[Lung perfusion scanning in the comprehensive diagnosis of pulmonary thromboembolism].

The aim of the study was to define the sensitivity, specificity, and diagnostic accuracy of lung perfusion scanning (LPS) in pulmonary thromboembolism (PTE). PTE diagnostic techniques are comparatively assessed. The data on 108 patients with suspected PTE and lung perfusion defects revealed at pulmonary scintigraphy were analyzed. The diagnostic techniques included electrocardiography (ECG), 150 echocardiography, venous ultrasonography, chest X-ray, and LPS. The significant signs of PTE were singled out of 150 ones (history data, complaints, clinical symptoms, instrumental findings, autopsy data); LPS data were analyzed in detail. The sensitivity, specificity, and accuracy of LPS were 95.2, 20, and 77.7%, respectively. It is shown that lung scans should be interpreted, by taking into account X-ray data, and LPS should follow ECG, venous ultrasonography, and chest X-ray.

[Characteristics of hemodynamic and external respiratory function in patients with concomitant wounds of the heart and lung during early postoperative period].

The parameters of intracardiac hemodynamics and external respiratory function (ERF) were studied by echocardiography and computed spirography with pneumotachometry in 123 patients with punctured and lacerated wounds of the chest in the early postoperative period. All the patients were divided into 6 groups according to the pattern of injuries. Group 1 included 25 patients with chest wound without organ damages; Group 2 comprised 42 patients with wound of the lung; Group 3 consisted of 22 patients with wound of the left ventricle (LV); in Group 4 there were 11 persons with wound of LV and the lung; Group 5 included 8 victims with wound of the right ventricle (RV); and Group 6 comprised 15 patients with wounds of the lung and RV. One- and five-day follow-ups revealed the most pronounced disorders of intracardiac hemodynamics and ERF in patients with concomitant wound of the lung and RV (Group 6). At the same time it was found that when wounds of the lung were concomitant with those of the heart, there was discoordination of RV and LV work with decreased volumetric blood flow along the pulmonary artery. These impairments also persisted by day 5 of the moment of wound. By that time there were positive hemodynamic and ERF changes in the other groups.

[Characteristics of cardiac insufficiency in myocardial infarction in the pre-rupture period]. / Osobennosti serdechnoi nedostatochnosti pri infarkte miokarda v predrazryvnom periode.

Of 61 patients with myocardial infarction (MI), complicated by cardiorrhexis (CR), 72% had heart failure (HF) in the prerupture period. A small MI zone (35.8 +/- 2.6% of the left ventricular area) was marked in 29 cases of instantaneous CR. Coronary arteries (CA) outside the necrotic zone were slightly necrosed (up to 50%). These factors as well as the hyperdynamic syndrome in 75% of the patients with instantaneous CR on the 1st day and a high frequency of left ventricular aneurysms made it possible to associate HF development with myocardial dyskinesia. In prolonged MI there were several HF causes: a large MI zone (47.9 +/- 3.1%), noticeable CA stenosis outside the MI zone. However, early CR development (on the 4th day) and a high frequency of aneurysms (62%) could be indicative of a considerable contribution of dyskinesia to HF development. A variant of prolonged CR combined with dysfunction of the papillary muscles was attended by HF development in 100% of cases in an intermediate value of a MI zone and the CA state. However, dysfunction of the papillary muscles was one of the variants of myocardial dyskinesia. A conclusion was made of an important role played in HF genesis by myocardial dyskinesia binding HF and CR by the single mechanism.

[Ultrasonic diagnosis of papillary muscle dysfunction in patients with acute myocardial infarct]. / Ul'trazvukovaia diagnostika disfunktsii papilliarnykh myshts u bol'nykh ostrym infarktom miokarda.

A study of 123 patients with acute myocardial infarction demonstrated the potentials of combined use of sectoral scanning and Doppler echocardiography in the diagnosis of the papillary muscle dysfunction syndrome. Two basic pathogenetic mechanisms of papillary muscle dysfunction associated with acute myocardial infarction are identified: direct involvement of the papillary muscles and papillary muscle dysfunction developing in cases of marked left-ventricular dilatation associated with acute aneurysm of the heart. Two-dimensional impulse Doppler echocardiography is found to be a more sensitive method, as compared to sectoral scanning, in the diagnosis of mitral lesions in patients with acute myocardial infarction.

[Changes in intracardiac blood flow in the acute period of myocardial infarction (according to the results of 2-dimensional impulse Doppler echocardiography]. / Izmeneniia vnutriserdechnogo krovotoka v ostrom periode infarkta miokarda (po dannym dvukhmernoi impul'snoi doppler-ékhokardiografii).

Quantitative parameters of intracardiac blood flow were examined by impulse dopplerography in normal subjects and patients with acute transmural myocardial infarction with reference to the severity of disturbance of left-ventricular segmental contractility. The flow rate through the apical region and left-ventricular efferent tract was basically similar in normal subjects and coronary patients without myocardial infarction. Where myocardial segmental contractility was disturbed, changes in flow rate are different at different left-ventricular levels and depend on the site of infarction, the extent of left-ventricular involvement and the condition of intact myocardium. Reduced flow rate in left ventricular cavity and the efferent tract is indicative of a profound depression of both total and segmental left-ventricular myocardial contractility.