Provoked venous thromboembolism during ten-year follow up at the Clinical Centre University of Sarajevo.

Aim To determine risk factors for deep vein thrombosis (DVT) in hospitalized patients in a 10-year follow-up. Methods In this observational study data were collected from the disease history of patients admitted to the Department of Angiology of the Clinical Centre University of Sarajevo in the period of 10 years (2008-2017). Of 6246 hospitalized patients, 1154 were with established diagnosis of DVT and included in the study as a basic inclusion criterion. Results Provoked venous thromboembolism was recorded in 45.75% of hospitalized patients. In 54.25% cases DVT was classified as idiopathic; in the remaining cases with DVT external risk factors were identified. Every fourth patient had a history of malignancy, and this risk factor was significantly more common among women and younger patients. Cancer of female reproductive organs, colon, lung, breast and prostate cancer were most common. One of 10 women had DVT during pregnancy or postpartum period. Out of the total number, 10.9% patients had DVT after surgery, 2.3% after injury. DVT was found in 1.6% of drug addicts. Rethrombosis was diagnosed in 5.2% patients within a year, while 9.2 % patients had rethrombosis within five years. Conclusion Provoked venous thromboembolism is an entity that can be prevented. Malignancy and surgical treatment are the most common risk factors and these patients should be treated with special care. The creation of a register of patients with venous thromboembolism in Bosnia and Herzegovina would enable the development of a preventive strategy in the groups of patients at risk.

Venous Thromboembolism During Ten-year Follow up on Clinical Center University of Sarajevo.

INTRODUCTION: Venous thromboembolism (VTE) consists of two entities, deep venous thrombosis (DVT), and its complication, pulmonary embolism (PE). The main therapeutic goal is the prevention of this complication. AIM: The aim of the study was to present epidemiological data of patients with the diagnosis of deep venous thrombosis, with regard to the location of thrombosis, the value of fibrinogen and D-dimer in relation to the sex of the patients, the presentation of therapeutic modality, with the presentation of PE and treatment outcomes. METHODS: The study has a retrospective and observational feature, covering the period from 2008 to 2017, and included 1154 patients with the diagnosis of deep venous thrombosis as a basic criterion for inclusion. Data on sex, age, diagnosis with thrombosis localization, hospitalization duration, administered therapy, D-dimer and fibrinogen values, pulmonary thromboembolism and mortality were collected. RESULTS: The deep venous thrombosis was mostly located at the lower limbs - in 1079 respondents (93.5%), then at the upper limbs in 65 (5.63%) cases. The left side is more represented (58.9%) than the right (40.3%), which is statistically significant (χ2=40.03, p<0.005), while 0.9% of patients had DVT bilaterally. At the lower limbs is the most common iliac thrombosis, represented in 47% of thrombosis cases at the lower limbs. Subclavian axillary thrombosis has been reported in ¾ cases at the upper limbs. The mean fibrinogen concentration in all respondents is 5.2 mg/L, for men 5.0 mg/L and for women 5.3 mg/L, above the reference values (1.8-3.8 g/L). The mean value of D-dimer was 7.33 mg/L for all respondents, 8.46 mg/L for women and 6.5 mg/L for men, which was high above the reference limit (0.55 mg/L). From baseline, 88 (7.6%) of respondents had proven/high-grade pulmonary thromboembolism as a DVT complication in the observed period. Pearson correlation established a positive correlation between lethal outcome and patient age, r=0.13, p<0.005, followed by a higher incidence of lethal outcome after DVT in older patients. CONCLUSION: The incidence of venous thromboembolism is approximately equal among the genders, and increases with the age of the patients, especially in men. Fibrinogen and D-dimer values in hospitalized patients are higher than the reference, in both cases more among women. Multidisciplinary approach to patients, in cooperation with angiologists, pulmonologists, cardiologists and nuclear medicine specialists is an imperative. The development of a state-level registry that would follow the incidence of deep venous thrombosis, with reference to risk factors, is imperative and necessary in planning of community health system.

Prolonged spasm of the left anterior descending coronary artery.

Coronary artery spasm is one of the well-known causes of anginal chest pain. We presented the case of prolonged spasm of the left anterior descending coronary artery which happened during coronary angiography leading to pulse less state and low blood pressure with syncope and appearing of ventricular fibrillation on ECG. During one hour of successful cardiopulmonary resuscitation, the patient had again normal pulse and blood pressure. Coronary angiography performed immediately after DC's showed normal coronary angiogram. After two days the patient left the hospital without brain disorders.

Successful percutaneous septal alcohol ablation after surgical myectomy.

Hypertrophic obstructive cardiomyopathy (HOCM) is a primary, usually familial and genetically fixed myocardial hypertrophy, with dynamic left ventricular outflow tract obstruction. An alternative to surgical myectomy in the treatment of severe, drug refractory, HOCM is percutaneous transluminal septal myocardial ablation (PTSMA). We report a case of 24 year old female patient who had the first septal myectomy but because of progression of her disease, the percutaneous treatment of hypertrophic obstructive cardiomyopathy was performed. A year after the PTSMA the patient was without of symptoms.

