Chamber In Patients Research Articles

Morphometric analysis of the anterior chamber in patients with refractory glaucoma after micropulse cyclophotocoagulation

PURPOSE. To evaluate the anatomical-topographic parameters of the anterior chamber of the eye before and after micropulse cyclophotocoagulation (mCPC) in patients with refractory glaucoma in pseudophakic and phakic eyes.METHODS. The study included 60 patients (62 eyes) with moderate (7 eyes) and advanced (55 eyes) refractory glaucoma. Study groups were formed as follows: the 1st group consisted of 31 pseudophakic eyes (32 patients), the 2nd group included 31 phakic eyes (30 patients). All patients underwent mCPC according to a modified technique. To assess anatomical parameters patients underwent optical coherence tomography of the anterior segment (AS-OCT). Anterior chamber angle (ACA) and anterior chamber depth (ACD) were measured at specific follow-up time points after mCPC.RESULTS. Hypotensive effect by the end of 12-month follow-up was achieved in the patients of the first group in 83.1% of cases, in the second group — in 80.6% of cases (p<0.05). According to OCT findings, anterior chamber depth in patients with phakic eyes during the 12-month follow-up remained the same as before surgery — 2.43±0.21 (mm). In the other group with pseudophakic eyes, anterior chamber depth also did not change during the observation period, with an average value of 3.27±0.12 (mm). No significant changes (p>0.05) were found in the irido-corneal angle measurements in the 4 meridians over the entire follow-up period in both groups.CONCLUSION. Micropulse cyclophotocoagulation performed at fluence rate F=121 J/cm2 does not result in changes of structures of the anterior segment of the eye. The stability of anterior chamber anatomy as well as the absence of postoperative complications in early and longterm follow-up proved the minimal traumatic effect of this surgery in patients with refractory glaucoma.

Clinical validation of grass pollen exposure chamber in patients with allergic rhinitis triggered by timothy grass.

The fluctuation in concentrations of airborne allergens frequently presents a challenge to assessing the efficacy of allergen immunotherapy (AIT) in 'field' studies. Allergen exposure chambers (AECs) are specialized medical installations developed to expose individuals to allergens at defined and consistent concentrations under a controlled environment. The aim of the study was to validate the provocation test with timothy grass pollen as well as to assess its safety in the AEC in patients with allergic rhinitis. In the ALLEC® AEC, varying concentrations of timothy grass pollen were dispersed. Allergic symptoms were measured by total nasal symptom score (TNSS), acoustic rhinometry, peak nasal inspiratory flow (PNIF) and nasal discharge volume. Lung function, assessed through peak expiratory flow rate (PEFR) and forced expiratory volume in the first second (FEV1), was used to evaluate safety. The consistency of the test was proved by the stability of environmental conditions, including temperature, humidity and CO2 levels, as well as constant concentrations of grass pollen at predetermined levels ranging from 1000 to 10,000 particles per cubic meter (p/m3). Allergic individuals developed symptoms at concentrations of 3000 p/m3 and above, across all measured endpoints. Lung function was not affected throughout all the challenges. The reproducibility of symptoms was confirmed throughout the tests. The concentration of 8000 p/m3 together with a challenge duration of 120 min was found to be optimal. The study demonstrates that the ALLEC® grass pollen exposure chamber provides a reliable and safe method for inducing repeatable symptoms in patients with allergic rhinitis. This approach can be effectively applied for allergy diagnostics and clinical endpoint determination during AIT.

