Objective: to determine the ultrasound signs of right heart dysfunction, which increase the prognostic value of the recommended parameters of left ventricular (LV) dysfunction in patients with heart failure with reduced ejection fraction (HFrEF).

Materials and methods. The prospective study included 79 patients with HFrEF LV with clinical manifestations of chronic heart failure functional class III according to the New York Heart Association (HF NYHA Class III) in 52 patients (65.8%) and HF NYHA Class IV in 27 (34.1%). The primary end point was death during a follow-up period of up to 3 years while waiting for heart transplantation.

Results. Overall mortality was 33 patients (41.7%), 17 (21.5%) during the 1st year of follow-up. Regression analysis revealed the following independent ultrasound predictors of poor prognosis: LV ejection fraction on 3D-echocardiography (3DE LVEF), p = 0.014; global longitudinal strain of the LV (GLS LV), p = 0.010, and of the interventricular septum basal segment (IVSLS BS), p = 0.012; mean longitudinal strain of the basal segment of the right ventricle free wall (FWLS BS RV), p = 0.003. Changes in the configuration and dilatation of the LV cavity, an increase in LV end-diastolic pressure, impaired contractility, and strain of the LV myocardium can affect the function of the right ventricle (RV) through the common interventricular septum (IVS). Dilatation of the RV due to an increase in the end diastolic area (RV EDA) of more than 30 cm2 (p = 0.012) and end systolic area (RV ESA) of more than 25 cm2 (p = 0.001), an increase in the volume of the right atrium (3DE AKI) of more than 100 ml (p = 0.036), and a decrease in the % inspiratory collapse of the inferior vena cava (% IVC) less than 30% (p = 0.005) demonstrated a prognostic significance in the observed patients. A decrease in the deformation properties of the pancreas due to the longitudinal component and impaired strain of the basal segment makes a greater contribution to RV dysfunction (FWLS BS, % < -15% (p < 0.001)).

Conclusions. RV dysfunction in patients with HFrEF is an unfavorable prognostic factor, independently associated with existing LV dysfunction. The most significant ultrasound sign for surveillance prediction of patients with LV HFrEF and RV dysfunction are indicators of ventricular myocardial deformation. Remodeling of the right chambers and dysfunction of the RV is a trigger for the separation of the RV and pulmonary artery, which ultimately leads to adverse outcomes.

The article discusses the evolution of transthoracic echocardiography due to the introduction into clinical practice of new technologies and methods of cardiac ultrasound and the development of pocket ultrasound devices. Often, new technologies did not replace the old ones but were used as an addition to them, which led to an increase in the duration and complexity of the examination. On the other hand, the use of portable ultrasound machines has made it possible to perform point-of-care transthoracic echocardiography, but it has been limited by solving a specific clinical problem. It became clear that different clinical situations require examinations that differ in complexity, labor intensity, levels of experience, and training of the doctors. Various types, features, and place in the clinical practice of transthoracic echocardiography are presented. The necessity of changing approaches to both accounting for effort estimates depending on the protocols and volumes of examinations and to planning the work of ultrasound and functional diagnostics departments is substantiated. Ways to solve problems that hinder the introduction of targeted, including focused, examinations into routine clinical practice are proposed.

These guidelines may have been translated, from the originals published by ISUOG, by recognized experts in the field and have been independently verified by reviewers with a relevant first language. Although all reasonable endeavors have been made to ensure that no fundamental meaning has been changed the process of translation may naturally result in small variations in words or terminology and so ISUOG makes no claim that translated guidelines can be considered to be an exact copy of the original and accepts no liability for the consequence of any variations. The guidelines are only officially approved by the ISUOG in their English published form.

Hydranencephaly is a rare abnormality of the central nervous system (CNS) of the fetus,  in which the  cerebral hemispheres are absent and replaced with cerebrospinal fluid, while the structures of the posterior fossa, thalami and falx cerebri remains normal. The ischemic, hemorrhagic complications, infection of the fetus, the toxic effects of carbon monoxide, butane and genetic abnormalities are potential causes of a hydranencephaly development. The article presents  the modern data on the possible causes of the hydranencephaly development, and clinical case of prenatal ultrasound diagnosis of hydranencephaly at 28–29 weeks of gestation, highlighting a specific ultrasound signs of this pathology. The management strategy and  genetic testing recommendations are described. The difficulties of differential diagnosis and the key signs of similar disorders are discussed, as well as recommendation for future pregnancy planning.

Objective: to evaluate the dynamics of echographic parameters of structural changes in the endometrium depending on the morphological type of chronic endometritis (CE) before and after etiotropic therapy.

Material and methods. A retrospective cohort based on the results of examination of 140 patients of reproductive age with a verified diagnosis of CE before and after complex etiotropic therapy. A pelvic ultrasound was performed in the 1st phase of the menstrual cycle with measurements of the endometrial and uterine volume, followed by a calculation of the percentage endometrial/uterine volume ratio (EV/UCV). The groups of hypoplastic, mixed, and hyperplastic morphotypes were formed according to the values of EV/UCV. The B-mode examination included the assessment of the structure and echogenicity of the uterine cavity mucosa; the line of closure or divergence of the endometrial layers; the external contour of M-echo; the presence of liquid in the uterine cavity, and acoustic artifacts, in particular reverberation, as a sign of gas bubbles.

Results. An increase in the thickness and volume of the endometrium, and EV/UCV was obtained after therapy  in the hypoplastic morphotype. There were no changes in the thickness or volume of the endometrium in the mixed morphotype. A significant decrease in the thickness and volume of the endometrium, and EV/UCV were found in the hyperplastic morphotype. In all morphotypes, the endometrium remained mostly hyperechoic and heterogeneous, with an abnormal midline.

Conclusion. The hypoplastic and mixed morphotypes are characterized by more persistent endometrial changes that are difficult to treat. Pathological signs were eliminated much more often in the hyperplastic morphotype. The results of the study demonstrate the absence of a complete reduction in the analyzed ultrasound criteria of CE after end of treatment for all morphological types.

Parametrial endometriosis is a severe form of the disease associated with the involvement of the ureters and pelvic nerves, which leads to sexual, urinary, and intestine dysfunction. Surgery in such cases requires a complex multidisciplinary approach, which can be planned only with a detailed preoperative diagnosis. The article presents a review of current international guidelines for parametrium ultrasound. The capabilities of ultrasound are demonstrated by our own ultrasound images of normal parametrium and in deep endometriosis.