Browsing by Author "Karan, Radmila (47161180600)"

Introduction. Aortic coarcation is a congenital condition mostly detected and treated during childhood. Adult patients with coarctation and associated cardiac lesions represent a challenge and a subject of debates concerning adequate treatment. We report 2 patients with aortic coartation when a surgical treatment was necessary. Case report. First patient was a 61-year-old male with previous mechanical aortic valve implantation. He underwent one stage surgical reconstruction of aortic coarctation and surgical repair of aneurysm of ascending aorta. The second patient was a 49-year-old female with aortic aneurysm, bicuspid aortic valve, severe aortic insufficiency and coarctation of aorta below branching of subclavian artery. She underwent the Bentall procedure and surgical repair of coarctation by bypass where the proximal anastomosis was made between the terminal part of Dacron graft and the lateral part of graft used for Bentall, while the distal anastomosis was made between the terminal part of Dacron graft and the lateral part of descending aorta below coarctation. The postoperative course and the follow-up of the patients of 3 and 1 year, respectively, were without complications. Conclusion. Single operation is a better choice in the patients with concomitant pathology such as the aortic aneurysm, or aortic valve disease. Each patient should be analyzed on a single basis, and a decision about a surgical technique and surgical course brought accordingly. © 2019 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Persistent left superior vena cava (PLSVC) is a common congenital venous anomaly, usually associated with other congenital heart diseases (12%). Its incidence in the general population is 0.5%. In cardiac surgery patients, it is suspected when using the left subclavian vein or left internal jugular vein for central venous catheter or hemodialysis catheter placement. Transthoracic ultrasound exam is useful in confirming the position of catheters in the venous system by injecting a 5% glucose solution that can be visualized in the right atrium after administration through the catheter. Hemodialysis catheters can be inserted in the PLSVC with good catheter function and no major risk in increase of complications. © 2025, Sociedade Brasileira de Cirurgia Cardiovascular. All rights reserved.

Background: The aim of our study was to evaluate the degree of genetic homozygosity in the group of patients with coronary artery disease (CAD), as well as to evaluate morphogenetic variability in CAD patients regarding the presence of investigated risk factors (RF) compared to a control sample of individuals. Additionally, we aimed to evaluate the distribution of ABO blood type frequencies between tested samples of individuals. Methods: This study analyzed individual phenotype and morphogenetic variability of 17 homozygously-recessive characteristics (HRC), by using HRC test in a sample of 148 individuals in CAD patients group and 156 individuals in the control group. The following RF were analyzed: hypertension, diabetes mellitus, hyperlipidemia, and smoking. Results: The mean value of HRC in CAD patients is significantly higher, while variability decreases compared to the control sample (CAD patients: 4.24 ± 1.59, control sample: 3.75 ± 1.69; VCAD-patients = 37.50%, VC = 45.07%). There is a significant difference in individual variations of 17 HRC between control sample and CAD patients (χ2 = 169.144; p < 0.01), which points out to different variability for tested genes. Mean values of HRC significantly differed in CAD patients in regard to the number of RF present. A blood type (OR = 1.75) is significant predictor for CAD, while O blood type (OR = 0.43) was significantly associated with controls. Conclusion: There is a higher degree of recessive homozygosity in CAD patients versus individuals in the control sample, and the presence of significant variations in the degree of recessive homozygosity as the number of tested RF increases. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.

The aim of this study was to examine the incidence and significance of right heart failure (RHF) in the early and late phase of left ventricular assist device (LVAD) implantation with the identification of predictive factors for the development of RHF. This was a prospective observational analytical cohort study. The study included 92 patients who underwent LVAD implantation and for whom all necessary clinical data from the follow-up period were available, as well as unambiguous conclusions by the heart team regarding pathologies, adverse events, and complications. Of the total number of patients, 43.5% died. The median overall survival of patients after LVAD implantation was 22 months. In the entire study population, survival rates were 88.04% at one month, 80.43% at six months, 70.65% at one year, and 61.96% at two years. Preoperative RHF was present in 24 patients, 12 of whom died and 12 survived LVAD implantation. Only two survivors developed early RHF (ERHF) and two late RHF (LRHF). The most significant predictors of ERHF development are brain natriuretic peptide (BNP), pre-surgery RHF, FAC < 20%, prior renal insufficiency, and total duration of ICU stay (HR: 1.002, 0.901, 0.858, 23.554, and 1.005, respectively). RHF following LVAD implantation is an unwanted complication with a negative impact on treatment outcome. The increased risk of fatal outcome in patients with ERHF and LRHF after LVAD implantation results in a need to identify patients at risk of RHF, in order to administer the available preventive and therapeutic methods. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

