Objective - The purpose of this investigation was to determine the frequencies and types of associated congenital heart disease and other cardiac lesions in children with congenital anomalies of the kidneys and urinary tract (CAKUT). Participants and method - This was a prospective cardiac evaluation of children with diagnosed CAKUT, conducted between January 2013 and December 2015 at the Department of Pediatrics of the University Clinical Hospital, Tuzla. All cases were reviewed for age, gender, consanguinity, occurrence of congenital heart disease (CHD) and CAKUT in family history. Cardiac examination included: physical examination, noninvasive blood pressure measurement, a twelve lead electrocardiogram and echocardiogram. Results - Complete cardiac examination was performed in 144 children with congenital anomalies of the kidneys and urinary tract. Clinically insignificant morphological or hemodynamical changes were noted in 13% or 9.0% children. Congenital heart disease was found in 32 (22.2%), hypertrophic cardiomyopathy in 2 and pulmonary hypertension in 1 of the 144 children. In 4 children congenital heart disease was part of other known genetic syndromes, and all of these cases had severe CHD. In twenty-six or 76.5% of the total of 32 patients it was already known, and in 6 (23.5%) CHD was discovered during this research. Ventricular septal defect was the most common malformation (13% or 40.6% of patients). Vesicoureteral reflux was the most frequent CAKUT associated with CHD. Conclusions - The results of this study showed a significant association between CAKUT and CHD. Therefore we suggest performing cardiac assessment of all children with CAKUT.

A 6.6-year-old girl presented for leftsided cardiac enlargement on chestradiography (Panel A). Th ree yearsearlier she had undergone a lobectomyof the lower lobe of the leftlung for extraction of an echinococcalcyst.

An otherwise healthy, 12.5-year-old malepresented with sudden onset chest pain, wasadmitted to hospital for elevated blood pres-Panel 1Panel 2Acta Medica Academica 2011;40(1):83DOI 10.5644/ama2006-124.12sure. Physical examination showed systolicheart murmur grade 2/6 in the aortic areawith abdominal vascular murmur and normalperipheral pulses. Blood pressure waselevated: (left arm) 170/110 mmHg, (left leg)185/115 mmHg. The plasma renin activity(6.5 nmol/l/h) was elevated. Renal functionwas normal. Doppler blood flow fromboth renal arteries showed a suspected mildobstruction.

Objective – The research was undertaken with the aim of establishing the range and frequency of congenital heart disease (CHD) in children with Down syndrome (DS), who are monitored at paediatric cardiology centres in Bosnia and Herzegovina, its association with other anomalies, the time of diagnosis of DS and CHD, and to analyse their surgical care.  Patients and methods – By a cross-sectional study, data was collected on children aged from 0 to 18 years with DS and CHD who were monitored at paediatric cardiology centres of primary, secondary and tertiary health care (Banja Luka, BihaA‡, Bijeljina, Mostar, Sarajevo, Tuzla and Zenica) in Bosnia and Herzegovina.  Results – Data for 100 children (51 boys and 49 girls) of an average age of 6.1 (from 0 to 17.1) were collected and analysed. The most frequently diagnosed CHD was atrioventricular septal defect, which was found in 36% of children followed by ventricular septal defect in 33%. In 79% children the CHD was isolated and 21% had multiple heart anomalies. Associated anomalies of other systems were found in 26% of children. In only one case was an intrauterine suspicion of DS established. A statistically significant reduction in the age of post-natal diagnosis of DS and CNHD was registered. In 73% patients cardiosurgical treatment was indicated, 43% underwent surgery, 19% are waiting for surgery and in 11% pulmonary hypertension developed.  Conclusion – The range of CHD found in children with DS in Bosnia and Herzegovina does not differ from most similar research. The results obtained show that in the period in question there was insufficient prenatal diagnostics of DS and CHD. Postnatal diagnostics, although also insufficient at the beginning of the period in question, significantly improved over time, which resulted in a reduction of the age at which the diagnosis of DS and CHD was established. Moreover there was a clear reduction in the time difference between the diagnosis of DS and the diagnosis of CHD. However, the possibilities of early cardio-surgical treatment are still limited. The results should serve in drawing up a plan of prospective monitoring of these patients in Bosnia and Herzegovina in order to define better their specific health needs.