The goal the work was to study the possibility of using elastography on an open heart to determine the stiffness of the left ventricular myocardium. Material and methods. Intraoperative elastography was performed in 6 patients with isolated aortic stenosis and dissecting aneurysm of the ascending aorta with aortic insufficiency. Three patients underwent surgery to replace the aortic valve with mechanical prostheses (SIM-19) and three were operated to replace the ascending aorta with an artificial prosthesis with aortic valve replacement (David’s operation). The average age of the patients was 42±9 years (42–53) years. All patients underwent surgery under conditions of artificial blood circulation. Initially, elastography was evaluated on a working heart, and then on full artificial circulation. The study was performed on a VK 5000 ultrasound device with an intraoperative «stick» type sensor at a frequency of 7.5–15 Mhz, gain of 1.6 Db, resolution of 127 hz. The deformation coefficient was evaluated. The imaging program was exposed as for neurosurgery with a frequency of 15 Mhz. Visualization was performed in B-mode, followed by obtaining shear wave elastography with calculation of the deformation coefficient. Results. Wave elastography was evaluated for various heart pathologies with different myocardial thickness. It was found that the stiffness in the studied areas of the myocardium is different. Thus, in patients with atherosclerotic aortic stenosis and a pressure gradient of more than 100 mmHg, the deformation coefficient was increased, in accordance with the thickness of the myocardium and amounted to 3.81–4.06, and in patients with aortic root dilation and aortic insufficiency, the deformation coefficient was 1.64–2.9. Conclusion. Intraoperative assessment of the left ventricular myocardial deformation coefficient is possible only on a stopped heart and gives an idea of the state of the heart muscle with the possibility of soft and hard areas. Shear wave elastography provides information about the elasticity and hardness of the tissue, which indirectly reflects the viscosity of the myocardium. This study was aimed at verifying the methodology for assessing the characteristics of the elasticity of the left ventricular myocardium for myocardial overload by pressure (aortic stenosis) and volume in case of a dissecting aortic aneurysm with aortic insufficiency.

It is assumed that the wall shear stress (WSS), which determines the function of the endothelium, is constant along the arterial bed. The assessment of turbulence, blood flow velocity in the arterial system in healthy (13 patients) and in patients with the initial form of atherosclerosis in the femoral artery (42 patients) was discussed. The study quantified blood flow in the common femoral artery using V Flow with visualization of blood flow with a high frame rate. The results obtained in the femoral arteries were evaluated by the wall shear rate, velocity profile and oscillation index (OSI). It was shown that the average value of WSSmean in the femoral artery in healthy and in patients with stenosis <30–35% is 0.9± 0.4 – 0.91±0.4 Pa and does not significantly differ. The wall thickness in the common femoral artery in patients with the initial form of atherosclerosis was 0.9–1.1 mm, and in healthy patients 0.8–0.9 mm. The correlation between the parameters was evaluated by nonparametric analysis of Kendall’s Taub. It was revealed that there is no correlation between WSSmean and blood flow velocity (Vs) in both healthy and patients with the initial form of atherosclerosis.

Goal. To analyze the evolution of the myocardial contraction force through the assessment of kinetic energy in patients with aortic stenosis based on intraventricular blood flowsMaterial and methods. According to the selection criteria, 21 healthy volunteers (age 34 ± 3) and 105 patients with aortic stenosis (age 62 ± 4) were examined before and after surgery for 7–10 days. Transthoracic echocardiography was performed on a Vivid E9 device in 2, 3 and 4 chamber positions with registration of intraventricular blood flows, calculation of the rate of change in volume and kinetic energy depending on the left ventricular EDV, pressure gradient (ΔP) on the aortic valve with an assessment of the displacement of the left ventricular endocardium contour, based on technologies for tracking speckles of ultrasonic images in the MultiVox program.Results. Our goal was to quantify kinetic energy (KE) during the entire cardiac cycle of the left ventricle (LV) using echocardiography. One of the main strengths identified in these studies is the high reproducibility of the assessment of LV blood flow and hemodynamics the average coefficient of variability 7 ± 2% for assessing LV function. Studies have shown increased diagnostic reliability without spending additional time. In systole, the KE before the LV operation was higher than normal values (0.62–0.78 J) after the operation, the KE approached the norm, averaging 0.55 J.Conclusion. Changes in intraventricular blood flow in patients with pressure overload of the heart demonstrate higher systolic energy compared to the control group. Different time values of energy in systole and diastole, observed in patients before surgery, represent an objective approach to assessing the work of the heart. The energy analysis reflects earlier signs of mechanical myocardial disorders, compared with the ejection fraction and, possibly, predict the development of cardiac remodeling. Adequate correction of the defect normalizes the work of the heart already in the early postoperative period.

