CONGRESS OF CONGRESS OF CARDIOLOGISTS & CARDIOLOGISTS &

ANGIOLOGISTS ANGIOLOGISTS

BOSNIA & HERZEGOVINA BOSNIA & HERZEGOVINA WITH INTERNATIONAL WITH INTERNATIONAL

PARTICIPATIONPARTICIPATION

Acc.Prof.dr. Senka Mesihović-DinarevićAcc.Prof.dr. Senka Mesihović-Dinarević

SARAJEVO 28.05.2010.SARAJEVO 28.05.2010.

PAEDIATRIC CARDIOLOGYPAEDIATRIC CARDIOLOGY

embrembryyoloologicalgical knowledgeknowledge mormorphpholoologicalgical anatom anatomyy segmental analsegmental analysysiiss

DevelopmentalDevelopmental biolog biologyy from from conception up to the end of the second conception up to the end of the second month of life, allows the solution of month of life, allows the solution of mormorphphogeneogenesissis (pat (pathhogeneogenesissis) ) andand etiologetiology of cardiac malformations.y of cardiac malformations.

MorMorphpholoologicalgical anatom anatomyy is essential for the is essential for the recognition of heart chambers as well as to recognition of heart chambers as well as to define a real diagnosis.define a real diagnosis.

TheThe language of segmentallanguage of segmental anal analysisysis (1976.god):(1976.god): the relation ofthe relation of visceral organ visceral organss towards towards atriatriuummss

(visceroatrial (visceroatrial relationrelation)) interrelation of the heart chamberinterrelation of the heart chamber ( (heart loopheart loop)) the relation of the heart towards great vesselsthe relation of the heart towards great vessels

((cconotrunonotrunccal al relation)relation)

On the basis of On the basis of segmental analsegmental analysis, it is ysis, it is possible to make anpossible to make an anatom anatomical and ical and physiological physiological diagnodiagnosissis..

DetaDetail cil cliniliniccaall ev evaalualuation istion is e esssensentitialal for for patinet’s judgementpatinet’s judgement with congenital heart with congenital heart anomalies.anomalies.

Modern Modern diagnostidiagnosticc andand t thheraperapeutical approach eutical approach inin p paaediatriediatricc ccardiologardiology means early y means early application of application of ffooetal eetal ecchohoccardiograardiographyphy ((independently of child’s position intrauterine)independently of child’s position intrauterine) starting fromstarting from 18 18 tto 20 o 20 weeks of intrauterine weeks of intrauterine lifelife;; Detection of CHDDetection of CHD Rhythm disordersRhythm disorders TTransransccatathheter teter thheraperapy of certain lesions and y of certain lesions and

disordersdisorders..

Paediatric clinic of CCU Sarajevo is Paediatric clinic of CCU Sarajevo is organised through:organised through:

Hospital part andHospital part and Out pts clinicsOut pts clinics

Total surface: 6 500 m kvadratnih.Total surface: 6 500 m kvadratnih. Mini laboratory and X ray departmentMini laboratory and X ray department

gastroenterology, gastroenterology, nepfrology, nepfrology, cardiology, cardiology, neonatology, neonatology, paediatric paediatric Int.care and therapyInt.care and therapy,, neonatal Int. Care nad therapy,neonatal Int. Care nad therapy, pulmology, pulmology, neuropediatry, neuropediatry, endocrinology, endocrinology, hhematooncologyematooncology,, fiziatry,fiziatry, alergoimmunorheumatologyalergoimmunorheumatology

addmision, triage and urgent department addmision, triage and urgent department +day hospital+day hospital

Clinic has 12 departments:Clinic has 12 departments:

Cardiology department:Cardiology department:

12 beds12 beds

Out pts department:Out pts department:

ECHO laboratoryECHO laboratory Cardiology out pts Cardiology out pts Rhythm laboratoryRhythm laboratory

PAEDIATRIC and NEONATAL PAEDIATRIC and NEONATAL INTENSIVE CARDIOLOGY INTENSIVE CARDIOLOGY

DEPARTMENTDEPARTMENT

Pediatric Educational Center of Sarajevo Pediatric Educational Center of Sarajevo ((PECS)PECS) founded in 2003. founded in 2003.

