. Cardiothorac. Surg. 2006; 30:753-759.

14.   Patel N.D., Williams J.A., Nwakanma L.U., et al. Impact of lateral wall myocardial infarction on outcomes after surgical ventricular restoration. Ann.Thorac. Surg. 2007; 83:2017-2027.

15.   Tulner     S.A., Bax J.J., Bleeker G.B., et al. Beneficial hemodynamic and clinical effects of surgical ventricular restoration in patients with ischemic dilated cardiomyopathy. Ann. Thorac. Surg. 2006; 82:1721-1727.

16.   Athanasuleas C.L., Stanley A.W. Jr., Buckberg G.D., et al. Surgical anterior ventricular endocardial restoration (SAVER) in the dilated remodeled ventricle after anterior myocardial infarction. RESTORE group. Reconstructive Endoventricular Surgery, returning Torsion Original Radius Elliptical Shape to the LV. J. Am. Coll. Cardiol. 2001; 37:1199-1209.

17.   Dor V., Sabatier M., Montiglio F., Coste P., Di D.M. Endoventricular patch reconstruction in large ischemic wall-motion abnormalities. J. Card .Surg. 1999;14:46-52.

18.   Patel N.D., Williams J.A., Barreiro C.J., et al. Surgical ventricular remodeling for multiterritory myocardial infarction: defining a new patient population. J. Thorac. Cardiovasc. Surg. 2005; 130:1698-1706.

19.   Ribeiro G.A., da Costa C.E., Lopes M.M., et al. Left ventricular reconstruction benefits patients with ischemic cardiomyopathy and non-viable myocardium. Eur. J. Cardiothorac. Surg. 2006; 29: 196-201.

20.   Suma H., Isomura T., Horii T., et al. Nontransplant cardiac surgery for end-stage cardiomyopathy. J. Thorac. Cardiovasc. Surg. 2000; 119:1233-1244.

21.   Yamaguchi A., Adachi H., Kawahito K., et al Left ventricular reconstruction benefits patients with dilated ischemic cardiomyopathy. Ann. Thorac. Surg. 2005; 79:456-461.

22.   Yu H.Y, Chen YS., Tseng W.Y, et al. Why is the surgical ventricular restoration operation effective for ischemic cardiomyopathy? Geometric analysis withmagnetic resonance imaging of changes in regional ventricular function after surgical ventricular restoration. J. Thorac. Cardiovasc. Surg. 2009; 137:887-894.

23.   Rossejkin E.V., Kobzev E. E., Bazylev V. V. Neposredstvennye rezul'taty hirurgicheskoj rekonstrukcii levogo zheludochka [Immediate results of surgical reconstruction of left ventricular]. XIX Vserossijskij s#ezd serdechno-sosudistyh hirurgov. 2013. http://new.rassh.ru/report/neposredstvennye _rezultaty_khirurgi_cheskoy_rekonstruktsii_ levogo_ zheludochka/[In Russ].

24.   Shabalkin B.V., Rabkin I.H., Belov Ju.V. i dr. Prognozirovanie posleoperacionnoj serdechnoj nedostatochnosti pri hirurgicheskom lechenii anevrizm serdca. Krovosnabzhenie, metabolizm i funkcija organov pri reko struktivnyh operacijah. [Prognosis of post-operative heart insufficiency on surgical treatment of heart aneurysms. Blood circulation, metabolism and functioning of organs during reconstruction operations.] Erevan 1984; 166-168 [In Russ].

25.   Komeda M., David T.E., Malik A., Ivanov J., Sun Z. Operative risks and long-term results of operation for left ventricular aneurysm. Ann. Thorac. Surg. 1992; 53:22-29.

26.   Van         der Wall E.E., Bax J.J. Different imaging approaches in the assessment of left ventricular dysfunction: all things equal? Eur. Heart J. 2000; 21:1295-1297.

27.   Lorenz C.H., Walker E.S., Morgan V. L., Klein, S.S., Graham T.P. Jr. Normal human right and left ventricular mass, systolic function, and gender differences by cine magnetic resonance imaging. J. Cardiovasc. Magn. Reson. 1999; 1:7-21.

28.   Belov Ju.V. Postinfarktnoe remodelirovanie levogo zheludochka serdca: ot koncepcii k hirurgicheskomu lecheniju [Postinfarction remodeling of left ventricular: from concept to surgical treatment.]. M., izd. De-Novo. 2002; S:194 [In Russ].