OBJECTIVE:The purpose of this study was to evaluate the dynamics of changes in the shear stress of the internal carotid artery wall by visualizing the vector flow before and after carotid endarterectomy. PATIENTS AND METHODS:We examined 30 apparently healthy male and female volunteers (34±2.2 years), 23 patients with pathology of the internal carotid artery prior to carotid endarterectomy (65±2.9 years), and 14 patients (of the 23 surgically treated patients) on POD 4-5 after carotid endarterectomy (61.6±2.7 years). The study was carried out on an ultrasound machine Mindray Resona 7 (China) equipped with a linear transducer (3-11 MHz) and the updated V flow software. Systolic blood flow velocity (Vs) before and after stenosis is correlated with the wall shear stress (WSS) by vector analysis. The WSS was analyzed in the internal carotid artery downstream and upstream of the plaque. The change in the direction of the WSS vector during the cardiac cycle was described using the oscillatory shear index (OSI). The turbulence of the flow, the wall thickness 1 cm proximal to the bifurcation of the common carotid artery, and the percentage of stenosis at the plaque level before and after surgery were evaluated. Stenosis of the internal carotid artery was determined by longitudinal scanning using the ECST method. The intra-group correlation coefficient was calculated when measuring the stress and shear of the wall. RESULTS:The average values of turbulence in stenosis were higher in systole than in diastole (p<0.001). The turbulent flow correlated with the wall shear stress before the operation (-0.5137; p<0.05). The adequacy of correction of ICA stenosis >70% was assessed by the blood flow rate and the ratio of WSS to the proximal and distal bed. The criteria for adequate correction were considered normalized values of intravascular blood flows, wall shear stress, and oscillatory shear index. CONCLUSION:In stenosis of the internal carotid artery, the wall shear stress was significantly higher in the direction of blood flow, which is characteristic of turbulence. Movement speeds at medium and high values of deformation serve as one of the indicators for assessing pathology and identifying areas of vessel stenosis. In the postoperative period, the direction of the flow vectors corresponds to normal values, which serves as an additional criterion for the effectiveness of surgical correction. Recording of the wall shear stress using vector flow mapping in patients with cerebrovascular diseases is a new direction for evaluating the results of surgical treatment.

ЦЕЛЬ ИССЛЕДОВАНИЯ Изучить регистрацию внутрижелудочковых потоков крови в полостях сердца и их взаимосвязь с миокардом и клапанным аппаратом у здорового человека. МАТЕРИАЛ И МЕТОДЫ В исследование включены 62 здоровых добровольца, не имеющих сопутствующей патологии, средний возраст 41±6 лет (23—47 лет), которым выполняли трансторакальную эхокардиографию. РЕЗУЛЬТАТЫ Были оценены основные анатомические и гемодинамические параметры у здоровых добровольцев. Сердечный цикл сопровождается достаточно тесным взаимоотношением между миокардом и потоками. Скорости потоков в левом желудочке формируются по сердечному циклу, а это непосредственно связано с миокардом и объемами полостей сердца. ЗАКЛЮЧЕНИЕ Исследование потоков крови в полостях сердца дает более глубокое понимание физических явлений в гемодинамике и функции миокарда, что важно, прежде всего, для диагностики и разработки новых хирургических технологий при реконструктивных операциях на сердце и сосудах.