The aim of this study was to examine the incidence and significance of right heart failure (RHF) in the early and late phase of left ventricular assist device (LVAD) implantation with the identification of predictive factors for the development of RHF. This was a prospective observational analytical cohort study. The study included 92 patients who underwent LVAD implantation and for whom all necessary clinical data from the follow-up period were available, as well as unambiguous conclusions by the heart team regarding pathologies, adverse events, and complications. Of the total number of patients, 43.5% died. The median overall survival of patients after LVAD implantation was 22 months. In the entire study population, survival rates were 88.04% at one month, 80.43% at six months, 70.65% at one year, and 61.96% at two years. Preoperative RHF was present in 24 patients, 12 of whom died and 12 survived LVAD implantation. Only two survivors developed early RHF (ERHF) and two late RHF (LRHF). The most significant predictors of ERHF development are brain natriuretic peptide (BNP), pre-surgery RHF, FAC < 20%, prior renal insufficiency, and total duration of ICU stay (HR: 1.002, 0.901, 0.858, 23.554, and 1.005, respectively). RHF following LVAD implantation is an unwanted complication with a negative impact on treatment outcome. The increased risk of fatal outcome in patients with ERHF and LRHF after LVAD implantation results in a need to identify patients at risk of RHF, in order to administer the available preventive and therapeutic methods. © 2022 by the authors. Licensee MDPI, Basel, Switzerland.

Introduction. Endocarditis is the most common cardiovascular manifestation of brucellosis with high mortality rate. Brucella is less accesable to antibiotic (but not for all) and relapse can occur after a various period of clinical latency. Case report. A 55-year-old farmer was diagnozed with acute systemic Brucella infection in May 2008 and treated with antibiotic therapy in regional hospital for two months and for three months after discharge. He began to feel myalgia, arthralgia, malaise, shortness of breath, abdominal pain, vomiting, diarrhoea and lost weight eight months after initial symptoms occured. Because symptoms progressed he was admitted to our hospital in February 2009. Based on a combination of epidemiological, clinical data (on admission he was catchetic, adynamic, dyspneic, hypotensive 80/50 mmHg, fever up to 39.5°C), positive serological Wright test for brucellosis (1: 5,120), and echocardiographic examination findings, the diagnosis of very severe relapse of brucellosis with mitral valve endocarditis, complicated with perforation of anterior mitral leaflet, severe mitral regurgitation and pulmonary hypertension was established. He was treated with a combined triple antibiotic therapy (vancomycin, ciprofloxacin and gentamicin, and swiched to regimen with doxycycline, gentamicin and imipenem, replacing gentamicin by rifampicin) for 4 weeks and for the next 2 weeks was receiving trimetoprime/sulfamethoxazole and rifampicin. The patients' condition was improved and he was operated. The diagnosis of infective endocarditis was confirmed intraoperatively. Mitral valve replacement was performed, and combined triple antibiotic treatment (amikacin + ciprofloxacin + cefazolin, for 2 weeks and cephazolin + doxycycline + rifampicin, for 2 weeks) was continued, following with two antibiotics (doxycycline + rifampicin) for 5 months. The patient completely recovered without any signs of infection 30 months postoperatively. Conclusion. A combined antibiotic therapy and surgery reduce complications and mortality associated with Brucella endocarditis and improve quality of patients' life.

