Browsing by Author "Ilić, Slobodan (57212487618)"

Introduction/Objective Although cardiac tumors in the pediatric population are found infrequently, their occurrence is constant and with occasional variations. The purpose of this study is to show our experience with surgical options of these masses in two leading national university-level pediatric centers over four decades. Methods This retrospective study is presenting a total number of 24 surgically treated pediatric patients who have been operated on 1998–2020. There were 16 children with primary masses and eight children with metastatic cardiac tumors. Two patients with tumor-like intracardiac masses were not included in the series but had been mentioned as diagnostic challenges. Our patients did not have cardiac transplantation options. Results The average age of our patients was five and a half years, and the most frequent operated tumor was the cardiac myxoma. Four children had neurological symptoms. There were two deaths, one in the primary tumor group and one metastatic patient misdiagnosed as a primary tumor in the early ages of our department. We had two recurrent cases, a girl with Carney complex, and an infant with an extremely rare form of cardiac malignancy after a myxoma extraction. One child required a permanent pacemaker insertion. Conclusion Although rare, the pediatric cardiac tumors can be a source of different life-threatening conditions and lifelong sequelae. Therefore, special considerations should be paid to the diagnostic and surgical modalities of their treatment. © 2023, Serbia Medical Society. All rights reserved.

Introduction Pulmonary artery stenosis (PS) is a congenital heart defect which occurs in 10% of all congenital heart defects. Pulmonary balloon valvuloplasty (BVP) has been the treatment of choice of PS over the last 30 years.; Methods The study included 88 patients diagnosed with PS. The patients were divided into three groups based on the severity of the disease. Also, they were divided into two age groups in order to analyze the frequency of complications. Hemodynamic measurements and echocardiography results were recorded before, 24-36 hours after BVP and at the end of follow-up.; Objective The purpose of this study was to evaluate the efficacy of this method based on middle-term hospital follow-up, and safety of BVP based on our experience.; Results The studied group involved patients of average age 3.75±4.3 years (20 days to 17 years). Immediately after BVP a significant decrease of pressure gradient across the pulmonary valve (PV) was recorded in all patients; this result was similar in all 3 groups of patients regardless of the severity of stenosis (p<0.001). Complications of BVP occurred most commonly in children up to 12 months of age (ventricular tachycardia 4.5% and supraventricular tachycardia 6.8%). Pulmonary valve insufficiency after dilatation occurred in 6.6% of cases, and was most common in children aged up to 12 months. In 87 (98.9%) patients BVP was a definitive solution, and a significant residual stenosis was not recorded during follow-up.; Conclusion BVP is a safe and effective procedure in the treatment of isolated PS in children, regardless of the severity of stenosis but also regardless of patients’age. © 2014, Srpsko Lekarsko Drutsvo. All rights reserved.

Introduction Arterial switch operation (ASO) is a cardiosurgi-cal method of choice for complete anatomical correction of transposition of great arteries. Improvement of this procedure has made considerably improved the outcome and long-term prognosis of children born with this complex congenital heart disease. Objective The aim of this study was to estimate the success rate of ASO through retrospective analysis of mortality and late complications. Methods This study included 57 children operated from 1stJanuary 2005 until 31st December 2009. Parameters that could influence the outcome of surgery were investigated. The following late complications were investigated: neopulmonary artery stenosis, neoaortic stenosis and regurgitation, as well as clinical signs of heart failure. Results Early postoperative mortality was 15.8% (9/57 patients). During follow-up (8 to 72 months, average 36.5 months) there were no lethal outcomes. On the last echocardiography examination, 73.2% patients had neoaortic regurgitation and 67.4% patients had neopulmonary regurgitation, but all of them were mild in intensity. Neopulmonary stenosis had 32.6% of patients, but only two had moderate or severe stenosis. No one had ischemic ECG changes. Three reinterventions were performed due to serious residual problems: surgical correction of neoaortic stenosis, surgical correction of neopulmonary stenosis and transcatether balloon dilatation for aortic reco-arctation. At the end of the follow-up period, only one of 46 consistently followed patients had signs of heart failure which required therapy (2.2%), while the majority of patients were without any symptoms and with good effort tolerance. Conclusion Arterial switch operation has been successfully performed at our institution, with acceptable perioperative mortality and excellent late outcome. © 2014, Serbia Medical Society. All rights reserved.

