A detailed literature review on arteriovenous malformation of the vein of Galen, aimed at systematizing modern knowledge on this problem, was carried out. The data analysis includes anatomical, genetic, morphological, and pathophysiological aspects, classification, clinical features, diagnosis, postnatal prognosis of mortality and neurological complications taking into account predictors of adverse outcomes. The mechanisms of decompensation caused by postnatal rearrangements of hemodynamics are described in detail.

The article also highlights the modern methods of treatment in the neonatal period.

The importance of prenatal formation of risk groups and determination of indications for the fetal surgical treatment is emphasized.

Craniosynostosis is the process of premature fusion of the sutures of the skull. There is a high risk of both the maternal and fetal trauma during delivery craniosynostosis child, if the condition is left untreated, complications such as raised intracranial pressure, neurocognitive disorders and cosmetic defects may be implicated. Prenatal ultrasound`s detection rate of craniosynostosis is low. We present a clinical description of a patient with isolated fetal sagittal craniosynostosis during pregnancy. The following ultrasound signs were found during the study: scaphocephalic head shape, dropping growth of the biparietal diameter and cephalic index, the stable growth of the head circumference as the pregnancy progressed, the absence of hypoechogenicity of the sagittal suture, brain shadowing sign, a bony groove in the area of the synostosis by 3D ultrasound. After birth, the diagnosis was confirmed by computed tomography of the brain, surgical treatment was performed at the age of three months. Our clinical case and literature data suggest that craniosynostosis could be diagnosed antenatally. If a fetal head size value, a cephalic index outside the normal range, or a change them in during pregnancy is detected, a detailed scan of the fetal skull and cranial sutures, including 3D scanning, should be performed. An increase in antenatal diagnosis of craniosynostosis will enable to a decrease maternal trauma and perinatal complications.

Heminasal hypoplasia/aplasia is a developmental anomaly within the spectrum of disorders affecting the formation of the nasal cavity, external nose, and sinuses, characterized by underdevelopment or partial absence of these structures. Fewer than 100 cases of this pathology have been described worldwide, with only a few detected prenatally. The article presents a case of heminasal hypoplasia suspected by third-trimester ultrasound, where underdevelopment of the right nasal wing and nasal passage was detected in the fetus. The article outlines the prenatal ultrasound features of this developmental anomaly, as well as details of diagnosing a full spectrum of nasal, ocular, and craniofacial skeletal malformations detected in the first years of the child’s life. The discussion includes a differential diagnosis, which considers choanal atresia in association with CHARGE-syndrome and maxillofacial microsomia, and reviews similar clinical descriptions presented in the global literature.

In spite of numerous unsuccessful attempts by researchers to solve the problems of ovarian cancer screening with transvaginal ultrasound, its use in the ovarian cancer diagnosis is quite reasonable and appropriate. Modern domestic and foreign data on the issues of serous borderline tumors and low-grade serous ovarian carcinomas differentiation are analyzed. Ultrasound is the most commonly used modality for the diagnosis of ovarian tumors. Ultrasound, using modern ultrasound technologies, performed by an experienced specialist, allows avoiding unnecessary or ineffective surgery. The imaging features typical for serous borderline tumors and tumors of low-grade malignancy are important for timely and correct differential diagnosis, which results in the selection of an adequate volume of surgery for these patients. Improved imaging of ovarian cancer opens up prospects for increasing the treatment effectiveness and evaluation of possibilities of early diagnosis of serous borderline ovarian tumors and low-grade serous carcinomas.

The research purpose was to study the performance of left ventricular (LV) rotation and twist under the decrease in LV longitudinal and circumferential strains and to determine the possible association of such changes with the risk of cardiovascular complications according to the GRACE 2.0 scale in patients with unstable angina and myocardial infarction with preserved ejection fraction of the left ventricle.

Materials and Methods. The study included 320 patients with acute coronary syndrome (unstable angina and myocardial infarction)  with preserved ejection fraction of the left ventricle ≥50%. The patients were divided into groups depending on the magnitude of longitudinal and circumferential strains: the first group - absence of longitudinal and circumferential dysfunction, 27 patients (8,5%); the second group – predominant longitudinal dysfunction (global longitudinal strain (GLS)) <16% with global circumferential strain (GCS) ≥25%, 68 patients (21,2%); the third group - transmural dysfunction (GLS <16% and GCS <25%), 225 patients (70,3%). Echocardiography was performed with the use of US scanner Affiniti 70. In 2D speckle-tracking mode the values of longitudinal (LS, %) and circumferential (CS, %) strains were assessed, the values of GLS and GCS, peaks of systolic basal and apical rotation, the values of LV twist and twist index were calculated. Additionally, the strain index was evaluated. All patients underwent coronary angiography with the calculation of the Gensini score; the risk of cardiovascular complications was calculated according to the Global Registry of Acute Coronary Events (GRACE) scale version 2.0.

Results. It was found out that patients in the 3rd group may have initial signs of heart failure due to more severe coronary myocardial damage. The medium value of GLS in patients of the third group was less than 12%, which is one of the criteria for reducing the contractility of the LV myocardium, a significant independent predictor of the occurrence of cardiovascular complications (CVC), and serves as a reason for therapy optimization in such patients. A distinctive feature of the patients in the second group, apart from the initial decrease in GLS, is a significant increase in the strain index, which can be used to evaluate the contribution of both individual indicators and their combination to LV contractility.