Background: The aim of our study was to evaluate the degree of genetic homozygosity in cardiac surgical patients with postoperative acute kidney injury (AKI), compared to the subgroup without postoperative AKI, as well as to evaluate antropomorpho-genetic variability in cardiac surgical patients with regard to the presence and severity degree of AKI. Materials and methods: The prospective cohort study included an analysis of 138 eligible coronary artery disease (CAD) surgical patients that were screened consecutively. The tested group was divided into three subgroups according to RIFLE criteria: Subgroup NoAKI (N = 91), risk (N = 31), and injury (N = 16). All individuals were evaluated for the presence of 19 observable recessive human traits (ORHT) as a marker of chromosomal homozygosity and variability. Results: Comparing subgroups NoAKI and risk, four ORHTs were significantly more frequent in the risk subgroup. Comparing subgroups NoAKI and injury, nine ORHTs were significantly more frequent in the injury subgroup; while comparing the injury subgroup and risk, five ORHTs were significantly more frequent in injury than in the risk subgroup. Results also showed a significant increase in the mean value of ORHTs for the injury subgroup compared to NoAKI subgroup (p = 0.039). Variability decreased proportionally to the increase in the severity of AKI (VNoAKI = 32.81%, VRisk = 30.92%, and VInjury = 28.62%). Conclusion: Our findings pointed to the higher degree of recessive homozygosity and decreased variability in AKI patients vs. NoAKI individuals, thus presumably facilitating the development and severity degree expression of AKI in patients after cardiac surgery. Copyright © 2022 Karan, Kovačević-Kostić, Kirćanski, Čumić, Terzić, Milićević, Velinović, Velinović and Obrenović-Kirćanski.

Background: Transcatheter aortic valve replacement (TAVR) was developed for inoperable patients with severe aortic stenosis. However, despite TAVR advancements, some patients remain untreated due to complex comorbidities, necessitating less-invasive approaches. Non-invasive ultrasound therapy (NIUT), a new treatment modality, has the potential to address this treatment gap, delivering short ultrasound pulses that create cavitation bubble clouds, aimed at softening embedded calcification in stiffened valve tissue. Methods: In the prospective Valvosoft® Serbian first-in-human study, we assessed the safety and efficacy of NIUT and its impact on aortic valve hemodynamics, on the left ventricle, and on systemic inflammation in patients with severe symptomatic aortic stenosis not eligible for TAVR or surgery. Results: Ten patients were included. Significant improvements were observed in hemodynamic parameters from baseline to one month, including a 39% increase in the aortic valve area (from 0.5 cm2 to 0.7 cm2, p = 0.001) and a 23% decrease in the mean transvalvular gradient (from 54 mmHg to 38 mmHg, p = 0.01). Additionally, left ventricular global longitudinal strain significantly rose, while global wasted work significantly declined at one month. A dose–response relationship was observed between treatment parameters (peak acoustic power, intensity spatial-peak pulse-average, and mean acoustic energy) and hemodynamic outcomes. NIUT was safely applied, with no clinically relevant changes in high-sensitivity troponin T or C-reactive protein and with a numerical, but not statistically significant, reduction in brain natriuretic peptide (from 471 pg/mL at baseline to 251 pg/mL at one month). Conclusions: This first-in-human study demonstrates that NIUT is safe and confers statistically significant hemodynamic benefits both on the valve and ventricle. © 2024 by the authors.

Introduction. Heart injuries can be classified as penetrating and non-penetrating (blunt). Penetrating wounds are usually caused by stabbing with a piercing object, weapon or projectiles - missiles. The right atrium is damaged in most cases, because of its anatomical position - making the most of the anterior side of the heart. Morbidity caused by stabbing injuries to the heart is 20%-30%, while piercing wounds cause 30%-60% of deaths. Case report. A 28- year-old patient was admitted to our clinic with acute ischemia of the extremities. Angiography revealed a bullet in the right common femoral artery, occluding it. The patient denied having any piercing or shooting wound to his leg, but he said that four years before he had been shot to his chest. Echocardiography revealed an atrial septal defect of secondary type. An event reconstruction revealed that, four years after shooting, the bullet was displaced from the heart to the right common femoral artery. Conclusion. This case report is unique because of the rare type of injury, time that passed from the injury, the way bullet entered the artery (via atrial septal defect) and especially the success of both surgical procedures (embolectomy and repair of atrial septal defect).

