Accessory mitral valve tissue (AMVT) is an extremely rare congenital cardiac abnormality in adults. Patients typically present with symptoms and signs of left ventricular (LV) outflow tract (LVOT) obstruction. LVOT obstruction caused by AMTV was diagnosed mostly in the first decade of life. However, isolated cases of AMVT with LVOT obstruction in adulthood are uncommon (1, 2). This paper reports a case of an adult patient aged 56 years with severe LVOT obstruction and severe mitral regurgitation (MR) caused by AMVT.

Background: Cardiac myxoma is the most common benign tumor of the heart. It presents with a variety of clinical signs and symptomatology making diagnosis frequently quite a challenge. Objective: The aim of this article is to present a case report of giant right atrial myxoma with symptoms of right heart failure in adult patient. Case report: We present a case of large right atrial myxoma which is an uncommon location for this type of heart neoplasms, discovered incidentally in a female patient 77-year-old who came to our polyclinic for cardiological exam with hypertension last 11 years and obesity. Results and Discussion: Various clinical signs and symptoms produced by cardiac myxomas have been reported in the literature. Depending on location and morphology, cardiac tumors can produce four types of clinical manifestations: systemic-constitutional, embolic, cardiac, and secondary metastatic manifestation. Echocardiography as non-invasive imaging method and Transesophageal echocardiography has superior role for precise evaluation of cardiac tumors. Transesophageal echocardiography has superior role for accurate diagnostic evaluation of cardiac mass. Surgical excision of cardiac myxoma carries a low-operative risk and gives excellent short- and long-term results. Conclusion: Myxoma is the most prevalent primary heart tumor. It is rare to find a myxoma in the right atrium, occurring only in 15-20% of myxoma cases. Clinical manifestations of myxomas consist in a triad: constitutional symptoms, embolization and intracardiac obstruction. Transesophageal echocardiography has superior role for precise evaluation of cardiac tumors. Currently, there is no effective medical treatment, and surgical excision of the tumor is necessary.

ACCEPTED: December 18, 2020 Aim: To present a therapeutic modality of peripartum cardiomyopathy (PPCM). Case report: A 24-year-old female patient, with no prior known diagnosis, was admitted to the Department of Cardiology with signs of acute heart failure. A 45 days prior to admission she delivered a healthy baby (first pregnancy) via cesarean section, while 20 days before hospitalization she developed symptoms like dyspnea, orthopnea, fatigue, weakness and extremely low tolerance to effort. Upon admission on X-ray, heart shadow was enlarged and, while on electrocardiogram (ECG) there was a sinus tachycardia with negative T waves from V1-V5. Echocardiography on admission showed initial dilatation of cardiac chambers, reduced ejection fraction of left ventricle (EFLV; estimated about 25%) with global hypokinesia, signs of moderate to severe mitral and tricuspid regurgitation with mild pulmonary hypertension, along with hemodynamically nonsignificant circumferential pericardial effusion (diastolic separation of 8mm). Laboratory findings were as follows: NT-pro BNP 1810.0 pg/mL; signs of anemia, while inflammatory parameters, cardiac necrosis markers, urea, creatinine, D-dimer and thyroid hormones values remained in reference values. Testing for known cardiotropic viruses was not positive and PPCM was diagnosed. The patient was treated with cardio selective beta blocker (metoprolol), angiotensin-converting enzyme (ACE) inhibitor (ramipril), diuretics (furosemide), spironolactone, and digoxin along with supportive therapy. After twelve days of hospital treatment, there was significant improvement of the clinical status of our patient. Her symptoms were notably ameliorated. EFLV before discharge improved to 40%, heart chambers dimensions were in referral values, while mitral and tricuspid regurgitation were significantly reduced into a mild grade, while pericardial effusion was also in regression. Follow-up examination after two and six months showed further improvement of patients’ conditions while after six months only beta-blocker and acetylsalicylic acid were prescribed in therapy.

Anomalous origin of the left coronary artery (LCA) from the pulmonary artery (ALCAPA) syndrome is a potentially lethal and rare congenital cardiac anomaly (for approximately 1 in 300,000 live births). 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. When pulmonary arterial pressure decreases, it results in reversal of flow so that LCA drains from the right coronary artery through collateral vessels into the pulmonary artery. This phenomenon causes ischemia or eventually infarction of the anterolateral left ventricular wall. Sudden death may occur because of inadequate collateral circulation between LCA and the right coronary artery and/or development of arrhythmia. ALCAPA can be found both in infants and in older individuals, with the absence or presence of strong collateral circulation from the right coronary artery, with different clinical presentations. Clinical diagnosis of ALCAPA can be demanding. Findings can be similar to those in dilatative cardiomyopathy and the diagnosis of ALCAPA has to be excluded, principally in the presence of ischemic ECG findings. 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 paper presents 3 patients with ALCAPA syndrome as well as the variations in their age, clinical presentation, modality of treatment (pharmacological treatment, surgical correction and percutaneous coronary stent implantation after graft obstruction) and outcome.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is rare, but life-threat-ening condition. The treatment of choice in patients with ALCAPA is the establishment of a dual coronary artery system with surgical reimplantation of the left coronary artery in the left coronary sinus. Percutaneous coronary intervention is infrequent in the pediatric population but can be a life-saving by promptly restoring flow to an obstructed coronary artery. It is a highly demanding and high-risk procedure in infants due to the technical difficulties and the small coronary artery diameter in infants.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is rare, but life-threatening condition. The treatment of choice in patients with ALCAPA is the establishment of a dual coronary artery system with surgical reimplantation of the left coronary artery in the left coronary sinus. Percutaneous coronary intervention is infrequent in the pediatric population but can be a life-saving by promptly restoring flow to an obstructed coronary artery. It is a highly demanding and high-risk procedure in infants due to the technical difficulties and the small coronary artery diameter in infants.