29.   Dor V., Sbatier M., DiDonato M., et al. Efficacy of endoventricular patchplasty in large post-infarction akinetic scar and severe left ventricular dysfunction: comparison with a series of large dyskinetic scars. J. Thorac. Cardiovasc. Surg. 1998;116:50-59.

30.   Dor V., Civaia F., Alexandrescu C., Sabatier M., Montiglio F. Favorable effects of left ventricular reconstruction in patients excluded from the Surgical Treatments for Ischemic Heart Failure (STICH) trial. J. Thorac. Cardiovasc. Surg. 2011; 141:905-9164.

31.   Bokerija L.A., Fedorov G.G. Hirurgicheskoe lechenie bol'nyh s postinfarktnymi anevrizmami serdca i soputstvujushhimi tahiaritmijam [Surgical treatment of patients with postinfarction aneurysms accompanying tachyarrhythmia.]. Grudnaja i serd.-sosud.hirurgija. 1994; 4:4-8 [In Russ].

32.   Cooley D.A. Repair of post-infarction aneurysm of the left ventricle. Cardiac surgery: state of the art reviews, Vol. 4, No. 2. Philadelphia: Hanley and Belfus, 1990; P. 309

33.   Dor V. Clinical, Sabatier M., Montiglio F., et al. Hemodynamic, and electrophysiologic results of 207 left ventricular patch reconstructions for infarction left ventricular aneurysm. l. Presented at the 72nd Annual Meeting of the American Association for Thoracic Surgery, Los Angeles, CA, April. 1992; 26-29.

34.   Artrip J.H., Oz M., Burkhoff D. Left ventricular volume reduction surgery for heart failure: a physiologic perspective. J. Thorac. Cardiovasc. Surg. 2001;122: 75-82.

35.   Burkhoff D., Wechsler A.S. Surgical ventricular remodeling: a balancing act on systolic and diastolic properties. J. Thorac. Cardiovasc. Surg. 2006;132:459-63.

36.   Ratcliffe M.B., Guy T.S. The effect of preoperative diastolic dysfunction on outcome after surgical ventricular remodeling. J. Thorac. Cardiovasc. Surg. 2007; 134:280-283

37.   Jones R.H., Velazquez E.J. Michler R.E., et al. Coronary bypass surgery with or without surgical ventricular reconstruction. N. Engl. J .Med. 2009;360:1705-17.

38.   Chernjavskij A.M., Marchenko A.V., Karas'kov A.M. Raschet ploshhadi vykljuchenija postinfarktnoj anevrizmy levogo zheludochka [Calculation of area of postinfarction aneurism dismiss]. (Grudnaja i serdechnososudistaja hirurgija. 2002; 6. 54-58 [In Russ]. 

Abstract:

Background: case report of a rare congenital anomaly - the diverticulum of the right ventricle of the heart, revealed by echocardiography and magnetic resonance imaging (MRI) of the heart.

Aim: was to show possibilities in detection and differential diagnosis of diverticulum of the right ventricle.

Materials and methods: patient, 23 years, during examination after passed pneumonia, underwent echocardiography wich revealed an aneurysm of right ventricle. Patient underwent further examination: MRI of heart in T1-WS and T2-WS, «gradient echo» and dynamical regime (Cine-SSFP) in standard positions. Demonstration of diverticulum is based on reconstruction imaging (MPR). Results: due to MRI data, in right ventricle we found a bulging 1,2х2,0 cm with clear contours, wich decreased in systole with myocardum of right ventricle - «true diverticulum of right ventricle». We marked difficulties in the diagnosis associated with the paucity of clinical manifestations.

Conclusions: MRI made it possible to study individual morphological anatomy of the diverticulum, to demonstrate and to assess in detail the topography that helped to make decisions on further management of the patient. 

References

1.      Cavalle-Garrido T., Cloutier A., Harder J., et al. Evolution of fetal ventricular aneurysms and diverticula of the heart: an echocardiographic study. Am. J. Perinatol. 1997; 14:393-400.

2.      Krasemann T., Gehrmann J., Fenge H., et al. Ventricular aneurysm or diverticulum? Clinical differential diagnosis. Pediatr. Cardio. 2001; 22:409-411.

