Doppler echocardiographic assessment of hemodynamic parameters on patients with tetralogy of Fallot

Continuous Doppler echocardiography was used for the study of hemodynamic parameters on various stages of treatment of 61 children (mean age 12.4 months) with tetralogy of Fallot. Twenty five patients were studied before surgery during spells of cyanosis and hyperpnea. Thirty six patients were treated with systemic - pulmonary arterial anastomosis and in 25 patients total correction was carried out. Doppler echocardiographic study was repeated in 2 weeks and 1 year after surgery. Attack of cyanosis and hyperpnea was associated with reduction of pulmonary blood flow and increase of venoaortic shunting. Comparison of hemodynamic parameters before and after creation of aorta-to-pulmonary artery anastomosis allowed to establish Doppler echocardiographic criteria of assessment of the anastomosis functional state. Repetitive Doppler echocardiographic studies showed that hemodynamic results of total correction depended on the type of repair of right ventricular outflow tract. Severity of pulmonary artery valve insufficiency also depended on the type and extent of surgical intervention.     

Urgent operations for diseases of the thyroid gland and postoperative complications

Anasplastic carcinoma of the thyroid gland (243 cases), polinodous goiter of cervical retrosternal localization (25 cases), acute purulent strumitis or thyroiditis (9 cases) induced disturbance of aero-digestive organs of the neck and resulted in the necessary urgent surgical care. The most dangerous complications after 23777 operations on the TG requiring repeated surgical intervention were bilateral lesion of the recurrent nerves (1% of observations), hemorrhages in the TG bed (0.38% of observations). Timely surgical treatment as well as exact knowledge of the neck anatomy, visual control of the recurrent laryngeal nerves, cover of the nerves and lessening the TG bed volume with a part of the parietal leaf of the 4th fascia of the neck in each thyroid operation considerably decreased the danger of asphyxia and the appearance of life threatening complications at the early postoperative period.     

Doppler-echocardiographic assessment of the degree of pulmonary hypertension and right-ventricular pressure in patients with ventricular septal defects

The study was performed in 53 children aged 3 months to 4 years who had ventricular septal defect. Systolic pressure in the right ventricle, pulmonary artery and the severity of pulmonary hypertension were determined by two way: 1) from arteriovenous shunt via ventricular septal defect before its surgical closure; 2) from systolic regurgitation via the tricuspid valve after its seal. Right ventricular diastolic pressure was measured by Doppler echocardiography using diastolic blood flow through the tricuspid valve. Before ventricular septal defect closure, the correlation ratio of Doppler echocardiographic to cardiac catheterization values was 0.76 and that of Doppler echocardiographic to intrasurgical manometry was 0.79. In the postoperative period, a catheter was left in the right ventricle in 14 children and its pressure was simultaneously measured by the blind method. The correlation was 0.97 for right ventricular systolic pressure and 0.89 for diastolic one.     

Diagnosis of spinal fractures using optical processing of the roentgenologic image

X-ray examinations by a traditional method in 694 patients with non-complicated compression fractures in the thoraco-lumbar part of the vertebral column do not always give the exact picture of the character of fractures of the vertebral column. The method of optic processing the roentgen picture was used in 30 patients for more detailed analysis of structural changes in the vertebrae bodies. The method allowed to specify structural changes in the vertebra bodies, including the detection of the fracture plane, abruption of a body portion, detection of an additional contour of the limiting plate in its pressing into the vertebra body and the zone of infiltration in the upper portions of the body.     

The Doppler echocardiographic method of determining right ventricular pressure in patients with congenital heart defects in the early postoperative period

A comparative analysis of the results of invasive and noninvasive measurement of right ventricular pressure showed a high correlation for systolic (r = 0.97, P less than 0.05, n = 41) and diastolic (r = 0.89, p less than 0.05, n = 41) pressures. The noninvasive technique is applicable only in the presence of tricuspid regurgitation or that of ventricular septal defect ejection. Moreover, in slight or minimal tricuspid regurgitation when the peak of systolic regurgitation is poorly seen, there is a difference between the results of these measurements (7-10 mm Hg). It has been concluded that Doppler echocardiography is an informative noninvasive tool for measuring pressure in the right ventricle and pulmonary artery and offers an opportunity of determining pulmonary hypertension quantitatively before and after surgery.     

Surgical treatment of local-expanded forms of thyroid carcinoma

An analysis of surgical treatment of 377 patients with advanced thyroid carcinoma is presented. The work included 82 combined, 90 expanded and 218 palliative operations (as well as 68 shave-resections). In 56 cases surgical interventions were two-or three-staged. This approach improved the immediate results and did not change the long-term results of treatment. It was shown that surgical treatment in advanced thyroid carcinoma gave good results in the majority of cases (recovery or long-term palliation). Combined and expanded operations were non effective in anaplastic thyroid carcinoma. In well-differentiated thyroid carcinoma the 10-year survival was noted in 70.2% of patients.     

Doppler echocardiography in the assessment of arteriovenous blood ejection in patients with ventricular septal defects]

To assess Doppler echocardiography used to determine blood ejection through ventricular septal defect, this procedure and cardiac catheterization were performed in 32 patients. Comparison of the findings showed a high correlation (r = 0.81; p < 0.05). To determine whether echocardiographic accesses are correctly chosen, volumetric greater circulation was measured from the suprasternal access in the ascending aorta and aortic arch, but volumetric lesser circulation was measured from the parasternal access in the pulmonary trunk and from the apical access of the projection of 4 chambers through the mitral orifice. The comparison of the findings showed a high correlation in this group. Twenty one patients were examined after plastic surgery of ventricular septal defect, who had been clinically suspected to have a residual shunting. An analysis of the findings made it possible to develop Doppler echocardiographic criteria for differential diagnosis of graft vibration due to arteriovenous blood ejection.