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Prompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.

Treatment of persistent and long-persistent forms of atrial fibrillation remains a pressing issue. Using a personalized approach can help to more successfully eliminate arrhythmias and reduce the return probability. One of these approaches is the use of radiofrequency ablation in conjunction with modern high-tech research methods. The article describes a clinical case of successful catheter ablation of persistent atrial fibrillation in a patient with a mechanical mitral valve prosthesis, due to the use of non-invasive topical diagnostics prior to surgery.

Aim. To evaluate the informational and diagnostic significance of the myocardial Tei index.Patients and methods. The study assessed data of echocardiographic studies of 9,256 patients aged 1 month to 60 years, 1,350 healthy individuals, and 7,906 patients with various cardiovascular diseases with abnormal volume-capacitive characteristics of the heart (congenital heart defects, different types of cardiopathy, and hypertensive disease).Results. The cutting points of the normal values of the indicator were established. Data showed that the Tei index did not reflect changes in the pumping function of the left ventricle and did not depend on the contractility of the left ventricle (LV), but it had direct significant correlation with the left ventricular filling pressure, both in normal and pathological conditions. Correlation was more significant in adult patients.Conclusion. Normal values of the Tei index less than 0.5 were observed in more than 95% of practically healthy individuals of any age. The maximum sensitivity and specificity of the myocardial performance index was found in patients with restrictive and dilated cardiopathy and common atrioventricular connection.

BackgroundFluid retention is one of the most common reasons for the heart failure decompensation. The purpose of the study is to estimate the sensitivity, specificity of the ultrasound method for evaluating congestive phenomena in the systemic and pulmonary circulations in patients with the atrial fibrillation (AF) and chronic heart failure (CHF).MethodsThe study includes 28 patients with the paroxysmal AF with and without CHF, who were planned for the radiofrequency pulmonary veins isolation. The maximum and minimum diameters of the right superior pulmonary vein and inferior vena cava on exhalation were measured echocardiographically. An average pressure in the right and left atria was measured intraoperatively. Сorrelation between the maximum and minimum diameters of the right superior pulmonary vein and an average pressure in the left atria and between inferior vena cava on exhalation and an average pressure in the right atria was calculated. The sensitivity, specificity of ultrasound methods for evaluating congestive phenomena in the systemic and pulmonary circulations was evaluated.ResultsThere was positive correlation between the minimum diameter of right superior pulmonary vein and invasive mean pressure in the left atrium (R=0.65, PConclusionsThe new ultrasound method of congestion diagnostics in the pulmonary circulation by the maximum and/or minimum diameter of the right superior pulmonary vein can be effectively applied in clinical practice in the same way as the well-known technique of congestion diagnostics in the systemic circulation by the diameter of the inferior vena cava in patients with the atrial fibrillation and chronic heart failure.

The aim of the study was to evaluate the influence of risk factors on the development of a combination of atrial fibrillation and sick sinus node syndrome and to determine the relationship of these cardiac arrhythmias to the polymorphism of the CASQ2 gene. The study included 95 patients, mean age 61.1 ± 14.3 years; Of them men - 48 (50.5%), with AF - 38 (40.0%), SSS - 17 (17.9%) and their combination - 40 (42.1%). Patients are divided into 3 groups, depending on the type of heart rhythm disturbance. The analysis of polymorphism rs6684209 of the gene of calsequestrin CASQ2 in all patients by the method of analysis of restriction fragment length polymorphism was performed. The size of the left atrium, ejection fraction, the presence of chronic heart failure (CHF), the presence of dyslipidemia, the increased body mass index (BMI), myocardial hypertrophy of the left ventricle were evaluated as factors influencing the development of the tachy-brady syndrome. It was revealed that all patients in the first group had CHF (y = 4.44, p = 0.03, x = 4.88, p = 0.02), and patients with CHF FC II significantly prevailed. Dyslipidemia in patients with a combination of two types of heart rhythm disturbances is much more common (x = 6.24, p = 0.01) than in patients with only AF. The BMI was significantly different in the first and third groups (t = 2.1, CC = 55, p = 0.03). Analysis of the frequency distribution ofgenotypes of the CASQ2 gene and alleles did not reveal the presence of statistically significant differences between the groups studied. According to the research on the development of a combination of two cardiac arrhythmias of AF and SSS, such factors as CHF, BMI and the presence of dyslipidemia influence. The relationship between the development of the tachy-brady syndrome and the genetic polymorphism of the protein calsequestrin in the sample was not revealed. A population with a heterozygous type of inheritance of a protein called calsequestrin is less prone to developing a dilatation of the left atrium.

Aim.Development of a model for calculating of predicted values of key echocardiography (EchoCG) parameters in patients of different ages and staturelweight values.Material and methods.The study included 10604 apparently healthy patients aged from 1 day to 65 years; 5726 (54%) of them are female. In addition to the general clinical study, all patients underwent EchoCG with the measurement of standard indicators as recommended by the American Society of Echocardiography. We measured body surface area (BSA) and selected a regression model, which most adequately links the values of the EchoCG parameters and staturel-weight values.Results.All EchoCG parameters showed a significant correlation with BSA. The patients were divided into four groups to receive more homogeneous cohorts. We have identified newborns and adults. A group of children was additionally divided according to BSA, by less than 0,3 m2 and more than 0,3 m2. The calculated regression equations were reliable in both cases — before and after separation. Comparison of dispersion excesses showed a better dependence among the separated groups. The separation also significantly increased the prediction accuracy.Conclusion.The proposed mathematical models relevantly predict the normal values of variables. The method is well suited for calculating the Z-index of main EchoCG parameters.

Aim. To evaluate the speckle-tracking echocardiography (STE) application in atrial fibrillation (AF) patients during catheter treatment, by the data from intracardiac echocardiography (ICE).Material and methods. Totally, 30 patients included, with persistent and paroxysmal AF. In 25 (84%) the main disease was arterial hypertension, of those 14 (46%) had hypertension together with coronary heart disease. In 16% cases (4 patients) AF was idiopathic. All patients had indications for catheter treatment of the arrhythmia.Results. Before the start of radiofrequency intervention (RFI), superior pulmonary vein (PV) deformation was 24,5±1,5%, after the intervention 17,5±1,1%, tissue deformation decreased by 7% (р