Browsing by Author "Milovanović, Vladimir (36935585800)"

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.

Background: Acute kidney injury (AKI) is a common postoperative complication following cardiopulmonary bypass (CPB) surgery. New biomarkers to identify patients with early AKI (before increases in serum creatinine) are needed to facilitate appropriate treatment. This study aimed to test the role of urinary liver fatty-acid-binding protein (L-FABP) as an early biomarker for AKI in children undergoing CPB surgery. Methods: This is a case-control study of children undergoing CPB. AKI was defined as 50 % increase in serum creatinine at 48 h after surgery. For each patient, five serum and urine samples were obtained corresponding to time 0 h (presurgery) and 2, 6, 24, and 48 h after surgery. Results: Twenty-seven patients, median age 360 days, were enrolled. AKI developed in 11 patients (41 %); three needed renal replacement therapy (peritoneal dialysis); there were two deaths. There were significant differences between patients with and without AKI in L-FABP levels at 2, 6, and 48 h after surgery, length of hospital stay, and CPB time; there were no differences in gender, patient age, and body weight. L-FABP was normalized to urinary creatinine concentration at all time points, with area under the receiver operator curve (AUC ROC) 0.867 at 2 and 6 h postoperatively. Correlation coefficient between L-FABP and length of hospital stay after surgery was statistically significant (r = 0.722, p value = 0.000). Conclusions: Our results suggest that urinary L-FABP can be used to diagnose AKI earlier than rise in serum creatinine in children undergoing CPB. © 2013 IPNA.

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 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.