Comparative analysis of the anterior chamber changes after intravitreal injections of aflibercept and brolucizumab

BACKGROUND: Currently, the information is insufficient about the effect of multiple intravitreal injections (IVI) of brolucizumab in comparison with aflibercept on the parameters of iridolenticular diaphragm. AIM: The aim of this study is using optical coherence tomography of the anterior segment (AS-OCT) to evaluate changes in the parameters of the anterior chamber in patients with multiple intravitreal injections of aflibercept and brolucizumab in the treatment of the neovascular form of age-related macular degeneration (nAMD). MATERIALS AND METHODS: In total, 60 patients (60 eyes) were included into the study. The follow-up period duration was 12 months. Patients were divided into 2 groups: group 1 — 30 patients receiving intravitreal injections of aflibercept, group 2 — 30 patients receiving intravitreal injections of brolucizumab. Using a Revo NX tomograph, AS-OCT was performed, the depth of the anterior chamber and the dimensions of the anterior chamber angle were examined. The measurement was performed before intravitreal injections, one month after the first, one month after the third intravitreal injections, and one year after treatment. RESULTS: In both groups, a shift of the iridolenticular diaphragm was noted according to AS-OCT data — a significant decrease in depth of the anterior chamber, anterior chamber angle parameters before treatment and after 4 months of treatment, as well as after a year of treatment. In group 1, in contrast to group 2, a greater number of intravitreal injections led to a greater decrease in the depth of the anterior chamber (rxy = 0.415, p = 0.02) and to a greater narrowing of the anterior chamber angle on the nasal and temporal sides (rxy = 0.37, p = 0.049 and rxy = 0.424, p = 0.02, respectively). CONCLUSIONS: For the first time, changes of the anterior chamber of the eye were determined against the background of multiple intravitreal injections of aflibercept and brolucizumab in the treatment of the neovascular form of age-related macular degeneration using AS-OCT.

The function of right cardiac chambers in patients with asthma according to Doppler echocardiography

Objective. To determine the functional state of right cardiac chambers in patients with asthma of varying severity according to Doppler echocardiography. Subjects and methods. Cardiopulmonary hemodynamics was assessed in 56 asthmatic patients, by using ultrasound. The examinees were divided into 3 groups by the severity of the disease. Results. With an increase in the severity of asthma, diastolic dysfunction of the right ventricle (RV) progressed with the development of its dysfunction that further plays a dominant role in developing chronic heart failure. As diastolic dysfunction of the RV progressed in the asthmatic patients, there was an increase in the contractile activity of the right atrium (RA) simultaneously with a decrease in the Е/А ratio. Conclusion. In asthmatic patients, diastolic dysfunction in the right cardiac chambers frequently precedes systolic dysfunction, which manifests itself in a change in the ratio of various phases of RV filling. During RV diastolic dysfunction, there is a relative increase in the contractility of RA.

Left atrium volume and ventricular volume ratio algorithm as indication of pulmonary hypertension etiology.

Pressure overload of the right heart (pulmonary hypertension [PH]) can be an acute or a chronic process with various pathophysiologic changes affecting the dimensions of the heart chambers. The automatic four-chamber volumetric analysis tool is now available to measure the volume of the cardiac chambers in patients undergoing a computed tomography pulmonary angiogram (CTPA). To characterize the volumetric changes that occurred in response to increased systolic pulmonary arterial pressures (sPAP) in acute events, such as acute pulmonary embolism (APE), compared with other etiologies. Consecutive patients who underwent CTPA and echocardiography within 24 h between 2011 and 2015 were included. Differences in cardiac chamber volumes were investigated in correlation to the patients' sPAP. The final cohort of 961 patients included 221 (23%) patients diagnosed with APE. The right (RV) to left (LV) ventricular volume ratio (VVR) was higher, while the left atrial (LA) volume index was smaller (P < 0.001) in the patients with APE. A decision tree for the prediction of APE showed that an RV to left VVR >2.8 was characteristic of APE, whereas an LA volume index >37.5 mL/m² was more compatible with PH due to other etiologies (P < 0.001). The combination of VVR and LA volume index may help in differentiating between APE and chronic PH. CTPA-based volumetric information may be used to help clarify the underlying etiology of the dyspnea.