3.      Rodts-Palenik S., Barrilleaux S., Jeanty Ph. Diverticulum of the right ventricle http://www.sonoworld.com/ fetus/page.aspx?id=1474

4.      Bankl H. Congenital malformation of heart and great vessels: Synopsis of Pathology, Embryology, and Natural History. Urban and Schwarzenberg. 1977; 263.

5.      Cumming G.R. Congenital diverticulum of the right ventricle. Am. J. Cardiol. 1969; 23:297.

6.      Wax J.R., Moran A., Pinette M.G., et al. Prenatal sonographic diagnosis of fetal right ventricular diverticulum. J. Ultrasound Med. 2007; 26(2):267-270.

7.      Pressoir R., Downing J. W. Congenital diverticula of the right ventricle of the heart: A case report. Journal of the National Medical Association. 1980; 72, 3: 262-264.

8.      Sangawa K., Aoki A., Yoshino T. Resection of a right ventricular diverticulum of fibrous type by off-pump cardiac surgery; report of a case. Kyobu Geka. 2009; 62(2):152-156.

9.      Farnsworth P.B., Lefkowitz M., Shehadi W., et al. Spontaneous rupture of fibrous diverticulum of the right ventricle. Am .J. Dis. Child. 1972; 123:248-250.

10.    Freedom R.M., Yoo S.J., Mikailian H. Cardiac diverticulum and aneurysm. The Natural and Modified History of Congenital Heart Disease. Blackwell Publishing. 2003:475-478.

11.    Rajs J., Thoren C., Kjellman M. Spontaneous rupture of a congenital diverticulum of the right ventricle in a 1-month-old child. Eur. J. Cardiol. 1977; 16(2): 131-137.

12.    Benatar A., Vorsselmans A. Foetal right ventricular outpouching associated with ventricular bigeminy. OA Case Reports. 2013; 12; 2(6):51.

13.    Marijon E., Ou Ph., Fermont L., et al. Diagnosis and outcome in congenital ventricular diverticulum and aneurysm. J. Thorac. Cardiovasc. Surg. 2006; 131: 433-437.

14.    Hamaoka, K., Onaka M., Tanaka T. Congenital ventricular aneurysm and diverticulum in children. Pediatric Cardiology 1987; 8:169-175.

15.    Uhl H.S. A previously undescribed congenital malformation of the heart: almost total absence of the myocardium of the right ventricle. Bulletin of the JohnsHopkinsHospital. 1952; 91 (3): 197-209.

16.    Bharati S., Rowen M., Camarata S.J., et al. Diverticulum of the right ventricle. Arch. Pathol. 1975; 99:383-386.

17.    Carter J.B., Van Tassel R.A., Moller J.H., et al. Congenital diverticulum of the right ventricle. Association with pulmonary stenosis and ventricular septal defect. Am. J. Cardiol. 1971; 28:478.

18.    Cantrell J.R., Haller J.A., Ravitch M.M. A syndrome of congenital defects involving the abdominal wall, sternum, diaphragm, pericardium, and heart. Surg, Gynecol, Obstet. 1958; 107:602-614.

19.    Okereke O.U., Cooley D.A., Frazier O.H. Congenital diverticulum of the ventricle. J. Thorac. Cardiovasc. Surg. 1986; 91:208-214.

20.    McAulife F.M., Hornberger L.K., Johnson J., et al. Cardiac diverticulum with pericardial effusion: report of two new cases treated by in utero pericardiocentesis and a review of the literature. Ultrasound Obstet. Gynecol. 2005; 25:401-404.

21.    Treistman B., Cooley D.A., Lufschanowski R., Leachman R.D. Diverticulum or aneurysm of left ventricle. Am. J. Cardiol. 1973; 32:119-123.

22.    Paronetto F., Strauss L. Aneurysm of the left ventricle due to congenital muscle defect in an infant: report of a case with discussion of pathogenesis of associated endocardial fibroelastosis. Am. J. Cardiol. 1963; 12:721-729.

23.    Archbold R.A., Robinson N.M., Mills P.G. Long-term follow-up of a true contractile left ventricular diverticulum. Am. J. Cardiol. 1999; 83:810-813.

24.    Hornberger L.K., Dalvi B., Benacerraf B. Prenatal sonographic detection of cardiac aneurysms and diverticula. J. Ultrasound Med. 1994; 13:967-970.

