This study has been conducted in an effort to establish more suitable and accurate scoring model we use in everyday practice. Among the specific outcome prediction models, in 1989 Parsonnet et al elaborated a method of uniform risk stratification for evaluation of the results of cardiac surgery procedures. We have tested two forms of the Parsonnet score, Initial and Modified Parsonnet score, in our patients. In the first half of the year 2007, 145 patients were operated in Sarajevo Heart center. All operated patients in that period, have participated in this study. The overall hospital mortality was 4,13 (6 deaths). This study shows that the initial and modified Parsonnet's scores are predictive for operative mortality in adult cardiac surgery patients.

Nomenclature Historical Pages cardiogram, suggesting coronary ostial involvement, were also observed. Echocardiography documented severe aortic regurgitation. Emergency root replacement with a valved conduit was performed with open distal repair at 24 8C, employing selective antegrade cerebral perfusion. Cardiopulmonary bypass, cardioplegic arrest and antegrade cerebral perfu-sion times were 293, 141, and 22 min. The patient was weaned from extracorporeal perfusion with a 0.04 mgykgy min epinephrine infusion. Neurocognitive function improved after a period of coma, and progressively returned to baseline. The only neurological motor deficit was temporary right upper hemiparesis. Computed tomograms documented a right-sided hemispheric stroke, and reperfused arch vessels despite residual arch dissection (Fig. 2). The patient was discharged from the intensive care unit 36 days after surgery. 3. Discussion Medical therapy for type A acute aortic dissection yields unfavourable results. Although successful repair has been reported, preoperative stroke and especially coma are usually considered contraindications for immediate surgery w2–5x, in spite of the absence of criteria to define irreversible brain damage preoperatively. In the first patient, short-term delayed repair was performed after resuscitative measures in the comatose patient, and the timing of the indication was primarily based on the resumption of initially absent brainstem reflexes, whereas the second patient underwent immediate surgery. The postoperative period was temporarily characterized by profound coma, but late recovery was dramatic in apparently hopeless conditions. This suggests the possible benefits of immediate restoration of cerebral blood flow, even in case of altered or absent brainstem reflexes, and outlines the unreliability of the widely adopted Glas-gow coma scale for patient stratification, as previously outlined in a small case series by our group in which, the preservation of brainstem reflexes was considered a criterion to indicate emergent repair w5x. It might also be speculated that, in case of partial compression of the arch vessels, neurological dysfunction may have a higher potential for recovery. Finally, P300 peak latencies recorded with cognitive evoked potentials represent a useful tool to evaluate neurocognitive function, and are normally increased soon after open-heart operations w6x. In our first patient, the P300 latency recorded-2 months after the acute event, was only mildly increased when compared to healthy controls, and was similar to measurements after valve surgery. Our experience stresses the potential for reversibility of dissection-induced neurological injury, and confirms a higher likelihood of a more severe ischaemic insult in right-sided territories. Extensive arch surgery was not performed because of the absence of …

Coronary artery aneurysms (CAAs) are rare and their management is controversial. Their incidence varies from 1,5% to 5% of the coronary angiographies, with predilection of the right coronary artery. Unruptured coronary aneurysms are often silent and may remain undiagnosed. The etiology can be either congenital or acquired. We describe a case of a left anterior descending artery (LAD) aneurysm treated with an off-pump surgical revascularization with a LIMA to LAD without exclusion or ligature of the aneurysm.

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 Patients benefit, reduction of treatment costs, as well as providing data needed for the science progress, are only some of the items that implicate the importance of preoperative evaluation of operative risk and mortality. In order to determine the risk profile of adult cardiac patients and identify the mortality in different procedures, a set of multicentric clinical studies has been carried out in the past decade. A study involving 19030 patients in 128 centers from 8 European countries was conducted at the end of 1995. Product of that study is EuroSCORE (European System for Cardiac Operative Risk Evaluation). PATIENTS AND METHODS In this survey we will point out the results of two different EuroSCORE forms (Additive and Logistic) which we applied in 145 cases of patients operated in Sarajevo Heart Center in the first half-year of 2007. RESULTS From 145 procedures 124 (85%) was bypass procedures, 18 (12.4%) valvular and 3 (2,6%) other procedures (dissection of AA, mixoma LA). CONCLUSION Aditive EuroSCORE model is use friendly and simple for bedside use. In mortality prediction Logistic EuroSCORE is more sensitive (exclude mortality in larger patient groups), and is also more precise in mortality prediction in all groups of patients.

Our aim was to evaluate risk stratification model, European System for Cardiac Risk Evaluation (logistic EuroSCORE) for patients treated in clinical hospital. EuroSCORE is useful to separate patients into risk groups so that the mortality and morbidity risk can be compared. From 1st January 2006 to 31st July 2006 the total of 124 adults have been operated and were classified according to the EuroSCORE algorithm. We have compared correlation of the predicted mortality and observed mortality (as death within the 30 days following the operation) and frequency of postoperative complications. All patients were divided into three risk groups. The low risk group had 30 patients with 0 death (0%) and 1 morbidity (3,33%). The medium risk group had 59 patients with 0 death (0%) and 4 morbidity (6,77%). The high risk group had 35 patients with 2 death (5,71%) and 5 morbidity (14,28%). Mortality in our clinic is much less than predicted mortality and we can be satisfied with our results. Incidence of complications after cardiac surgery is between 25 and 40% (STS database). Our results are within that range. We recommend logistic version of EuroSCORE as good and simple method to predict postoperative prognosis.