Изменения морфо-анатомических параметров передней камеры глаза при различных видах коррекции иридохрусталикового барьера у пациентов с силиконовой тампонадой витреальной полости

In case of combined pathology, in particular aphakia and regmatogenic retinal detachment, an important point is the leveling of changes in the iridocrustal apparatus. When analyzing the morpho-anatomic parameters of the angle and depth of the anterior chamber using optical coherence tomography, distinctive features were revealed in patients with various methods of correcting the defect of the iridohrustal barrier. Purpose. of the study was to evaluate anatomical changes in the angle and depth of the anterior chamber in patients with various types of intraocular correction of the defect of the capsule-binding apparatus under conditions of tamponade of the vitreal cavity with silicone oil. Material and methods. Studies were conducted on 74 eyes of patients aged 56 to 75 years with various methods of correction of aphakia and silicone tamponade of the vitreal cavity. Results. There was a significant decrease in the anterior chamber angle in various sectors in patients with aphakia, in contrast to patients with anterior chamber and transclerally fixed intraocular lenses. A similar trend is observed in patients with anterocameral intraocular lenses, relative to the group of patients with artifacia. A decrease in the depth of the anterior chamber was revealed in patients with anterior chamber lenses relative to patients with transcleral fixation and articulation was revealed in the upper sector. In the temporal sector, there is a decrease in this indicator in patients with aphakia relative to patients with artifakia. Conclusion. In the conditions of silicone tamponade of the vitreal cavity, the technique of transcleral fixation of intraocular lenses provides the most physiological indicators of the anterior chamber angle comparable to single-format indicators of patients with artifacia. Keywords: intraocular lens, aphakia, regmatogenic retinal detachment

Total 24-Hour Energy Expenditure Measured By Calorimetry Chamber In Patients With Colorectal Cancer: Baseline Findings From The Prime Study

Total 24-Hour Energy Expenditure Measured By Calorimetry Chamber In Patients With Colorectal Cancer: Baseline Findings From The Prime Study

Abstract P1-10-14: Higher radiation dose to the heart in left sided breast cancer; anatomy versus dosimetry

Abstract Abstract: Background: There is assumption that omitting the internal mammary chain radiotherapy (IMC RT) in patients with breast cancer (BC) will significantly reduce the cardiac exposure for all patients regardless the cardiac anatomy of each patient. Aim: to evaluate the impact of IMC RT on the dose received by the heart and its chambers in patients with favorable versus unfavorable cardiac anatomy. Patients and methods: CT scans were obtained of 20 patients with left-sided BC, 10 with favorable and 10 with unfavorable cardiac anatomy. Three plans were generated for each patient, one treating only the breast with tangents, and one treating the breast and IMC with wide photon tangents, and one treating the breast and IMC to 50Gy with photon tangent fields and a matching medial electron field. Dose volume histograms (DVHs) were generated for the heart and chambers. The equivalent uniform doses (EUDs) were calculated for each DVH, and the mean EUDs for plans with unfavorable and favorable cardiac anatomy were compared using a two-sided two-sample T-test Results: The mean dose received by the heart from plans with tangents plus IMC fields in patients with favorable cardiac anatomy was significantly lower than that received from plans with tangents only or wide tangents in patients with unfavorable anatomy (P &amp;lt; .0001). The average EUD for plans with tangents and IMC fields in the favorable group was 16 Gy (SD = 4.5) as compared to 36 Gy (SD = 3.6) and 37 Gy (SD = 5.1) for plans with tangents only and wide tangents in the unfavorable group, respectively ((P &amp;lt; .0001). The doses to the right ventricle were not significantly different. Conclusions: Ttreatment plans should be individualized based on the cardiac anatomy of each patient. Citation Format: Mohamed Alm El-Din, Andrzej Niemierko, Alphonse Taghian. Higher radiation dose to the heart in left sided breast cancer; anatomy versus dosimetry [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P1-10-14.

