Introduction. In conditions of the Emergency Cardiology Department, a timely and differential diagnosis of myocardial pathology is especially important in the absence of visible focal changes and significant coronary artery stenosis. This group of patients includes recipients of a transplanted heart, when it is difficult to count on the high sensitivity of perfusion images alone. This can be explained by the diffuse, balanced distribution of ischemia. Objective. To present the possibilities of perfusion myocardial single photon emission computed tomography synchronized with electrocardiography for a detailed assessment of the functional condition of both ventricles of the transplanted heart Material and methods. We have presented three clinical case reports of the patients with different pathology of the transplanted heart who referred themselves to the emergency cardiology clinic and underwent electrocardiographysynchronized perfusion myocardial single photon emission computed tomography for diagnostic purposes. Results. In all the cases presented, the radionuclide study influenced making the diagnosis and changing the treatment tactics. In the first case, it was possible to identify focal myocardial changes, for which coronary angiography and percutaneous coronary intervention with thromboextraction were immediately performed. In the second case, the image analysis reflecting the function of the myocardium (polar maps of wall movement and systolic thickening) allowed us to note a low efficacy of treatment for the transplanted heart rejection. In the third clinical case, the initial single photon emission computed tomography suggested the inflammatory nature of changes in the myocardium, which was verified by the results of endomyocardial biopsy. Conclusion. In the presented clinical cases, the urgently performed electrocardiography-synchronized perfusion myocardial single photon emission computed tomography made it possible to perform invasive interventions in time and thereby contribute to the recovery of the graft functional state and patient's condition improvement.

BACKGROUND Numerous studies have shown that coronary reperfusion with primary percutaneous coronary intervention (PCI) improves outcomes in patients with ST-segment elevated myocardial infarction (STEMI). However, the question of the effect on the myocardium as a whole of an isolated intervention on an infarct-related artery in multivessel coronary disease remains incompletely studied.AIM OF STUDY To study the features of perfusion redistribution and myocardial function using perfusion single photon emission computed tomography (SPECT) in patients with STEMI and multivessel coronary disease after isolated PCI on an infarct-related artery.MATERIAL AND METHODS SPECT-ECG (electrocardiography) was performed in 32 patients (27 men and 5 women) with STEMI. According to the ECG results, the location of focal myocardial changes was regarded as “lower” MI in 19 (59%) patients, “anterior” in 13 patients (41%). Coronary angiography revealed a multivessel lesion of the coronary vessels in all of them. The patients were divided into groups according to the location of the infarction and the area of the lesion: group 1 — lower MI (stenting of the right coronary artery (RCA) and its branches) — 19 patients (mean age — 57.7±2.5; median — 55 [51.5; 63.5]), of which 8 with small-focal (1a) and 11 with large-focal infarction (1b); group 2 — anterior MI (stenting of the left coronary artery (LCA) and its branches) — 13 patients (mean age — 55.4±3.5; median — 54 [48.5; 62.5]), of which 5 with small-focal (2a) and 8 with large-focal infarction (2b). SPECT-ECG was performed 3 times: 1st — on days 2–3 after PCI of the infarct-related artery, 2nd — 6 days after PCI, and 3rd — 6 months after PCI.RESULTS After RCA stenting in patients with lower MI and multivessel coronary disease, SPECT-ECG revealed a statistically significant decrease in local contractility of individual segments of the anterior septal and lateral walls (with sufficient revascularization of the RCA system) and worsening of perfusion and right ventricular (RV) volumes. After stenting of the LCA branches in patients with anterior MI and multivessel coronary disease, a statistically significant decrease in local contractility in the basal segment of the diaphragmatic wall was observed, as well as impaired perfusion and an increase in the volume of the RV (with successful revascularization of the anterior interventricular branch). All these findings could be the result of partial steal of the blood supply to neighboring areas and myocardial remodeling after PCI in patients with multivessel coronary artery disease.CONCLUSION 1. According to the data of single-photon emulsion computed tomography synchronized with electrocardiography in the early and late period of myocardial infarction after percutaneous coronary intervention in patients with multivessel coronary disease, there is a significant improvement in perfusion and function of the infarct-associated artery system. 1. Recanalization of only the left coronary artery with remaining stenoses in the right coronary artery in the long-term period can lead to an increase in the size of the cavity of the right ventricle of the heart and uneven distribution of perfusion in its The revealed statistically significant disturbances in perfusion and local contractility of neighboring areas after percutaneous coronary intervention of an infarct-related artery may be the result of steal of the blood supply and early myocardial remodeling in multivessel disease. 3. Disturbances in perfusion and local contractility in neighboring myocardial blood supply pools after percutaneous coronary intervention of an infarct-related artery dictates the need to repeated single-photon emulsion computed tomography synchronized with electrocardiography as early as possible in patients with multivessel coronary disease in order to assess the redistribution of perfusion and myocardial remodeling for timely complete revascularization, preventing recurrent coronary