Introduction: Obesity is a complex condition with multifactorial origin. Assuming that such a state is genetically controlled, the aim of our study was to evaluate the degree of genetic homozygosity among overweight and obese individuals by the homozygously recessive characteristics (HRC) test. Material and methods: We analysed the presence, distribution and individual combination of 15 selected genetically controlled recessive phenotype traits in a sample of 140 individuals with increased body mass index (overweight individuals n = 100 and obese individuals n = 40) and a control group of normal weight individuals (n = 300). Results: Obese individuals have significantly higher mean values for genetic homozygosity than those with normal weight (normal weight:3.61 ±1.48; obese:4.13 ±1.47, p <0.05) and difference in the presence of certain individual combinations of evaluated phenotype traits (Σχ2 = 76.9; p <0.01). There was no difference in average homozygosity of such genetic markers between groups of normal weight and overweight individuals (normal weight:3.61 ±1.48; overweight:3.93 ±1.51, p >0.05) and between groups of overweight and obese individuals (overweight:3.93 ±1.51; obese:4.13 ±1.47, p >0.05). There is no difference in the presence of certain individual combinations of evaluated phenotype traits between overweight and obese individuals (Σχ 2 = 20.6; p >0.05). Conclusions: There is a populational genetic difference in the degree of genetic homozygosity and variability between the group of normal weight and group of obese individuals, indicating a possible genetic component. Overweight and obese individuals have a genetic predisposition, but different expression of genetic loads could be one of the possible explanations for different susceptibility to increase of fat mass and body mass index. Copyright © 2012 Termedia & Banach.

In the current article, 3 cases of aortic aneurysm and dissection in pregnant patients with Marfan's syndrome are reported. It is well known that pregnancy is a risk factor for the development of aortic aneurysm and dissection in women with Marfan's syndrome since it is shown that dissection can develop both before and after labor. Marfan patients with an aortic root diameter greater than 4 cm should undergo preconceptual counseling for surgical aortic repair before pregnancy. Pregnant Marfan patients with an aortic aneurysm should be closely and continuously evaluated by multidisciplinary specialists in order to prevent possible aortic dissection that could be fatal for both the mother and the fetus.

INTRODUCTION: While the survival rates for patients with end-stage heart failure have dramatically improved with newer generations of left ventricular assist devices, LVAD-specific infections are important cause of morbidity, mortality, and hospital readmissions in these patients. METHODS: We performed a retrospective analysis of all driveline infections in patients who had undergone LVAD implantation at a single cardiosurgical center. Between June 2013 and March 2017, 51 patients underwent implantation of LVAD. Among these, 12 received Heart Ware LVAD,34 Heart Mate II LVAD, and 5 Heart Mate III LVAD. The end goal for LVAD therapy was destination therapy in three patients and bridge-to-transplantation in 48 patients. RESULTS: One month, six months, and one-year survival rates were 90%, 85%, and 81%, respectively. Five patients developed driveline infections. Median time from LVAD implantation to driveline infections was 126 days. One of these patients underwent heart transplantation. Two patients were treated with antibiotics and surgical driveline repositioning with extensive debridement of the wound. Two patients with a chronic infection were treated conservatively with regular wound cleaning. CONCLUSION: Driveline infections remain a serious therapeutic challenge. With the development of surgical techniques and new devices, it is possible to reduce morbidity and increase survival rate in patients with implanted LVAD. © 2020, Edizioni Luigi Pozzi. All rights reserved.