Aim      To evaluate the right and left ventricular function and their interaction in patients with ischemic heart disease (IHD) complicated with mitral valve insufficiency (MVI) according to data of echocardiography (EchoCG) with the strain in gray scale, vector and diagram analyses.Material and methods  The study included 118 patients evaluated with EchoCG at the preoperative stage of treatment; 71 of these patients had ischemic MVI (group 1) and 47 patients had uncomplicated IHD (group 2 or comparison group). Mean age of patients was 64±10 years. All patients underwent a surgery in an appropriate volume for myocardial revascularization supplemented with mitral valve plasty or replacement in patients with MVI.  Standard EchoCG parameters and data obtained by postprocessing the EchoCG gray-scale images using the strain in gray scale, vector and diagram analyses were evaluated.Results In patients with complicated IHD, both global and local left ventricular (LV) systolic function and the right ventricular (RV) fractional area change (FAC) were significantly decreased. At the same time, there were no significant differences in the tricuspid annular plane systolic excursion (TAPSE) measured in M-mode and in the tricuspid annular systolic wave velocity (VSta), which also characterize the RV systolic function. The global longitudinal strain, the velocities of LV volume change and RV area change, and the long axis change velocity were informative for the right and left chambers, whereas the velocities of LV volume and RV area changes better detected RV disorders. The Pearson's correlation analysis used to identify the most significant parameters of interventricular interaction showed the presence of a strong inverse correlation, in the group of MVI patients, between the RV FAC and the degree of LV diastolic dysfunction (Е / e') - r= -0,62; p=0.000, as well аs the degree of MVI (vena contracta) - r= -0.58; p=0.001. In the comparison group of IHD patients without MVI, the correlation of RV FAC with E / e' was absent (r=0.28; p=0.192). The volume change velocity (dVol / dt) moderately correlated with the RV end-systolic and end-diastolic area in IHD patients but not in IHD patients with MVI. The RV area change velocity (dS / dt) evaluated during systole and diastole moderately significantly correlated with the LV end-diastolic volume.Conclusion      Additional overload of left heart chambers in ischemic MVI is a factor that influences the development of the systemic and pulmonary circuit disorders. Recording and evaluation of global longitudinal strain, LV volume change velocity, and long axis change velocity with simultaneous recording of the segmental myocardial displacement velocity serve as highly informative criteria for disorders of LV and RV function. The vector analysis allows quantitative estimation of the local segmental myocardial function. Decreased velocities of the free RV wall segmental displacements during systole and diastole are characteristic of systolic and diastolic dysfunction in patients with IHD complicated with mitral regurgitation.

ЦЕЛЬ ИССЛЕДОВАНИЯ Оценка деформации и сдвига сосудистой стенки до и после стентирования аневризмы брюшной аорты. МАТЕРИАЛ И МЕТОДЫ Обследованы 12 пациентов (средний возраст 63,2±6 лет) с аневризмой брюшного отдела аорты. По данным компьютерной томографии оценивали анатомические размеры аневризмы. Ультразвуковое исследование выполняли на аппарате «Vivid 7» (GE, США) линейным датчиком 3,5—5,0 МГц с регистрацией изображений и расчетом скоростей кровотока в области брюшной аорты непосредственно в средней части аневризмы и в области бифуркации аорты. В этих же участках инвазивно измеряли артериальное давление. Повторно регистрацию скоростей кровотока и давления выполняли сразу после стентирования аневризмы аорты. Полученные результаты вносили в базу данных с последующей обработкой в программе Ansys Workbench 19.2 и программе MultiVox для оценки сдвига деформации стенки аорты. РЕЗУЛЬТАТЫ Основываясь на данных анатомии и профиля кровотока, напряжения сдвига и эластичности сосудистой стенки, рассматривали количественные показатели механики стенки, а также влияние асимметрии аневризмы и неоднородной толщины стенки на пиковое напряжение. Деформацию сдвига стенки аорты оценивали по результатам моделирования с целью определения риска осложнений при патологии сосудистой стенки. Наблюдали ретроградный кровоток в аневризме, что обусловлено податливостью артериальной стенки и расширением аорты. Взаимодействие стенки сосуда, кровотока и давления определяют напряжение, которое характеризует прочность сосуда на разрыв расширенной артериальной части. В аневризме брюшной аорты определены две области с отчетливыми паттернами сдвига напряжения. Проксимальная область потока характеризуется колебаниями с низкими средними значениями. В дистальной части аорты происходит слияние потоков, что приводит к турбулентности с образованием больших отрицательных значений напряжения сосудистой стенки. ВЫВОД Распределение напряжений и изменения направления вектора сдвига стенки в области аневризмы брюшной аорты влияют на структурные изменения целостности стенки и важны для определения прогрессирования заболевания. Низкие пиковые значения пристеночного напряжения сдвига стенки интерпретируются как характерные признаки предстоящего разрыва.

