Background/Objectives: Congenital heart disease (CHD), affecting approximately 1% of live births, has transitioned to a chronic condition due to advances in diagnostics and surgery, resulting in an increasing adult congenital heart disease (ACHD) population. This study characterizes the clinical and demographic profiles of ACHD patients in Serbia, focusing on congenital anomalies, mortality rates, and key clinical factors to identify opportunities for improving care and outcomes. Methods: This observational single-center study was conducted at the Cardiovascular Institute “Dedinje” in Belgrade, Serbia, involving patients diagnosed or treated for CHD between 2006 and 2022. Results: A total of 1532 patients were included in the study, with common diagnoses including atrial septal defects (ASD) (47.65%) and ventricular septal defects (VSD) (13.19%). The mean patient age was 48.31 years, with a slight predominance of females (57.21%). The complexity of CHD was categorized as mild (54.6%), moderate (36.5%), and severe (6.3%). The mortality rate was 4.2%, with higher rates observed in conditions like Ebstein anomaly (17.78%) and congenital aortic stenosis (11.76%). Conclusions: This study provides a comprehensive overview of the current state of ACHD management in Serbia, highlighting the high prevalence of ASD and VSD among patients, the challenges associated with moderate and severe CHD, and the notable mortality rates for certain conditions. The findings underscore the importance of improving early detection, individualized treatment plans, and multidisciplinary care to enhance patient outcomes in this growing population.

Background and Objectives: Left ventricular aneurysm (LVA) causes geometric changes, including reduced systolic function and a more spherical shape, which is quantified by the sphericity index (SI), the ratio of the short to long axis in the apical four-chamber view. This study aimed to assess SI’s value in A-LVA and B-LVA, identify influencing factors, and evaluate its clinical relevance. Materials and Methods: This clinical study included 54 patients with post-infarction LVA and used echocardiography to determine LVA locations (A-LVA near the apex and B-LVA in the basal segments), with SI and other echocardiographic measures assessed in both systole and diastole for the entire cohort and stratified by A-LVA and B-LVA groups. Results: Among the 54 patients, 41 had A-LVA and 13 had B-LVA. The mean SI was 0.55 in diastole and 0.47 in systole for the cohort. Patients with A-LVA had a mean SI of 0.51 in diastole and 0.44 in systole, while B-LVA patients exhibited significantly higher SI values, with 0.65 in diastole and 0.57 in systole, due to lower long-axis (L) values in both phases. The mean left ventricular ejection fraction (EF) was 23.95% in A-LVA and 30.85% in B-LVA, with no significant difference. However, apical aneurysms were larger (greater LVAV and LVAA) and more significantly reduced functional myocardium. LVEDV, LVESV, LVEDA, and LVESA did not differ significantly between A-LVA and B-LVA. In cases of severe mitral regurgitation (MR), SI was notably higher (0.75 in diastole) due to a marked reduction in the L axis. Conclusions: SI is key in differentiating A-LVA and B-LVA on echocardiography. B-LVA has lower volume and area values, but similar aneurysm and left ventricular volumes and EF. Higher SI in B-LVA is due to a reduced L-axis, and is worsened by severe mitral regurgitation (MR). Surgical ventricular reconstruction (SVR) compensates for L-axis reduction, with preservation of the L axis critical for achieving a more physiological shape. SI thus serves as a marker for left ventricular geometry and surgical outcomes.

Coronary artery fistulas (CAFs) are rare congenital anomalies, presenting in 0.05–0.9% of cases, characterized by an aberrant connection between a coronary artery and a cardiac chamber or great vessel. Clinical manifestations can include heart failure, myocardial ischemia due to coronary steal, arrhythmias, or infective endocarditis. We report a case of a 39-year-old man initially evaluated in 2016 for peripheral edema and suspected right ventricular (RV) abnormality. Earlier assessments indicated a left anterior descending (LAD) coronary artery–RV fistula, but initial catheterization was nondiagnostic. Transthoracic echocardiography (TTE) revealed a dilated left coronary artery (LCA) and an RV apex aneurysm, confirmed by CT and coronary angiography, showing a 14 mm LAD fistula with large aneurysmal sacs (45.6 × 37.3 mm). Cardiac MRI demonstrated a tortuous LAD fistula draining into RV aneurysmal sacs with preserved biventricular function. Surgical intervention was recommended, but the patient declined and was lost to follow-up until 2022, being asymptomatic. Re-evaluation showed progression in aneurysm size (47 × 45 mm and 16 × 18 mm) without ventricular functional change. Follow-up TTE in 2023 indicated stable findings. This case emphasizes the necessity of multimodal imaging (TTE, CT, MRI, angiography) for CAF diagnosis and management planning. Given the variability in CAF presentation and outcomes, individualized management—including surgical, percutaneous, or conservative strategies—is crucial. Persistent follow-up is essential for monitoring potential complications and guiding treatment, even in asymptomatic patients refusing intervention.

