Актуальность подготовки учебно-методического пособия по лучевым методам диагностики легочной гипертензии для ординаторов и врачей-рентгенологов обусловлена возрастающей частотой и тяжестью легочной гипертензии, значительно отягощающей прогноз и качество жизни пациента, многообразием причин, приводящих к развитию этого грозного осложнения. Врачи практического здравоохранения должны быть знакомы с возможностями современных методов визуализации в выявлении легочной гипертензии, так как своевременное выявление и диагностика легочной гипертензии позволяет применить целый спектр методов лечения, от консервативных до хирургических, благоприятно влияющих на прогноз больных с легочной гипертензией. Пособие разработано в соответствии с Федеральным государственным образовательным стандартом высшего образования - подготовка кадров высшей квалификации по программам ординатуры по специальности 31.08.09 Рентгенология. Учебно-методическое пособие может быть использовано в образовательном процессе ординаторов, аспирантов, врачей-рентгенологов.

Актуальность подготовки учебно-методического пособия по магнитно-резонансной томографии (МРТ) сердца для ординаторов и врачей-рентгенологов обусловлена возрастающей ролью метода МРТ в диагностике заболеваний сердца, в первую очередь таких, как миокардиты , кардиомиопатии и ишемическая болезнь сердца. Врачи практического здравоохранения должны быть знакомы с возможностями современных методов визуализации для решения сложных диагностических задач. Пособие разработано в соответствии с Федеральным государственным образовательным стандартом высшего образования - подготовка кадров высшей квалификации по программам ординатуры по специальности 31.08.09 «Рентгенология». Учебно-методическое пособие может быть использовано в образовательном процессе ординаторов, аспирантов, врачей-рентгенологов.

Modern pathogenetic therapy of idiopathic pulmonary arterial hypertension (IPAH), a severe life-threatening cardiovascular disease of unknown etiology, leads to a positive clinical effect due to reverse remodeling of the vessels of the microvasculature of the lungs. Highly effective drugs of specific therapy that act on the main targets of pathogenesis have now been introduced into clinical practice. The presented clinical case of a patient with diagnosed in 2014 IPAH with an initial functional class III according to the WHO classification demonstrates high long-term efficacy and safety of specific therapy based on the use of the soluble guanylate cyclase stimulator riociguat for 5 years after replacing previous therapy with sildenafil with further implementation of the strategy of sequential combination therapy due to the addition of ambrisentan and selexipag.

Our observation demonstrates a case of a 40-year-old female with idiopathic pulmonary arterial hypertension World Health Organization functional class III, who was admitted to NMRC of Cardiology repeatedly due to disease progression including dyspnea worsening and exercise tolerance decrease after previous COVID-19 infection on riociguat (7.5 mg daily), macitentan (10 mg daily) and selexipag (1600 mcg daily) therapy. Clinical examination demonstrated high-risk status according to the expected 1-year mortality. Due to unreleased treatment goals and high-risk status, we performed transition from selexipag to inhale iloprost. After therapy escalation the patient demonstrated a significant improvement in clinical condition, dyspnea reduction and exercise tolerance increase. The current treatment strategy for pulmonary arterial hypertension is based on regular multiparametric risk stratification approach in PAH patients. The impact of COVID-19 may become an important cause of clinical worsening in PAH patients during COVID-19 pandemic. Directed on vasodilatation and antiproliferation mechanisms of action of PAH-specific drugs are supposed to be protective in COVID-19 patients. However, the probability of clinical worsening in PAH patients despite PAH-specific therapy intake needs to be closely monitored to perform timely treatment correction in order to achieve low-risk status and to improve the prognosis of PAH patients.

ФГБУ «НМИЦ кардиологии» Минздрава России, Москва

The paper gives a clinical example of diagnosing hepatic epithelioid hemangioendothelioma. With allowance made for that the tumor occurs rarely (less than 1% of cases of all vascular tumors), the authors provide the clinical example to demonstrate the capabilities of imaging techniques, by applying an integrated approach.

The paper presents an update on endovascular methods for closure of the left atrial appendage in order to prevent thromboembolic events in patients with nonvalvular atrial fibrillation. It analyzes the results of occlusion devices as an alternative to longterm anticoagulant therapy from the standpoint of evidencebased medicine, advantages, and features of design and implantation of occlusion devices, such as Watchman, Amplatzer, WaveCrest, and Lariat system. Literature searching was carried out using the databases PubMed and Scopus.

The clinical case demonstrates the difficulties of differential diagnosis and the determination of treatment tactics in a patient with chronic thromboembolic pulmonary hypertension, recidivous cardiac myxoma and radiographic pattern of dissemination in lung tissue.

The paper describes a clinical example of the topical diagnosis of adrenocorticotropic hormone (ACTH)-producing typical peripheral pulmonary carcinoid. The first stage in its diagnosis was to rule out the production of ACTH by the pituitary gland. The paper presents information on the most common localization of functioning neuroendocrine tumors, as well as a diagnostic algorithm to search for an ectopic focus of the ACTH-secreting tumor that causes hypercorticism. Taking into account that bronchopulmonary neuroendocrine tumors with ectopic hormone production occur rarely (5%), a clinical example is given to demonstrate the capabilities of imaging techniques and standards for their implementation using an integrated approach.

