First experience with "live" three-dimensional echocardiography in Russia

Revival of interest to three-dimensional echocardiography during recent years was invoked by introduction of essentially novel ultrasound technology of "live" three-dimensional imaging. We introduce here the first experience of the use of three-dimensional echocardiography in Russia comprising examination of 74 patients with various pathology of the heart. Positions and sections are described allowing best visualization of pathology of cardiac valves and other intracardiac structures. Our experience shows that at present three-dimensional echocardiography should be considered to be an important supplement to standard echocardiography. However in some cases it can be the only non-invasive technique able to provide complete information on the size of ventricular and atrial septal defects, valvular and other cardiac pathology.     

Recurrence of poly-nodular euthyroid goiter

Results of surgical treatment of 93 patients with polynodular euthyroid goiter were studied. Influence of the operative intervention volume, morphological form of goiter and postoperative hormonal therapy conduction on the frequency of the recurrency occurrence was noted.     

Antitachycardia and resynchronization devices in the treatment of heart failure and prevention of sudden death

According to the modern ideas of the heart failure pathogenesis the noticeable contribution introduces ventricular dissynchrony which essence consists of the electrical and mechanical dissociation of different segments of the myocardium. In recent years the new method of cardiac resynchronization therapy has been worked out and achived good results. Its main purpose is the resynchronization of the heart by three-chamber or biventricular stimulation, which leads to an improvement of the effectiveness of heart activity. At the same time implanted cardioverter-defibrillator systems are actively used in the complex treatment of heart failure as a mean of sudden cardiac death prevention. In this article we present results of main international studies, which reveal clinical effectiveness of both methods for decreasing total mortality and frequency of hospitalizations, prolonging life span, and improving quality of life.     

The radionuclide diagnosis of dilated cardiomyopathy: a new approach to assessing myocardial perfusion function by 201Tl scintigraphic data at rest and during the performance of the dipyridamole test]

A method for quantitative determination of the percentage of left ventricular myocardial 201Tl isotope uptake at rest and during dipyridamole test was first used in patients with dilated cardiomyopathy and coronary heart disease complicated by circulatory insufficiency or chronic myocarditis. This method makes it possible to judge the level of myocardial blood flow and perfusion reserve in these diseases. The most common differences were found between patients with coronary heart disease and those with chronic myocarditis. The patients with chronic myocarditis exhibited the greatest sizes of perfusion defects, highest values of 201Tl uptake at rest and a lower myocardial perfusion reserve during dipyridamole test. In response to exercise, most patients with chronic myocarditis had diminished perfusion defects, whereas those with coronary heart disease displayed increased defects. The myocardial perfusion was varied in patients with dilated cardiomyopathy. Some patients had a scintigraphic pattern close to that in patients with chronic myocarditis and others had a pattern identical to that in patients with coronary heart disease.     

Initial Riociguat Monotherapy and Transition from Sildenafil to Riociguat in Patients with Idiopathic Pulmonary Arterial Hypertension: Influence on Right Heart Remodeling and Right Ventricular–Pulmonary Arterial Coupling

Purpose

To evaluate the influence of riociguat on World Health Organization functional class (WHO FC), 6-min walk distance (6MWD), right heart remodeling, and right ventricular–pulmonary arterial (RV–PA) coupling in patients with idiopathic pulmonary arterial hypertension (IPAH) who are treatment-naïve or who have failed to achieve treatment goals with sildenafil therapy.

Methods

Twenty patients with IPAH were enrolled: 12 had not previously received PAH-targeted therapy (treatment-naïve subgroup) and 8 had been receiving sildenafil therapy but failed to achieve treatment goals; on entering this pilot study these 8 patients were switched from sildenafil to riociguat therapy (treatment-switch subgroup). Patients received riociguat individually dose-adjusted up to a maximum of 2.5 mg three times daily. After 12 weeks, patients were assessed for WHO FC, 6MWD, right heart remodeling, and RV–PA coupling.

Results

Riociguat significantly improved WHO FC in treatment-naïve patients (from 0/4/8/0 patients in WHO I/II/III/IV at baseline to 1/6/5/0 at week 12) and in treatment-switch patients (from 0/4/4/0 patients in WHO I/II/III/IV at baseline to 1/4/3/0 at week 12). Additionally, treatment-naïve and treatment-switch patients showed significant improvements at week 12 versus baseline in 6MWD (increases of +?76.8 m and +?71.6 m, respectively), RV systolic function, and RV–PA coupling.

Conclusion

These results support the proven efficacy of riociguat in patients with IPAH, including treatment-naïve patients and those switching to riociguat following failure to achieve treatment goals with sildenafil, and suggest that it may be possible to delay disease progression in this patient group.

     

Postoperative hypothyroidism in patients with multi-nodular goiter

Results of surgical treatment of 69 patients with polynodous euthyroid goiter were studied. There was established, that postoperative hypothyrosis is occurring more often in women aged from 41 to 70 years with colloid goiter in combination with adenoma of thyroid gland (in 60% observations) and adenomatous goiter (in 42.8%). Increase of residual tissues volume of thyroid gland do not always provide the decrease of the hypothyrosis frequency occurrence. The physician control absence for the hormonal therapy management worsens the postoperative hypothyrosis course.