Faculty of Medicine

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SUCCESSFUL TREATMENT OF ENDOCARDITIS WITH NONSPECIFIC PRESENTATION IN A KIDNEY TRANSPLANTPATIENT-CASE REPORT
(Macedonian Association of Anatomists, 2023-11)
Uspcov, Julijana
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Kabova Karanfilovikj, Angela
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Spasovska, Adrijana
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Infective endocarditis (IE) is a serious complication in patients with transplanted kidney, leading to graft loss and a high mortality rate. We present a case of native valve endocarditis in a 51-year-old male with transplanted kidney that had atypical clinical course. The patient experienced prolonged subfebrile temperature with paroxysmal arrhythmia and development of cardio-pulmonary insufficiency. Transthoracic echocardiography (TTE) set the diagnosis of aortic valve vegetation with severe aortic regurgitation and pulmonary edema. We failed to isolate a microbiological agent, but all blood cultures were taken under antibiotic therapy. The patient was treated with surgical replacement of the native aortic valve with mechanical heart valve with significant clinical improvement. Ten days after the intervention, he was discharged with reduced markers of inflammation and proper function of the kidney graft. Immunosuppressive therapy was gradually reinstated. One year later, the patient was clinically stable and with proper graft function. Early diagnostic and therapeutic intervention, particularly intensive antibiotic therapy and surgical management can preserve the patient and the kidney allograft.
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EVALUATION OF RESPIRATORY FAILURE FOLLOWING PEDIATRIC CARDIAC SURGERY
(Macedonian Association of Anatomists and Morphologists, 2021-08)
Background: This study evaluated the respiratory failure (postoperative reintubation, respiratory acidosis, deterioration of gas blood, respiratory disfunctions, hypoxia) after congenital heart surgery. Material and methods: To evaluate the impact of respiratory failure (within 48 hours postoperatively) in patients undergoing congenital heart surgery. This retrospective study included 45 operated patients (male and female aged 3 to 9 months) who had undergone cardiac surgery at the University Clinic for Pediatric Surgery in a period of two years. Type of congenital heart diseases, perioperative and postoperative parameters (duration of cardiopulmonary bypass - CPB, cross-clamping of aorta, duration of stay in ICU and complications) were analyzed. Results: Of a total of 45 operated patients, five required reintubation, and their average age was 7.5 months, and median body weight 7.8 kg. Perioperative procedures were prolonged (duration of CPB - 97 minutes, aortic cross-clamping time - 59 min. and duration stay in ICU -7.2 days), caused postoperative complications (chylothorax, respiratory infection and thoracic bleeding) and worsening of respiratory failure. We evaluated postoperative respiratory failure in five reintubated patients. Conclusion: Prolongated perioperative and postoperative procedures were significantly associated with postoperative complications, worsening of the general condition and prolonged postoperative treatment.
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THE RISK FACTORS FOR POSTOPERATIVE OUTCOMES IN NEONATAL CARDIAC SURGERY
(Macedonian Association of Anatomists and Morphologists, 2020-12)
ABSTRACT Background: In the last three decades a neonatal cardiac surgery has improved the approach and methods for adequate treatment of complex congenital heart defects. Although we have advances in fetal cardiac imaging and improved perioperative cardiac procedures, the postoperative outcomes in neonatal care (neonates) are still present. Objective: To present our experience of operated neonates with congenital heart defects in a tertiary referral center, Neonatal Intensive Care Unit (NICU) in Skopje N. Macedonia. Materials and methods: We conducted a retrospective study including neonates who underwent surgical intervention between January 2013 and December 2015 at the University Clinic for Pediatric Diseases in Skopje. We analyzed perioperative and postoperative variables. The main outcomes were duration of cardiopulmonaly bypass (CPB), and x-cross of aorta, duration of mechanical ventilation, intensive care unit stay and postoperative complications. Fourteen (14) neonates were discharged from our Clinic. Results: Out of a total of 85 children, 15/85 (17.6 %) were neonates; males 12/15(80%) females 3/15 (20 %). The overall mortality was 1/15% (6.6%). There were 13/15 (86.6%) corrective procedures and 2/15 (13.3%) palliative ones. The mean duration of CPB was 46.6 min. (18±296 min.), the mean duration of x-cross of aorta was 17.5 min. (10±65 min.). The mean duration of mechanical ventilation was 3.4 days (1±15 days), duration of inotropic support was 4.2 days (1± 16 days) and ICU stay was 5.8 days (7.9 ± 14days). After the operation, 2/15 (13.3%) neonates required reintubation in the ICU. Postoperative complications were confirmed in 3 neonates (intracranial bleeding with seizures, block nodes AV and pneumonia). The incidence of all postoperative complications was 6.6%. Fourteen (14) patients were discharged from the Clinic. Conclusion: Due to adequate cardiac surgery, significant technological advances, devices and increasing experience in neonatal cardiac surgery we have improved postoperative outcomes.
