[The significance of respiratory and orthostatic tests in duplex scanning in diagnostics of celiac artery compression syndrome].

The preoperative transabdominal ultrasonics duplex scanning (UDS) of celiac artery was made in quiet breathing, in inspiration, in expiration, using vertical position in 180 patients. As well as the intra-abdominal UDS was made before the decompression of the celiac artery using the pulmonary ventilation during narcosis and relaxation. Peak systolic blood velocity, degree of stenosis, arterial pressure gradient in the celiac artery and volume blood velocity were hemodynamically significant in quiet breathing, in expiration and intraoperatively, reliably lower in inspiration in vertical position. It is important to use respiratory and orthostatic tests in diagnostics of compressive stenosis of the celiac artery. The data, which were obtained in quiet breathing using vertical position, should be taken into account in order to distinguish the compressive stenosis from atherosclerotic stenosis or other origin.

[Intraoperative ultrasound duplex scanning in the diagnosis and assessment of results of surgical treatment of patients with celiac compression syndrome].

The authors have performed an analysis of main indicators of celiac duplex scanning in 180 patients with celiac compression syndrome before operation, during decompression and at the postoperative period. All the patients underwent surgical celiac trunk decompression. The indicators of the intraoperative celiac duplex scanning (stenosis degree, linear peak systolic circulation rate) of the celiac trunk shower hemodynamic reliable stenosis and were sufficiently different from preoperative findings. The stenosis degree and linear peak systolic circulation rate were less during intraoperative examination than before the operation. Intraoperative, duplex canning allowed compressive stenosis of the seliac trunk to be differentatied in some patients from intravasal one (atherosclerosis and arteritis), and its adequate decompression to be performed. When performing the celiac trunk decompression it is thought to be necessary to fulfill its intraoperative ultrasound duplex scanning before and after elimination of the compression.

[Aneurysmatic and occlusive lesions of the aorto-iliac segment in combination with cancer of the lungs and organs of the abdominal cavity].

An analysis of retrospective data has shown that 34 (14.4%) out of 236 patients with aneurysm of the abdominal aorta and iliac arteries and in 62 (5.1%) out of 1214 patients with occlusion or stenosis of these vessels mainly had cancer of the lungs (52%) and stomach (17.7%) with almost similar incidence in both groups. Colorectal cancer (8.3%) and cancer of other organs of the abdominal cavity were detected more rarely. Aneurysmatic (12 patients) and occlusive-stenosing (17 patients) lesions of the aorto-iliac segment were noted in 29 (0.4%) among 6834 patients with lung cancer or organs of the abdominal cavity. There were three subgroups of patients: (1) first cancer was diagnosed, and then aneurysm, stenosis or occlusion of these arteries (12-12.5%); (2) diseases of the arteries and cancer were diagnosed simultaneously (60-62.5%) and (3) first lesions of the arteries and later cancer (24-25%). Two-stage operative interventions for these diseases were made in 30 (31.2%) patients.

[Bypass grafting of the celiac trunk of superior mesenteric artery in treatment of patients with chronic ischemia of digestive organs].

In the period from 1984 to 2010 operations were made on 41 patients aged from 36 to 76 years with chronic ischemia of digestive organs (CIDO), infarction of the small intestine was determined in 7 of them mainly due to atherosclerotic injury of the celiac trunk (CT) and/or superior mesenteric artery (SMA). In 41 patients antegrade (15) or retrograde (26) shunting of CT and/or SMA were fulfilled with synthetic prostheses in combination with resection of the small intestine in 7 patients, with lethal outcome in 2 of them only. No prosthesis infection was noted. Lethality in early terms was 17.1% mainly at the early stage of the work. Observations during the period from one month to 24 years were followed up in 26 (63.4%) patients. Their state remains satisfactory, the shunts are patent. In treatment of patients with CIDO the antegrade and retrograde shunting of CT and/or SMA are shown to be effective methods.

[Celiac trunk compression syndrome associated with primary mitral valve prolapse].

A prospective study included 106 patients with celiac trunk compression syndrome (CTCS). Duplex scanning of the celiac trunk and superior mesenteric artery and echocardiography were performed during their examination. The investigation revealed primary mitral valve prolapse (PMVP) in 78 (74%) patients. Operations of decompression of the celiac trunk were made on 101 patients. After operation the symptoms (neurovegetative included) were found to disappear. No authentic distinctions were revealed in the clinical semiology and postoperative course of patients with CTCS and with a combination of CTCS and PMVP.