Aim . To evaluate the intersystemic (between the myocardium of the left coronary artery system and the right coronary artery system redistribution mechanisms of perfusion in the myocardium after revascularization in patients with coronary artery disease with focal cardiosclerosis using gated single photon emission computed tomography. Сardiosclerosis foci were initially identified by magnetic resonance imaging. Material and Methods . The study included 17 patients with coronary artery disease with multivessel coronary disease and large-focal cardiosclerosis according to the results of magnetic resonance imaging with contrast; the diagnosis of left ventricular aneurysm was established in 14 patients, the focal subendocardial cardiosclerosis was diagnosed in 3 patients. For various reasons, all patients underwent myocardial revascularization without the left ventricle reconstruction (coronary artery bypass grafting in 10 patients, percutaneous coronary intervention in 7 patients). Magnetic resonance imaging was used as the gold standard for focal cardiosclerosis before revascularization. All patients before and after revascularization underwent gated single photon emission computed tomography with MIBI scan. During the initial analysis of peaks on the profile slices of coronal and transversal midsections passing along the lateral walls of the left and right ventricles, we did not notice a clear visualization of in 8 patients (group 1), while an increased MIBI scan accumulation in the right ventricle myocardium was clearly visualized in 9 patients (group 2). Based on the peaks height of profile curves, we compared changes in the maxima of radiopharmaceutical accumulation before and after revascularization in the lateral walls of the left ventricle and right ventricle. All studies were performed using the original Cardiac Functional Imaging medical program in order to obtain quantitative information about the myocardial function of both the left ventricle, and also the right ventricle. This program made it possible to highlight the right ventricle area even in the case of its weak visualization through the initial formation of parametric images, where the right ventricle area was visualized. Results . When comparing the revascularization results of the two groups, we noted that the left ventricle ejection fraction increased significantly only in patients without initial visualization of the right ventricular myocardium. Left ventricle ejection fraction did not change after revascularization in patients with initially increased accumulation of the radiopharmaceutical in the right ventricle. Globally, only an improvement in the diastolic function of the left and right ventricles was noted in the latter group of patients. In addition, an increase in the right ventricular uptake level was noted for patients with focal cardiosclerosis and the initially increased uptake in the right ventricle after the maximum possible complete myocardial revascularization, which may indicate a redistribution of perfusion in favor of a more intact right ventricular myocardium. Conclusions . 1. In patients without signs of increased visualization of the right ventricle (group 1) after revascularization, we revealed a statistically significant increase in the left ventricle ejection fraction (p-value=0.024), a decrease in the end-systolic volume (p-value=0.024), an increase in the motion in segments corresponding to the peri-infarct scar zone (p-value=0.016), and a change in systolic thickening in the segment of the basal parts of the anterolateral wall (p-value=0.046). 2. Initially increased visualization of the right ventricle in patients with extensive focal cardiosclerosis in the myocardium of the left ventricle suggests the absence of the left ventricle ejection fraction increase after myocardial revascularization. 3. An increase in the visualization of the right ventricle after complete myocardial revascularization indicates an intersystemic redistribution of perfusion in favor of the preserved myocardium of this part of the heart.

A case of acute focal myocardial injury in a polymorbid female patient with intact coronary arteries according to direct coronary angiography is reported. Acute focal myocardial injury was detected by ECG-synchronized perfusion single-photon emission computed tomogra-phy (SPECT) of the myocardium, and confirmed by the results of postmortem examination. The article also discusses the possibility of using perfusion SPECT to diagnose acute focal changes against the background of focal inflammatory myocardial infiltration.