Определение цитокинов в сыворотке крови и во влаге передней камеры у пациентов с глаукомой и катарактой на фоне псевдоэксфолиативного синдрома

Purpose. To investigate changes in proinflammatory cytokines Interleukin (IL 1β) and Tumor necrosis factor (TNF-α) before surgery in anterior chamber moisture and in blood serum in cataract and in its combination with glaucoma due to pseudoexfoliative syndrome (PES). Material and methods. The results of the examination included 61 patients aged 56 to 86 years (average age 72.2 years) who were hospitalized for cataract surgery. Among them, 12 (19.7 %) people had primary open-angle pseudoexfoliative glaucoma with normalized intraocular pressure (IOP). A group of 34 patients were diagnosed with PES, but without the presence of glaucoma. The control group consisted of 15 patients with cataracts of comparable age without signs of PES. The analysis of the results took into account the data of ophthalmological examination, immunological studies, namely measurements of the concentration of IL-1ß and TNFa in blood serum and in the moisture of the anterior chamber, as well as somatic status. Results. PES, in general (i.e. in the study of 46 patients), occurred in 23.9 % of cases, stage II — in 43.5 % and stage III — in 32.6%. With a combination of cataracts and glaucoma (in the advanced stage), PES stage I was diagnosed more often — in 33.3 %.Inflammatory postoperative complications were diagnosed only in stages II or III of PES, and more often with a combination of glaucoma and cataract (in 33.3 % of cases) than with isolated surgical treatment of cataract (11.8 %). There was a statistically significant (p &lt; 0.05) increase in the indicators of proinflammatory cytokines IL- 1ß and TNF-α in blood serum and especially in the moisture of the anterior chamber in patients with PES in comparison with the age control group. Various concomitant somatic pathologies in patients with PES, especially in the presence of glaucoma, occurred more often (93.5 %) than in patients without pseudoexfoliation (73.3 %). Conclusion. Significantly increased, in comparison with the control rate, concentrations of proinflammatory cytokines IL-1β and TNFa in blood serum and moisture of the anterior chamber of the eyes with unoperated cataract, and especially when combined with glaucoma due to PES, correlated with the degree of its development and the risk of postoperative, including inflammatory, complications. Taking into account more frequent presence of somatic pathology in patients with PES, it is necessary to have more frequent dynamic follow-up after surgery of patients with PES for the purpose of early diagnosis and timely treatment of potential complications. Keywords: cataract, glaucoma, surgical treatment, pseudoexfoliative syndrome, proinflammatory cytokines Interleukin (IL-1β) and Tumor necrosis factor (TNF-α), postoperative, inflammatory complications

Comparison of bronchodilator response between Dosivent® and Aerochamber Plus® Flow-Vu® chambers in patients with bronchial hyperreactivity

Comparison of bronchodilator response between Dosivent® and Aerochamber Plus® Flow-Vu® chambers in patients with bronchial hyperreactivity

Comparison of bronchodilator response between Dosivent® and Aerochamber Plus® Flow-Vu® chambers in patients with bronchial hyperreactivity

Comparison of bronchodilator response between Dosivent® and Aerochamber Plus® Flow-Vu® chambers in patients with bronchial hyperreactivity

The association of I/D polymorphism of ACE gene with metabolic factors of cardiovascular risk, structural and functional state of left cardiac chambers in patients with diabetic nephropathy and essential hypertension

