Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) syndrome is a rare congenital cardiac anomaly. ALCAPA syndrome mostly presents in the first few months of life. Left untreated, the mortality rate in the first year of life is 90% secondary to myocardial ischemia or infarction and mitral valve insufficiency leading to congestive heart failure. Sudden death may occur because of inadequate collateral circulation between the left and right coronary artery systems and/or development of arrhythmia. Currently, the prognosis for patients with ALCAPA syndrome is dramatically improved as a result of both early diagnosis and improvements in surgical techniques, including myocardial preservation. This case report presents a four month old infant with ALCAPA syndrome including clinical presentation of severe cardiomyopathy and left-sided heart failure. Child was operated for reimplantation of ALCAPA to aortic root with satisfactory outcome.

Types of acquired heart disease among children include: cardiomyopathy, endocarditis, myocarditis, pericarditis, Kawasaki disease, arrhythmia, hypertension, rheumatic fever, and obesity. These are diseases that occur after birth, as opposed to congenital heart disease, which is present at birth. Acquired heart disease in children constitutes diagnoses which do not occur in adults (eg. Kawasaki disease), or which may be similar to conditions present in adolescents and adult patients (eg. dilated cardiomyopathy). Most frequently diagnosed are rheumatic fever and Kawasaki disease. Children who are diagnosed and treated for congenital heart disease are at higher risk of developing endocarditis and cardiomyopathy. Although heart disease in childhood has a complex aetiology – and is often caused by unknown factors – a wide palette of diagnostic tests is required to determine its cause, including: genetic, echocardiography, X-ray, MRI, CT, heart catheterisation, endomyocardial biopsy, and nuclear studies. Pathological process directly affects cardiac structures, causing myocardial dysfunction. If myocardinal function is suspected, it is necessary to take a detailed history of the disease, along with a physical examination, and apply a diagnostic and therapeutic algorithm in order to stabilise a haemodynamically compromised patient with acquired heart disease.

Introduction: Despite recent advances in anesthesia, cardiopulmonary bypass and surgical techniques, children undergoing congenital heart surgery require postoperativemechanical ventilation. Early extubation was definedas ventilation shorter than 12 hours. Aim of this study is to identify factors associated with successful early extubation after pediatric cardiac surgery.Methods: The study was performed during period from January 2006 to January 2011 at Pediatric Clinic and Heart Center University Clinical center Sarajevo. One hundred children up to 5 years of age, who have had congenital heart disease, with left–right shunt and obstructive heart disease were included in the study. Patients were divided into two groups: Group I - patients extubated within 12 hours after surgery and Group II - patients extubated 12 or more hours after surgery. Results: The most frequently encountered preoperative variables were age with odds ratio 4% 95%CI (1-7%), Down's syndrome 8.5 95%CI (1.6-43.15), failure to thrive 4.3 95%CI( 1-18). Statistically significant postoperative data included lung disease (reactive airways, pneumonia, atelectasis, pneumothorax) and with odds ratio 35.1 95 %CI (4-286) and blood transfusion with odds ratio 4.6 95%CI (2-12). Blood transfusion (p=0.002) (Wald=9.2) 95%CI (2-12), during as well as after operation procedure has statistically significant influence on prediction time of extubation. Proven markers were age with cut of 21.5 months (sensitivity 74% and specificity 70%) and extracorporeal circulation (ECC) with cut-of 45.5 minutes (sensitivity 71% and specificity 65%).Conclusion: Early extubation is possible in many children undergoing congenital heart surgery. Younger age and prolonged ECC time are markers associated with prolonged mechanical ventilation.

Introduction: Transcatheter closure is a treatment choice for the most children with patent ductus arteriosus (PDA). The closure of the ductus is indicated in any child or adolescent with developed symptoms of significant L-R shunt. The aim of this article is to present our results in 5 years treatment of patients with PDA and their outcome. Methods: From 2009 to 2014, 30 patients underwent a transcatheter closure of PDA at Centre for Heart and Pediatric clinic of Clinical University Centre of Sarajevo. Aortic angiogram was performed to evaluate the size, position, and shape of the duct for selection of appropriate occluder device type and size. All procedures were performed by local team of cardiologists from the Department of Cardiology, Pediatric clinic, with invasive cardiologists team from Sweden and Austria. Echocardiography was repeated at intervals of 24 hours, then 1month, 3 months, and 1 year after the procedure to assess the outcome. Results: Thirty patients underwent transcatheter closure of PDA during the study period. PDA of ≤ 2.0 mm was present in 8 patients and they underwent PDA closure with coils, while 22 patients had PDA diameter  ≥ 2 mm, and they were treated by Amplatzer duct occluder (ADO). Only in 2 (6.2%) patients complications have been observed. The length of hospital stay after the treatment was two to three days. Conclusion: Transcatheter closure of PDA is a modern, safe and efficient method that ensures a faster recovery of the patients, shortens the length of hospitalization.