редставленные клинические примеры демонстрируют радионуклидный способ раннего выявления повреждения митохондрий в качестве возможного предиктора развития дисфункции миокарда пересаженного сердца.Определение коэффициента вымывания радиофармпрепарата при перфузионной ОФЭКТ миокарда позволяет выявить сегменты с нарушенной митохондриальной функцией, определить диффузный или очаговый характер нарушений, что поможет клини

We report the successful surgical treatment of a giant true thrombosed aneurysm of the left ventricle.A 59-year-old male patient Z. was admitted with severe heart failure and chronic thrombosed aneurysm of the left ventricle, formed after acute extensive myocardial infarction, despite successful installation of a stent into the anterior descending artery in the acute period. Echocardiography revealed a significant increase in the volume of the left ventricular cavity, a significant decrease in the contractile function of the left ventricular myocardium (ejection fraction 32-36%), a giant left ventricular aneurysm (9x6 cm) with a parietal lining thrombus in the aneurysm cavity. Coronary angiography showed an aneurysmal dilatation of the circumflex branch of more than 6 mm, hemodynamically significant stenosis of two coronary arteries. According to the scintigraphy, the myocardium beyond the scar tissue was viable. The patient underwent resection of a left ventricular aneurysm, endoventricular plasty (Dor procedure), coronary artery bypass surgery of the circumflex artery and obtuse marginal branch of the left coronary artery.The patient was discharged in satisfactory condition on day 14 after surgery. At follow-up 6 months after surgery, an increase in the ejection fraction to 3941% was noted.

Introduction. Cardiovascular diseases rank leading in the world. The decompensation of chronic heart failure is the direct cause of death in most patients. The choice of a definitive treatment tactics is the key factor in these patients.Clinical case. A patient who had experienced myocardial Q-infarction with an ST segment elevation of anterior septal location complicated by the left ventricle anterior wall aneurysm and a decreased myocardial contractility was hospitalized with subcompensated chronic heart failure. Previously, and initially with that hospitalization, the patient was considered a candidate for heart transplantation. After the examination, a decision was made on the possibility of a multi-component reconstructive heart surgery, which was performed with a good clinical effect.Conclusion. The presented clinical case has confirmed the possibility of correcting the combined pathology in a patient with low myocardial contractility obtaining good immediate and long-term (1.5 years after surgery) results.

Aim. To determine the influence of the time gap between acute myocardial infarction with ST-segment elevation and intracoronary intervention performed later than 2.5 hours on myocardium, we studied indicators of perfusion over time with an aid of SPECT, including intraventricular asynchrony (2–4 days and 6–8 months after stent installation). Materials and method. We observed 22 patients with multivessel coronary lesion. The Russian program with the analysis of perfusion, function and the phase images was used in SPECT synchronized with ECG. Results. Showed that the time gap prior to coronary intervention in the acute phase of myocardial infarction may be directly connected with the increase in impaired perfusion during the end-systole and the severity of pathological intraventricular asynchrony without ECG signs. All patients had significantly decreased wall mobility and intraventricular asynchrony together with increased R-R interval in the late period (after 6–8 months) independently from the coronary intervention time. In patients of group 1 (coronary intervention within 6 hours), focal transmural lesions of myocardium significantly decreased. Conclusion. Late revascularization help decrease intraventricular asynchrony reducing the risk of heart failure in future.

Hepatopulmonary syndrome is a liver disease complication characterized by the clinical triad of an advanced chronic liver disease, a pulmonary vascular dilatation, and a reduced arterial oxygenation (hypoxemia: PaO2 less than 70 mm Hg at rest) in the absence of intrinsic cardiopulmonary disease. Precapillary vasodilatation, intrapulmonary angiogenesis and hyperdynamic circulation lead to arteriovenous shunting and reduced gas diffusion. In case of detecting macroscopic shunts, the pulmonary artery branch embolization could be performed. However, the hepatopulmonary syndrome can be cured nowadays by means of liver transplantation only. A 5-year survival in these patients is about 70%. The observed mortality is the highest during the surgery or early after, especially in patients with PaO2 lower than 50 mm Hg. It ranges from 8.5 to 29%. A prolonged oxygenation support is often required after liver transplantation using invasive or non-invasive ventilation, or even extracorporeal membrane oxygenation. In this review, we have focused on the recent advances in this field as described in available literature and have presented a case report of successful liver transplantation in a patient with a severe hepatopulmonary syndrome.