Introduction: Modern pediatric cardiology mainly deals with congenital heart defects (CHD), as the most common congenital anomalies. In most cases CHD requires surgical or interventional treatment. Goal: The goal of the research was to evaluate CHD treatment at Pediatric Clinic, University Clinical Center (UCC) Sarajevo, Bosnia and Herzegovina (B&H). UCC Sarajevo is the only institution in B&H where cardiac treatment of CHD in pediatric population is performed. Pediatric cardiosurgery has started to develop in Bosnia and Herzegovina in April 1997. Patients and methods: Study included 745 patients (period from April 1997 to January 2017). Results: Cardiac treatment was performed on 745 patients with CHD, 541 (72.6%) of them were acyanotic patients and 204 (27.4%) were cyanotic patients. Reoperation was performed in 49 (6.5%) of patients. Out of total number of patients, 59 (7.9%) died. In 660 children (88.5%) a complete correction and in 85 (11.5%) a palliative operation/correction was performed. Defects with left to right shunt were present in 397 (53.2%) patients, complex heart defects with Tetralogy of Fallot in 173 (23.2%), obstructive heart defects in 106 (14.2%), obstructive heart defects with shunt in 53 (7.1%), and others in 16 (2.1%) of patients. During surgery, extracorporeal circulation was regulated in 554 (74.3%) patients. Peri and early postoperative complications occurred in 180 (24.1%) of patients. During this period 24 pacemakers were implanted and 24 radiofrequency ablations were performed. Conclusion: Results of CHD cardiac treatment in childhood, which took place simultaneously, followed by the contractual joint programs and individual work of the Bosnian and Herzegovinian team has reached the highest level in the last two years, not only by the number, type and complexity of corrected CHD, but also by the age and body weight of the patients who underwent surgery, and development of invasive procedures, arrhytmology, pacemaker placement, intensive peri and postoperative treatment. That led pediatric cardiac surgery of UCC Sarajevo, to a position of leading center in the region.

Introduction: This study evaluated the frequency of domination of the coronary arteries types in patients treated by surgical myocardial revascularization. The aim of the study was to determine whether the left coronary circulation dominance is a prognostic factor for poorer outcome in patients undergoing coronary artery bypass surgery. Material and methods: A total sample consisted of 100 patients with coronary artery disease that were treated with coronary artery bypass grafting at the Clinic for Cardiac Surgery, Clinical Center of the University of Sarajevo. To all patients on the basis of preoperative coronary angiography was determined the dominance of the coronary arteries. Patients included in the study were divided into two groups, with the left and right with coronary dominance. Results: Left coronary dominance in a sample of patients was present in 21/100 (21%), right in 69/100 (69%) and balanced in 10/100 (10%) cases. Female gender was significantly more frequent in patients with left coronary dominance and proved to be a stronger predictor of poorer outcome, especially in combination with left main stenosis of the left coronary artery and left coronary dominance. Inability of revascularization of the r. interventricularis posterior (RIVP) was statistically significantly higher in case of left dominance 9/21 (42.9%), compared to the right 16/79 (20.3%), p=0.033. Lethal outcome was more common in case of left dominance in relation to the right (9.4% vs 0.9%). The incidence of surgical complications, respiratory, neurological and renal complications was not significantly different between groups, while the length of hospital stay was significantly higher in the group of patients with left dominance, p = 0.003. Conclusion: Left coronary dominance is an important risk factor for patients undergoing surgical myocardial revascularization.

