Current guidelines for patients after transcatheter aortic valve implantation (TAVI) recommend a multiparametric echocardiographic assessment to detect structural valve disorders (SVD). The article highlights the specific features of echocardiographic evaluation post-TAVI. It describes the nuances of visual assessment regarding the prosthesis position and shape. The calculation of hemodynamic characteristics is presented, taking into account critical methodological aspects in TAVI patients, as well as the features of quantitative assessment for both of intraprosthetic and paraprosthetic regurgitation flows.
Objective: To evaluate the potential of multiparametric high-frequency ultrasound (18–24 MHz) for monitoring early changes after photodynamic therapy (PDT) in patients with basal cell carcinoma (BCC). Materials and Methods . The prospective, single-center study included 31 patients with 51 histologically confirmed basal cell carcinoma lesions. All patients underwent multiparametric ultrasound imaging using an Aplio i800 ultrasound scanner (Canon, Japan) with 18–24 MHz linear transducers before and 24 hours after the PDT session. The protocol included evaluation of the tumor using B-mode, Doppler, and power Doppler mapping, including microcirculation (ADF and SMI) assessment with VI calculation, strain elastography, and fluorescence spectrometry. Results. Before treatment, all cutaneous lesions were presented as hypoechoic lesions with clear margins, an average thickness of 3.7 ± 1.2 mm, a heterogeneous solid structure, and hypervascularisation (VI 32.4 ± 4.1). 24-hours after PDT, a statistically significant decrease in VI to 4.2 ± 1.8 (p < 0.001) was observed. B-mode revealed an increase in tumor thickness to 4.4 ± 1.3 mm, decreased marginal clarity, and signs of perifocal edema. Fluorescence contrast decreased from 1:4 to 1:1. Elastography did not show significant changes in the early stages. Conclusion . Multiparametric ultrasound with high-frequency transducers (18–24 MHz) is an informative, noninvasive method for early monitoring of PDT efficacy. The most significant ultrasound feature of treatment response is a significant reduction in intratumoral blood flow, quantified using micro-Doppler techniques. This is due to the primary mechanism of PDT action –photochemical damage to tumor microvasculature and the development of coagulative necrosis.
Aim To determine and compare myocardial strain parameters for the left ventricle (LV), left atrium (LA), and right ventricle (RV) in healthy individuals using speckle-tracking echocardiography (STE) across equipment from two different manufacturers.Material and methods The study included 30 subjects with no known cardiovascular disease at the time of enrollment. Transthoracic echocardiography (TTE) was performed on all participants on the same day within a single hour by the same experienced clinician, using two ultrasound systems from different manufacturers sequentially. To evaluate chamber strain, dedicated cine loops were recorded for the LV, LA, and RV. The following parameters were analyzed: LV global longitudinal systolic strain and segmental longitudinal strain (17-segment model); LV radial and circumferential strain; RV free wall global and segmental longitudinal strain; and LA strain during the reservoir, conduit, and contractile phases.Results. The longitudinal strain values for the LV, RV, and LA obtained via STE in healthy individuals using software from two different manufacturers fell within the established normal ranges. A comparison of the strain metrics between the two software packages revealed significant differences in regional longitudinal systolic strain in 6 out of 17 LV segments, 1 out of 3 RV free wall segments, as well as in LV radial and circular strain, and LA global longitudinal strain during the contractile phase. Bland-Altman analysis demonstrated a mean bias exceeding 1 and wide confidence intervals for the metrics across the two software platforms.Conclusion The longitudinal strain values for the LV, RV, and LA obtained via STE in healthy individuals fell within the established normal reference ranges, regardless of the software vendor. A comparison of strain parameters calculated using software from different manufacturers revealed significant differences in several metrics. Consequently, strain values obtained from different software manufacturers are not directly comparable.