Background and Objectives: This study primarily aims to evaluate the preoperative staging effectiveness of PET-CT in early-stage cervical cancer, particularly, its ability to detect primary tumors and micrometastases. Materials and Methods: In this retrospective study, cervical cancer patients who had undergone preoperative 18F FDG PET-CT scans and were treated at the Department of Gynecology, Institute of Oncology, Vojvodina, in Sremska Kamenica, during the period from 2016 to 2020 were analyzed. Results: The study included 62 patients (mean age, 49.3 ± 9.6 years). Squamous cell carcinoma was the predominant histological type (95.2%), with G2 differentiation (82.3%) and FIGO stage Ib1 (80.6%) being the most common. Assessed by 18F FDG PET-CT, the mean tumor size was 26.4 ± 10.8 mm, which is slightly lower than the 26.9 mm measured during clinical examination (p = 0.784), with a significant (r = 0.678, p < 0.001) correlation between these methods. 18F FDG PET-CT demonstrated an overall accuracy of 88.7% for identifying primary tumors, with a sensitivity of 86.8%, specificity of 100.0%, PPV of 100.0%, and NPV of 56.2%. An intraoperative examination showed identical overall accuracy but higher sensitivity (98.1%) and lower specificity (33.3%). For 18F FDG PET-CT, the level of agreement with the histopathological examination was good (Kappa 0.656), while for the intraoperative examination, it was moderate (Kappa 0.409). Regarding the lymph node assessment, 18F FDG PET-CT’s accuracy was 82.2%, with a sensitivity of 53.8% and a specificity of 89.8%. The intraoperative examination showed lower accuracy (66.1%) but higher sensitivity (76.9%). The 18F FDG PET-CT Kappa value indicated moderate agreement (0.449), while the intraoperative examination showed poor agreement (0.282). Conclusions: In conclusion, significant effectiveness is shown by 18F FDG PET-CT for preoperative staging of early-stage cervical cancer, offering superior accuracy in detecting primary tumors and micrometastases, particularly in predicting lymph node metastases, thereby enhancing diagnostic accuracy and informing treatment decisions.

Background and Objectives: The primary objective of this study is to assess the effectiveness of 18F-FDG–PET–CT in preoperative staging of cervical cancer, focusing on determining surgical operability and exploring the correlation between its quantitative parameters and clinicopathological characteristics. Materials and Methods: This retrospective study included 62 cervical cancer patients treated at the Department of Gynecology, Clinic for Operative Oncology at the Institute of Oncology Vojvodina between January 2016 and January 2020, where preoperative clinical examinations and 18F-FDG–PET–CT were performed to assess the extent of cancer, followed by intraoperative and pathohistological examinations of surgically removed specimens to provide a comprehensive evaluation. Results: The mean tumor size measured by 18F-FDG–PET–CT was slightly greater than that obtained through clinical examination (26.4 mm vs. 26.0 mm), with a strong linear correlation (r = 0.678, p < 0.001) observed between the two measurement methods. The overall prediction accuracy of 18F-FDG–PET–CT for primary tumors is 88.7% (55/62) [sensitivity 86.8%, specificity 100.0%, PPV 100.0%, NPV 56.2%] and for intraoperative examination is 88.7% (55/62) [sensitivity 98.1%, specificity 33.3%, PPV 89.7%, NPV 75.0%]. The agreement with histopathological examination was good for 18F-FDG–PET–CT and moderate for intraoperative examination for primary tumors. Regarding lymph nodes, the overall prediction accuracy of 18F-FDG–PET–CT is 82.2% (51/62) [sensitivity 53.8%, specificity 89.8%, PPV 58.3%, NPV 88.8%] and for intraoperative examination 66.1% (41/62) [sensitivity 76.9%, specificity 63.3%, PPV 35.7%, NPV 91.2%]. The agreement with histopathological examination was moderate for 18F-FDG–PET–CT and poor for intraoperative examination for lymph node metastasis, highlighting that the overall accuracy of 18F-FDG–PET–CT (82.1%) was significantly higher than that of intraoperative examination (66.1%) (p = 0.002). Conclusions: In conclusion, 18F-FDG–PET–CT provides high accuracy in detecting primary tumors and superior predictive value for lymph node metastases compared to intraoperative examination, highlighting the importance of incorporating this imaging modality into the preoperative evaluation process to enhance diagnostic precision and inform treatment decisions.