Aims: To determine the frequency of asymptomatic carotid artery stenosis in patients with coronary artery disease and to what degree the extent of coronary artery disease and presence of certain risk factors can be indicators of carotid artery stenosis in asymptomatic patients. Material and methods: Retrospective evaluation of consecutive patients that underwent coronary artery bypass grafting (CABG) during one year without symptoms or signs of carotid artery stenosis. The pre-operative Doppler ultrasonography in color and B-mode, using Siemens Accuson Antares machine, was used to determine the presence and the degree of carotid artery stenosis. Patients were divided according to the presence of significant (≥50%) carotid artery stenosis. The same doctor performed all examinations. Following variables were analysed: Age, gender, body mass index, hypertension, diabetes, smoking, cholesterol, triglycerides and echocardiographic variables obtained from transthoracic echocardiography - the presence of aortic wall sclerosis, aortic valve sclerosis and mitral valve calcification. Results: We have demonstrated that in 18/272 (7.1%) of patients referred to CABG with hemodynamically significant carotid artery stenosis had asymptomatic stenosis. The risk of presence of carotid artery stenosis was more significant in those older than 60 years (OR 2.58; 95% CI 0.98-6.77, p=0.047) and in patients with left main coronary artery stenosis (OR 8.92; 95% CI 3.2-24.83, p < 0.001). Other investigated variables had no significant influence (p > 0.05). Conclusion: The presence of asymptomatic carotid artery stenosis is strongly associated with the presence of left main coronary artery stenosis and with age older than 60 years. Noninvasive screening for carotid disease is reasonable in these subgroups of patients referred to CABG.

Background Cardiac surgery-associated acute kidney injury (CSA-AKI) frequently occurs in patients assessed as low-risk for developing CSA-AKI. Neutrophil Gelatinase-Associated Lipocalin (NGAL), Kidney Injury Molecule-1 (KIM-1) and lactate are promising biomarkers of CSA-AKI but have not yet been explored in low-risk patients. Aim To evaluate urinary NGAL (uNGAL), KIM-1 and lactate as biomarkers of CSA-AKI in patients with low-risk for developing CSA-AKI. Methods This prospective, observational study included 100 adult elective cardiac surgery patients assessed as low-risk for developing CSA-AKI. UNGAL, KIM-1 and lactate were measured preoperatively, at the end of cardiopulmonary bypass (CPB) and 3, 12, 24 and 48 h later. Results Fifteen patients developed CSA-AKI. Patients with CSA-AKI had significantly higher lactate but similar uNGAL and KIM-1 levels compared to patients without CSA-AKI. Unlike uNGAL and KIM-1, postoperative lactate was good biomarker of CSA-AKI with the highest odds ratio (OR) 2.7 [1.4-4.9] 24 h after CPB. Peak lactate concentration ≥ 4 mmol/L carried dramatically higher risk for developing CSA-AKI (OR 6.3 [1.9-20.5]). Conclusions Unlike uNGAL and KIM-1, postoperative lactate was significant independent predictor of CSA-AKI with the highest odds ratio 24 h after CPB. © 2019 Mina Radovic, Suzana Bojic, Jelena Kotur-Stevuljevic, Visnja Lezaic, Biljana Milicic, Milos Velinovic, Radmila Karan, Sanja Simic-Ogrizovic, published by sciendo.

Background Cardiac surgery-associated acute kidney injury (CSA-AKI) frequently occurs in patients assessed as low-risk for developing CSA-AKI. Neutrophil Gelatinase-Associated Lipocalin (NGAL), Kidney Injury Molecule-1 (KIM-1) and lactate are promising biomarkers of CSA-AKI but have not yet been explored in low-risk patients. Aim To evaluate urinary NGAL (uNGAL), KIM-1 and lactate as biomarkers of CSA-AKI in patients with low-risk for developing CSA-AKI. Methods This prospective, observational study included 100 adult elective cardiac surgery patients assessed as low-risk for developing CSA-AKI. UNGAL, KIM-1 and lactate were measured preoperatively, at the end of cardiopulmonary bypass (CPB) and 3, 12, 24 and 48 h later. Results Fifteen patients developed CSA-AKI. Patients with CSA-AKI had significantly higher lactate but similar uNGAL and KIM-1 levels compared to patients without CSA-AKI. Unlike uNGAL and KIM-1, postoperative lactate was good biomarker of CSA-AKI with the highest odds ratio (OR) 2.7 [1.4-4.9] 24 h after CPB. Peak lactate concentration ≥ 4 mmol/L carried dramatically higher risk for developing CSA-AKI (OR 6.3 [1.9-20.5]). Conclusions Unlike uNGAL and KIM-1, postoperative lactate was significant independent predictor of CSA-AKI with the highest odds ratio 24 h after CPB. © 2019 Mina Radovic, Suzana Bojic, Jelena Kotur-Stevuljevic, Visnja Lezaic, Biljana Milicic, Milos Velinovic, Radmila Karan, Sanja Simic-Ogrizovic, published by sciendo.

