Faculty of Medicine

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Author: search.filters.author.Radica Muratovska-Delimitova

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    TROPONIN – OUR EXPERIENCE IN DETERMINATION OF MYOCARDIAL ISCHEMIC DAMAGE IN POSTOPERATIVE PERIOD OF CARDIAC SURGERY IN PEDIATRIC POPULATION
    (2017)
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    Lj. Kojik
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    Radica Muratovska-Delimitova
    Background: Troponin is an important biomarker for early evidence of ischemic damage to the heart tissue after a cardiac surgery conducted in the pediatric and adult populations. Elevated values correlate with perioperative and postoperative procedures and practices and are a significant factor for possible later complications. Methods: The study included 30 operated children divided into two groups, the first group of operated children without a cardiopulmonary bypass (CPB), and the second group of operated children with a cardiopulmonary bypass. The correlation between elevated troponin and perioperative and postoperative parameters was monitored (duration of CPB and aortic crossclamping time, stay in the intensive care and therapy during respiratory support, during inotropic support, the presence of renal or hepatic failure, postoperative complications). Results: In both groups of operated children troponin was elevated. In the first group of children operated without cardiopulmonary bypass, the average value of troponin was 9.5 ng/ml (range 6.5- 16.8 ng/l). In the second group of operated children (27 children) with cardiopulmonary bypass, the mean value of duration was 81.5 minutes (range 18 to 296 minutes), and X-cross time (aortic crossclamping time) in the same group of children was with a mean value of 28.2 minutes (range of 0-86 min.). In the first group of children the mean value of troponin was 9.5 ng/ml and in the second group 23.0 ng/ml. The obtained values of troponin have confirmed a highly significant correlation with perioperative and postoperative procedures. Conclusions: Troponin is a prognostic marker for early evidence of ischemic and necrotic changes of cardiac infarction in the pediatric population in cardiac surgery. Elevated values in the first 24-48 hours are significantly correlated with perioperative and postoperative procedures and are an important indicator of the extent of damage to the heart tissue. But its prognostic significance of myocardial ischemic changes is lost in a period between 2-6 months after cardiac surgery.
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    Troponin - factor for determination of myocardial ishemic damage in postoperative period of cardiac surgery in pediatric population
    (Macedonian Association of Anatomists and Morphologists, 2016)
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    V. Chadikovski
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    Lj. Kojikj
    Background: Troponin is an important biomarker for early evidence of ischemic damage to the heart tissue after a cardiac surgery conducted in the pediatric and adult populations. Elevated values correlate with perioperative and postoperative procedures and practices and are a significant factor for possible later complications. Methods: 30 operated children divided into two groups, the first group of operated children without a cardiopulmonary bypass CPB, and the second group of operated children with a cardiopulmonary bypass. A correlation between elevated troponin and perioperative and postoperative parameters was followed (duration of CPB and aortic cross-clamping time, stay in the intensive care and therapy during respiratory support, during inotropic support, the presence of renal or hepatic failure, postoperative complications). Results: In both groups of operated children the troponin was elevated. In the first group of children operated without cardiopulmonary bypass, the average value of troponin was 9,5ng/ml (range 6,5-16,8 ng/l). In the second group of operated children (27 children) with cardiopulmonary bypass, the mean valueof duration was 81.5 minutes (range 18 to 296 minutes), and X-cross time (aortic cross-clamping time) at the same children is with a mean value of 28,2 minutes (range of 0-86 min.). At the first group of children the troponin was with a mean value of 9,5ng/ml and in the second group with a mean value of 23,0 ng/ml. The obtained values of troponin have confirmed a highly significant correlation with perioperative and postoperative procedures. Conclusions: Troponin is a prognostic marker for early evidence of ischemic and necrotic changes of cardiac infarction in the pediatric population in cardiac surgery. Elevated values in the first 24-48 hours are significantly correlated with perioperative and postoperative procedures and are an important indicator of the extent of damage to the heart tissue. But its prognostic significance of myocardial ischemic changes is lost in a period between 2-6 months after the cardiac surgery.
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    Neurological disorders - convulsions after cardiac surgery in the pediatric population
    (Medical Faculty, Ss. Cyril and Methodius University in Skopje, 2016)
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    V. Chadikovski
    Objectives Neurological disorders are complications that can occur after cardiac surgery of congenital heart defects. They manifest as seizures lasting from several seconds to several hours. For their confirmation, several diagnostic procedures are used, as well as a long-term monitoring of the clinical condition of the children. This is particularly important for a possible occurrence of subsequent neurological disorders that can occur few years later. Methods The clinical status and vital parameters of the operated children in the postoperative period are followed-up. If there are seizures manifested, diagnostic examinations are carried out, as well as EEG monitoring and anticonvulsant therapy is initiated. Results From 30 operated children, seizures appeared only in one child - 30/1 (33%) in the first 48 hours. The cause for its development is the intracranial bleeding during cardiac surgery and prolonged duration of 296 minutes of CPB and 60 minutes of X-cross time (aortic cross-clamping time). Hypothermia implemented during the CPB lasted 45 minutes and the temperature was 31C degrees. Due to the prolonged cardiac surgery and deterioration of general condition, the postoperative period was also prolonged. Conclusions The onset of seizures after cardiac surgery is a rare complication that occurs in the early postoperative period. They are the first marker of brain dysfunction which requires a long-term monitoring of the condition of these children, because there is an increased risk of dysfunctional and cognitive disturbances in the later period.