Mirza Halimić

Mitral valve replacement in a patient with infective endocarditis and aneurysm of the cerebral artery: a case report.

OBJECTIVE Endocarditis can have profound and devastating neurological consequences, with the vast majority of these complications in patients with left-sided valvular disease. The approach to the acute management of stroke in children with infective endocarditis is limited by the inadequacy of published data on their clinical course and outcome. CASE REPORT This case report presents a 12 year old girl with diagnosed endocarditis, complicated with intracranial hemorrhage, due to the rupture of an aneurysm of the peripheral branch medial cerebral artery and gradient therapeutic approach, with an excellent final result. CONCLUSION Congestive heart failure resulting from valvular insufficiency required mitral valve replacement, after cerebral aneurysm clipping.

Central Venous Catheter as Vascular Approach for Hemodialysis – Our Experiences -

Introduction: Application of a central venous catheter (CVC), as a temporary or permanent vascular access for hemodialysis, has been continuous practice at the Sarajevo Pediatric Clinic, Department of Pediatric Intensive Care. The main goal of the article is to present our experiences with central venous catheters in the treatment of these patients. Material and methods: In the period from January 2009 to December 2014 a total of 41 patients were treated and a total of 56 catheters were placed. Results: The results show the prevalence of the femoral venous catheter (69,64%), with significantly smaller participation of jugular (28,57%) and symbolic participation of subclavian catheters (1,78%). Frequency of infections of 8,92% in our article is lower than the percentage contained in the data of the National Nosocomial Infections Surveillance System, which provided data related to 17% of catheter related infections. The most common agents of the catheter related infections in our patients are gram-negative bacteria from the Klebsiella pneumoniae group. Conclusion: The issue of the higher complication percentage during the treatment is linked with hemostasis related to bleeding into or around the catheters in 28,57% of patients, and to clotting disorder in terms of thrombosis in 10,71% of patients.

Evaluation of Congenital Heart Defects Treatment OptionsEstablishment of Pediatric Cardiology/Cardiosurgery in Bosnia and Herzegovina -

Introduction: Modern pediatric cardiology mainly deals with congenital heart defects (CHD), as the most common congenital anomalies. In most cases CHD requires surgical or interventional treatment. Goal: The goal of the research was to evaluate CHD treatment at Pediatric Clinic, University Clinical Center (UCC) Sarajevo, Bosnia and Herzegovina (B&H). UCC Sarajevo is the only institution in B&H where cardiac treatment of CHD in pediatric population is performed. Pediatric cardiosurgery has started to develop in Bosnia and Herzegovina in April 1997. Patients and methods: Study included 745 patients (period from April 1997 to January 2017). Results: Cardiac treatment was performed on 745 patients with CHD, 541 (72.6%) of them were acyanotic patients and 204 (27.4%) were cyanotic patients. Reoperation was performed in 49 (6.5%) of patients. Out of total number of patients, 59 (7.9%) died. In 660 children (88.5%) a complete correction and in 85 (11.5%) a palliative operation/correction was performed. Defects with left to right shunt were present in 397 (53.2%) patients, complex heart defects with Tetralogy of Fallot in 173 (23.2%), obstructive heart defects in 106 (14.2%), obstructive heart defects with shunt in 53 (7.1%), and others in 16 (2.1%) of patients. During surgery, extracorporeal circulation was regulated in 554 (74.3%) patients. Peri and early postoperative complications occurred in 180 (24.1%) of patients. During this period 24 pacemakers were implanted and 24 radiofrequency ablations were performed. Conclusion: Results of CHD cardiac treatment in childhood, which took place simultaneously, followed by the contractual joint programs and individual work of the Bosnian and Herzegovinian team has reached the highest level in the last two years, not only by the number, type and complexity of corrected CHD, but also by the age and body weight of the patients who underwent surgery, and development of invasive procedures, arrhytmology, pacemaker placement, intensive peri and postoperative treatment. That led pediatric cardiac surgery of UCC Sarajevo, to a position of leading center in the region.

The Use of Continuous Electrocardiographic Holter Monitoring in Pediatric Cardiology