Objective — to reveal an association of I/D polymorphism of ACE gene with metabolic factors of cardiovascular risk (CVR) such as visceral obesity (VO), insulin resistance (IR), dyslipidemia (DLP) as well as with indices characterized structural and functional state of left cardiac chambers in patients (pts) with diabetic nephropathy (DN) and essential hypertension (EH).&#x0D; Materials and methods. The investigation was conducted at the Clinical Department of Arterial Hypertensions and Kidney Diseases in L. T. Mala National Therapy Institute of NAMS of Ukraine (Kharkiv). Clinical examinations involved 82 pts, 42 (51.2 %) females and 40 (48.8 %) males with DN of I — IV stage and EH of II — III stage, aged 31 to 82 years old (an average age is (61.65 ± 1.28) years old). Three genotypes of I/D polymorphism of ACE gene included II — 18 (24.7 %), ID — 32 (43.8 %) and DD — 23 (31.5 %) of cases correspondingly were investigated in 73 (89.0 %) pts. Anthropometric measurements with calculations of body mass index (BMI), body fat percentage (BFP), body fat mass (BFM), fat mass index (FMI) were conducted by known formulas in all pts. Blood lipids were detected by enzyme method with measuring of total cholesterol, high‑density lipoprotein cholesterol (HDL‑C) and triglycerides (TG). Levels of cholesterol of very low density and low‑density lipoprotein (VLDL‑C, LDL‑C) were calculated by standard formulas. Blood glucose level was measured by glucose oxidase method and serum insulin was detected by immunoassay method. IR indices such as HOMA‑IR, triglyceride glucose index (TGGI) and METS‑IR (metabolic score for insulin resistance) were obtained by known formulas. I/D polymorphism of ACE gene (rs 4646994) was investigated with a usage of polymerase chain reaction. Structural and functional state of left cardiac chambers was estimated using transthoracic echocardiography. Systolic and diastolic blood pressure (SBP and DBP) were measured by Korotkov’s method. The results were statistically obtained with computer programs Microsoft Office Excel 2003 and Statistica 23.0.&#x0D; Results. In pts with II genotype, LDL‑C levels positively correlated with BFP (r = 0.490; p = 0.046) and BFM (r = 0.484; p = 0.049) in conditions with hypertriglyceridemia due to activation of visceral fat lipolysis in which a reverse correlation between relative thickness of left ventricle wall (RTLVW) and serum TG concentration (r = –0.540; p = 0.02) could be explained. In pts with ID genotype, presence of D allele in genotype was associated with an increase in RTLVW due to SBP influence (r = 0.358; p = 0.045). In genotype ID there was a relationship between IR index HOMA‑IR and BMI (r = 0.399; p = 0.029) and HOMA‑IR and FMI (r = 0.402; p = 0.025) that demonstrated VO participation of in the development of IR in pts with DN and EH and genotype ID. In pts with DN and EH, who had DD genotype, SBP level reversely correlated with HDL‑C (r = –0.498; p = 0.018) that could be explained by influence of IR on elevation of SBP and reduction of HDL‑C. In pts with DD genotype both SBP and DBP almost equally influenced on the left atrial diameter (r = 0.460; p = 0.036 and r = 0.453; p = 0.034 correspondingly). In pts with DN and EH whose had DD genotype IR index METS‑IR positively correlated with RTLVW (r = 0.419; p = 0.047) and left ventricle myocardial mass index (r = 0.518; p = 0.011) that confirmed an association of D allele of ACE gene with left ventricle hypertrophy caused both by EH and IR.&#x0D; Conclusions. It has been established that in patients with diabetic nephropathy and essential hypertension, the I/D polymorphism of ACE gene was associated with such metabolic factors of cardiovascular risk as visceral obesity, insulin resistance, dyslipidemia, and pathological left ventricle remodeling.&#x0D;

Left atrial function may mitigate the effect of mitral regurgitation on right chambers in patients with severe aortic valve stenosis

