Objective: to evaluate the value of 4D fetal heart ultrasound assessment of diastolic right : left ventricle volume ratio in diagnosis of significant hypoplasia of the left ventricle in hypoplastic left heart syndrome. Material and methods: the main group consisted of 21 fetuses with hypoplastic left heart syndrome, in which left ventricle length and end-diastolic dimension were equal or below the 5th percentile for gestational age. The control group consisted of 50 healthy fetuses. Prenatal ultrasound examination was performed at 18-21 weeks of gestation with the use of Voluson 730 Expert (GE Healthcare, USA) with Virtual Organ Computer-aided AnaLysis (VOCAL) and Spatio-Temporal Image Correlation (STIC) software with 4D convex transabdominal transducer (4-8.5 MHz). 4D volumes of the left and right ventricle in diastole and right : left ventricle volume ratio have been assessed. Results: at the gestational age of 18-21 weeks in fetuses of the control group the median of diastolic right : left ventricle volume ratio was 1.17 ml, the 5 and 95 percentile range - 1.00-1.23 ml, the minimum and maximum range - 1.00-1.23 ml; in the main group - 3.35 ml, 1.24-17.20 ml, 1.24-11.84 ml, respectively (P = 0.001). The sensitivity of diastolic right : left ventricle volume ratio > 1.23 in the in diagnosis of significant hypoplasia of the left ventricle in hypoplastic left heart syndrome - 100.0% (taking into account the inclusion to the main group the fetuses with left ventricle linear dimensions equal or below to lower limit of normal values with background of normal right ventricle dimensions). Conclusion: the use of right : left ventricle volume ratio allows to minimize 2D and 3D/4D measurement errors of absolute parameters, and reduce intraobserver and interobserver variability in ultrasound measurements.

Objective: to develop 4D ultrasound criteria of lung assessment in fetuses with congenital diaphragmatic hernia, with potential use for outcomes prediction. Material and methods: the results of 4D ultrasound in fetuses with gestational age 26-38 weeks with congenital diaphragmatic hernia (14 cases) were analyzed. According to the pregnancy outcomes, the fetuses were divided into two subgroups: survived (n = 10) and deceased in the early neonatal period (n = 4). Ultrasound examinations performed with the use of Virtual Organ Computer-aided AnaLysis (VOCAL) and 4D Histogram software of Voluson 730 Expert (GE Healthcare, USA) with 4D convex transabdominal transducer (4-8.5 MHz). The fetal lung-to-head ratio (contralateral lung volume to head circumference ratio) (1) and lung-to-lung echogenicity ratio with histogram analyses (2) were evaluated. Results: the significant differences of fetal lung-to-head ratio and also in lung-to-lung echogenicity ratio with histogram analyses between the two groups were obtained (P = 0.0047). Conclusion: fetal lung-to-head ratio (1) and lung-to-lung echogenicity ratio with histogram analyses (2) are possible to use for early neonatal death prediction.

Echocardiography is an actively developing modality that plays a key role in the diagnosis of coronary artery disease (CAD). In recent years, the important changes occurred in the examination protocols and analysis methods of resting and stress echocardiography in patients with CAD. Along with the standard visual analysis of wall motion, the speckle tracking mode is widely used to quantify local and global contractility when the resting or stress echocardiography is performed. Coronary artery imaging is increasingly used to assess blood flow velocities across stenosis at rest, as well as coronary flow reserve during the stress test. The stress echocardiography protocol has been expanded by including several parameters unrelated to left ventricular contractility. To increase the diagnostic value of stress echocardiography, some authors have suggested to combine it with a focused ultrasound examination of the carotid arteries. The described innovations have already found or are finding their place in everyday clinical practice. This article provides an overview of the current state of echocardiography use in patients with CAD.

The terms, defining the status of a diagnostic examination in the Federal Reference Guide for Instrumental Diagnostics are discussing in the article, with describing the definition of routine practice and the antonymous definitions of scientific practice and obsolete practice. The routineness of ultrasound examination is not determined by ease of performing, class of equipment, frequency of prescription, cost or non-innovation. The current status of ultrasound examination (recommended or not recommended for routine practice) may be checked in a Federal Reference Guide for Instrumental Diagnostics, which is constantly updated in accordance with current clinical practice and diagnostics guidelines, with special attention paid to the clinical practice guidelines approved by the Scientific and Practical Council of the Ministry of Health of the Russian Federation.

This document is a consensus document of Russian Specialists in Heart Failure, Russian Society of Cardiology, Russian Association of Specialists in Ultrasound Diagnostics in Medicine, and Russian Society for the Prevention of Noncommunicable Diseases. In the document a definition of focus ultrasound is stated and discussed when it can be used in cardiology practice in Russian Federation.