Background and Objectives: Left ventricular aneurysm (LVA) is associated with a decline in cardiac function, evidenced by a lower ejection fraction (EF), due to the reduction in the proportion of functional myocardium. The left ventricular end-diastolic volume (LVEDV), the left ventricular aneurysm volume (LVAV), and the LVAV/LVEDV ratio show a strong correlation with the EF. The aim of this study was to determine LVA characteristics post-myocardial infarction (basal vs. apical) and to evaluate the impact of aneurysm volume in diastole (LVAVd), aneurysm area in diastole (LVAAd), and their respective ratios with LVEDV and area (LVEDA) on the EF, in order to identify the most critical predictive factors for assessing and managing the negative impact of aneurysms on cardiac function. Materials and Methods: This observational study included post-infarction LVA patients at the “Dedinje” Cardiovascular Institute in Belgrade, Serbia, undergoing routine transthoracic echocardiography. Echocardiography assessed volumes (LVEDV, LVESV, LVAVd, LVAVs) and areas (LVAAd, LVAAs, LVEDA, LVESA) using the area–length method. The ratios (LVAVd/LVEDV, LVAVs/LVESV, LVAAd/LVEDA, LVAAs/LVESA) were derived from these measures. The left ventricular EF was calculated using Simpson’s method. Results: Basal aneurysms showed a significantly smaller LVAVd (p = 0.016), LVAAd (p = 0.003), and LVAAs (p = 0.029) compared to apical aneurysms, indicating that basal aneurysms are smaller in size. However, there was no significant difference in the EF and overall LV volumes between the groups, although the basal aneurysm group had a slightly higher EF and end-diastolic volume, with a slightly lower end-systolic volume. Furthermore, when comparing the correlation between the EF and the LVAVd, the LVEDV, and the LVAVd/LVEDV ratio, the results indicate that the LVAVd had the greatest impact on the EF (−0.695), followed by the LVAVd/LVEDV ratio (−0.637), and the lowest correlation is between the EF and LVEDV. A similar relationship is observed when comparing the EF with the LVESV, the LVAVs, and the LVAVs/LVESV ratio. Conclusions: Basal aneurysms are significantly smaller than apical ones, yet EF and LV volumes remain similar between the groups, with the EF being slightly higher in the basal group. In cases of LVA, LVAVd shows the strongest negative correlation with the EF, indicating its significant impact on systolic function, followed by the LVAVd/LVEDV ratio, with the weakest correlation seen between the EF and LVEDV.

Aim: To investigate out-of-hospital cardiac arrest (OHCA) trend, provided advanced life support (ALS) measures, automated external defibrillator (AEDs) utilization and by-standers involvement in cardiopulmonary resuscitation (CPR) during OHCA incidents. Methods: This cross-sectional study encompassed data pertaining to all OHCA incidents attended to by the Emergency Medical Service of Canton Sarajevo, Bosnia and Herzegovina, covering the period from January 2018 to December 2022. Results: Among a total of 1131 OHCA events, 236 (20.8 %) patients achieved return of spontaneous circulation (ROSC); there were 175 (74.1%) males and 61 (25.9%) females. The OHCA incidence was 54/100.000 inhabitants per year. After a 30-day period post-ROSC, 146 (61.9%) patients fully recovered, while 90 (38.1%) did not survive during this timeframe. Younger age (p&lt;0.05), initial rhythm of ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) (p&lt;0.05) and faster emergency medical team (EMT) response time (p&lt;0.05) were significantly associated with obtaining ROSC. Only 38 (3.3%) OHCA events were assisted by bystanders, who were mostly medical professionals, 25 (65.7%), followed by close family members, 13 (34.3%). There was no report of AED usage. Conclusion: This follow-up study showed less ROSC achievement, similar bystanders&rsquo; involvement, similar factors associated with achieving ROSC (age, EMT response time) and a decline in OHCA events (especially in year 2021 and 2022) comparing to our previous study (2015-2019). There was an extremely low rate of bystander engagement and no AEDs usage. Governments and health organizations must swiftly improve public awareness, promote better practice (basic life support), and actively encourage bystander participation.