Conclusion. In patients with unstable angina and myocardial infarction with preserved ejection fraction, the initial decrease (13–16%) of the left ventricle longitudinal strain with preserved circumferential strain was characterized by increased values of LV rotation and twist. A relationship between a decrease in LV longitudinal strain of less than 12% and the risk of CVC was found. In values of longitudinal strain more than 12%, the increased risk of CVC may be further refined by the combined index based on rotation/twist (strain index), the diagnostic value of which requires further investigation.

Right ventricular (RV) dysfunction plays a significant role in the progression, complications, and outcomes of chronic heart failure (CHF). Timely diagnosis of RV dysfunction allows for therapeutic adjustments and helps prevent adverse disease outcomes.

Objective. To determine the diagnostic value and reproducibility of RV longitudinal strain parameters for detecting RV dysfunction in patients with CHF and pulmonary hypertension (PH) using two-dimensional speckle-tracking echocardiography.

Materials and Methods. A total of 41 patients with CHF due to coronary heart disease or dilated cardiomyopathy and signs of PH, by transthoracic echocardiography, were examined. The mean age was 69.2 ± 10.1 years; 12 (29%) were women, and 29 (71%) were men. Left ventricular ejection fraction (LVEF) remained normal in most CHF patients (65.9%). Echocardiographic assessment included standard RV function parameters, as well as longitudinal strain (RV global longitudinal systolic strain (RVGLS) and RV longitudinal systolic free wall strain (RVFWLS)). The control group comprised 31 individuals with no signs of cardiac dysfunction at rest (mean age: 57.9 ± 12.2 years). The reproducibility of RVGLS and RVFWLS measurement method was evaluated by analyzing inter- and intra-operator variability.

Results. A significant decrease in all RV systolic function parameters was observed in CHF and PH patients (p < 0.0001). RV function parameters were lower in patients with reduced left ventricular ejection fraction. ROC analysis demonstrated high sensitivity and specificity of RVGLS and RVFWLS in detecting RV dysfunction. The assessment of inter- and intra-operator variability, as well as the intraclass correlation coefficient, confirmed the good reproducibility of RV longitudinal strain measurement method.

Conclusions. A comprehensive evaluation of RV function using strain imaging techniques in patients with CHF and PH improves the detection of RV dysfunction.

The increasing incidence of both benign and malignant breast pathology, along with advancements and the active implementation of high-tech surgical techniques, has led to a rise in the number of vacuum-assisted biopsies (VAB) performed. In addition to the growing number of VAB procedures, there is a trend toward expanding the method’s capabilities—from performing biopsies for diagnostic purposes to the complete removal of lesions for therapeutic purposes as an alternative to traditional segmental resection.  There are numerous variations of total VAB, but in most cases, it involves the removal of a single small lesion in one breast, as the limiting factors include the risk of intraoperative bleeding and incomplete tumor tissue removal. Therefore, key issues in the field of interventional minimally invasive breast surgery today include the development of an adequate intraoperative hemostasis technique aimed at preventing complications, expanding VAB capabilities for the removal of larger and multiple lesions, and defining ultrasound criteria for its effectiveness and adequacy in real-time navigation. 

The article presents an analysis of VAB procedures performed for the removal of single and multiple breast lesions in 986 patients, including simultaneous excision of multiple lesions in both breasts, with and without the use of laser interstitial coagulation (LIC). The methodology of LIC under real-time ultrasound guidance is described, along with ultrasound criteria for assessing its effectiveness and adequacy.

Objective:  To evaluate the effectiveness of laser interstitial coagulation (LIC) during ultrasound-guided vacuum-assisted biopsy (VAB)  in patients with breast masses. 

Materials and Methods:  From 2017 to 2024, a total of 986 patients underwent ultrasound-guided VAB in the day hospital of the B.V. Petrovsky Russian Research Surgery Center, SCC №2. A total of 1,433 breast lesions were removed, with the number of excised lesions per patient ranging from 1 to 7. The maximum lesion size removed was 54 mm.  Indications for intervention were determined based on instrumental diagnostic methods (stratified according to the BI-RADS scale), as well as patient history, symptoms, and laboratory findings. Before therapeutic VAB, all patients underwent preoperative morphological verification. While in the process of developing an effective intraoperative hemostasis technique, VAB was performed without LIC in 275 patients. In 711 patients, VAB was performed with LIC as a prevention against hemorrhagic complications.

Results:  The use of LIC significantly expands the capabilities of vacuum-assisted biopsy (VAB) for the removal of multiple and/or large breast lesions. The overall rate of hemorrhagic complications in the VAB group without LIC was 4.36%, whereas in the LIC-assisted VAB group, it decreased to 1.97%. The residual tissue rate in the VAB group without LIC reached 16%, while in the LIC-assisted group, it was reduced to 6.89%.  When adhering to the described ultrasound navigation technique and adequacy control of LIC, VAB serves as an alternative to “open” breast surgeries. LIC enhances the safety of VAB by minimizing the incidence of hemorrhagic complications, expanding its capabilities, reducing the risk of residual tissue, and promoting the formation of a finer scar.  According to univariate regression analysis, significant factors influencing hematoma development included lesion length, the number of lesions, lesion multiplicity, and LIC application. Multivariate analysis identified lesion length and the number of excised lesions as independent factors associated with an increased risk of postoperative hematomas, while the use of LIC was associated with a 2.47-fold reduction in hematoma risk.

Conclusion: LIC is an independent factor that significantly reduces the incidence of hemorrhagic complications during therapeutic vacuum-assisted biopsy by 2.47 times. This technique enables the safe and simultaneous removal of multiple lesions, including those affecting both breasts, as well as large-sized lesions. The use of LIC reduces the required duration of subsequent elastic breast compression from 24 to 6 hours and  the risk of residual tumor tissue, and minimizes scar formation in the tumor bed.