Objective: To show the place and role of continuous electrocardiographic twenty-four-hour ECG monitoring in daily clinical practice of pediatric cardiologists. Methods: According to protocol, 2753 patients underwent dynamic continuous ECG Holter monitoring (data collected from the “Register of ECG Holter monitoring” of Pediatric Clinic, UCC Sarajevo in period April 2003- April 2015). Results: There were 50,5% boys and 49,5% girls, aged from birth to 19 years (1,63% - neonates and infants, 2,6% - toddlers, 9,95% - preschool children, 35,5% - gradeschoolers and 50,3% children in puberty and adolescence). In 68,1% of patients Holter was performed for the first time. Indications for conducting Holter were: arrhythmias in 42,2% cases, precordial pain in 23,5%, suspicion of pre-excitation and/or pre-excitation in 10%, crisis of consciousness in 8%, uncorrected congenital/acquired heart defects in 4,2%, operated heart defects in 3,7%, hypertension in 3,1% cases, control of the pacemaker in 1,63% and other causes in 3,5% cases. Discharge diagnosis after ECG Holter monitoring were: insignificant arrhythmias in 47,1% cases, wandering pacemaker in 21,3%, pre-excitation in 16,2%, benign ventricular premature beats in 6,3%, atrioventricular block in 3%, sinus pause in 2.2% cases and other arrhythmias in 3,5%. In mentioned period 57 cases of Wolf Parkinson White syndrome were registered, in 4,5% of patients antiarrhythmic therapy was administered. Radiofrequent ablation was performed in 23 cases. Conclusion: The development of pediatric cardiac surgery has initiated development of pediatric arrhythmology as imperative segment of pediatric cardiology. Continuous ECG Holter monitoring has become irreplaceable method in everyday diagnostics and therapy of arrhythmias in children.

997 Ventilator-Associated Pneumonia (VAP) on Pediatric Intensive Care Unit

Introduction Ventilator-associated pneumonia (VAP) is a form of nosocomial infections - pneumonia which occurs in patients who are on mechanical ventilation for longer than 48 hours. It is very often complication on intensive unit care. Aim To evaluate prevalence VAP on Paediatric intensive care unit (PICU) and the most common causes. Subjects and methods: From mart 2009. till mart 2011., 42 patients age two months to eight years. Design of study: prospective Patients were divided according to age, gender, time of manifestations VAP, types of microorganisms isolated in cultures. Results From 42 investigated patients 22/42 (52.3%) were females. Patients were divided in the groups according to their age as follows: 0–6 months 9/42 (21.4%), 7–12 months 17/42 (40.4%), 1–3 years 11/42 (24.4%), 4–8 years 5/42 (11.9%)patients. According to time of manifestations VAP: between 48–96 hours of ventilations 14/42 (33.3%) patients, after 96 hours of ventilations 14/42 (33.3%) patients. According to types of microorganismus isolated in cultures: Klebsiella pneumoniae 12/42 (28.5%), Acinetobacter calcoaceticus 7/42 (16.6%), Staphylococcus aureus 7/42 (16.6%), Pseudomonas aeraginosa 4/42 (9.5%), Enterobacter4/42 (9.5%), Stenotrophomonas maltophilia 2/42 (4.7%), unknown 8/42 (19.2%).De-escalation therapy was administered in 30/42 (71.4%) patients. Dual antibiotic therapy was found in 22/42 (52.3%) patients. Mortality was 13/42 (30.9%) patients, in group therapy with deeskalation 7/13 (53.8%), whereas in the monotherapy group was 8/13 (61.5%) patients. Conclusion VAP is quite common complication on PICU. Previously taken cultures are very helpful in s timely selection antibiotics and successful recovery.

1135 Coronary Artery Anatomy Prior Tetralogy of Fallot Surgery

Intoduction Anomalous coronary artery disease is common among patients with Tetralogy of Fallot (ToF). The need to define the morfohaemodynamics of TOF is the priority in echo laboratory prior TOF surgery. Aim To evaluated coronary artery anatomy pre and intraoperatively by imaging technique-echocardiograhy and to establish frequency of congenital coronary arteries anomalies in patients with tetralogy of Fallot, as a plan of surgical approach in these patients. Methods Consecutive retrospective analysis of echocardiography data patients with tetralogy of Fallot and surgical protocols of total corrections of Tetralogy of Fallot was performed. Results During period from 01.01.2010 till 01.01.2011. at Paediatric clinic CCU Sarajevo Out pts Cardiology department 3577 pts were evaluated, 70/1.9%/pts with CHD and 13/70 with ToF (18%), age 25 monhts (9–60), 7 girls (53.8%). First Group had simple ToF/n-10/and Second Group had Pentalogia Fallot (n-3 pts). Anatomical correction was performed in all pts in Sarajevo by foregin an local team. Preoperativey 2/15.4%/pts with ToF had anmalous origin of anterior interventricular branch of RCA crossing RVOT which was as well confirmed intraoperatively. The surgical approcah was based upon the preoperativelly echo findings, so these 2 pts had RVOT-PA graft construction. All pts from the Second Group had normal anatomy of coronary arteries pre- and intraoperatively. Conclusion Non invasive transtoracic echocardiography (TTE) is very usefull tool in deliniation of coronary artery anatomy as a part of surgical approach plan in patients with TOF which defenitly could decrease the risk of surgery.