Abstract Introduction Left atrial (LA) function has been associated to right chambers hemodynamics in the context of mitral valve regurgitation (MR). However, this physiological interplay between left atrial function, mitral regurgitation and right ventricular (RV) parameters has not yet been clarified in patients with aortic valve stenosis (AS). Aim of the study To assess the combination of LA function and different MR grades with right chambers performance and pulmonary non-invasive hemodynamics status in patients with severe AS using an advanced automated echocardiographic approach. Methods Consecutive patients with severe AS referred to our institution were analyzed. Mitral regurgitation was classified according to integrative guideline-based criteria. 2D advanced speckle tracking echocardiography analysis was conducted to measure the LA peak atrial longitudinal strain (PALS) and right ventricular free wall strain, (RVFWS) using Tomtec Arena, version TTA2 41.00, with dedicated LV/LA/RV analysis option (Tomtec, Unterschlei heim, Germany). All conventional right chambers performance indexes were also measured: TAPSE, S'- TDI, fractional area change, systolic pulmonary artery pressure (sPAP). We featured 3 patients groups based on MR grade and LA function: (a) no/mild MR and preserved PALS (above the median); (c) &amp;gt;mild MR and reduced PALS; (b) the remaining patients with &amp;gt;mild MR and low PALS or &amp;gt;mild MR and high PALS. Results A total of 102 patients with severe aortic stenosis formed the study cohort: age was 82±9, 47% were female, mean left-ventricular-ejection-fraction 56%±12, more than mild MR was present in 24% of patients, mean PALS was 19±10%, sPAP 38±12 mmHg, RVFW strain 21±6%, and RVFW/sPAP 0.62±0.25. The 3 subgroups presented similar age and sex distribution. Right ventricular function significantly worsened moving from group (a) to (c); RVFW strain decreased from 25±5 (a) to 19±7 (b) and 17±5% (c), p&amp;lt;0.001; sPAP increased from 34±9 (a) to 39±12 (b) and 47±13 mmhg (c), p&amp;lt;0.001; and RVFW/sPAP decreased from 0.76±0.21 (a) to 0.54±0.23 (b) and 0.39±0.11 (c), p&amp;lt;0.001. Patients in the group (c) were more symptomatic (NYHA class III/IV increase from 40% in group a and 63% in group (b) to 80% in group c, p=0.006). When added to MR grade, in a logistic regression analysis, PALS provided incremental prediction of all right ventricular parameters (p&amp;lt;0.01). Conclusion This study highlights that the combination of MR and reduced LA function is associated with symptoms and RV impairment in patients with severe AS. These preliminary results suggest that preserved LA function may modulate the adverse effects of the AS-MR combination by preventing/delaying the development of pulmonary hypertension and right ventricular dysfunction. Funding Acknowledgement Type of funding sources: None.

Radiographic Images of the Narrowing of Dental Pulp Chambers in Patients Receiving Long-term Steroid Therapy

Radiographic Images of the Narrowing of Dental Pulp Chambers in Patients Receiving Long-term Steroid Therapy

Evaluation of the Therapeutic Effects of a Series of Treatments with Whole-Body Cryotherapy on Pain of the Cervical Spine in the Course of Degenerative Disease

Aim: To evaluate the therapeutic effect of a series of 10 treatments of whole-body cryotherapy combined with kinesitherapy on the cervical spine pain in the course of degenerative disease. Evaluation of the adverse effects occurrence during stay in a cryogenic chamber in patients of different ages. Materials and Methods: For the study, based on the inclusion and exclusion criteria, 29 patients were qualified out of 231 patients who underwent the procedure of whole-body cryotherapy combined with kinesitherapy during the period of observation. The following data were used in the study: data from medical records, a sociodemographic questionnaire, standardized methods – the VAS scale and a modified questionnaire of pain indicators according to Laitinen. Results: In the VAS scale in about 93.1%, and based on the modified questionnaire of pain indicators according to Laitinen, in as many as 96.5% of patients, a reduction in the intensity of pain of the cervical spine after 10 sessions of whole-body cryotherapy combined with kinesitherapy was observed. On average, pain symptoms decreased by 2.9 points on the VAS scale and the average score according to modified questionnaire of pain indices according to Laitinen was by 2.8. Conclusions: A series of 10 procedures of whole-body cryotherapy combined with kinesitherapy reduces the intensity of pain in the cervical spine in the course of degenerative spine disease. Cryogenic chamber treatment is safe and well tolerated, regardless of the age.

Accuracy and reliability of focused echocardiography in patients with Chagas disease from endemic areas: SaMi-Trop cohort study.