25.    Carrard C., Massardier J., Pangaud N. Fetal right ventricular diverticulum with pericardial effusion: report of a new case treated by in utero pericardiocentesis. Pediatr. Cardiol. 2010; 31(6):891-893.

26.    Bogaert J. Dymarkowski S., Taylor A.M. Clinical Cardiac MRI. Springer. 2005; 563.

27.    O’Donnell D.H., Abbara S., Chaithiraphan V., et al. Cardiac Tumors: Optimal Cardiac MR Sequences and Spectrum of Imaging Appearances. AJR. 2009; 193: 377-387.

28.    Finn J.P., Nael K., Deshpande V., et al. Cardiac MR imaging: state of the technology. Radiology. 2006; 241:338-354.

29.    Suilen C., Friedli B., Rutishauser W. Congenital intrathoracic left ventricular diverticulum in an adult. Chest. 1990; 98:750-751.

30.    Evans W., Madrid A., Castillo W., et al. All cardiac right ventricular outpouches are not created equal. Pediatr Cardiol. 2009; 30(7):954-957.

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.

References

1.     Berrizbeitia L.D., Tessler S., Jacobowitz I.J., et al. Effect of sternotomy and coronary bypass surgery on postoperative pulmonary mechanics. Chest. 1989, 96(4):873-876.

2.     Deng Y, Byth K., Paterson H.S. Phrenic nerve injury associated with high free right internal mammary artery harvesting. Ann. Thorac. Surg. 2003; 76(2):459-463.

3.     Mazzoni M., Solinas C., Sisillo E., et al. Intraoperative phrenic nerve monitoring in cardiac surgery. Chest. 1996, 109(6):1455-1460.

4.     O'Brien J.W., Johnson S.H., VanSteyn S.J., et al. Effects of internal mammary artery dissection on phrenic nerve perfusion and function. Ann.Thorac. Surg. 1991, 52(2):182-188.

5.     Tripp H.F., Sees D.W., Lisagor P.G., et al. Is phrenic nerve dysfunction after cardiac surgery related to internal mammary harvesting? J. Card. Surg. 2001, 16(3): 228-231.

6.     Canbaz S., Turgut N., Halici U., et al. Electrophysiological evaluation of phrenic nerve injury during cardiac surgery - a prospective, controlled, clinical study. BMC Surgery. 2004, 4:2.

7.     Merino-Ramirez M.A., Juan G., Rair^n M., et al. Electrophysiologic evaluation of phrenic nerve and diaphragm function after coronary bypass surgery: prospective study of diabetes and other risk factors. J. Thorac. Cardiovasc. Surg. 2006; 132:530-536.

8.     Metzner A., Rausch P, Lemes C., et al. The incidence of phrenic nerve injury during pulmonary vein isolation using the second-generation 28 mm cryoballoon. J. Cardiovasc. Electrophysiol. 2014; 25(5):466-470.

9.     Diehl J.L., Lofaso F., Deleuze P, et al. Clinically relevant diaphragmatic dysfunction after cardiac operations. J. Thorac. Cardiovasc. Surg. 1994; 107:487-498.

10.   Efthimiou J., Butler J., Woodham C., et al. Diaphragm paralysis following cardiac surgery: role of phrenic nerve cold injury. Ann. Thorac. Surg. 1991; 52:1005-1008.

11.   Smith B.M., Ezeokoli N.J., Kipps A.K., et al. Course, Predictors of Diaphragm Recovery After Phrenic Nerve Injury During Pediatric Cardiac Surgery. Ann. Thorac. Surg. 2013; 96:938-42.

12.   Kim W. Y; Suh H. J.; Hong S.-B.; Koh Y; Lim C.-M. Diaphragm dysfunction assessed by ultrasonography: Influence on weaning from mechanical ventilation. Critical Care Medicine. 2011; 12:2627-2630.

13.   Davison A., Mulvey D. Idiopathic diaphragmatic weakness. BMJ. 1992; 304:492-494.

14.   McCool F.D., Tzelepis G.E. Dysfunction of the Diaphragm. N. Engl. J. Med. 2012; 366:932-942.

15.   McCool F.D., Mead J. Dyspnea on immersion: mechanisms in patients with bilateral dia-phragm paralysis. Am. Rev. Respir Dis. 1989; 139:275-276.

