Faculty of Medicine

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Finding of a mass on the mitral valve in a patient on chronic dialysis
(Elsevier BV, 2025-04)
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Shokarovski, Marjan
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Lazovski, Nikola
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Mehmedovic, Nadica
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Myxomas are cardiac neoplasms that are most commonly located in the left atrium, usually arising from the vicinity of the fossa ovalis. However, there have been cases, although very rarely, of valvular myxoma. A cardiac mass found incidentally on echocardiography can present a challenge in particular if asymptomatic or found in an unusual location. We present the case of a 58-year-old male with kidney disease treated with chronic dialysis, referred to the cardiology clinic because of an incidental finding of a mitral valvular mass on routine transthoracic echocardiography. Although this lesion was initially misdiagnosed as native valvular endocarditis with vegetation, a series of clinical and radiological investigations led to the preoperative diagnosis of possible papillary fibroelastoma or calcified thrombotic mass. Given the increased risk of embolization due to the mass being mobile and greater than 1 cm in size, the patient was referred to cardiac surgery. Excision of the mass without mitral valve replacement was performed. Histopathological findings of the mass revealed the existence of a cardiac myxoma. In such cases of a mitral valve mass, multimodality imaging should have of high priority to achieve an accurate diagnosis. Although a definitive diagnosis can only be established after surgical excision of the mass and histopathological confirmation, it is very important to consider a differential diagnosis of mitral valve myxoma in any patient with an unexplained mitral valve mass.
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IMPACT OF CEREBRAL PERFUSION STRATEGIES ON NEUROLOGICAL OUTCOMES IN AORTIC ARCH REPAIR USING THE FROZEN ELEPHANT TRUNK TECHNIQUE
(Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 2025-07-18)
Shokarovski, Marjan
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Mehmedovic, Nadica
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Grazhdani, Sonja
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Grueva, Elena
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This study aimed to evaluate the impact of various cerebral perfusion strategies on neurological outcomes, comparing our results on trilateral antegrade cerebral perfusion (tACP) to reported rates from latest literature analysis on bilateral antegrade cerebral perfusion (bACP) and unilateral antegrade cerebral perfusion (uACP). Methods: A retrospective analysis was performed on 15 patients who underwent surgical intervention at the University Clinic for Cardiac Surgery in Skopje between 2018 and 2023. All patients included had elective chronic aortic dissections. Preoperative evaluation encompassed a detailed medical history, physical examination, diagnostic imaging, and risk stratification using the EuroSCORE II model. Standardized surgical techniques, including trilateral cerebral perfusion, were employed intraoperatively. The primary endpoint was the incidence of major neurological complications, including stroke and SCI, while the secondary endpoint was all-cause mortality. Results: Major neurological events, including stroke and transient ischemic attack (TIA), were observed in 6.7% of patients, with SCI occurring in a single case (6.7%). These rates are notably lower than previously reported figures of 5-15% for procedural strokes following complex aortic arch repairs employing uACP or bACP. All-cause mortality in our cohort was 20%, compared to the 31% reported in the literature for patients undergoing open aortic arch repair. Conclusion: In patients undergoing total aortic arch repair with the FET technique, tACP appears to be a viable strategy for cerebral and spinal cord protection. The complication rates observed in our cohort are favorable and support further investigation with larger patient populations to validate these findings.
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Multistage Hybrid Treatment of Aortic Aneurysm and Management of Postoperative Complications: A Case Report
(Macedonian Academy of Sciences and Arts/Walter de Gruyter GmbH, 2025-06-01)
Shokarovski, Marjan
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Mehmedovic, Nadica
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Grazhdani, Sonja
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Grueva, Elena
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The Frozen Elephant Trunk (FET) is a surgical procedure developed for simultaneous repair of the aortic arch and the proximal descending thoracic aorta. Experience has shown its technical feasibility and good clinical results, although complications remain possible. Case Presentation: A 66-year-old male presented for evaluation due to findings from computed tomography angiography of aneurysms in the ascending aorta, aortic arch, and abdominal aorta. The patient had a history of a quadruple coronary artery bypass graft (CABG) and placement of two stents in the descending thoracic aorta, which were improperly aligned, thrombosed, and further complicated the case. The patient underwent surgery involving sternotomy to perform the FET procedure, replacing the ascending aorta and aortic arch and placing a stent graft in the proximal descending thoracic aorta. Simultaneously, two coronary artery bypass grafts were performed. Postoperatively, the patient was stable, and the intervention outcome was satisfactory. Subsequently, endovascular treatment was carried out on the remaining thoracic aorta and abdominal blood vessels. However, respiratory failure necessitated the placement of stent grafts in the left main bronchus on two occasions. Despite extensive efforts, the patient succumbed to respiratory insufficiency. Conclusion: Timely intervention and a multidisciplinary approach played a key role in addressing complications, although the patient ultimately experienced a fatal outcome due to multiorgan failure.
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NEONATAL SIDE EFFECTS DURING PATIENT CONTROLLED INTRAVENOUS REMIFENTANIL FOR LABOR ANALGESIA
(Department of Anaesthesia and Reanimation, Faculty of Medicine “Ss. Cyril and Methodius” University in Skopje, 2020-04)
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Ivanov, Emilija
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Introduction: Remifentanil is becoming more and more popular as alternative method for labor analgesia. There are limited studies about the neonatal safety of remifentanil for labor analgesia. Materials and Methods: Our study included 80 pregnant women, at term, receiving intravenous PCA with remifentanil for labor analgesia. Our primary goal was to examine neonatal safety when using remifentanil. During analgesia fetus was monitored through continuous cardiotocography recording. After delivery we recorded neonatal Apgar scores in 1st, 5th and 10th minute, acid-base status, use of naloxone and any neonatal resuscitation. Parturients all the time during labor analgesia have one-to-one care and complete haemodynamic monitoring (SaO2, respiratory rate, non-invasive blood pressure, and heart rate). Results: Fetal heart rate (FHR) abnormalities were recorded in 12 patients, 4 of them had pathological continuous cardiotocograph (CTG) records. The most common Apgar score in the 1st minute was 8, in the 5th it was 9 and in the 10th minute it was 10. Intermediate values of all parameters from the umbilical acid-base status of newborns were within normal limits. Conclusion: Neonatal side effects during patient-controlled intravenous analgesia with remifentanil are minimal. One-to-one care, appropriate continuous monitoring of the parturient and neonate with available resuscitation kit are mandatory

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