Patient doses in interventional cardiology in Bosnia and Herzegovina: first results.

Cardiologists at the Cardiac Centre of the Clinical Centre of Sarajevo University performed invasive cardiology procedures in one room equipped with a Siemens Coroskop (Siemens Healthcare, Erlangen, Germany) unit with the possibility of digital cine imaging. The number of procedures performed with this unit is 1126 per year. The number of adults performing only diagnostic procedures is 816, therapeutic procedures 62 and both diagnostic and therapeutic 228. Twenty diagnostic examinations but no therapeutic procedure are performed on children per year. The workload is increasing year by year, with an average increase of 26 % per year. The X-ray system does not have a kerma area product (KAP) meter installed; therefore an external KAP meter was mounted on the X-ray tube. Gafchromic dosimetry films (International Specialty Products, Wayne, USA) were placed under the patient to record the skin dose distribution. The peak skin dose (PSD) was calculated from the maximum optical density of the dosimetry films. Dose measurements were performed on 51 patients undergoing therapeutic procedures (percutaneous transluminal coronary angioplasty and stent placement). Two patients received doses (KAP) larger than 100 Gycm(2). The PSD was higher than 1 Gy in 3 out of 16 evaluations, and one of these patients received a skin dose >2 Gy. No deterministic skin effects were recorded. The dosimetry results are similar to results reported in other countries. Invasive cardiac procedures deliver high doses to the skin that could cause deterministic effects (erythema). Physicians performing these procedures should be aware of these risks. More efforts should be put into the training of cardiologists in radiation protection.

Primary percutaneous coronary interventions network in Bosnia and Herzegovina--Sarajevo's proposal.

Reperfusion therapy is the most useful part of the treatment for patients suffering from an acute coronary syndrome. Start time of reperfusion therapy is an important factor which influenced positively on the number of days of hospitalization, and readmission, the risk of reinfarction, as well as both, short and long-term mortality. Today, several models of reperfusion therapy are available: thrombolytic treatment (pre-hospital or in-hospital setting), primary percutaneous coronary intervention (primary PCI or pPCI) or a combination of both. pPCI is preferred, as soon as possible, in centers with experienced teams, especially for patients in shock, or those with contraindicated fibrinolytic therapies. We will compared, very shortly, the daily practices in 4 countries (Czech Republic, Austria, Croatia, Serbia ), where (well) developed primary PCI hospital networks works efficiently for a years, with the current situation in Bosnia and Herzegovina. Our goal is to describe the easiest and quickest way of establishing the primary PCI network in Bosnia and Herzegovina. By combining the efforts of both Entities of Bosnia and Herzegovina will be possible in the forthcoming period, that B&H becomes a participant in the Stent for life initiative.

[Myocardial perfusion scintigraphy in evaluation of percutaneous transluminal coronary dilatations of the coronary artery bypass grafts]. / Perfuziona scintigrafija miokarda u procjeni perkutane transluminalne dilatacije aorto-koronarnih premostenja.

Significant multi-vessel stenoses of the coronary arteries are definitely treated with aorto-coronary by-pass grafting. Most often, the procedure is complicated with acute and subacute occlusion of the graft. Diabetics are high-risk patients, requiring more complex pre- and postoperative diagnostic work-up. Percutaneous transluminal coronary dilatation with stenting (PTCA) has been a well-established procedure of choice for the resolution of the occlussion over the last few years. The aim is to present a case of a diabetic patient, whose work-up and follow-up included all parts of the diagnostic-therapeutic pyramid in the treatment of the coronary disease. Given its characteristics, sensitivity, specificity and reproducibility, myocardial perfusion scintigraphy (MPS) should be an unavoidable step in the post-operative follow-up of diabetics with coronary disease. Myocardial perfusion scintigraphy proved highly efficient in assessing the grafts, as it renders morphological and functional data on the myocardial status that is directly proportional to the coronary arteries status.

[Presence of the muscular bridges and their influence on coronary insufficiency]. / Prisustvo misicnih mostova i njihov uticaj na koronarnu insuficijenciju.

In this work we have analyzed 512 coronary angiograms that were done during 2003 year at the Clinic for heart diseases and rheumatism of the University of Sarajevo Clinic Center (UCCS) and we have dissected 20 human hearts at the Institute for Anatomy. We strived to prove frequency of the muscular bridges on branches of the coronary artery, their localization and influence on the arteriosclerotic changes. Using coronary angiography method we consluded that the presence of the muscular bridges in observed population in 4.88% of cases, with the most frequent localization on the anterior interventricular branch (ramus interventricularis anterior). By dissection method the muscular bridges have been found in 55% of cases and the most frequent localization was on the anterior interventricular branch and branches of the right coronary artery. Smaller frequency of the muscular bridges, shown by the angiography method, can be explained by the fact that thick muscular bridges perform weak compression and because of that minimal systolic reduction of the lumen which can not be noticed by the angiography. The muscular bridges are four times frequent on males and they are the most frequent in the age group from 40 to 50 years. In the 88% of patients with the muscular bridges were found arteriosclerotic changes localized proximately from muscular bridge.