medvisМедицинская визуализацияMedical Visualization1607-07632408-9516RDS-Media Ltd.10.24835/1607-0763-2020-3-88-106medvis-953Research ArticleГРУДНАЯ КЛЕТКАTHORAXМетодики томографической визуализации ушка левого предсердия при планировании интервенционного лечения фибрилляции предсердийTechniques of left atrial appendage tomography for planning intervention treatment of atrial fibrillationhttps://orcid.org/0000-0002-2970-2394КаштановаН. Ю.KashtanovaN. Yu.

Каштанова Наталия Юрьевна – аспирант отделения рентгенологии и магнитно-резонансных исследований с кабинетом ультразвуковой диагностики

117997 Москва, ул. Большая Серпуховская, д. 27, Российская Федерация

Nataliya Yu. Kashtanova – resident of Radiology Department

27, Bol'shaya Serpukhovskaia str., Moscow, 117997, Russian Federation

nat.y.kashtanova@mail.ruhttps://orcid.org/0000-0001-7070-3391КондратьевЕ. В.KondratyevE. V.

Кондратьев Евгений Валерьевич – канд. мед. наук, старший научный сотрудник отделения рентгенологии и магнитно-резонансных исследований с кабинетом ультразвуковой диагностики

117997 Москва, ул. Большая Серпуховская, д. 27, Российская Федерация

Evgenij V. Kondratyev – Cand. of Sci. (Med.), senior research of Radiology Department

27, Bol'shaya Serpukhovskaia str., Moscow, 117997, Russian Federation

https://orcid.org/0000-0002-9645-8408РатниковВ. А.RatnikovV. A.

Ратников Вячеслав Альбертович – доктор мед. наук, профессор, заместитель главного врача – главный врач

194291, Санкт-Петербург, пр. Культуры, д. 4, Российская Федерация

Vyacheslav A. Ratnikov – Doct. of Sci. (Med.), Professor, Deputy chief physician – Chief Physician

4, prosp. Kultury, St. Petersburg, 194291, Russian Federation

https://orcid.org/0000-0002-6008-263XКарповР. А.KarpovR. A.

Карпов Роман Алексеевич – слушатель ординатуры Первой кафедры и клиники терапии усовершенствования врачей

194044 Санкт-Петербург, ул. Академика Лебедева, д. 6, Российская Федерация

Roman A. Karpov – resident of 1st Therapy department

6, Academic Lebedev str., St. Petersburg, 194044, Russian Federation

ФГБУ “НМИЦ хирургии имени А.В. Вишневского” Минздрава РоссииРоссияA.V. Vishnevsky National Medical Research Center of SurgeryRussian FederationФГБУЗ “Клиническая больница №122 им. Л.Г. Соколова” ФМБА РоссииРоссияL.G. Sokolov Clinical hospital №122 FMBA of RussiaRussian FederationФГБВОУ ВО “Военно-медицинская академия имени С.М. Кирова” Министерства обороны РоссииРоссияFSBMEI HE “S.M. Kirov Military Medical Academy”Russian Federation20200910202024388106Copyright © Каштанова Н.Ю., Кондратьев Е.В., Ратников В.А., Карпов Р.А., 20202020Каштанова Н.Ю., Кондратьев Е.В., Ратников В.А., Карпов Р.А.Kashtanova N.Y., Kondratyev E.V., Ratnikov V.A., Karpov R.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medvis.rdsmedia.ru/jour/article/view/953

Изменение внутрисердечной гемодинамики на фоне неправильного ритма фибрилляции предсердий создает условия для формирования тромбов в полости ушка левого предсердия. Наличие тромба в ушке является неблагоприятным прогностическим фактором последующих кардиоваскулярных событий, являясь источником до 64% случаев ишемических инсультов, а сопутствующая антикоагулянтная терапия приводит к большой частоте геморрагической транcформации. Симптомная и рефрактерная к медикаментозному лечению фибрилляция предсердий требует хирургической коррекции ритма или электрической кардиоверсии. Во время вмешательства существует высокий риск кардиоэмболического инсульта, поэтому на дооперационном этапе для его профилактики необходимо исключить тромбоз ушка левого предсердия. Основной метод визуализации ушка – чреспищеводная эхокардиография, но на сегодняшний день определенный вклад вносит компьютерная томография и, в меньшей степени, магнитно-резонансная томография. Целью данного научного обзора было изучение возможностей каждой методики и их роли в диагностическом алгоритме при обследовании пациентов перед катетерной абляцией источников фибрилляции предсердий.

Due to intracardiac circulatory changes atrial fibrillation creates conditions for thrombus formation in the left atrial appendage (LAA). The presence of thrombus in LAA is poor prognostic factor of subsequent cardiovascular events. It is the source of up to 64% of ischemic stroke cases, and concomitant anticoagulant therapy leads to a high frequency of hemorrhagic conversion. For patient with symptomatic and drug-refractory arrhythmia is recommended surgical rhythm correction or electrical cardioversion. There is a high risk of cardioembolic stroke during the intervention, so it is necessary to exclude LAA thrombosis at pre-operation stage. The main method of LAA visualization is transesophageal echocardiography, but today computed tomography and, less, magnetic resonance tomography become important. The purpose of this review is to analyze the possibilities of each visualisation technique and their role in the diagnostic algorithm when examining patients before catheter ablation of atrial fibrillation sources.

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The authors declare that there are no conflicts of interest present.