Objective: to evaluate the results of biomechanics of myocardial contraction during diastole in patients with coronary heart disease based on the results of vector analysisMATERIAL: the study is based on 79 patients with coronary heart disease with myocardial infarction and scarring of the heart muscle aged 53±4 years and 34 healthy volunteers — 41±3 years were examined. Before and after the operation of coronary artery bypass grafting, transthoracic echocardiography was performed, followed by computer image processing and calculation of hemodynamic parameters — EDV, ESV, EF, E\A. Vector analysis was used to estimate the rate of myocardial displacement (V), from the apex to the basal region in six regions of the left ventricle.RESULTS. To determine the mechanical characteristics of left ventricular (LV) contraction, a method was used that allows dynamic series of ultrasound images to track the rate of myocardial contraction in the basal, middle and apical parts of the heart. Before surgery, during diastole, the rate of myocardial contraction increased by more than 30% in comparison with the norm in the basal, middle, and apical regions. Changes occur due to a decrease in myocardial perfusion. In response, hyperfunction occurs, which leads to the activity of additional cardiomyocytes in maintaining heart performance. After the operation, the recovery of myocardial contraction rates to normal values was noted.CONCLUSION. The results showed the dynamics of the rates of myocardial displacement mainly in the diastole, but there is no complete recovery in the hospital period. Diagnosis of the mechanical function of the myocardium during the cardiac cycle is based on the dynamics of the rates of contraction from the apex to the basal part of the left ventricle. Evaluation of the activity of myocardial contraction has certain advantages in determining the state of diastolic function of the left ventricle.

ЦЕЛЬ ИССЛЕДОВАНИЯ Оценить функцию миокарда и внутрисердечные потоки крови в левом желудочке (ЛЖ) у больных с ишемической болезнью сердца (ИБС) до и после реваскуляризации миокарда. МАТЕРИАЛ И МЕТОДЫ Обследовано 68 пациентов с ИБС, средний возраст — 61,2±3,1 года. Выборка включала 36 (53%) пациентов без инфаркта миокарда в анамнезе (1-я группа) и 32 (47%) пациента с перенесенным Q-образующим инфарктом миокарда (2-я группа). До и после реваскуляризации миокарда выполняли трансторакальную эхокардиографию по стандартной методике с последующей компьютерной обработкой изображений, оценкой вихревых потоков в ЛЖ. По векторному анализу в систолу и диастолу оценивали скорости смещения миокарда (V), скорость изменения объема ЛЖ (dVol/dt), скорость изменения длинной оси ЛЖ (dL/dt). РЕЗУЛЬТАТЫ В 1-й группе после операции выявлено увеличение скорости изменения объема (dVol/dt) ЛЖ в систолу и его уменьшение в диастолу, а также снижение диастолической скорости изменения длинной оси ЛЖ (dL/dt). Во 2-й группе после операции отмечено повышение систолических и диастолических значений скорости изменения длинной оси (dL/dt), повышение систолических и диастолических скоростей сокращения миокарда (V), отражающих его региональную сократимость. У всех больных до реваскуляризации зарегистрированы значимые нарушения формирования внутрижелудочковых потоков крови в систолу и диастолу с выраженной диссинхронией сокращения в обе фазы сердечного цикла. ВЫВОД Восстановление коронарного кровотока в ишемизированных зонах проявляется не только в уменьшении диссинхронии и увеличении скоростей сокращения миокарда, но также приводит к восстановлению нормальных паттернов потоков крови в желудочке за цикл уже через 4 мес после реваскуляризации миокарда. Восстановление характеристик внутрижелудочковых потоков крови является интегральным показателем нормализации функции миокарда.