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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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SEIZURES AFTER PEDIATRIC CARDIAC SURGERY(REPORT OF THREE CASES) - WHAT CAN WE CONCLUDE?
(Ss. Cyril and Methodius University, Faculty of Medicine, Department of Anaesthesia and Reanimation, 2019)
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Stevic M.
ABSTRACT Seizures are complications that can occur after cardiac surgery of congenital heart disease. Their incidence is overall low. Enthought poorly reported in the literature their notification, early treatment and follow up is essential for further child neurological development. Furthermore, factors that lead to seizures after cardiac surgeries are additionally reported with controversies. While some authors discuss that the diagnosis and the type of surgery are essential for their occurrence other corelate them to prolonged duration of cardiopulmonary bypass (CPB), x-cross of aorta, prolonged hypothermia or duration of mechanical ventilation and intensive care unit (ICU) stay. In this article, we present series of cases of children who had seizures after cardiac surgery, where we made a comparation of several factors like diagnoses, duration of cardiopulmonary bypass and age, as possible factors for seizure occurrence.
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Bilateral chylothorax – complication after cardiac surgical intervention in neonates – case report
(Medical Faculty, Ss. Cyril and Methodius University in Skopje, 2018)
ABSTRACT Background: Chylothorax is a rare complication after cardiac surgery of congenital heart diseases. In majority of cases treatment is conservative and long-lasting. In rare cases a surgical intervention is necessary. Case report: We present a case of a seven-month infant with congenital heart defect, which was diagnosed in the first days of his life. A cyanogenic heart defect –single ventricle, TGA, pulmonaly stenosis, PDA, was detected. During the cardiac surgery a Glenn procedure was realized. In the postoperative period deterioration of the general condition was observed along with respiratory insufficiency, onset of bilateral pleural effusion, chylothorax that was confirmed with cytological and biochemical examinations. Conservative treatment with low-fat diet was conducted. After one month of hospitalization and treatment at the Department of Intensive Care ( ICU ), there was an improvement in the condition and the infant was referred to another department. Conclusion: Onset of chylothorax following cardiac surgery is a complication, which usually appears during intervention in the aortic arch and single ventricle. The first choice of treatment is conservative one, with enteral intake of milk rich in long-chain free fatty acids and medium-chain triglycerides. If there is no improvement in the condition, a surgical intervention is necessary.
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The most common complications in intensive care unit department after cardiac surgery in children
(Macedonian association of anatomists and morphologists, 2018)
Introduction: Having regard all the progress in the field of pediatrics, nowadays heart surgery can be performed with excellent outcomes. Serious complications can cause high morbidity and mortality rates. This study has been performed in order to determine the incidence of morbidity and mortality. Methods: During 2013-2015, the retrospective study was performed with 65 patients undergoing surgery for congenital heart disease which was reviewed for incidence of complications. We used the database of University Clinic for Children's Diseases and University Clinic of Pediatric Surgery in Skopje. Results: 33 children with complications, have been divided into 2 groups cardiac and extra cardiac complications with mean age of 6,5 ± 0,35 (rang 0,5 - 108 months). The first group included SVT (6,25 %), AV-block (6,25 %), pacing (6,25 %) and pericarditis (9,3 %). In the extra cardiac complications, the most common was bleeding (12,5 %), renal failure (9,3 %), chylothorax (9,3 %), seizures (9,3 %), reintubation after surgery (15.6 %), sepsis (12,5 %) and severe pneumonia (6,25 %). The duration of CPB was 68,32 ± 31,9 minutes, the duration of MV was 2,04 ± 2,42 days, and ICU stay was 3,90 ± 3,45. The incidence of mortality was 9,2 % whereby the most common was sepsis, reoperations for previous lung chronic diseases and renal failure. Conclusion: Prolonged duration of CPB, duration of MV and ICU stay, are significant risk factors for the increased number of cardiac and extra cardiac complications. It is necessary to apply the measures and careful monitoring of patients to minimize these effects.

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