[Early diagnosis of pulmonary hemodynamic disorders in patients with pulmonary sarcoidosis].

A hundred and eleven patients with pulmonary sarcoidosis (PS) were examined to detect early impairments of pulmonary hemodynamics and myocardial function. A package of examinations included Doppler echocardiography at rest and with the Valsalva test, as well as electrocardiography and myocardial scintigraphy. In patients with early PS, right ventricular diastolic dysfunction is shown to be preceded by systolic dysfunction, as manifested itself in the altered ratio of different phases of right ventricular filling. As a method for early diagnosis of latent hypertension, the authors propose to use the Valsalva test to create a short-term volume overload of the right cardiac cavities. The study has indicated that left cardiac dilatation, decreased ejection fraction, left ventricular diastolic dysfunction, and the presence of large focal portions of fibrosis in the ventricular myocardium, interventricular septum, and papillary muscles can be considered to be early Doppler echocardiographic signs of sarcoidosis of the heart in patients with PS.

[Syndrome of compression of the celiac trunk of the abdominal aorta in adults].

The article presents results of examinations and surgical treatment of 300 patients aged from 19 through 72 years with the syndrome of compression of the celiac trunk of the abdominal aorta. Under study were the symptoms and features of the clinical course as well as the possibilities of diagnosis with the help of ultrasonic duplex scanning and aortography. The principal method of treatment of this syndrome is thought to be operative decompression of the celiac trunk resulting in the reestablished hemodynamics in this vessel and in recovery of the greatest part of the patients.

[Aneurysms of the pancreaticoduodenal artery in association with stenosis or occlusion of the celiac trunk].

On the basis of an analysis of 69 patients including 2 personal observations the authors discuss the questions of pathogenesis, clinical picture, diagnosis and treatment of aneurysms of the pancreaticoduodenal artery in association with stenosis or occlusion of the celiac trunk (CT). A description of 2 cases with a true not broken aneurysms of the inferior pancreaticoduodenal artery and subocclusion of the celiac trunk is given which was caused by compression of the latter by the median arcuate ligament of the diaphragm and neurofibrous tissue of the celiac plexus. These patients were detected as a result of examinations and operative treatment of 556 patients with compressive stenosis of the celiac trunk for the period from 1982 through 2002. In one case a transcatheter embolization of the aneurysm was fulfilled followed in 3 months by a compression of the celiac trunk, in the other case a compression of the celiac trunk was made first and then in 5 months it was followed by resection of the aneurysm with a favorable outcome.

[The significance of investigation of the left ventricle diastolic function in cardiosurgery].

An examination of 79 patients (main group) with congenital, acquired heart diseases and ischemic heart disease (IHD) without activity of the rheumatoid process and infectious endocarditis and 64 subjects of the same age has shown that in order to improve the assessment of the results of operative treatment of patients with the acquired heart disease and IHD it is necessary to test the diastolic function of the left ventricle (LV) in addition to the systole parameters. Cardiosurgical correction of pathological processes either causing or aggravating LV diastolic dysfunction (overloading LV with the volume or pressure, myocardium ischemia) can either eliminate or reduce its degree. A pathological monophasic filling of LV is a sign of a pronounced systole-diastolic dysfunction of LV and lung hypertension. A radical operative intervention reestablishes the biphasic filling of LV and reduces pressure in the pulmonary artery.

[Blood rheological properties and their interrelation with pulmonary hypertension in patients with chronic dust bronchitis]. / Issledovanie reologicheskikh svoistv krovi i ikh sviaz' s legochnoi gipertenziei u bol'nykh khronicheskimi bronkhitami.

Nineteen patients with chronic obstructive disease of the lungs and 15 patients with chronic non-obstructive bronchitis of the dust etiology were examined for the purpose of investigating the rheological blood properties and of their interrelation with pulmonary hypertension. The hemorheological properties were evaluated by spontaneous aggregation of erythrocytes and thrombocytes. The control group comprised 8 healthy subjects. The results denoted that the rheological blood properties are to a great extent impaired in patients with dust bronchitis. The rheological blood properties worsened as hypertension of the small blood-circulation circle was increasing; it preceded the development of pulmonary hypertension in patients with chronic obstructive disease of the lungs. The aggregation changes appear to be primarily related with the functional state of thrombocytes in patients with chronic non-obstructive bronchitis; a concurrently higher aggregation of thrombocytes and erythrocytes was observed in patients with chronic obstructive disease of the lungs. The obtained data can be useful for designing a medicamental correction scheme of rheological impairments as a trend within the treatment of affected hemodynamics in the small blood-circulation circle in patients with duct bronchitis.