Functional sinus surgery implies the use of specialized optical systems. At present, most clinics use a set of endoscopes with viewing angles of 0°, 30°, 45°, and 70°. In most cases, endoscopes with viewing angles of 45° and 70° are used for visualization of the anatomical regions of the maxillary sinus. However, even the use of a 70° endoscope does not always provide adequate visualization of anterior and medial regions, located anteriorly to the nasolacrimal duct. Lack of full visualization of these anatomical regions can lead to incomplete debridement of them or unjustified formation of additional access into the sinus. In order to mitigate the problem of insufficient visual control during endoscopic maxillary sinus surgery, numerous instruments have been developed, already implemented in clinical practice, as well as promising models that are at the stage of clinical trials and testing. Among them are rigid endoscopes with various viewing angles, rigid endoscopes with variable viewing angles, flexible endoscopes, rigid endoscopes with a flexible tip, and robot-assisted systems. All of them have their own advantages and disadvantages, which will be detailed in this review. Rigid angled endoscopes are optimal in most cases of maxillary sinus surgery. A flexible endoscope provides optimal visualization of the maxillary sinus lumen at the stage of outpatient postoperative follow-up. Endoscopes with variable viewing angles do not allow replacement of standard angled optics due to the presence of certain drawbacks. Rigid endoscopes with a deflectable tip and robot-assisted endoscopic systems are currently at the stage of development and study.
Objective: to identify a promising subgroup of patients in the group of patients with acute myocardial infarction and atrioventricular block of II–III degree for implantation of a permanent pacemaker at the earliest possible time.Materials and methods: a retrospective non–randomized study was conducted, which included 124 patients with acute myocardial infarction in the anterior descending artery basin and atrioventricular block of II–III degree. All clinical cases meeting the criteria below were included from a continuous sample of 9687 patients with acute coronary syndrome treated in 2014–2024. Upon admission, all patients were sent to the X-ray room, where coronary angiography was performed, according to the results of which the anterior descending artery was visualized as an infarct-dependent artery and successful revascularization by stenting was performed. Despite the successful revascularization of the anterior descending artery, all patients retained atrioventricular blockade of the II–III degree, which served as the basis for temporary pacing through subclavian access, if there was no restoration of atrioventricular conduction within 14 days, then a permanent pacemaker was implanted. Depending on the type of atrioventricular block, the patients were divided into 2 groups. The AV-proximal group consisted of 58 patients with acute myocardial infarction in the anterior descending artery basin and proximal type of atrioventricular block of II–II degree, the AV-distal group consisted of patients with acute myocardial infarction in the anterior descending artery basin and distal type of atrioventricular block of II–III degree. Atrioventricular blockade of the II–III degree was considered distal with an elongation of the QRS complex of the electrocardiogram of more than 0.12 seconds, and proximal – respectively less than 0.12 seconds.Results: The groups were comparable in all clinical and demographic indicators, with the exception of the frequency of coronary heart disease in the anamnesis, which was more common in the AV-distal group (49 (84.5%) and 64 (97%) in the AV-proximal and AV-distal groups, respectively, p = 0.007; error = 5.9 at 95% confidence interval [1,2;28,4]), and the frequency of AV-conduction recovery in the period up to 14 days from the moment of myocardial infarction, which was significantly higher in the AV-proximal group (48 (83%) and 5 (7.8%) in the AV-proximal and AV-distal groups, respectively, p = 0.001; Recovery = 58.56 with a 95% confidence interval [18.8; 182.8]), as well as the average time of temporary pacing before restoration of AV conduction or implantation of a permanent pacemaker was significantly less in the AV proximal group (7 [5;7] and 14 [14;14] in the AV proximal and AV is the distal, respectively, p = 0.03). When analyzing the complications of temporary pacing, no significant difference was obtained between the groups, except for the frequency of inflammatory skin phenomena in the puncture area and the location of the electrode for temporary pacing (3 (5.2%) and 12 (18.2%) in the AV-proximal and AV-distal groups, respectively, p = 0.01; inflammation = 4.0 [1,1;15]).Conclusion: In patients with acute myocardial infarction in the anterior descending artery basin and distal type of atrioventricular blockade of II – III degree, who underwent successful endovascular revascularization, the chance of AV recovery in the period up to 14 days from the moment of acute myocardial injury is almost 60 times higher than if they had a proximal type of blockade (Recovery = 58.56 at 95% confidence interval [18.8; 182.8]), the risk of inflammatory skin phenomena in the puncture area and the location of the electrode for temporary pacing, which is 4 times higher in the group with distal type of AV block (inflammation = 4.0 [1.1;15]), which correlates with the time of temporary pacing. There is probably a need for more aggressive treatment tactics in patients with acute coronary syndrome in the anterior descending artery basin and distal type of atrioventricular blockade of II–III degree, consisting in early implantation of permanent sources of the rhythm driver from the moment of myocardial infarction.