КАРДИОЛОГИЯ И СЕРДЕЧНО-СОСУДИСТАЯ ХИРУРГИЯ, 3, 2017 doi: 10.17116/kardio201710316-22 Феномен постоперативной дисфункции межжелудочковой перегородки: влияние на результаты реваскуляризации у пациентов с исходно выраженной дисфункцией левого желудочка Г.Б. САЙФУЛЛИНА1*, д.м.н., проф. Е.Н. ОСТРОУМОВ2, д.м.н., проф. Н.Б. АМИРОВ3, А.Р. САДЫКОВ1, А.И. АБДРАХМАНОВА4, Л.И. ГОРНАЕВА1, д.м.н., проф. М.В. ПАНАСЮК1, д.м.н., проф. М.М. ИБАТУЛЛИН1, д.м.н. Р.Н. ХАЙРУЛЛИН1

Aim. To determine the influence of the time gap between acute myocardial infarction with ST-segment elevation and intracoronary intervention performed later than 2.5 hours on myocardium, we studied indicators of perfusion over time with an aid of SPECT, including intraventricular asynchrony (2–4 days and 6–8 months after stent installation).Materials and method. We observed 22 patients with multivessel coronary lesion. The Russian program with the analysis of perfusion, function and the phase images was used in SPECT synchronized with ECG.Results. Showed that the time gap prior to coronary intervention in the acute phase of myocardial infarction may be directly connected with the increase in impaired perfusion during the end-systole and the severity of pathological intraventricular asynchrony without ECG signs. All patients had significantly decreased wall mobility and intraventricular asynchrony together with increased R-R interval in the late period (after 6–8 months) independently from the coronary intervention time. In patients of group 1 (coronary intervention within 6 hours), focal transmural lesions of myocardium significantly decreased.Conclusion. Late revascularization help decrease intraventricular asynchrony reducing the risk of heart failure in future.

This case presents an episode of electrical storm (ES) in post-myocardial infarction patient results from myocarditis. ES was interrupted by aneurysmectomy and additional isolation of VT origins by radiofrequency catheter ablation. The histological evaluation of aneurysm material proved acute myocarditis. The key findings indicating acute inflammation in myocardium was an increased level of peripheral inflammatory biomarker IL6 and autoantibodies to beta1-adrenergic receptor (beta 1-AAbs). Gated SPECT with phase images analysis turned out to be appropriate imaging strategy in visualizing potentially reversible causes of ventricular arrhythmias such as myocarditis. Taking together our findings might add some information on the pathogenesis and predisposing factors of ventricular arrhythmias especially in the cases of electrical storm. (C) 2015 The Czech Society of Cardiology. Published by Elsevier Sp.zo.o. All rights reserved.

Aim. To define influence of the left ventricle (LV) perfusion defects on the clinical status dynamics after coronary angioplasty in patients with the expressed myocardium dysfunction of ischemic etiology. Materials and methods. Examined 86 patients (81 men and 5 women aged from 46 to 73 years) before and in 2–3 days after percutaneous coronary intervention with diagnosis: CAD, CHF with NYHA class III–IV, echocardiography parameters of LV: ejection fraction less than 40%, end-diastolic volume is more than 200 ml. Perfusion defects of myocardium estimated with use of ECG-gated single photon emission computed tomography. Predictors were defined: perfusion defects on LV apex (in score), perfusion defects in the area of LAD, LCx and RCA (%), the LV global perfusion defects (in score and %). Results. In 42% of cases 6-minute walk test increased to 3 times; The NYHA class decreased by 2 classes (group 1). In 28 cases 6-minute walk test increased to 2 times and the NYHA class decreased on 1 class. In 22 patients 6-minute walk test increased less than 50% of reference values and there was no dynamics NYHA class (50 patients of the group 2). Initial extent of LV global perfusion defects in group 1 – 41,2 ± 4,0%, in group 2 – 58,3 ± 2,4% (р = 0,0004). Similar values are received for perfusion indicators in the area of LAD and the LV apex. Prevalence of myocardial perfusion defects at rest reflects prevalence of a cardiosclerosis in a cardiac muscle. Conclusion. Degree of LV myocardial perfusion defects in patients with the expressed heart failure of ischemic etiology is the key indicator influencing clinical efficiency of coronary angioplasty. Critical size for definition of the favorable forecast of revascularization are 60% and more perfusion defects testifying that in a cardiac muscle the focal cardiosclerosis prevails over the functioning myocardium.