Chagas disease remains a major cause of cardiovascular death in endemic areas. Focused echocardiography (FoCUS) is a point-of-care means of assessing cardiac function which can be useful for the diagnosis of cardiac involvement. This study aims evaluating the characteristics of validity and reliability of FoCUS applied on Chagas disease patients. Patients with Chagas disease coming from an endemic area were selected from a large cohort (SaMi-Trop). A simplified echocardiogram with only three images was extracted from the conventional echocardiogram performed in this cohort. The images were evaluated by an observer who was blinded to the clinical and echocardiographic data, to determine the accuracy and reliability of FoCUS for cardiac assessment. The analysis constituted of 5 prespecified variables, dichotomized in absence or presence: left ventricular (LV) size and systolic function, right ventricular (RV) size and systolic function, and LV aneurysm. We included 725 patients with a mean age of 63.4 ± 12.3 years, 483 (67%) female. Abnormal electrocardiogram was observed in 81.5% of the patients. Left and right ventricular dysfunctions were found in 103 (14%) and 49 (7%) of the patients, respectively. Sensitivity, specificity, positive predictive value and negative predictive value were 84%, 94%, 70% and 97% for LV enlargement and 81%, 93%, 68% and 97% for LV systolic dysfunction, respectively, and 46%, 99%, 60% and 98% for RV dilatation, and 37%, 100%, 100% and 96% for RV dysfunction, respectively. Inter and intraobserver agreement were 61% and 87% for LV enlargement and 63% and 92% for LV dysfunction, respectively, and 50% and 49% for RV size and 46% and 79% for RV dysfunction, respectively. LV apical aneurysm was found in 45 patients (6.2%) with the lowest sensitivity of FoCUS study (11%; 95% CI 2-28%). FoCUS showed satisfactory values of validity and reliability for assessment of cardiac chambers in patients with Chagas disease, except for apical aneurysm. This tool can identify heart disease with potential impact on patient management in the limited-resource setting.

Cardiac magnetic resonance imaging in assessing heart function in patients with Ebstein's anomaly

Abstract Ebstein's anomaly (AE) is a rare congenital heart disease in which the development of the tricuspid valve (TV) and right ventricular myocardium (RV) is impaired. Evaluation of the RV using echocardiography has certain difficulties due to the irregular shape, these limitations can be overcome by CMR. CMR helps the surgeon to assess the degree of tissue delamination of all leaflets from the RV, to determine the boundaries of the atrialized part of the RV, as well as to assess the effectiveness of the operation. Purpose To assess changes in the areas of the heart chambers in patients with Ebstein's anomaly and in the long-term period after cone reconstruction using magnetic resonance imaging. Methods Conducted a single-center, retrospective study. The study included 9 patients with AE and 15 patients in the long-term period after cone reconstruction. The average age was 6.08 [2; 10] years, weight - 26.73 [12.5; 33] kg, height 116.24 [90; 137] cm, body surface area 0.9 [0.55; 1.06] m2. CMR was performed before operation and upon admission for a follow-up examination in the long-term period. CMR was performed on tomography with a magnetic field induction of 1.5 T. To visualize the TV, dynamic images were used in 2- and 4-chamber projection. We used the method of assessing the area of each heart chamber separately in systole and diastole according to the CMR. Results According to the CMR, there were changes in the area before operation in each chamber in systole and diastole, except for the atrialized part of the RV. There were statistically significant changes in the functional part of the RV before operation in a 4-chamber projection in systole 5.73 [4.15; 8.2] mm2 and diastole 11.76 [7.35; 17.2] mm2 and in a 2-chamber position in systole 34.3 [23.25; 44.65] mm2 and diastole 45.66 [33.85; 54.4] mm2 (p=0.001 and p=0.025, respectively). The areas of the RA, LA, LV also had statistically significant changes in systole and diastole. Statistical analysis showed significant results in all parts of the heart, except for the atrialized part of the RV before operation (p=0.4 and p=0.092) in 2-, 4-chamber projections. Comparison of chambers before and after operation in % ratio showed that the area of the functional part of the RV increased after cone reconstruction, due to the exclusion of the atrialized part and suturing of the edge of the TV leaflets to the true annulus fibrosus. Conclusion The use of CMR, in patients with Ebstein's anomaly before operation and in the long-term period, to assess the areas of the heart chambers, confirmed the absence of contractility in the atrialized part of the RV and the need for its suturing. Moving the point of closure of the TV leaflets to the true annulus fibrosus and excluding the atrialized part during conical reconstruction allows increasing the area of the functional part of the RV with a positive effect on the hemodynamics of the heart. Funding Acknowledgement Type of funding sources: None. Values of the area of the heart chambersCMR, 4-chamber projection