[Biomechanical and flow characteristics of stentless and stented aortic valve bioprostheses]. / Biomechanicheskie i potokovye kharakteristiki beskarkasnykh i karkasnykh bioprotezov aortal'nogo klapana.

A comparative investigation of biomechanical and hydrodynamic characteristics of stentless and stented bioprostheses was carried out. It was demonstrated that stentless bioprostheses are functionally superior to stented ones. The differences between biomechanics and hydrodynamics of the examined stentless bioprostheses "BioLab", "AB-Mono-Kemerovo" and DD2 and stented bioprostheses "Wessex", "KemCor" and "Bionox-2" were shown.

[Compression stenosis of the celiac trunk in children and adolescents]. / Kompessionnyi stenoz chrevnogo stvola u detei i podrostkov.

Operations for compression stenosis of the celiac trunk (CSCT) were made on 97 patients aged 5.5-18 years (56 women and 41 men). Three basic clinical syndromes were observed: pain abdominal, dyspeptic and neurovegetative. The appearance or intensification of abdominal pains observed in 71.3% of the patients were connected with meal, in 59.69% of them it was simultaneous with physical exercise. The diagnosis of OSCT was based mainly on findings of ultrasonic duplex scanning. The indications to decompression of the celiac trunk were: clinical manifestations of CSCT, the stenosis degree at the maximal expiration more than 50%, peak systolic velocity of the blood flow more than 2 m/s and a gradient of arterial pressure more than 15 mm Hg. The decompression of the celiac trunk consisted in the dissection of a median arcuate ligament of the diaphragm, its interior crura and celiac ganglion fibers. Convalescence and recovery was stated in 87 of 97 patients in the nearest and long-term follow-up.

[Criteria of functional operability and indications for intraoperative volumetric monitoring of patients during extensive surgical procedures on the lung]. / Kriterii funktsional'noi operabel'nosti i pokazaniia k intraoperatsionnomu voliumetricheskomu monitoringu u bol'nykh pri obshirnykh operativnykh vmeshatel'stvakh na legkikh.

The investigation included 32 patients after extensive operative interventions on the lungs: pneumonectomy with circular resection of the trachea bifurcation and different kinds of combined pneumonectomies. Methods of Doppler echocardiography and thermal dilution were used for studying the parameters of lesser circulation before, during and after operation. Patients with the initially impaired hemodynamics had more pronounced functional changes after surgical procedures. The shift limits of the main ultrasonic indices of the right ventricle function were determined in order to form a group of the higher prognostic risk.

[Valsalva's test in patients with bronchial asthma]. / Primenenie proby Val'sal'vy u bol'nykh bronkhial'noi astmoi.

To examine feasibility of usage of phase IV hemodynamic alterations in the course of Valsalva's test in patients with bronchial asthma for detection of latent insufficiency of the right heart and pulmonary hypertension, 24 patients with mild bronchial asthma and 8 healthy individuals were subjected to Doppler echocardiography. The results indicate that this method is simple, well tolerated, can assess functional reserves of the lesser circulation. It can be used both for primary diagnosis and follow-up.

[Ultrasound scanning and invasive methods of examination of the celiac trunk and superior mesenteric artery in the diagnosis and evaluation of results of the surgical treatment of their stenotic lesions]. / Ul'trazvukovoe skanirovanie i invazivnye metody issledovaniia chrevnogo stvola i verkhnei bryzheechnoi arterii v diagnostike i otsenke rezul'tatov operativnogo lecheniia pri ikh stenoticheskom porazhenii.

The ultrasound duplex scanning with colored pictures of blood flow in the celiac trunk and superior mesenteric artery with occlusive lesion of them by atherosclerosis or compression by the diaphragm is a highly sensitive and sufficiently accurate research method. It allows to detect disturbances in patency of these vessels, the state of blood flow in them and to assess the results of operative treatment. A comparison of the data of preoperative ultrasound duplex scanning and aortic-arteriography has shown coincidence of the localization and, in most cases, the degree of stenosis of the celiac trunk and superior mesenteric artery. The results of direct electromanometry proved to be similar to those of dopplerography in 88% of cases before the operation and in all the cases after decompression of the celiac trunk.

