[A. N. Bakoulev Scientific Center for Cardiovascular Surgery].

OBJECTIVE: to assess dynamics of diastolic function for detection of development of diastolic dysfunction (DD) and it's causes, to evaluate the effect of DD on prognosis in the postoperative period in patients with acquired heart diseases. MATERIALS AND METHODS: We included in this study 112 patients with aortic and mitral valve diseases (90 men, 22 women, median age 51 [35; 57] years). All patients underwent echocardiography (echo), tissue Doppler, speckle tracking echo prior to surgery, in the early postoperative period (8-14 days) and in 12-36 months after surgery. In 28 patients dynamic contrast-enhanced magnetic resonance imaging was also performed. Patients were divided into groups according to prognosis: group 0 - without complications; group 1 - with postoperative heart failure (HF) and preserved left ventricular ejection fraction (EF); group 2 - with HF and EF <45 %. The following parameters were used for identifying left ventricular (LV) DD: septal velocity es <7 cm / sec, lateral el <10 cm / sec, average E / e ratio >14, left atrial (LA) volume index >34 ml / m2, peak tricuspid regurgitation velocity >2.8 m / sec. RESULTS: Initially diastolicLV function was normal in 34 of 112 patients (30.4 %), in early postoperative period DD emerged in 9 (26.5 %) of these patients. The appearance of LV DD was associated with decrease of septal es immediately after surgery and its subsequent progressive decline in the long-term postoperative period from 8.5±0.71 to 4.6 ±0.53 cm / sec (p=0.005). Worsening of diastolic function and lowering of septal velocity was detected namely in patients with presence of fibrosis. In the group of other patients in whom fibrosis was not studied and the degree of DD increased there was a transient decrease of lateral el (from 10.2±3.1 to 7.5±2.43 cm / sec, p=0.035) and an increase of the E / el (from 10.53±4.07 to 14.5±5.23, p=0.05) in the early period after the operation. There were no correlations between DD and LV EF,LV volumes, and development of arrhythmias. The prognostic model for DD included average longitudinal deformation of LA (global LA longitudinal strain) and E / e ratio on the tricuspid lateral annular velocity. CONCLUSIONS: Appearance of DD in postoperative period after correction of acquired heart defects was due to damage of the septal diastolic function which correlated with fibrosis and was indicative of inadequate myocardial protection. The model of development of heart failure with normal EF after operation was designed.

Experimental Study of Kinematic Activity of Left Ventricular Myocardium.

A method of invasive and non-invasive examination of epicardial motion was tested on domestic pigs (n=15). The invasive study employed a contact kinematic sensor of the epicardial wall motion, which determined the amplitude, velocity, and angular parameters of examined epicardial region. A non-invasive assessment of the epicardial kinematics based on echocardiographic 2D Velocity Vector Imaging and ECG recoding used to determine the heart electrical axis. The 4-chamber views were uses to analyze the longitudinal displacements of lateral wall of the left ventricle at the basal, mid, and apical segments. In addition, the radial displacements were determined in short axis projections at basal and apical segments as well as at the level of papillary muscles. The animals with normal or horizontal heart's electrical axis demonstrated similar displacement of the epicardium along X-axis and in longitudinal direction, while displacement along Y-axis corresponded to that in radial direction. The combined invasive and non-invasive approach in measurement of epicardium motion makes it possible to quantify the kinematic epicardial activity.

[The value of transesophageal echocardiography for determination of tactics of cardioversion of atrial fibrillation]. / Znachenie chrespishchevodnoi ékhokardiografii dlia opredeleniia taktiki kupirovaniia fibrilliatsii predserdii

Transesophageal echocardiography was carried out in 110 patients before cardioversion of nonvalvular atrial fibrillation which duration exceeded 2 days. Twenty thrombi were found in 18 patients (16.4%). Anticoagulant phenindione was given to these patients for 3 weeks. Patients without thrombus received intravenously amiodarone followed with procainamide. Sinus rhythm was restored in 39.3% of these cases. In 5.5% of patients atrial fibrillation terminated spontaneously. Control transesophageal echocardiography showed that after 3 weeks there remained 11 atrial thrombi but all of them lost motility. Electrical cardioversion was successful in 90.7% of patients receiving short term and in 80% of patients receiving 3-week anticoagulant therapy (p>0.05). All patients received phenindione for 4 weeks after cardioversion. There were no thromboembolic or hemorrhagic complications. Ability of transesophageal echocardiography to detect atrial thrombi allows to carry out early cardioversion and to identify patients with high risk of embolism.