Aim. To demonstrate the capabilities of magnetic resonance imaging (MRI) and magnetic resonance (MR) angiography in the complex examination of patients with various types of transposition of great arteries (TGA) at the pre- and postoperative stages.Material and Methods. A total of 38 MRI studies of the heart and blood vessels were performed in 33 patients with various forms of transposition of great vessels.Results. The main purpose of MRI was to identify postoperative complications after arterial switch operation for simple TGA. Cicatricial changes in the wall of the left ventricle were revealed in two patients, which was the basis for coronary angiography. Coronary angiography revealed no significant coronary artery stenosis requiring surgical intervention. The aortic root was dilated to an average of + 2.85 Z-score in six patients after arterial switch operation, which required further dynamic observation. Stenosis of the branches of the pulmonary artery due to the use of the Lecompte maneuver was revealed in one patient. Heart catheterization was performed according to the results of MRI. Invasive pressure measurement revealed neither significant stenosis nor indications for surgical treatment. MRI data were used as one of the criteria for anatomical correction readiness in group of patients with congenitally corrected transposition of the great vessels, along with data of echocardiography and heart catheterization.Conclusion. MRI and MR angiography are the “gold standard” in the pre- and postoperative examination of patients with various forms of TGA . Using MR angiography, it is possible to carry out morphometry and clarify the spatial arrangement of vessels including that after correction of TGA. In most cases, MRI allows to correctly differentiate the morphology of the heart chambers and their relative position. It also allows to perform volumetry and to assess the parameters of local and global contractile function of the ventricles, which is essential for preoperative assessment and dynamic observation at all stages of correction.
The aim of the study was to develop criteria for optimal tactics of treating hepatic hemangiomas of various sizes and localization including endovascular, percutaneous puncture ablative, and open resection interventions. Materials and Methods. The results of treating 95 patients (65 women and 30 men aged 26-65 years) with hepatic hemangiomas have been analyzed. Tumor diagnosis was based on the data of echosonoscopy, MRI, multispiral computed tomography with intravenously injected contrasting medium, US dopplerography, and puncture biopsy. 78 patients were operated on, 63 of them underwent isolated surgery, whereas 15 patients were treated with a combination of methods. In 17 cases, the decision was made not to use operative treatment. Results. After open resection operations (n=34), complications in the form of bilomas were observed in 3 patients in the postoperative period, in 1 patient the tumor growth continued two months after the resection of liver segment IV. Sclerotherapy of hepatic hemangiomas with ethanol (n=13) resulted in the recovery of 10 patients, massive intravascular hemolysis has developed in one patient, two patients died. After radiofrequency thermoablation of hepatic hemangiomas less than 5 cm in diameter (n=4), recovery was achieved. Echosonoscopy showed the reduction of blood flow and absence of tumor growth in 12 patients after isolated endovascular embolization of the vessel nourishing hepatic hemangioma. The combined treatment according to the method developed by us resulted in clinical recovery of all 15 patients. Conclusion. Sclerotherapy of hepatic hemangiomas with ethanol, especially those being large in size, may cause unpredictable complications and individual pathological reactions with severe outcomes. Surgical treatment is not required if morphologically verified hepatic hemangiomas are less than 3 cm in diameter without evident clinical manifestations and growth. When the diameter of hepatic hemangiomas is in the range of 3-5 cm with a tendency to growth, radiofrequency thermoablation is preferred. Hemangiomas of the left liver lobe more than 5 cm in size should be treated by resection methods. Our combined method is designed to treat hemangiomas of the right liver lobe exceeding the size of 5 cm. If the right lobe tumor is more than 10 cm, it is advisable to make a decision in favor of open operation.
Bezopasnost yodsoderzhaschih rentgenokontrastnyih sredstv v svete novyih rekomendatsiy mezhdunarodnyih assotsiatsiy ekspertov i klinitsistov [Safety of iodine-containing X-ray contrast agents in the light of new recommendations of international associations of experts and clinicians]. Russian electronic journal of radiology. 2012; 2 (1): 11. 3. Vitko NK, Ter-Akopyan AV, Pankov AS, Tagaev NB. Primenenie rentgenokontrastnyih veschestv v interventsionnoy kardiologii i angiologii: istoriya, oslozhneniya i ih profi laktika [The use of radiocontrast substances in interventional cardiology and angiology: history, complications and their prevention].
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