The experimental and clinical efforts of Demikov and Kolesov between 1952 and 1964 related to coronary anastomosis between the internal thoracic artery and left anterior descending artery on a beating heart. Sones and Shirey (Cleveland, 1962) were pioneers of selective coronary angiography. The first coronary artery bypass grafting using a saphenous vein graft was performed by Garrett, Dennis, and DeBakey in Houston in 1964. Since that time, coronary surgery has become one of the most frequently performed surgical procedures in the world. Coronarography can be considered the golden standard of diagnostics. Current supplements to coronarography are: functional assesment of the fractional flow reserve; intravascular ultrasound; and optical coherence tomography, for the estimation of atherosclerotic plaque. When combined, these techniques provide high-quality diagnoses. Diagnostic coronarography is followed by percutaneous coronary procedures, the results of which are comparable to those of coronary surgery. Prerequisites of coronary artery bypass grafting (CABG) are grafts and vascular conduits. Alternative flow into ischaemic myocardial territory takes place across these vascular conduits. Usage of the left internal mammary artery is a proven superior standard in operative surgery, due to its better survival rates and prevention of massive myocardial reinfarction. Saphenous vein grafts are most frequently used in the myocardial territory that is not supplied by the left anterior descending artery. In 2018, we will have the final results of the ART trial, which is testing the usage of arterial grafts in coronary surgery. Preliminary results show superiority of the right internal mammary artery as a graft when compared with other arterial grafts (except the left internal mammary artery). Nowadays, myocardial revascularisation with cardiopulmonary bypass is perfomed in 7580% of cases. Off-pump coronary artery bypass (beating heart) surgery is performed in 20% of cases. Besides these procedures, there are less invasive procedures such as minimal invasive direct coronary bypass (MIDCAB), totally endoscopic coronary bypass (TECAB) and

The experimental and clinical efforts of Demikov and Kolesov between 1952 and 1964 related to coronary anastomosis between the internal thoracic artery and left anterior descending artery on a beating heart. Sones and Shirey (Cleveland, 1962) were pioneers of selective coronary angiography. The first coronary artery bypass grafting using a saphenous vein graft was performed by Garrett, Dennis, and DeBakey in Houston in 1964. Since that time, coronary surgery has become one of the most frequently performed surgical procedures in the world. Coronarography can be considered the golden standard of diagnostics. Current supplements to coronarography are: functional assesment of the fractional flow reserve; intravascular ultrasound; and optical coherence tomography, for the estimation of atherosclerotic plaque. When combined, these techniques provide high-quality diagnoses. Diagnostic coronarography is followed by percutaneous coronary procedures, the results of which are comparable to those of coronary surgery. Prerequisites of coronary artery bypass grafting (CABG) are grafts and vascular conduits. Alternative flow into ischaemic myocardial territory takes place across these vascular conduits. Usage of the left internal mammary artery is a proven superior standard in operative surgery, due to its better survival rates and prevention of massive myocardial reinfarction. Saphenous vein grafts are most frequently used in the myocardial territory that is not supplied by the left anterior descending artery. In 2018, we will have the final results of the ART trial, which is testing the usage of arterial grafts in coronary surgery. Preliminary results show superiority of the right internal mammary artery as a graft when compared with other arterial grafts (except the left internal mammary artery). Nowadays, myocardial revascularisation with cardiopulmonary bypass is perfomed in 7580% of cases. Off-pump coronary artery bypass (beating heart) surgery is performed in 20% of cases. Besides these procedures, there are less invasive procedures such as minimal invasive direct coronary bypass (MIDCAB), totally endoscopic coronary bypass (TECAB) and

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.

This paper presents the way of successful implementation of client-server applications in Heart Center Sarajevo. Joint work of IT experts and medical experts from the clinic resulted in a software solution for the automatisation of work procedures.

INTRODUCTION Intraoperative transesophageal echocardiography (TEE) is a useful tool during valvular, great vessels and CABG surgery. In several large studies TEE has been shown to have higer sensitivity than TTE for native valve (94-100% vs. 44-63%) and prosthetic valves (75% vs 25%) both have high specificity (91-98%). TEE has got its value, particularly when surgeon intends to repair diseased valves, which are favorable operations due to its better survival rate, better ventricular function and fewer tromboembolic events. Most commonly valve repairs performed in patients with mitral and tricuspid valve diseases although reparative procedures have been described for all valve positions. AIM Our aim is to define how important is TEE during mitral valve repairing operations. PATIENTS AND METHODS At our institution, during five years period (between may 1999. and may 2004.) 29 patients have been operated with mitral valve repairing and monitored by TEE intraoperatively. They all went through preoperative preparations at the Clinic for Heart diseases and rheumatism, as well as Cardiology dept. of Cardiac surgery clinic KCU Sarajevo. We were following ASE/SCE guidelines for intraoperative examination during four different intraoperative mitral valve surgery stages, using Siemens ultrasound machine Sonoline Versa Plus with TEE multiplane probe type MPT-4. RESULTS For 20 pts. (71%) mitral valve repairing has been performed solely, in 9 (29%) pts. combined mitral and tricuspide valves repairing. In two cases (6,9%) after not satisfied repairing cardiac surgeon had to replaced native (previously repaired) mitral valve with mechanical prosthesis. 7 pts. (24%) got Carpantier rings and others 22 (76%) have been operated with pericardium patch. CONCLUSIONS IOP TEE proved to be very useful in determination of the nature, severity and egzact anatomic location (scaloping) of the mitral and other valves disorders, in assessment of the urgency and feasibility of valves reparation and in plaining of the surgical procedures. In the case of poor surgical valve reparations, intraoperative TEE is the first method of choice in monitoring the process of valve reparation and in estimating the time for valve replacement.