Activities:Activities:  1.1. Asthma schoolAsthma school2.2. Paediatric summer schoolPaediatric summer school3.3. UUltrasound schoolltrasound school4.4. Ressuscitation schoolRessuscitation school5.5. Endocrinology schoolEndocrinology school

6.Phatmacologic 6.Phatmacologic houses in houses in child’s service,child’s service,

7.Courses,7.Courses,8.Lectures,8.Lectures,9.Publishing9.Publishing

Publishing services:Publishing services:

Annual Publication as a result of Annual Publication as a result of Paediatric Summer schoool: “News Paediatric Summer schoool: “News from Paediatrics“:from Paediatrics“:2003-2009;2003-2009;

Book 60.years of Paediatric clinic of Book 60.years of Paediatric clinic of CCU SarajevoCCU Sarajevo

Textbooks + CD for 3 medical Textbooks + CD for 3 medical schools (2005.)schools (2005.)

Bilten no.1-7.Bilten no.1-7.

Lecturs/Education:Lecturs/Education:

Medical schoolMedical school Dentistry schoolDentistry school School for health sciencesSchool for health sciences SpecialisationsSpecialisations SubspecialisationsSubspecialisations Further educationsFurther educations TreningsTrenings

Pediatric clinic of CCU SarajevoPediatric clinic of CCU Sarajevo

Admissions: 2003: 2895Admissions: 2003: 2895

Admissions 2009: 4984Admissions 2009: 4984

Pediatric clinic of CCU SarajevoPediatric clinic of CCU Sarajevo

Number of pts in 12 out pts clinics: Number of pts in 12 out pts clinics:

2003: 25 9212003: 25 921

2009: 41 3722009: 41 372

MortalityMortality

2009. was (number of pts 4948) 1,7%, 2009. was (number of pts 4948) 1,7%, in relation to 2008. when mortality was 2% in relation to 2008. when mortality was 2% (number of pts 4278) (number of pts 4278)

As in years before, there is decrease tendency, despite As in years before, there is decrease tendency, despite extremly difficulte and complicate cases as well as extremly difficulte and complicate cases as well as stage of patient’s illness, from whole B&H.stage of patient’s illness, from whole B&H.

. . . . Highly specialise tertiery institution functions with Highly specialise tertiery institution functions with

capacity of 130 beds + 30 intensive care. capacity of 130 beds + 30 intensive care. Staff (225): 38 specialists paediatricians Staff (225): 38 specialists paediatricians

(3 proffesors, 3 PhD, 5 doctors of medical sciences, (3 proffesors, 3 PhD, 5 doctors of medical sciences,

12 masters), 7 residents, 2 cl.psihologists, 9 high 12 masters), 7 residents, 2 cl.psihologists, 9 high medical nurses, 4 dipl.med.nurses, 131 ordinary med. medical nurses, 4 dipl.med.nurses, 131 ordinary med. nurses & 27 workers in additional services.nurses & 27 workers in additional services.

The mirror of one country development is refflected The mirror of one country development is refflected in the degree of in the degree of pediatric cardiology and pediatric cardiology and cardiosurgreycardiosurgrey development, which in Sarajevo in development, which in Sarajevo in past several years achieves good results thanks to past several years achieves good results thanks to cooperation with colleagues from Austria. cooperation with colleagues from Austria.

Cardiosurgery 1996.-2010.:Cardiosurgery 1996.-2010.:

1996-1999: Samaritan’s purse evacuated: 150 pts1996-1999: Samaritan’s purse evacuated: 150 pts

Foreign teams:Foreign teams:

USA (prof.Novick)USA (prof.Novick) Austria (prof.Wollenek)Austria (prof.Wollenek) Sweden (prof.Johanson)Sweden (prof.Johanson)

Local teamLocal team

From 1996-2010:From 1996-2010:

1996-1999: 1996-1999:

Samaritans’ purse: Samaritans’ purse:

150 pts150 pts

1996.1996. 24 pts24 pts

1997.1997. 43 pts43 pts

1998.1998. 55 pts55 pts

19991999 28 pts28 pts

Treatment in AustriaTreatment in Austria

2008-2009: 2008-2009: Austria team+Federal Austria team+Federal

Insurance company:Insurance company:

2008.2008. 30 pts30 pts

2009.2009. 33 pts33 pts

2009.2009. 27/33 pts 27/33 pts operatedoperated

20092009 6/33 pts6/33 pts

Follow upFollow up

Total number of Total number of cardiosurgical cardiosurgical paediatric paediatric patinets from 1997.till 25.04.2010. is patinets from 1997.till 25.04.2010. is 421.421.

From May 1998-25.04.2010. total number of From May 1998-25.04.2010. total number of CCCC was was 180180::

154/180 diagnostic and 25 interventional.154/180 diagnostic and 25 interventional.

