[The State of Vascular Bed, Parenchyma and Perfusion of Lungs in Chronic Thromboembolic Pulmonary Hypertension According to Data of Subtraction Pulmonary Angiography].

AIM: to assess the state of vascular bed, parenchyma, and perfusion of lungs in patients with chronic thromboembolic pulmonary hypertension (CTEPH) using the method of subtraction computed tomography (CT). METHODS: CT pulmonary angiography (CTPA) was performed in 45 patients with verified CTEPH (18 men, 27 women, age 26-79 years) by CT scanner using the "Lung subtraction" standard protocol. Parameters analyzed were characteristics of the state of main pulmonary artery (MPA) and the right ventricle (RV), and calculated CT angiographic (CTA) obstruction and perfusion defect scores. RESULTS: Significant correlation was found between CTA obstruction score and perfusion defect score (r=0.34, p=0.02). Mean pulmonary arterial pressure (mPAP) correlated with MPA diameter (r=0.4, p=0.02), RV wall thickness (r=0.6, p=0.0003) and the ratio of MPA diameter to ascending aortic diameter (r=0.5, p=0.002). Significant correlation was also found between RV wall thickness and pulmonary vascular resistance (PVR) (r=0.4, p=0.04). Neither CTA obstruction score nor perfusion defect score correlated with PVR and mPAP. The data of CT did not correlate with results of 6-minute walk test. CONCLUSION: In patients with CTEPH subtraction CTPA allows carrying out complex diagnostics of the state of vascular bed, parenchyma and perfusion of the lungs.

[Chronic thromboembolic pulmonary hypertension developed in a female patient with lupus erythematosus and secondary antiphospholipid syndrome]. / Khronicheskaia tromboémbolicheskaia legochnaia gipertenziia, sformirovavshaiasia u bol'noi sistemnoi krasnoi volchankoi c vtorichnym antifosfolipidnym sindromom.

Chronic thromboembolic pulmonary hypertension (CTEPH) is one of the potentially curable forms of pulmonary hypertension, in which pulmonary thromboendarterectomy is the gold standard treatment. However, over the last decade, great attention has been given to a combined therapeutic approach including both drug therapy and surgical treatment and the application of endovascular technologies. This clinical case demonstrates the diagnostic difficulties of CTEPH and the opportunities of a comprehensive approach to therapy for the disease with mandatory assessment of preoperative surgical and medical treatment in order to improve the patient status and to prepare for surgery.

[Use of dual-energy computed tomographic angiopulmonography in patients with chronic thromboembolic pulmonary hypertension before and after pulmonary artery thromboendarterectomy].

OBJECTIVE: To estimate the contribution of dual-energy computed tomographic (CT angiopulmonography t o a diagnostic algorithm in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and its role in the evaluation of postoperative changes. MATERIAL AND METHODS: CT angiopulmonography was performed on the 64-slice Discovery HD 750 system (GE Healthcare) using the dual-energy scanning mode (140 and 80 kV). The examination results in patients with CTEPH were analyzed. RESULTS: All the patients were found to have typical CT signs of CTEPH: abnormal contrast enhancement of the pulmonary arteries, their dilatation and tortuosity; signs of right cardiac overload: right ventricular dilatation and/or hypertrophy, bronchial artery dilatation, decreased peripheral vascular pattern, mosaic pulmonary perfusion, and wedge-shaped perfusion defects on the iodine maps. Mosaic pulmonary perfusion areas were also found in all the patients. Perfusion defects were more clearly visualized when dual-energy CT by constructing iodine perfusion maps was used. Analyzing the perfusion maps in 6 patients operated on revealed a 20-50% reduction in perfusion deficit. CONCLUSION: Information on the vascular bed and pulmonary perfusion may be obtained in patients with CTEPH within one investigation, which is important to plan surgical treatment. Construction of iodine pulmonary perfusion maps allows evaluation of perfusion recovery after artery thromboendarterectomy.

[Diabetus mellitus and surgical treatment of coronary heart disease].

Nearly 40-year experience of surgical treatment of coronary heart disease testifies to higher coronary heart disease (CHD) morbidity and mortality rates among diabetes mellitus patients in comparison to non-diabetic patients. At the same time, comparative study of CHD treatment methods efficacy in diabetes mellitus patients has shown that surgery is preferred to angioplasty, especially in the most severe cases--in presence of coronary occlusion, insulin-dependent diabetes and left-ventricle dysfunction. More inferior results of coronary bypass surgery in diabetic patients in comaparison to non-diabetic were conditional on a more pronounced arterial calcinosis and diffuse distal arterial involvement, as well as more severe aortal ateromatosis, flebopathy and more often wound infection occurrence. In the department of cardio-vascular surgery in Russian cardiologic scientific productive complex a quarter of all patients waiting for the coronary bypass surgery are diabetic. Selection algorithm, preoperation preparation, peculiarities of surgical technique and principles of postoperative supervision of these patients were specially designed. With adequate preparation, remission of diabetes and use of microsurgery, postoperative prognosis for these patients (both stratified and real) is comparative to that for the main group of patients. One-year follow up after the bypass surgery data testifies to the low difference in autovenous and autoarterial shunt patency in diabetic and non-diabetic patients. Long-term (10 years) survival rate is significantly lower in the group of diabetic patients. Proposed cardioprotective postoperative strategy is designed to improve both short and long-term efficacy ofsurgical revascularization in CHD patients with concomitant diabetes mellitus.