OBJECTIVE Endocarditis can have profound and devastating neurological consequences, with the vast majority of these complications in patients with left-sided valvular disease. The approach to the acute management of stroke in children with infective endocarditis is limited by the inadequacy of published data on their clinical course and outcome. CASE REPORT This case report presents a 12 year old girl with diagnosed endocarditis, complicated with intracranial hemorrhage, due to the rupture of an aneurysm of the peripheral branch medial cerebral artery and gradient therapeutic approach, with an excellent final result. CONCLUSION Congestive heart failure resulting from valvular insufficiency required mitral valve replacement, after cerebral aneurysm clipping.

Introduction Despite recent advances in anaesthesia, cardiopulmonary bypass and surgical techniques, children undergoing congenital heart surgery require postoperative mechanical ventilation. Early extubation was defined as ventilation shorter than 12 h. Aim To identify markers associated with successful early extubation after paediatric cardiac surgery. Methods Retrospective-prospective clinical study was performed in Paediatric Clinic and Heart Centre Clinical Centre Univerity of Sarajevo during period from 01.01.2006. till 01.01.2011. Study included 100 children up to 5 years of age with congenital heart disease with left–right shunt and opstructive congenital heart disease, Patients were devided into two groups: I Group-54 patients extubated within 12 h after surgery and Group II- 46 patients extubated more then 12 h after surgery. Results The most frequently encountered preopeartive variables were age with odds ratio 4% 95% CI(1–7%), Down’s syndrome 8,5 95% CI (1,6–43,15), failure to thrive 4,3 95% CI(1–18). Statisticly significant postoperative data included lung disease (reactive airways, pneumonia, atelectasis, pneumothorax) and with odds ratio 35,1 95% CI (4–286) and blood transfusion with odds ratio 4,6 95% CI(2–12). Proven markers were age with cut of 21,5 months (sensitivity 74% and specificity 70%) and extracorporeal circulation (ECC) with cut of 45,5 min (sensitivity 71% and specificity 65%). Conclusion Younger age and prolonged time ECC are markers associated with prolonged mechanical ventilation.

OBJECTIVE To determine the reliability of transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) in predicting the size of an atrial septal defect (ASD). MATERIAL AND METHODS The study included 16 patients who underwent the catheter-based procedures to close an atrial septal defect between February 2008 and December 2011 at the Paediatrics Clinic, CCU Sarajevo, after clinical and TTE and TEE evaluation. In order to determine the assumed diameter of the balloon (A-SBD), we used the formula of quantification A-SBD=TTE defect diameter×1:09 + 3.9 mm and A-SBD=1.1× transesophageal diameter of ASD+2.0 mm. The ASD was examined using the long-axis view, the basal short-axis view, the apical four-chamber view and the subcostal view to observe its position, diameter and relation to neighbouring structures. The largest diameter was selected as the reference diameter. RESULTS Of the total number of treated patients, 11 were female. Treatment was conducted by a foreign and local team of invasive cardiologists. The average age of the patients was 8.43 years (2 -17 years). Apart from a transient disturbance of rhythm in the youngest patients, there were no other intra and postprocedural complications. The obtained formulas represent "our" default size of the SBD, based on measurements of TTE and TEE: A-SBD (TTE)=6.02+0.86×TTE and A-SBD (TEE)=3.93+0.86×TEE. CONCLUSION ASD diameter determined by TTE and TEE can reliably determine the appropriate size needed Amplatzer Septal Occluder device.

Introduction Gastrooesophageal reflux disease (GERD) could be one of the causes of chest pain with or without Helicobacter pylori (HP) infection. Aim To evaluate origin of chest pain and to correlate positive history of chest pain and gastrointestinal system diseases. Subjects and Methods During 01.01.2005. to 01.01.2008., 352 patients age 4 to 18 years, from Cardiology and Gastroenterology department of Paediatric clinic of CCU Sarajevo with history of chest pain were investigated. The evaluation was done by protocol: history, physical examination, ELISE test on HP, oesophagogastroduodenoscopy (EGDS) with biopsy and histological examination, Holter ECG, echocardiography, psychogenic assessment and laboratory parameters. Results From 352 investigated patients with chest pain, 80 (22.7%) were ELISE HP and EGDS biopsy positive, 64% pts were females. Patients were divided in groups: I: age 4–11 years (with in 21.2% positive findings), II: age 11–15 years (HP+ in 56.2%), and group III age 15–18 years with in 22.6% positive HP findings. Laboratory parameters were normal. Psychogenic findings were positive in 12.5% pts. By ECG Holter in 3.6% a premature extrasystole were detected. Patients with HP infection were treated according therapeutic protocol with proton pump inhibitors plus two antibiotics for 4 weeks. During follow up post therapy period of six months, there were no subjective or clinical signs of chest pain in 52.5% patients. Conclusion The cause of chest pain in this study, in presence of HP infection was detected in statistically significantly higher percentage in older groups of patients. With appropriate therapeutic treatment, chest pain symptoms were solved.