We presented surgical treatment of three patients indicated for implantation of a permanent mechanical circulatory support device and with the associated left ventricular aneurysms. In order to evade the left ventricular rupture, adverse thromboembolic events and provide safe implantation of the inflow c annula, L VAD H M3 i mplantation together with the reconstruction of the left ventricular aneurysmal wall was performed in two patients. Regarding the third patient, LVAD implantation upon the reconstruction of the left ventricular wall was abandoned because there was no safe location for placement of the inflow cannula. © 2020 Forum Multimedia Publishing, LLC.

We analyzed morphogenetic variability and degree of genetic homozygosity in male and female individuals with coronary artery disease (CAD) versus unaffected controls. We have tested 235 CAD patients; 109 were diagnosed also with diabetes mellitus (DM) and 126 with hypertension (HTN). We additionally evaluated 152 healthy individuals without manifested CAD. For the evaluation of the degree of recessive homozygosity, we have performed the homozygously recessive characteristics (HRC) test and tested 19 HRCs. In controls, the frequency of HRC for males was 2.88 ± 1.89, while for females, it was 3.65 ± 1.60. In the CAD group, the frequency of HRC for males was 4.21 ± 1.47, while for females, it was 4.73 ± 1.60. There is significant difference in HRC frequencies between controls and CAD separately for males (p < 0.001) and females (p < 0.001). The same applies between controls and CAD with DM (males: p < 0.001 and females: p = 0.004), and controls and CAD with HTN (males: p < 0.001 and females: p < 0.001). There is no significant difference in HRC frequencies between the group of CAD with DM and the group of CAD with HTN (males: p = 0.952 and females: p = 0.529). Our findings point to the increased degree of recessive homozygosity and decreased variability in both genders of CAD patients versus controls, indicating the potential genetic predisposition for CAD. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.

Background: Calcific aortic stenosis is commonly treated using surgical or transcatheter aortic valve replacement; however, many patients are not considered suitable candidates for these interventions due to severe comorbidities and limited life expectancy. As such, non-invasive therapies might offer alternative therapeutic possibilities in these patients. This study aimed to assess the safety of non-invasive ultrasound therapy and its ability to improve valvular function by softening calcified valve tissue. Methods: This prospective, multicentre, single-arm series enrolled 40 adult patients with severe symptomatic aortic valve stenosis at three hospitals in France, the Netherlands, and Serbia between March 13, 2019, and May 8, 2022. Patients were treated with transthoracically delivered non-invasive ultrasound therapy. Follow-ups were scheduled at 1, 3, 6, 12, and 24 months. The primary endpoints were procedure-related deaths within 30 days and improved valve function. We report the 6-month data. This study is registered at ClinicalTrials.gov, NCT03779620 and NCT04665596. Findings: 40 high-risk patients with a mean Society of Thoracic Surgeons score of 5·6% (SD 4·4) and multiple severe comorbidities were included. The primary endpoint, procedure-related mortality, did not occur; furthermore, no life-threatening or cerebrovascular events were reported. Improved valve function was confirmed up to 6 months, reflected by a 10% increase in mean aortic valve area from 0·58 cm2 (SD 0·19) at baseline to 0·64 cm2 (0·21) at follow-up (p=0·0088), and a 7% decrease in mean pressure gradient from 41·9 mm Hg (20·1) to 38·8 mm Hg (17·8; p=0·024). At 6 months, the New York Heart Association score had improved or stabilised in 24 (96%) of 25 patients, and the mean Kansas City Cardiomyopathy Questionnaire score had improved by 33%, from 48·5 (SD 22·6) to 64·5 (21·0). One serious procedure-related adverse event occurred in a patient who presented with a transient decrease in peripheral oxygen saturation. Non-serious adverse events included pain, discomfort during treatment, and transient arrhythmias. Interpretation: This novel, non-invasive ultrasound therapy for calcified aortic stenosis proved to be safe and feasible. Funding: Cardiawave. © 2023 Elsevier Ltd