We examined a total of 106 patients with ischaemic heart disease (mean age - 59±7 years) and 30 apparently healthy people (mean age - 36±4 years). Myocardial revascularization was performed with the help of stenting and coronary artery bypass grafting. The patients with ischaemic heart disease were divided into 2 groups: Group 1 with postinfarction cardiosclerosis and Group 2 without Q-forming myocardial infarction. Echocardiography was performed using the Vivid E9 machine prior to operation, intraoperatively, and 10-14 after the intervention. We registered the end-systolic volume and end-diastolic volume of the left ventricle, ejection fraction, cardiac index. Alterations of velocity were assessed in relation to of the volume of the left ventricle (dVol/dt), length of the ventricle (dL/dt) in systole and diastole, as well as myocardial shift velocity in 3 endocardial regions - basal (V1), middle (V2), apical portions (V3) and interrelationship with intraventricular blood flows. It was determined that myocardial dysfunction leads to impairment of the structure of the flow, change of acceleration, which is accompanied by a decrease in the cardiac productivity. Impairment of segmental contractility of the left ventricle is manifested by a decrease of vectors of myocardial motion velocity by more than 20%. Intraventricular flows in cardiac chambers may serve as predictors of adequacy of correction of coronary pathology.

Aim To evaluate results of myomectomy by intraventricular pressure gradients (IVPG) and blood flows in patients with obstructive hypertrophic cardiomyopathy (OHCMP).Material and methods The study included a total of 76 subjects, 42 patients with OHCMP (mean age, 39±7 years) and 34 healthy volunteers (mean age, 41±3 years). Prior to and after myomectomy, transthoracic echocardiography was performed and followed by digital image processing and calculation of IVPG and left ventricular (LV) vortex flows. Vector analysis was used to estimate the myocardial displacement rate (V), vortex flows, and LV apex-to-base pressure gradients.Results The study showed a dynamic decrease in the LV apex-to-outflow IVPG by more than 50% and recovery of myocardial contraction velocity in the septal area (р<0.001). The decrease in LV cavity pressure gradient serves as an index for evaluating the effectiveness of OHCMP correction. Myomectomy reduces the load on the myocardium and abolishes mitral valve regurgitation with improvement of LV blood flows as also evidenced by the dynamics of long axis velocity change during the cardiac cycle (dL / dt) and the myocardial contraction velocity (V).Conclusion Effectiveness of the surgical correction of OHCMP is based on the dynamics of myocardial contraction velocities, vortex blood flows, and a decrease in LV apex-to-base IVPG.

The article is devoted to the novel methodological approach to assessment of function of the myocardium and the left ventricle as a whole with the help of modern methods of processing ultrasound images obtained by echocardiography. It contains presentation of theoretical prerequisites for elaboration of a new direction, as well as mathematical computations basing on which quantitative parameters for assessment of myocardial function and blood flows within chambers of the heart were obtained. The fundamental principle in assessing these parameters was the use of the phase structure of the cardiac cycle.