Background and Objectives: The saphenous vein graft (SVG) remains the most frequently used conduit worldwide, despite its common disadvantage of early graft failure. To solve the problem and reduce the SVG damage, Souza implemented a new technique where a vein is harvested with surrounding fascia and fat tissue (the so-called no-touch technique). Materials and Methods. A prospective study conducted from February 2019 to June 2024 included 23 patients who underwent myocardial revascularization using a no-touch vein, with follow-up control examinations using computed tomographic angiography to detect graft stenosis or occlusion. Results. Of the entire patient group, 17 (73.9%) were male, with a mean age of 67.39 ± 7.71 years. The mean follow-up period was 25 months. There were no major adverse cardiovascular or cerebrovascular events (MACCEs) during hospitalization, although one patient died in the hospital. Another patient died due to malignancy, but no MACCEs occurred during the follow-up period. According to multi-slice CT coronary angiography, the results were impeccable, with an astonishing 100% patency observed in all 20 IMA grafts and 58 no-touch SVGs examined. Conclusions. The excellent patency rate during the early follow-up period confirmed that the no-touch technique is a good option for surgical revascularization.

AIM Despite advancements in the diagnosis, treatment and monitoring of patients with acute coronary syndrome (ACS), morbidity and mortality following ACS remain high. The aim of this study was to actively seek possible predictors of adverse outcomes after ACS aiming to identify high-risk patients promptly. METHODS This retrospective cohort study investigated patients with ACS hospitalized at Clinical Centre of the University of Sarajevo from 2019 to 2021. Patients were followed up for a period of 12 months post-discharge to assess major cardiovascular events (MACE) and MACE associated independent predictors. RESULTS The study included 121 patients, mostly male 102 (84.3%), with a mean age of 60.83±12.61 years; prevalent risk factors were hypertension 94 (77.7%), dyslipidaemia 84 (69.4%), diabetes mellitus 91 (75.2%), active smoking 67 (55.4%) and positive family history of cardiovascular diseases 81 (66.9%). MACE occurred in 33 (27.3%) patients since the initial ACS, and those patients were older (p=0.012), had higher level of creatinine (p<0.001), lower ejection fraction at discharge (p<0.001) and larger left atrial diameter (p=0.032). Serum creatinine (OR=1.014, 95% CI 1,003-1,026, p=0.017) and ejection fraction (OR=0.924, 95% CI 0,869-0,984, p=0.013) were independent predictors associated with a 12-month follow up MACE following ACS. CONCLUSION Monitoring of serum creatinine level, left atrial diameter, and ejection fraction post-acute coronary syndrome as potential indicators of future MACE within a 12-month follow-up period is of great importance. These findings emphasize the need for tailored management strategies to mitigate risks in this patient population.