Idiopathic pulmonary hypertension (IPAH) is a rare cardiovascular disease of unknown etiology, but the most common form of pulmonary arterial hypertension, defined as mean pulmonary arterial pressure >25 mmHg and pulmonary vascular resistance >3 Wood Units. Endothelial dysfunction seems to play an integral role in the pathogenesis of IPAH: the activation of endothelin-1 causes the hypertrophy of smooth muscle cells and endothelial cells, fibrotic changes, immune inflammation and vasoconstriction which leads to small pulmonary arteries and arterioles remodeling. The endothelial system activation is the reason for using endothelin receptor antagonists (ERA) to block the endothelin receptors type A (ETA) or both types (ETA, ETB). ERA, as the main class of PAH-specific therapy, is presented by bosentan and macitentan, dual endothelin receptor antagonists, and ambrisentan, non-sulfonamide, ETA-selective ERA. This clinical case demonstrates the successful treatment with ambrisentan as the part of combination therapy in the patient with severe IPAH.

The paper describes a case of primary diagnosis of functioning patent ductus arteriosus in a 75-year-old female patient.

Pulmonary hypertension is a menacing complication of a number of diseases, which is responsible for high mortality rates and considerably poorer quality of life in a patient. The timely detection for pulmonary hypertension allows timely initiation of treatment, thus improvement in prognosis in the patient. Chest X-ray is the most commonly used radiographic technique for various causes. Physicians’ awareness about the radiographic manifestations of pulmonary hypertension may contribute to the earlier detection of this severe disease. Owing to the natural contrast of reflected structures, a chest X-ray film gives a unique opportunity to assess pulmonary circulation vessels, to reveal the signs ofpulmonary hypertension, and to estimate trends in the course of the disease.The paper details a procedure for analysis and the normal radiographic anatomy of pulmonary circulation vessels, gives the present classification of pulmonary hypertension, and sets forth its X-ray semiotics.

The paper sets forth the basic provisions of the accreditation of healthcare workers, the principles of a new approach to continuing postgraduate education, by introducing the storage system of credit units, and the tasks of educational establishments to form self-education motivation and to master novel competences.

The paper considers the mechanisms of development of contrast-induced nephropathy in the use of iodinated radiopaque contrast agents (RCAs), as well as the criteria of their assessment. It gives different existing recommendations for prevention of the nephrotoxic effects of RCAs.

OBJECTIVE:To reveal diagnostic features in atrial septal defect (ASD) in different age groups; to define a role of X-ray study in the diagnosis of ASD. MATERIAL AND METHODS:Forty-eight patients (16 men and 32 women) aged 15 to 71 years with ASD at different sites were examined. All the patients underwent chest X-ray, echocardiography, and cardiac phase-contrast magnetic resonance imaging (MRI). The examinees were divided into 2 age groups: 1) less than 40 years (n = 18) and 2) more than 40 years (n = 30). The groups were compared using quantitative and alternative signs and they did not significantly differ in the volume of intracardiac shunt and in the size of the defect. The X-ray and MRI indicators reflecting the calibers of pulmonary arteries were also compared in patient groups with different pulmonary artery systolic pressures (PASP) (< 35, 36-60, and > 60 mm Hg). RESULTS:The older age group more frequently showed signs of heart failure, valvular regurgitation, and an atypical X-ray pattern. The sizes of atria, pulmonary artery and its branches, and PASP were also increased in the older age group. The patient group with high PASP (> 60 mm Hg) significantly differed from the others in all the indicators analyzed. Normal PASP and moderate pulmonary hypertension groups greatly differed only in the Moore index. CONCLUSION:Chest X-ray reflects rather precisely the hemodynamic type of the defect. High pulmonary hypertension has clear X-ray and MRI manifestations. The specificity of X-ray in the diagnosis of PASP is lower in the older age group due to the higher rate of an atypical X-ray pattern. Radiology is important in detecting pulmonary venous hypertension in patients with PASP. Pulmonary venous hypertension is indicative of elevated pressure in the left atrium and pulmonary veins and arises from different causes: shunt inversion, restrictive defect, mitral valve comorbidity, and left ventricular systolic and diastolic dysfunction.

Poster: ECR 2011 / C-1458 / Combined use of MRI and echocardiography for one-year follow-up of left ventricular (LV) remodeling after aortic valve surgery by: E. A. Mershina , Y. Selyavko, I. Korobkova, V. Sinitsyn; Moscow/RU

The paper discusses the concept of risk-group patients who have an increased probability of immediate systemic adverse reactions to contrast agents used clinically in various radiodiagnostic techniques. It analyzes the pathogenesis of allergoid reactions to X-ray and magnetic resonance, contrast media. On this basis, the authors describe the abnormalities and nosological entities the patients had in their medical history before diagnostic studies will be indicative of the increased risk of these complications to the administration of a contrast agent.