[State of cardiopulmonary hemodynamics in patients with mucoviscidosis according to Doppler echocardiography]. / Sostoianie legochno-serdechnoi gemodinamiki u bol'nykh mukovistsidozom po dannym ékhodopplerkardiografii.

AIM: Doppler echocardiography (DEC) assessment of cardiopulmonary hemodynamics in patients with mixed and pulmonary forms of mucoviscidosis (MV). MATERIALS AND METHODS: 44 MV patients were divided into 4 groups depending on the presence or absence of echocardiographic and DEC data on right ventricular failure (RVF) or pulmonary hypertension. RESULTS: In MV patients, diastolic dysfunctions of the right heart may be preclinical and often precede systolic disorders. Development of RVF in some MV patients proceeds with distinct decline in myocardial contractility without stages of myocardial hypertrophy and pulmonary hypertension. CONCLUSION: Right atrium is able to certain extent compensate RVF in MV due to enhancement of its contractility.

[The diagnostic significance of clinical signs of right ventricular insufficiency in patients with chronic obstructive bronchitis]. / Diagnosticheskoe znachenie klinicheskikh priznakov nedostatochnosti pravogo zheludochka u bol'nykh khronicheskim obstruktivnym bronkhitom.

An echocardiographic study of right ventricular myocardial contractility in 123 patients with chronic obstructive bronchitis (COB) confirmed the suggestion that in COB patients symptoms of right ventricular failure (cyanosis, acrocyanosis, crural edema, dilated liver) may have extracardiac origin. In echocardiographic diagnosis of right ventricular failure one should measure the speed of the anterior wall movements in the systole, diastole and ejection fraction.

[Diastolic function of the right ventricle in patients with lung diseases as evidenced by Doppler echocardiography]. / Diastolicheskaia funktsiia pravogo zheludochka serdtsa u pul'monologicheskikh bol'nykh po dannym impul'snoi ekhodoppler-kardiografii.

The study was undertaken to examine the most informative Doppler echocardiographic parameters to determine right ventricular diastolic function in 46 pulmonological patients with pulmonary hypertension and right ventricular failure and 11 healthy individuals. The patients exhibited the highest blood velocity in the rapid filling phase, as compared to the healthy persons. They also demonstrated increased maximum blood velocities in the rapid filling phase on atrial systole and prolonged late blood flow in the rapid filling phase. Thus, Doppler echocardiography may be useful in the non-invasive diagnosis of right ventricular diastolic dysfunctions.

[The contractile capacity of the myocardium in patients with chronic obstructive bronchitis]. / Sostoianie sokratitel'noi sposobnosti miokarda u bol'nykh khronicheskim obstruktivnym bronkhitom.

As many as 123 patients with chronic obstructive bronchitis (COB) were examined. Myocardial contractility was estimated by echocardiography. The data obtained indicate that in COB patients, the contractility of the right and left heart is disordered. The level of systolic pressure in the pulmonary artery did not exceed 45 mm Hg in COB patients and cannot be the cause of the overload of the right heart. The decrease of left ventricular contractility is not associated with the concomitant pathology of the cardiovascular system. The causes of myocardial contractility disorders in COB patients remain unclear.

[The hemodynamic status of patients with chronic obstructive bronchitis and different degrees of respiratory failure]. / Sostoianie gemodinamiki u bol'nykh khronicheskim obstruktivnym bronkhitom s razlichnoi stepen'iu dykhatel'noi nedostatochnosti.

Changes in myocardial function of the right ventricle depending on oxygen tension in arterial blood were studied in 95 patients suffering from chronic obstructive bronchitis (COB) characterized by dramatic bronchial patency impairment and varying degree of respiratory insufficiency. Central hemodynamics was examined by echo-Doppler-cardiography and integral rheography. It has been established that in COB patients, the status of hemodynamics agrees well with the grade of respiratory insufficiency. As hypoxia increases, systolic pressure in the pulmonary artery rises; the size of the right ventricle and the width of its anterior wall increase; contractile function of the right ventricle does not depend on changes in oxygen tension in arterial blood; the compensatory increase of the cardiac and stroke indices is accompanied, as hypoxia rises, by diminution of pulmonary vascular resistance.