The authors performed clinical studies based on modelling of an ascending aortic aneurysm in 37 patients and 10 apparently healthy subjects. Echocardiography was carried out in the B-mode using the Vivid E9 device (USA, GE). The linear dimensions of the aorta were assessed at three points - in the immediate vicinity of the valves, in the area of the maximum dilatation and in the area of decreased dilatation with registration of blood flow velocity in the aorta. The aortic walls were contoured with the division of equal intervals into 4 portions in order to obtain longitudinal shear deformation velocity during the cardiac cycle. We worked out a system of assessing the velocity vector fields with the help of transthoracic echocardiography in patients with an ascending aortic aneurysm, based on registration of blood flows, which made it possible to obtain the components of velocity. We also determined an optimal method of assessing turbulence in the aorta taking into account the direction of the vectors. Obtained were the numerical data of aortic wall deformation velocity in the longitudinal direction and calculation of the weighting function with the distinction between pathology and the norm. Based on the deformation, the distance between the registered points, and the movement of the vascular wall, we determined the reference values of blood flow velocity inside the aorta and immediately close to its walls.

Objective: to evaluate the effectiveness of endovascular aortic valve replacement (TAVI) according to transesophageal echocardiography. Materials and methods: 29 TAVI operations were performed in patients with aortic valve stenosis (AV) with Lotus Valve system (Boston Scientific, USA) and CoreValve (Medtronic, USA). All patients underwent intraoperative Chpehokg on devices sh50 (Philips, the Netherlands), ACUSON SC2000 (Siemens, Germany) transesophageal sensors X7-2t, Z6Ms, at the following stages of operation: 1 - after intubation of the patient; 2 - the main stage of operation: when placing the conductor in the cavity of the left ventricle, after balloon valvuloplasty, when positioning and implantation of the prosthesis; 3 - the end of the operation. TEE at the beginning and end of the operation was conducted according to the accepted Protocol. Results: all patients had pronounced AV stenosis, peak and average pressure gradients on AV were 90.0±27.0 and 51.5±16.5 mm Hg. respectively. Intraoperative TEE in 3D mode and creating a model of the aortic root, the calculated linear dimensions of the aortic root, which coincided with the data of CT. One patient was diagnosed with worsening of the degree of mitral stenosis to expressed in the formulation of the CoreValve system, and also recorded one episode of severe pericardial effusion after placing the conductor in the cavity of the left ventricle. In all patients, hemodynamic parameters and function of prostheses after surgery were within normal limits, with an average pressure gradient on the AK prosthesis was 5.9±2.8 mm Hg. Conclusion: Tee is a basic method in the assessment of valvular structures of the heart, is of great importance for the timely diagnosis of complications during surgery endovascular aortic valve replacement, and research in 3D and 4D modes can replace the expensive research.

OBJECTIVEto examine relationship between anatomical changes of the left ventricle (LV), dynamics of velocity of its volume modification, and blood flows in the LV in patients with mitral regurgitation (MR) before and after surgical treatment.MATERIALS AND METHODSWe included into this study 58 patients with severe 3-4 degree MR (38 men, 20 women aged 24-69 [mean age 51±9] years) in sinus rhythm (96 %) or atrial fibrillation (4 %). The control group included 86 healthy volunteers, mean age 39±7 years. Transthoracic echocardiographic studies were performed in both groups by standard technique at rest using a high-quality echocardiograph Vivid E9, equipped with a 3.5-4.6 MHz multi frequency transducer (in patients before and after surgical repair - mitral valve [MV] replacement and MV reconstruction with annuloplasty ring). The analysis of files recorded was performed off-line by vector analysis technique including estimation of myocardial deformation velocities and dynamics of LV volume modification, construction of "flow-volume" diagram, calculation of the expended kinetic energy, and registration of intraventricular blood flows.RESULTSEnd diastolic volume (EDV), end systolic volume (ESV) and total stroke volume (TSV) (effective + retrograde) were significantly increased in patients with severe LV volume overload before surgery in comparison with the control group (p.

Patients with atrial fibrillation (AF) routinely undergo different imaging modalities for the evaluation of the left atrial (LA) appendage to rule out thrombus prior to the AF ablation procedure. Recently, uninterrupted novel oral anticoagulants were introduced for patients undergoing atrial fibrillation (AF) ablation to minimize the peri-procedural thromboembolism risk. We performed a retrospective analysis to evaluate the safety of uninterrupted rivaroxaban and whether transesophageal (TEE) or intracardiac echocardiography (ICE) is necessary for patients undergoing AF ablation.