Introduction Diagnosis of neonatal coarctation of the aorta (CoA) still presents a challenge in routine practice because of absence of reliable morphologic and functional parameters for early detection of this congenital heart defect in newborns. Objective The aim of this study is to identify easy obtainable two-dimensional echocardiographic parameters for detection of the CoA in newborns. Methods Echocardiographic evaluation was performed in 30 newborns with CoA and 20 healthy neonates (control group). Measurements of the proximal transverse arch (PTA), distal transverse arch (DTA), isthmus, distance between the left common carotid artery (LCCA) at the origin of the left subclavian artery (LSA), were obtained by two-dimensional echocardiography. Aortic arch hypoplasia was defined using Mouleart, Karl and Mee criteria, and Z-value. Index 1 was calculated as a ratio of DTA and distance between origins LCCA-LSA, Index 2 was calculated as a ratio of the ascending aorta and the distance between LCCA-LSA origins, and Index 3 was calculated as a ratio of PTA and distance between LCCA-LSA origins. Results Index 1 was significantly lower in patients with CoA in comparison with control group (0.50 vs. 1.39; p≤0.01). A cutoff point at 0.39, for Index 1, showed a sensitivity of 92% and specificity of 99% for the diagnosis of neonatal CoA, while cut off points at 0.69 and 0.44, for Index 2 and Index 3, showed the highest sensitivity and specificity for the diagnosis of CoA in newborns. Conclusion By using these echo indexes, two-dimensional echocardiographic aortic arch measurement becomes a simple, reliable noninvasive method for the evaluation of aortic coarctation in newborns and may lead to earlier diagnosis and subsequent surgical correction. © 2015 Serbia Medical Society. All rightsreserved.

Introduction/Objective Transcatheter closure is a well-established procedure for treatment of patent ductus arteriosus (PDA). We aimed to make a comparison between transcatheter PDA occlusion with Flipper coil and Amplatzer Duct Occluder (ADO) and to determine the incidence and significance of procedural complications. Methods Between November 2004 and October 2014, 148 patients were eligible for transcatheter PDA closure at the University Children’s Hospital in Belgrade, Serbia. The median age was 5.9 years (the range of 0.9 years to 17.3 years) and the median weight was 21 kg (the range of 8.8 kg to 94 kg). Follow-up evaluations with Doppler echocardiogram were performed at one day, three months, and one and two years after the PDA occlusion. Results Median narrowest PDA diameter was 1.5 mm (the range of 0.5 mm to 5.6 mm). Flipper coil was used for PDA closure in 84 (59.2%) and ADO in 58 patients (40.8%). There was no significant difference in the rate of immediate complete closure between the coil and the ADO group (86.9% vs. 75.9%, p = 0.089), but a significantly higher rate of complete closure was achieved with ADO at one day (83.3% vs. 98.3%, p = 0.004), three months (85.7% vs. 100%, p = 0.002), and both one and two years after the implantation (91.7% vs. 100%, p = 0.041). In total, 12 complications occurred during the procedure, seven of which with coil and five with ADO occlusion of PDA. Conclusion Transcatheter closure of PDA using both coils and ADOs is a very safe and effective procedure. ADO proved superior to coil in terms of complete closure rate as early as one day after the procedure. © 2017, Serbia Medical Society. All rights reserved.

Introduction Combination of acute aortic dissection associated with aortic coarctation in pediatric population is extremely rare. We are presenting a 12-year-old patient with these two conditions who was successfully treated with two-stage surgery. Case Outline A boy with no trauma history was admitted for chest pain. The diagnosis of acute aortic dissection associated with aortic coarctation was established with echocardiography and computed tomography angiography. Emergent surgery was performed-excision of the ascending aorta aneurysm with supracoronary graft replacement and preservation of native aortic valve. Subsequently, through posterolateral left thoracotomy, the patient underwent end-to-end aortoplasty for coarctation repair. Conclusion Two-stage surgery provides favorable outcome in this rare, life threatening condition in the pediatric age group. Native aortic valve was preserved and extra-anatomic bypass of aortic coarctation was avoided. Further monitoring of aortic valve is mandatory. © 2017, Serbia Medical Society. All rights reserved.