16.   Steier J., Jolley C.J., Seymour J., et al. Sleep-disordered breathing in unilateral diaphragm paralysis or severe weakness. Eur. Respir. J. 2008; 32:1479-1487.

17.   Wang C.S., Josenhaus W.T. Contribution of the diaphragmatic-abdominal displacement to ventilation in supine man. J. Appl. Physiol. 1971; 31:576-80.

18.   Stradling J.R., Warley A.R. Bilateral diaphragm paralysis and sleep apnoea without diurnal respiratory failure. Thorax. 1988; 43:75-77

19.   Summerhill E.M., El-Sameed YA., Glidden T.J. Monitoring recovery from diaphragm paralysis with ultrasound. Chest. 2008; 133:737-743.

20.   El-Sobkey S.B., Salem N.A. Can lung volumes and capacities be used as an outcome measure for phrenic nerve recovery after cardiac surgeries? J. Saudi. Heart Assoc. 2011; 23:23-30.

21.   Laroche C.M., Mier A.K., Moxham J., Green M. Diaphragm strength in patients with recent hemidiaphragm paralysis. Thorax. 1988; 43:170-174.

22.   Линденбратен Л.Д. Лучевая диагностика поражений диафрагмы. Радиология и практика. 2001; 2:6-21. Lindenbraten L.D. Luchevaja diagnostika porazhenij diafragmy[Beam diagnostics of diaphragm lesions]. Radiologija ipraktika. 2001; 2:6-21[In Russ].

23.     Suwatanapongched T., Gierada D.S., Slone R.M. et al. Variation in Diaphragm Position and Shape in Adults With Normal Pulmonary Function. Chest. 2003; 123(6): 2019-2027. 

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.

References

1.     Brown M., Schaff N., Suri R. et al. Indexed Left Ventricular Dimensions Best Predict Survival After Aortic Valve Replacement in Patients With Aortic Valve Regurgitation. Ann Thorac Surg. 2009; 87: 1170-1176.

2.     Grayburn P, AppletonC., DeMaria A. et al. Echocardiographic Predictors of Morbidity and Mortality in Patients With Advanced Heart Failure. The Beta-blocker Evaluation of Survival Trial. J Am Coll Cardiol. 2005; 45: 1064-1071.

3.     Kleml., Shah D., White R. et al. Prognostic Value of Routine Cardiac Magnetic Resonance Assessment of Left Ventricular Ejection Fraction and Myocardial Damage. Circ Cardiovasc Imaging. 2011; 4: 610-619.

4.     Malm S., Frigstad S., Sagberg E.; et al. Accurate and reproducible measurement of left ventricular volume and ejection fraction by contrast echocardiography a comparison with magnetic resonance imaging. J Am Coll Cardiol. 2004; 44 (5): 1030-1035.

5.     Bogaert J., Dymarkowski S., Taylor A. M. et al. Clinical Cardiac MRI. Springer. 2012; 721.

6.     Kreitner, K-F, Sandstede J. Leitlinien for den Einsatz der MR-Tomographi in der Herzdiagnostik. Fortschr Roentgenstr. 2004; 176: 1185-1193.

7.     Bellenger N.G., Burgess M.I., Ray S.G. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionucleide ventriculography and cardiovascular magnetic resonance. Are they interchangeable? Eur Heart J. 2000; 21: 1387-1396.

8.     Bernard Y, Meneveau N., Boucher S. et al. Lack of agreement between left ventricular volumes and ejection fraction determined by two-dimensional echocardiography and contrast cineangiography in postinfarction patients. Echocardiography. 2001; 18: 113-122.

9.     De Haan S., de Boer K., Commandeur J. et al. Assessment of left ventricular ejection fraction in patients eligible for ICD therapy: Discrepancy between cardiac magnetic resonance imaging and 2D echocardiography. Neth Heart J. 2014; 22 (10): 449-455.

10.   Gardner B., Bingham S., Allen M. et al. Cardiac magnetic resonance versus transthoracic echocardiography for the assessment of cardiac volumes and regional function after myocardial infarction: an intrasubject comparison using simultaneous intrasubject recordings. The J of Cardiovasc ultrasound. 2009; 7: 38.

