Faculty of Medicine

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Myocardial Function after Coronary Artery Bypass Grafting in Patients with Preoperative Preserved Left Ventricular Ejection Fraction-The Role of the Left Ventricular Longitudinal Strain
(MDPI AG, 2023-05-12)
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Risteski, Petar
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Popov, Aron Frederik
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Shokarovski, Marjan
Background and Objectives: The role of coronary artery bypass grafting (CABG) on postoperative left ventricular (LV) function in patients with preoperatively preserved left ventricular ejection fraction (LVEF) is still being discussed and only a few studies address this question. This study aimed to assess LV function after CABG in patients with preoperatively preserved LVEF using left ventricular longitudinal strain assessed by 2D speckle tracking imaging (STI). Materials and Methods: Fifty-nine consecutive adult patients with coronary artery disease (CAD) referred for a first-time elective CABG surgery were enrolled in the final analysis of this prospective single-center clinical study. Transthoracic echocardiography (TTE), with conventional measures and STI measures, was performed within 1 week before CABG as well as 4 months after surgery. Patients were divided into groups based on their preoperative global longitudinal strain (GLS) value. Differences in systolic and diastolic parameters between groups were analyzed. Results: Preoperative GLS was reduced (GLS < -17%) in 39% of the patients. Parameters of systolic LV function were significantly reduced in this group of patients compared to the patient group with GLS% ≥ -17%. In both groups, 4 months after CABG there was a decline in LVEF but statistically significant only in the group with GLS% ≥ -17% (p = 0.035). In patients with reduced GLS, there was a statistically significant postoperative improvement (p = 0.004). In patients with preoperative normal GLS, there was not a significant change in any strain parameters after CABG. There was an improvement in diastolic function parameters measured by Tissue Doppler Imaging (TDI) in both groups. Conclusions: There is improvement in LV systolic and diastolic function after CABG in patients with preserved preoperative LVEF measured by STI and TDI. GLS might be more sensitive and effective than LVEF for monitoring improvements in myocardial function after CABG surgery in patients with preserved LVEF.
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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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