Background and Objectives. Distinct pressure curve differences exist between akinetic (A-LVA) and dyskinetic (D-LVA) aneurysms. In D-LVA, left ventricular (LV) ejection pressure decreases relative to the aneurysm size, whereas A-LVA does not impact pressure curves, indicating that the decrease in stroke volume (SV) and cardiac output is proportional to the size of dyskinesia. This study aimed to assess the frequency of A-LVA and D-LVA, determine aneurysm size parameters (volume and surface area), and evaluate predictive parameters using echocardiography in A-LVA and D-LVA. Furthermore, it aimed to compare individual echocardiographic parameters, according to ejection fraction (EF) and SV, with hemodynamic events shown in experimental models of A-LVA and D-LVA and their significance in everyday clinical practice. Materials and Methods. This clinical study included patients with post-infarction left ventricular aneurysm (LVA) admitted to the cardiovascular institute ‘’Dedinje”, Serbia. Echocardiographic volume and surface area of LV and LVA were determined (by the area–length method) along with EF (by Simpson’s method). Results. A-LVA was present in 62.9% of patients, while D-LVA was present in 37.1%. Patients with D-LVA had significantly higher systolic aneurysm volume (LVAVs) (94.07 ± 74.66 vs. 51.54 ± 53.09, p = 0.009), systolic aneurysm surface area (LVAAs) (23.22 ± 11.73 vs. 16.41 ± 8.58, p = 0.018), and end-systolic left ventricular surface areas (LVESA) (50.79 ± 13.33 vs. 42.76 ± 14.11, p = 0.045) compared to patients with A-LVA. The ratio of LVA volume to LV volume was higher in the D-LVA in systole (LVAVs/LVESV). The end-diastolic volume of LV (LVEDV) and end-systolic volume of LV (LVESV) did not significantly differ between D-LVA and A-LVA. EF (21.25 ± 11.92 vs. 28.18 ± 11.91, p = 0.044) was significantly lower among patients with D-LVA. Conclusions. Differentiating between A-LVA and D-LVA using echocardiography is crucial since D-LVA causes greater hemodynamic disturbances in LV function, and thus surgical resection of the aneurysm or LV reconstruction must have a positive effect regardless of myocardial revascularization surgery.

Background and Objectives. In emergency departments, chest pain is a common concern, highlighting the critical importance of distinguishing between acute coronary syndrome and other potential causes. Our research aimed to introduce and implement the HEAR score, specifically, in remote emergency outposts in Bosnia and Herzegovina. Materials and Methods. This follow-up study conducted a retrospective analysis of a prospective cohort consisting of patients who were admitted to the remote emergency medicine outposts in Canton Sarajevo and Zenica from 1 November to 31 December 2023. Results. This study comprised 103 (12.9%) patients with low-risk HEAR scores and 338 (83.8%) with high-risk HEAR scores, primarily female (221, 56.9%), with a mean age of 63.5 ± 11.2). Patients with low-risk HEAR scores were significantly younger (50.5 ± 15.6 vs. 65.9 ± 12.1), had fewer smokers (p < 0.05), and exhibited a lower incidence of cardiovascular risk factors compared to those with high-risk HEAR scores. Low-risk HEAR score for prediction of AMI had a sensitivity of 97.1% (95% CI 89.9–99.6%); specificity of 27.3% (95% CI 22.8–32.1%); PPV of 19.82% (95% CI 18.67–21.03%), and NPV of 98.08% (95% CI 92.80–99.51%). Within 30 days of the admission to the emergency department outpost, out of all 441 patients, 100 (22.7%) were diagnosed with MACE, with AMI 69 (15.6%), 3 deaths (0.7%), 6 (1.4%) had a CABG, and 22 (4.9%) underwent PCI. A low-risk HEAR score had a sensitivity of 97.0% (95% CI 91.7–99.4%) and specificity of 27.3% (95% CI 22.8–32.1%); PPV of 25.5% (95% CI 25.59–28.37%); NPV of 97.14% (95% CI 91.68–99.06%) for 30-day MACE. Conclusions. In conclusion, the outcomes of this study align with existing research, underscoring the effectiveness of the HEAR score in risk stratification for patients with chest pain. In practical terms, the implementation of the HEAR score in clinical decision-making processes holds significant promise.

Aim To analyse the correlation between different surgical methodologies employed in valve diseases treatment and their subsequent impact on the duration of hospitalization. Methods This retrospective study conducted at the Clinical Centre of the University of Sarajevo analysed medical records of 163 valve disease patients treated between January 2019 and November 2022. The patients were divided into two groups: 77 had openheart valve surgery and 86 underwent minimally invasive cardiac surgery (MICS). Results The mean duration of the surgical procedures was 3.9±1.3 hours, with conventional open-heart surgery requiring an average of 3.6±1.1 hours and minimally invasive cardiac surgery (MICS) procedure 4.2±1.5 hours. No substantial disparities were found in the total length of hospitalization between the two groups, as both conventional (8.2±4.5 days) and MICS (8.7±7.0 days) demonstrated similar duration. Similarly, the total duration of intensive care unit (ICU) stay displayed similarity, with conventional surgery patients staying an average of 3.9±2.8 days and MICS patients of 4.2±4.1 days. The pattern of blood transfusion and fresh-frozen plasma usage revealed higher rates in the conventional valve surgery group comparing to the MICS group. Conclusion Minimally invasive valve surgery, despite slightly longer operative times, resulted in lower blood transfusion requirements and comparable hospitalization and ICU stay.