Inflammatory damage to the myocardium in patients with novel coronavirus disease (COVID-19)

The aim. To analyze current evidence about etiology, pathogenesis, clinical manifestation, diagnosis, and treatment of patients with COVID-19 associated myocarditis. Multisystem inflammatory syndrome is possible in COVID-19 including inflammatory damage to the myocardium, which may last over several months and worsen the disease outcome. Mechanisms of inflammatory cardiac damage include direct damage by SARS-CoV-2, massive release of cytokines, dysregulation of the renin-angiotensin system. All these factors can aggravate pre-existing overload of the right heart chambers in patients with multifocal pneumonia, thrombosis of coronary arteries and myocardial ischemia. Inflammation of the myocardium manifests with typical symptoms of myocarditis and pericarditis. It can be accompanied by heart failure with rapid decompensation, arrhythmia, acute coronary syndrome or even sudden death. Laboratory findings in COVID-19 associated myocarditis include high levels of CRP, BNP, NT-proBNP, and D-dimer. Transthoracic echocardiography allows for an assessment of the left ventricular dysfunction and diagnosis of a pericardial effusion. Heart MRI according to the Lake Louise Diagnostic Criteria is the most sensitive diagnostic method in acute myocarditis. Medical imaging is indicated only in cases when results obtained can potentially influence the patient management tactics and should be performed according to the shortest protocol due to high risks of virus transmission. Conclusions. ESC experts (2020) do not provide unanimous recommendations for the treatment of SARS-CoV-2 associated myocarditis, considering a lack of the evidence base. Patient management is limited to adequate treatment of heart failure, arrhythmia, acute coronary syndrome, and prevention of thrombotic complications. Ongoing studies are aiming to evaluate potential place of glucocorticoids, intravenous immunoglobulins, antibodies against IL-6 receptor, colchicine in the treatment of COVID-19.

Transcatheter Aortic Valve Implantation in Bicuspid Aortic Valve Pathology: Current Evidence and Technical Challenges

Transcatheter aortic valve implantation (TAVI) is an established therapy for severe symptomatic aortic valve stenosis (AS) in patients at high and intermediate risk for surgical aortic valve replacement (SAVR). Current evidence also suggests at least non-inferiority of TAVI in low-risk patients compared to SAVR. However, there are special subsets of patients and anatomical circumstances in which TAVI is traditionally considered a suboptimal treatment strategy due to procedure inherent increased risks (e.g., rupture of cardiac chambers in patients with severe calcifications of the left ventricular outflow tract, valve migration in very large aortic annuli). One of these special subsets is bicuspid AS. Bicuspid aortic valve disease is the most common congenital heart defect and most frequent reason for AS in patients &lt;70 years of age. Bicuspid aortic valve pathology is characterized by special anatomical complexities like asymmetrical cusp proportion and calcium distribution, a more pronounced annular ellipticity compared to tricuspid aortic valves and concomitant dilation of the thoracic aorta. These factors have led physicians to traditionally indicate TAVI more reluctantly in those patients in the past. In this article, current evidence for TAVI for bicuspid AS is discussed and technical challenges are highlighted.

Experience in Applying Hyperbaric Oxygen Therapy Using Portable Pressure Chambers for the Treatment of Patients with the Novel Coronavirus Infection COVID-19

This communication presents the experience of using mobile pressure chambers in patients with the confi rmed novel coronavirus infection in hospital settings. The obtained preliminary results indicate positive antihypoxic effects of hyperbaric oxygen therapy (HBO) applied in the form of increased saturation. After a session of HBO, patients demonstrated an increase in the oxygen saturation of capillary blood hemoglobin at the average level of 3.71 points. Differences between SatO2 levels prior to and following HBO treatment were signifi cant in the CT2, CT3 and CT4 groups (p0.05). As expected, the effi cacy of HBO in terms of the oxygen saturation of capillary blood hemoglobin was the greatest in the patient groups showing pronounced clinical and radiological changes in the lungs.