Aim evaluated function and perfusion of myocardium in 12 cirrhotic patients before and after liver transplantation (LT). Materials and methods. ECG-gated single photon emission computed tomography (SPECT) was used. Results . It was found that hyperdynamics diminished liver transplantation: left ventricle (LV) end-systolic volume (ESV) rose from 23 to 33 ml (p = 0,026), LV ejection fraction decreased staying normal from 76 до 60% (p = 0,08), calculated cardiac output declined from 4941 to 3066 ml/min (p = 0,009), peak ejection rate (PER) from 314 to 218 ml/sec, (p = 0,003), peak fi lling rate decreased from 248 to 182 ml/sec (p = 0,037), eccentricity coeffi cient also decreased from 0,81 to 0,77 (p = 0,028). Local alteration of perfusion was found only in 2 cases. Conclusion . Hyperdynamic systolic dysfunction and diastolic dysfunction improve after liver transplantation. Further studies are required to estimate the applicability of SPECT in liver transplantation candidates' evaluation.

Честухин В.В.1, Миронков А.Б.1, 2, Бляхман Ф.А.3, 5, Остроумов Е.Н.4, Колчанова С.Г.5, Шкляр Т.Ф.3, 5, Азоев Э.Т.1, Саховский С.А.1 1 Отделение рентгенохирургических методов лечения (зав. – проф. В.В. Честухин) ФГБУ «ФНЦ трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России (директор – академик РАМН, проф. С.В. Готье), Москва, Российская Федерация 2 Отделение рентгенохирургических методов диагностики и лечения (зав. – к. м. н. А.Б. Миронков) ГБУЗ «ГКБ No 12 ДЗ г. Москвы» (гл. врач – к. м. н. А.В. Саликов), Москва, Российская Федерация 3 Кафедра медицинско й физики (зав. – проф. Ф.А. Бляхман) ГБОУ ВПО «Уральский государств енный медицинcкий университе т» (ректор – проф. С.М. Кутепов) Минздрава России, Екатеринбург, Российская Федерация 4 Отделение радиоизотопной диагностики (зав. – к. м. н. А.Е. Ермоленко) ФГБУ «ФНЦ трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России (директор – академик РАМН, проф. С.В. Готье) Москва, Российская Федерация 5 Кафедра общей физики (зав. – проф. В.Г. Черняк) Института естественных наук (директор – к. ф-м. н. В.В. Кружаев) ФГАОУ ВПО «Уральский федеральный университет им. Первого Президента РФ Б.Н. Ельцина» Минобрнауки РФ, Екатеринбург, Российская Федерация

The aim of this study was to define influence of completeness heart revascularization on a functional condition of myocardium at ischemic cardiomyopathy. Materials and methods. 61 men and 5 women aged from 46 till 73 years with the diagnosis an ischemic cardiomyopathy were investigated before and after coronary angioplasty (EDV LV 256,1 +/- 7,4 ml, EF LV -36,1 +/- 1,1%). 46 patients had at receipt CHF with NYHA functional class 4, 20 -CHF with NYHA functional class 3. Functional status (6-minute walking test) -109,7 +/- 20,5 m. Chronic total occlusion was the major type of coronary artery disease (92 of 176 epicardial branches). By means of echocardiography and quantitative gated SPECT estimated dynamics of systolic and diastolic function, change of perfusion, thickening and myocardial movement. Results. The full revascularization managed to be executed to 32 patients, incomplete -to 34 patients (34 occluded arteries didn't manage to be opened). In the whole group the 6-minute walking test increased to 268,2 +/- 19,9 m (p < 0,001), EF LV grew to 39,+/- 1,1% (p < 0,01) due to reduction of end systolic volume, degree of mitral regurgitation decreased from 1,6 +/- 0,1 to 1,2 +/- 0,1 (p < 0,007), pulmonary artery pressure decreased from 39,1 +/- 1,7 to 32,1 +/- 1,2 mm Hg (p < 0,01). Distinctions in dynamics of the main functional indicators between groups of complete and incomplete revascularization it isn't revealed. The factor of expressiveness of collateral blood flow in the region of occluded arteries probably compensates violation of an antegrade blood flow and defines a myocardial condition. Conclusion. The volume of myocardial revascularization at patients with ischemic cardiomyopathy isn't defining factor in a clinical condition of them after executed percutaneous coronary intervention.