Background: The incidence of HF following ACS remains unacceptably high at discharge and several identified risk factors contribute to the development of HF in this context. Objective: This study investigated the prevalence and clinical significance of HF in patients admitted to the Clinic for Heart, Blood Vessels, and Rheumatic Diseases at the Clinical Center of the University of Sarajevo following ACS. Methods: This retrospective observational study was conducted at the Clinic for Heart, Blood Vessels, and Rheumatic Diseases of the Clinical Center of the University of Sarajevo between February 1st and April 1st, 2023, involving patients who were admitted because of ACS. Results: Patients with HFrEF were significantly (p=0.034) older (70.0 (62.0;76.0) vs 67.0 (57.5;75.0)), had (p=0.046) higher median score of LDH (321.5 (222.3; 501.5) vs. 256.0 (200.0; 420.0)), fibrinogen (p=0.047) (4.5 (3.2; 5.1) vs 3.6 (2.8; 5.0)), and NT-proBNP (p<0.001) (3705.0 (2500.0; 12559.5) vs. 500.0 (275.0; 333.0)), had enlarged left atrium diameter (3.9 (3.4; 4.4) vs 3.6 (3.1; 4.1)), enlarged left ventricular diameter both in diastole (5.1 (4.5; 5.8) vs 4.6 (4.1; 5.1)) and systole (3.7 (3.2; 4.1) vs 3.5 (3.1; 3.7)), thinner interventricular septum diameter both in diastole (1.1 (1.0; 1.2) vs 1.2 (1.1; 1.3)) and systole (1.3 (1.2; 1.5) vs. 1.4 (1.3; 1.5)) and elevated right ventricular systolic pressure (37.0 (30.0; 47.5) vs. 35.0 (28.0; 40.0 )) compared to patients without HFrEF. Severe mitral regurgitation was more observed in group of patients with HFrEF (p<0.001). Conclusion: HFrEF patients showed a 40% incidence of post-ACS, had elevated LDH, fibrinogen, and NT-proBNP levels, along with distinct echocardiographic differences, including enlarged heart chambers and higher mitral regurgitation rates following ACS. Early HF risk factor management is crucial for optimizing outcomes in ACS patients.

Background: Out-of-hospital cardiac arrest (OHCA) refers to the cessation of mechanical cardiac activity outside healthcare facilities which requires prompt intervention and intensive resuscitative efforts. The COVID-19 pandemic has caused significant disruptions to OHCA systems-of-care, adversely affecting every component of the chain of survival. Objective: The objective of this study was to examine the potential impacts of the COVID-19 pandemic on OHCA events, to draw comparisons between the period before and during the COVID-19 pandemic. Methods: This cross-sectional study encompassed data pertaining to all OHCA incidents attended to by the Emergency Medical Service of Canton Sarajevo, covering the period from January 2017 to December 2022, before and during the COVID-19 pandemic. Results: During observed period, a total of 1418 [796 (56.1%) before and 622 (43.9%) during COVID-19 pandemic] OHCA events have occurred in Canton Sarajevo of which 297 (20.9 %) [180 (12.7%) before and 117 (8.2%) during COVID-19 pandemic] obtained ROSC. After a 30-day period following the ROSC) it was observed that the predominant outcome, accounting for 181 (12.7%) [106 (7.4%) before and 75 (5.2%) during COVID-19 pandemic] of cases, was a complete recovery. An examination before and during COVID-19 pandemic revealed a decline in OHCA during the year 2021 and 2022 when COVID-19 pandemic was at its highest in the country Being younger, quicker EMT response time and individuals with the initial rhythm of VF or VT were significantly associated with obtaining ROSC (p<0.05). Only 48 (3.3%) of 1418 OHCA events were assisted by bystanders There was no report of AED usage. Conclusion: In conclusion, our investigation highlights the impact of the COVID-19 pandemic on OHCA events in Canton Sarajevo, revealing a decrease in OHCA incidence and a reduction in cases achieving ROSC. Notably, EMT response time was shorter during the pandemic.