internal orifice and tissue annulus diameters, the values of transprosthetic parameters (peak and mean gradients, blood flow velocities) through «CorBeat» were close to physiological values of transvalvular native aortic parameters and had a tendency to be not dependent on the size of prosthesis (p =0,63). In the article for the first time a morphometric database of geometric values of internal orifice area of normal native aortic valves in adults was used taking into account both the gender and the body surface area's of a patient. There was also used the standardized prosthesis size Z-score which represents the number of SDs by which the internal prosthesis area differs from the mean normal native aortic valve area for the patient's body surface area. The article emphasizes the need of the personal selection of the size and the type of prosthesis for any patient as well as the need for new design development of prosthetic heart valves.Key words: mechanical heart valve prostheses, prosthetic stenosis, prosthesis design efficiency, heart valves occluders, full-flow aortic mechanical heart valve prosthesis. ВведениеПри имплантации механического протеза клапана сердца (ПКС) конструктивные элементы протеза -пришивная манжета, стенки корпуса, запирающие эле-менты -занимают часть полезной площади отверстия фиброзного кольца, что приводит к повышению транс-протезных градиентов, скоростей кровотока и изменению структуры течения крови. Названные виды гемодина-мических возмущений характеризуют собой признаки конструктивного стеноза. Они особенно заметны у про-тезов малых диаметров (<23 мм) в сочетании с большой площадью поверхности тела пациента (ППТ >2,0 м 2 ). Конструктивный стеноз присущ всем типам механиче-ских клапанов сердца и наблюдается, прежде всего, в аор-тальной позиции. Выраженность гемодинамических при-знаков стеноза может быть снижена путем оптимизации конструктивного решения ПКС: увеличения площади проходного отверстия (А отв.ПКС , см 2 ) за счет уменьшения толщины стенок корпуса протеза и изменения формы
The article is devoted to the actual problem of analysis of the digital economy impact on the current state of world economy, the problem of transition to a qualitatively new level to meet the requirements of digital civilization. The authors suggest a number of specific constructive proposals to adapt the Russian economy to the new intellectual and information era. Large-scale technological changes are accompanied by changes in the institutional structure of society. On the current state of the "digital economy" in the context of international economic relations. Integrated author's influence of the "digital economy" on the current state of the world economy, on the problem of transition to a qualitatively new level associated with the requirements of digital civilization. Methods of the study. In the course of the study, simulation modeling with the use of economic and logical methods was used, allowing to reach the methodology of optimizing the ratio of development of a digital economy.Conclusions and Relevance Although the digitalization of the economy has positive consequences (trade expansion, productivity growth, competition, job creation, etc.), it also has one significant drawback connected with a serious transformation of jobs, which can lead to an explosive increase in technological unemployment, especially in developing countries, as the World Bank warns. As a result, the competition among the middle class will considerably increase, which can lead to the wages stagnation.
Objective: Analysis and presentation of the capabilities of the new ultrasound technique —the index of volume remodeling (IRV), which allows comprehensive assessing of pathological remodeling of the heart as an integrated functional anatomical system. Materials and methods: For this study 316 patients with acquired mitral valve disease (MVD) were examined prior to and following mitral valve replacement with bileaflet, disc-, and bioprostheses. Key parameters of the heart were measured in classical echocardiographic projections (end systolic area, end-diastolic area, end systolic volume, and end diastolic volume of ventricles, ventricular ejection fraction, atrial volume, and the ratio of ventricular to atrial volumes). The patients were examined 1–2 days prior to and following the surgery—before discharge, 6 months later, 1 year later, and then annually within next 5 years. The examination data were collected in one- and two-dimensional modes by using Philips EpiQ-7, iE33, HDI, Siemens Acuson, and HP Sonos 2500 diagnostic ultrasound machines equipped with 2.5 and 3.5 MHz transthoracic sensors. Results: A comprehensive study of structural geometric remodeling parameters of heart cavities in the context of acquired MVD allowed identifying new patterns in changes of the heart chambers geometry. These changes are reflected in the IRV, a digital indicator of the severity of cardiac pathological remodeling. Analysis of the dynamics of post-operative vs. pre-operative IRV-based remodeling data also showed that the index is highly sensible to the hemodynamic features of through-flows in various designs of prostheses. The IRV has a pronounced prognostic power and allows predicting the long-term outcome of surgical treatment with an accuracy of 82.35%. Conclusions: The IRV predictive accuracy formed the basis of the original classification of types of cardiac remodeling, which can assist both in determining the optimal timing for surgery, and in conjunction with other clinical diagnostic data, in predicting the long-term outcome of heart geometry restoration depending on the type of surgical correction. The IRV can be used in evaluation of the heart geometry for any cardiac pathology. It makes the approach to the analysis of pathological remodeling of the heart understandable, consistent, and universal, and also opens up opportunities for further expanding the diagnostic capabilities of radiology in cardiac surgery at all stages of the diagnostic process.
Цель исследования презентация возможностей нового программного модуля HeartModel (НМ) для автоматизированной трехмерной реконструкции объемов и архитектоники левых камер сердца в условиях кардиохирургической клиники. Материал и методы. Проведен анализ работы программного обеспечения НМ, установленного на ультразвуковой системе экспертного класса EpiQ-7, с использованием матричного фазированного трансторакального датчика Х5-1. Для демонстрации возможностей программы была проведена трех- мерная реконструкция левых камер сердца у 9 пациентов. Результаты. Программа НМ автоматически рассчитывает систолический и диастолический объемы левого желудочка (ЛЖ), длину полости, фракцию выброса, а также систолический объем левого предсердия (ЛП). Таким образом, применение методики НМ значительно сокращает время проведе- ния исследования, так как освобождает врача от необходимости вручную определять по ЭКГ систолу и диастолу, трассировать контур ЛЖ, а затем отдельно, тоже вручную, рассчитывать объем ЛП други- ми методиками, заложенными в компьютерную программу аппарата. Заключение. Все особенности сердца при различных типах патологии должны быть предельно точ- но визуализированы и оценены для разработки оптимальной стратегии и тактики лечения. Появление нового программного обеспечения HeartModel открывает перед врачом ультразвуковой диагностики новые возможности в оценке геометрии, объемов и архитектоники левых камер сердца.
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