The mitral valve prolapse is characterized by the degeneration of the valve leaflets, accompanied by their thickening, increasing surface area and flexibility. The mitral valves leaflets bulge (prolapse) beyond the plane of the atrioventricular ring into the left atrium during ventricular systole and lose the ability to close tightly, leading to the mitral regurgitation. Acute chord rupture of the mitral valve posterior leaflet is a rare but important cause of severe mitral regurgitation and the development of acute or progressive chronic heart failure. Acute mitral insufficiency, accompanied by hemodynamic disorders, requires an urgent valve plastic surgery or valve prosthetics. The mitral valve plastic surgery gives a number of undeniable advantages over prosthetics, providing the best hemodynamic parameters, saving the patient from lifelong receiving of anticoagulant drugs. Detailed qualified echocardiographic evaluation of all structures of the mitral valve (fibrous ring, MV leaflets by segments, overlapping structures, structure of the chordal apparatus, papillary muscles) provides the necessary information for the mitral valve reconstructive plastic surgery with the choice of the method that is most optimal for a certain patient at the preoperative stage. We report herein a clinical observation of the patient with a diagnosis: acquired heart disease, the mitral valve posterior leaflet prolapse with mitral insufficiency Grade 3. Chronic heart failure IIA. II FC. Atrial fibrillation. The patient underwent multicomponent mitral valve reconstruction with the creation of a neochord and the fibrous ring plastic on the duplicate of a PTFE strip (soft support ring), pairwise isolation of the pulmonary vein entrance and right cavotricuspid isthmus.

Methods: We selected 32 patients among 241 patients with advanced pancreatic cancer. All 32 patients took abdominal CT more than one time, before their pancreatic cancers were diagnosed. Eight of the 32 patients underwent pancreatic resection.We reviewed all patients' abdominal CT and checked how abnormal findings appeared in the pancreas before finding their pancreatic cancer. Results: Twenty-three (71.8%) of the 32 patients had a localized constriction of the pancreatic parenchyma before appearing the pancreatic cancer. We named it "K-shaped sign" based on the figure. All of the 23 patients showed focal fatty changes around the area the K-shaped sign appeared. Four (17.3%) of the 23 patients had both K-shape sign and a partial main pancreatic duct dilatation. Nineteen of the 32 patients had a normal pancreas without focal fatty change on CT before the K-shaped sign occurred. Thirteen of the 32 patients had detected the Kshaped sign since the initial abdominal CT. All the 32 patients had the pancreatic cancer in the K-shaped sign's area. Conclusion: We introduced new CT finding before pancreatic cancer could be found, and named it "K-shaped sign" on CT. Although the "K-shaped sign" phenomenon has to be associated with early pancreatic cancer, it is unclear what the cause of the phenomenon is. When the K-shaped sign is observed on CT, the onset of a pancreatic cancer should be considered and determined by using more precise modalities.

No abstract

The use of the contrast agent SonoVue has been allowed in Russia since June 2014. Since then, russian experts have been accumulating their own experience in the contrast agent application for various diseases. The analysis of the obtained data showed that, besides the typical characteristics of the lesions enhancement, described in the literature, there can be atypical cases due to various causes (longterm course of the disease, co-morbidity). We present a clinical case of pancreas cystic lesion in female patient, that was misunderstood as a cystic tumor preoperatively. Considering the epithelial lining nature, absence of the accurate signs of the presence of an ovarian-like stroma, and also the significant secondary changes in the cystic wall such as hyalinosis, cholesterol deposits and macrophage accumulations, the lesion was interpreted as a long-standing pancreatic retention cyst with secondary changes by a morphological study. The features of the enhancement patterns of this lesion can be explained by the presence of significant secondary changes in the wall of cyst, that was first diagnosed in this patient 10 years ago.

Contrast-enhanced ultrasound began to develop rapidly  in recent years inRussia. Due to the physical properties of contrast agents it is possible to differentiate malignant and benign lesions. However, this method only involves a subjective evaluation of the obtained results. For the objectification of ultrasound with contrast enhancement implemented the function “TIC-analysis” (time intensity curve analysis).  The aim: to assess the clinical value of the TIC-analysis in the differential diagnosis of adenocarcinoma of the pancreas and chronic pseudotumoral pancreatitis by contrast – enhanced ultrasound.Materials and methods. In A.V. Vishnevsky Institute of surgery contrast – enhanced ultrasound and TIC-analysis was performed on 23 patients with focal lesions of the pancreas. All patients were operated on, tumors were verified morphologically: adenocarcinoma of the pancreas  in 18 (78%) patients, chronic pseudotumoral pancreatitis – in 5 (22%) patients.Results. The results about intensity of the tumors obtained by the TIC analysis do not allow to differentiate these pathological processes statistically significant (p > 0.05), which, in all probability, due to the fact that pancreatic  adenocarcinoma and chronic pseudotumoral pancreatitis have similar morphological characteristics in the form of pronounced desmoplastic stromal response and fibrosis-hyalinosis, respectively. The “Time to peak| parameter allowed us to determine statistically significant that pancreatic adenocarcinoma had an early accumulation of contrast agent (average 16 sec) and early washout (from an average of 17 sec); the chronic pseudotumoral pancreatitis had the slow accumulation of contrast agent (average  85 sec) and slow washout (from an average of 86 seconds) (p < 0.05).Conclusion. The “Time to peak” parameter at ultrasound examination with echocontrast allows statistically significantly differentiate adenocarcinoma of the pancreas  and chronic pseudotumoral pancreatitis.