421 pts operated421 pts operated

ASDASD 6767

VSDVSD 6969

PDAPDA 5757

TOFTOF 4949

More than 1 simple lesion (2-5)=44More than 1 simple lesion (2-5)=44VCC complexus without ToF=43VCC complexus without ToF=43

pacemaker, other CHD=7pacemaker, other CHD=7

CoACoA 2828

ASAS 1212

PSPS 1111

AVSDAVSD 2525

PAPVRPAPVR 55

TAPVRTAPVR 44

Preoperative & postoperative treatment is Preoperative & postoperative treatment is allways done by Sarajevo team:Pediatric allways done by Sarajevo team:Pediatric clinic and+Centre for heart of CCU Sarajevo.clinic and+Centre for heart of CCU Sarajevo.

2009. 43 pts had cardiosurgery: Austrian 2009. 43 pts had cardiosurgery: Austrian team done 14 pts, 3 CC, Sweedish team team done 14 pts, 3 CC, Sweedish team operated on 12 pts, in Italy operated 3 pts operated on 12 pts, in Italy operated 3 pts

LOCAL CARDIOSURGICAL TEAM:LOCAL CARDIOSURGICAL TEAM:

2009=4OP (ASD1+1DAP)2009=4OP (ASD1+1DAP) 2008=3OP2008=3OP 2007=02007=0 2006=12 (9PDA+3ASD)2006=12 (9PDA+3ASD) 2005=02005=0 2004=02004=0 2003=2 (ASD)2003=2 (ASD) 2002=02002=0 2001=02001=0 2000=4 (1PDA,1ASD, 2CoA)2000=4 (1PDA,1ASD, 2CoA)

Total:25Total:25

Cardiosurgery & CC Cardiosurgery & CC 2008-2009.god2008-2009.god

20082009

OP

CC05

1015202530354045

OP

CC

OP 24 43

CC 3 3

2008 2009

TranstTransthhoraoraccal eal ecchohoccardiograardiographyphy inin B B&&H H has a longhas a long tradi traditiontion..

First First UUSS machinemachine inin Sarajev Sarajevoo 1977. 1977.

2009.2009.

Cardiology department: Cardiology department: 485 addmisions, 4540 out pts485 addmisions, 4540 out pts

The pThe prressure for obtaining ultrasound essure for obtaining ultrasound examination in our laboratory is examination in our laboratory is extraordinaryextraordinary..

50%

8% 10%

32%

L-D shunt Obstructivne L. Cyanotic L. Mixed L.

DIAGNOSTIC PROCEDURES DIAGNOSTIC PROCEDURES (2009):(2009):

ECG: 3024ECG: 3024 Echocardiography: 3768Echocardiography: 3768 Holter ECG:245Holter ECG:245 Holter BP 43Holter BP 43 Ergometry 60Ergometry 60 Fonocardiography: 56Fonocardiography: 56 Tilt-table test: 26Tilt-table test: 26

Cardiosurgery:Cardiosurgery: How does it work?How does it work? Diagnosis is made at Paediatric clinic Sarajevo and in : Diagnosis is made at Paediatric clinic Sarajevo and in :

Bihać, Mostar, Banja Luka, Travnik, Zenica, Tuzla by Bihać, Mostar, Banja Luka, Travnik, Zenica, Tuzla by subspecialists of cardiologysubspecialists of cardiology

Transffer to SarajevoTransffer to Sarajevo Addmission at Paediatric clinic-Cardiology departmentAddmission at Paediatric clinic-Cardiology department Transffer to Centre for heart CCU Sarajevo/CCTransffer to Centre for heart CCU Sarajevo/CC Postoperatively at PICU Paediatric thanPostoperatively at PICU Paediatric than Post intensive Cardiology departmentPost intensive Cardiology department Discharge homeDischarge home Follow up by local subspecialists and cardiologists in Follow up by local subspecialists and cardiologists in

SarajevoSarajevo

At present:At present:

Local teamLocal team: : ASD, PDAASD, PDAForeign teamsForeign teams: : AustrianAustrian (3 x times a year; (3 x times a year; in 2009 x1 arrival,in 2009 x1 arrival, in 2008 x1 arrival), in 2008 x1 arrival), SweedenSweeden (3 x times a year) (3 x times a year)

Humanitarien Humanitarien evacuation to Italy: 2pts per monthevacuation to Italy: 2pts per month

An average number of pts with CHD is An average number of pts with CHD is 50-60 in FBiH50-60 in FBiH

PlanPlan: to develop foetal echocardiography in: to develop foetal echocardiography in order to reduce CHDorder to reduce CHD

CC: th:CC: th: closure of PDA, ASD closure of PDA, ASD

Local teamLocal team to operate independetly to operate independetly

In years to come: Regional paediatric cardiosurgeryIn years to come: Regional paediatric cardiosurgery: : KosovoKosovo........

THANKS FOR YOUR ATTENTION!THANKS FOR YOUR ATTENTION!