Зважаючи на негайну необхідність стандартизації візуалізації деформації міо-карда (стрейну) в 2010 році Європейська асоціація з ехокардіографії (ЕхоКГ) (нині – Євро-пейська асоціація серцево-судинної візуалізації, EACVI) та Американське товариство з ЕхоКГ (ASE) вперше запросили технічних представників усіх зацікавлених постачальників для участі в загальному проекті з метою концентрації зусиль на зниженні варіабельності вимірювань стрейнів за даними різних виробників програмного забезпечення. Результатом цієї роботи став сумісний ініціативний документ EACVI, ASE та виробників програмного забезпечення, опублікований у 2015 році [1], що забезпечував відповідні загальноприйняті визначення, назви, абревіатури, формули вимірювань і процедури розрахунків фізичних даних, що отри-муються за результатами спекл-трекінг ЕхоКГ (СТЕ), та на сьогодні вже став загальним міжна-родним стандартом. Цей документ є адаптацією сучасного досвіду з СТЕ робочої групи з СТЕ Асоціації серцево-судинних хірургів України та Українського товариства кардіологів з ураху-ванням місцевого досвіду.

Intracoronary administration of drugs allows to achieve the fastest possible effect in interventional cardiology. This allows to avoid all the biological filters of the body and achieve the required concentration of the active substance at the injection site. Also, given the local action, systemic side effects are nearly absent. The aim. To study the literature data of the leading countries of the world in the field of intracoronary drug administration. To analyze the experience of different centers on the use of various medications in the treatment of the phenomenon of distal microembolization. Results. One of the first drugs administered intracoronary was streptokinase for the treatment of acute myocardial infarction. After that, it became clear that this method of delivering drugs is possible and can be used. With the beginning of the treatment of acute coronary syndromes by stenting, one of the possible complications arose in the form of no-reflow. At the same time, realizing that this is a local problem, they began to use the possibility of intracoronary administration of drugs to treat this phenomenon. The main advantage of this method is quick response to drug administration. Today, the drugs of choice in the treatment of no-reflow are verapamil, adenosine, nitroprusside, adrenaline. On the other hand, probably the most common drug that is administered intracoronary is nitroglycerin. It is used as a vasodilator in the event of spasm of the coronary arteries. Subsequently, it has been recommended to deliver drugs via a microcatheter or aspiration catheter to achieve even more selective effect in the area of the affected vessel, and this also minimizes drug loss due to coronary reflux into the aortic sinuses while usinga guiding catheter. Work is also underway on the use of intracoronary insulin in acute coronary syndrome in order to reduce the area of damage in myocardial infarction. It is also very promising to study the introduction of stem cells directlyinto the myocardium through a microcatheter in order to regenerate the myocardium after a heart attack. Conclusions. Intracoronary administration of drugs allows to achieve the maximum effect in the shortest possible time. Today, many drugs can be used in this way, starting from the treatment of the phenomenon of distal microembolization and ending with myocardial regeneration after myocardial infarction.

Background. The current state of interventional cardiology is aimed at reducing the number of probable complica-tions of procedures and increasing patient comfort. That is why there was a stage evolution of changing endovascular ap-proaches from transfemoral to transradial. But despite the significant benefits of transradial access, it leaves behind some important complications. One such complication is occlusion of the radial artery. The frequency of this situation ranges from 1 to 30%. That is why the world’s leading interventionists are increasingly using distal transradial access, which is associated with fewer cases of postoperative occlusion of the radial artery. The aim. Occlusion of the radial artery is not an obstacle to changing access to the contralateral artery or more dan-gerous transfemoral access. With distal transradial access it is possible to recanalize artery and provide target procedure. Materials and methods. The study included 318 patients who were scheduled for re-intervention. Among these patients, 12 had a radial artery occlusion, which is 3.7% of the total control group. Successful recanalizations with distal access were performed in 9 patients (75%), and in 3 patients (25%) the attempts were unsuccessful. The technique of recanalization of chronic occlusion included selection of hydrophilic, both non-coronary and coronary wires. At the end of the procedure, hemostasis was performed according to standard procedures using aseptic bandages. Complications of hemostasis were not detected in any patient in the control group. The postoperative period was unremarkable. Conclusions. The study showed the possibility of using distal transradial access to recanalize chronic occlusions of the radial artery, which allows not to waste time on replacement of the contralateral radial artery or life-threatening transfemoral access and perform the necessary amount of the intervention. Besides, this preserves the radial artery for further use in bypass surgery or hemodialysis arteriovenous fistula.

Background. Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy. Extended septal myectomy ( ESM) is one of the priority methods of treatment of drug-refractory obstructive HCM. In recent years, hospital mortality during surgical correction of obstructive HCM in expert centers does not exceed 1–2 %. However, typical threatening complications of septal myectomy, such as iatrogenic ventricular septal defect (VSD) and rupture of the anterior or posterior walls of the left ventricle (LV), remain a topical issue in surgery of HCM. Objective: to show the role of preoperative CT-planning to predict and reduce possible technical problems associated with ESM, including iatrogenic VSD. Methods and materials. This study includes 217 symptomatic patients with obstructive HCM, who from April 2016 to October 2019 as one of the steps of preoperative planning underwent cardiac CT prior to ESM. Cardiac CT was performed to delineate the left ventricular myocardium, assess the distribution of hypertrophy and the presence of crypts. Special attention was also paid to the anatomy of the mitral valve (MV) and subvalvular apparatus. Coronary artery patency was assessed by CAD-RADS, a standardized method for reporting the results of coronary CT angiography to determine tactics for further management of the patient. Results and discussion. In the study group, the average age of patients was (49 ± 15) years, 48 % – men. All patients had a symptomatic, drug-refractory obstructive form of HCM. The mean maximum wall thickness of the interventricular septum (IVS) was (20 ± 5) mm (range 16–33). The average LV mass was (118 ± 23) g/m2. 195 patients (89.9 %) had systolic anterior motion ( SAM) of the MV. MV and subvalvular apparatus anomalies were detected in 62 patients (28.6 %). A zone of scarring and regression of IVS after alcohol septal ablation (ASA) was detected in 7 patients (0.3 %) with residual LV outflow gradient. Coronary arteries atherosclerosis was detected in 32 patients (14.7 %). Conclusions. Preoperative CT-planning of septal myectomy allows to obtain information on morphology of the LV, IVS, MV and subvalvular apparatus, and gives the surgeon the advantage to form a more accurate plan for the location and volume of septal resection, and avoid complications when correcting obstructive HCM. No iatrogenic VSD was detected in any of the patient in the study group. Key words: hypertrophic cardiomyopathy, computed tomography, preoperative planning, extended septal myectomy.