11.   Bellenger N.G., Francis J.M., Davies L.C. et al. Establishment and performance of a magnetic resonance cardiac function clinic. J Cardiovasc Magn Reson. 1999; 1 (4): 323-330.

12.   Darasz K.H., Underwood S.R., Bayliss J. et al. Measurement of left ventricular volume after anterior myocardial infarction: comparison of magnetic resonance imaging, echocardiography, and radionuclide ventriculography. The Int J of Cardiovasc Imaging. 2002; 18(2): 135-142.

13.   Li C., Lossnitzer D., Katus H.A. et al. Comparison of left ventricular volumes and ejection fraction by monoplane cineventriculography, unenhanced echocardiography and cardiac magnetic resonance imaging. Int J Cardiovasc Imaging. 2012; 28 (5): 1003-1010.

14.   Duncan A.I., Lowe B.S., Garcia M.J. et al. Influence of concentric left ventricular remodeling on early mortality after aortic valve replacement. Ann Thorac Surg. 2008; 85 (6): 2030-2039.

15.   Lang R., Bierig M., Devereux R. et al. Recommendations for Chamber Quantification: A Report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group. J Am Soc Echocardiogr. 2005; 18: 14401463.

16.   Belenkov Ju.N., Ternovoj S.K., Sinicyn V.E. Magnitno-rezonansnaja tomografija serdca i sosudov [Cardiac and vesssels MRI]. M.: Vidar. 1997; 144 [In Russ].

17.   Di Donato M., Sabatier M., Dor V. Akinetic versus dyskinetic postinfarction scar: relation to surgical outcome in patients undergoing endoventricular circular patch plasty repair. JACC. 1997; 29: 1569-1575.

18.   Hoffmann R., von Bardeleben S., ten Cate F., et al. Assessment of systolic left ventricular function: a multicentre comparison of cineventriculography, cardiac magnetic resonance imaging, unenhanced and contrast-enhanced echocardiography. Eur Heart J. 2005; 26: 607-16.

19.   Jenkins C., Moir S., Chan J. et al. Left ventricular volume measurement with echocardiography: a comparison of left ventricular opacification, three-dimensional echocardiography, or both with magnetic resonance imaging. Eur Heart J. 2009; 30: 98-106.

20.   Lim T.K., Burden L., Janardhanan R., et al. Improved accuracy of low-power contrast echocardiography for the assessment of left ventricular remodeling compared with unenhanced harmonic echocardiography after acute myocardial infarction: comparison with cardiovascular magnetic resonance imaging. J Am Soc Echocardiogr. 2005; 18: 1203-1207.

21.   Thomson H.L., Basmadjian A., Rainbird A. et al. Contrast echocardiography improves the accuracy and reproducibility of left ventricular remodeling measurements: A prospective, randomly assigned, blinded study. J Am Coll Cardiol. 2001; 38: 867-875.

22.   Buziashvili Ju.I., Kljuchnikov I.V., Melkonjan A.M. i soavt. Ishemicheskoe remodelirovanie levogo zheludochka (opredelenie, patogenez, diagnostika, medikamentoznaja i hirurgicheskaja korrekcija) [Ischemic remodeling of left ventricle (determination, pathogenesis, diagnostics, drug and surgical correction]. Kardiologija. 2002; 42 (10): 88-94 [In Russ].

23.   Chernjavskij A.M., Kareva Ju.E., Denisova M.A. i soavt. Problema predoperacionnogo modelirovanija levogo zheludochka [Problem of post-operative remodeling of left ventricle]. Kardiologija i serdechno-sosudistaja hirurgija. 2015; 2: 4-7 [In Russ].

24.   Di Donato M., Castelvecchio S., Kukulski T. et al. Surgical Ventricular Restoration: Left Ventricular Shape Influence on Cardiac Function, Clinical Status, and Survival. Ann Thorac Surg. 2009; 87 (2): 455-461.

25.   Ahn H.S., Kim H.K., Park E.A. et al. Isolated, broad-based apical diverticulum: cardiac magnetic resonance is a «terminator» of cardiac imaging modality for the evaluation of cardiac apex. Korean Circ J. 2013; 43 (10): 702-704.

26.   Lloyd S.G., Buckberg G.D. Use of cardiac magnetic resonance imaging in surgical ventricular restoration. Eur J of Cardiothoracic Surg. 2006; 216-222.