Patients with Sy. Marfan, in their great number, find the problem with pathological findings on the heart, but the most dealing complications of this illness are rupture and dissection of aneurismatic aorta. Carefully approach, adequate intervention and what kind of treatment decision, may upgrade quality of the lifestyle and prolong lifespan in this patients. However, the most common death cause in those patients is still rupture of aorta. Treatment of the patients with this problem should go in direction that solves dissection, aortic insufficiency and malperfusion Sy. The most dissection cases are solved by implantation of the valve conduit and reimplantation of the coronary orifices. Some surgeons prefer preservation of the aortic valve, therefore others establish complication prevention pattern with applying surgical treatment before appearance of the complications. In this study we would like to present experience of the Sarajevo Heart Center and our results in the 6 Marfan Sy. cases, within the last two years. We were in position to witnes strong hereditary connection among father and his two daughters who have the same illness. Complications caused by Marfan were successfully removed by surgical treatment. Surgical treatment consists of replacing ascending aorta and in same time replacing coronary ostia using Shelhigh-stentless valve conduit. The same surgical procedure we have performed on two sisters resulted with repair of dissection in first sister's case, and acted complication preventive to the other sister. All this facts indicate necessity for the closeness of the center that is, with experience of employees and their medical and surgical capability, versatile to treat and improve lifestyle to people with Marfan.

The aim of this study is to compare the effects of colloidal cardioplegia and blood cardioplegia in patients who underwent cardiac surgical procedures with cardiopulmonary bypass, and to evaluate their influence on hemodilution, bleeding and consumption of donor blood products in a retrospective clinical study. 100 male patients who underwent cardiac surgical procedure were divided into two groups: 50 patients were administered intermittent normotherm or mild hypotherm (34 degrees C) Calafiore blood cardioplegia with potassium chloride 14,9%; 50 patients were administered one initial doses of cold Kirsch - solution followed from intermittent cold colloidal cardioplegia using hydroxyethyl starch (HES 450/0,7). Hemoglobin values after the first dose of cardioplegia were significantly lower in the HES-group than in the Calafiore- group). After the first dose of cardioplegia platelets count was lower in the HES-group than in the Calafiore-group. Hemoglobin and hematocrit values 24h postoperative were lower in the HES-group than in the Calafiore-group. There was no difference in chest-drainage bleeding 12h and 24h postoperative between the groups. The consumption of donor erythrocyte concentrate and fresh frozen plasma was significantly higher in the HES-than in the Calafiore- group. The choice of either colloidal or blood cardioplegia does not influence the postoperative chest-drainage bleeding. The results suggest that high molecular colloidal cardioplegia with HES-solution is associated with higher hemodilution during and after cardiopulmonary bypass and significantly increases the consumption of donor blood products.

The aim of this study is to compare the effects of colloidal cardioplegia and blood cardioplegia in patients who un- derwent cardiac surgical procedures with cardiopulmonary bypass, and to evaluate their influence on hemodilu- tion, bleeding and consumption of donor blood products in a retrospective clinical study.  male patients who underwent cardiac surgical procedure were divided into two groups:  patients were administered intermittent normotherm or mild hypotherm (°C) Calafiore blood cardioplegia with potassium chloride , ;  patients were administered one initial doses of cold Kirsch - solution followed from intermittent cold colloidal cardiople- gia using hydroxyethyl starch (HES /,). Hemoglobin values after the first dose of cardioplegia were signifi- cantly lower in the HES-group than in the Calafiore- group). After the first dose of cardioplegia platelets count was lower in the HES-group than in the Calafiore-group. Hemoglobin and hematocrit values h postoperative were lower in the HES-group than in the Calafiore-group. There was no difference in chest-drainage bleeding h and h postoperative between the groups. The consumption of donor erythrocyte concentrate and fresh frozen plasma was significantly higher in the HES-than in the Calafiore- group. The choice of either colloidal or blood cardioplegia does not influence the postoperative chest-drainage bleeding. The results suggest that high molecular colloidal cardioplegia with HES-solution is associated with higher hemodilution during and after car- diopulmonary bypass and significantly increases the consumption of donor blood products.

incidence varies from , to  of the coronary angiographies, with predilection of the right coronary artery. Unruptured coronary aneurysms are often silent and may remain undiag- nosed. Th e etiology can be either congenital or acquired. We describe a case of a left anterior descending artery (LAD) aneurysm treated with an off -pump surgical revascularization with a LIMA to LAD without exclusion or ligature of the aneurysm.

Treatment of patients with "low output" syndrome is very complex as well as surgery method as well as post operative treatment. Surgery requests experience and well trained surgical team which is able to produce off pump revascularization of myocardium and in short period of time eliminate global contra effects of ischemia already damaged myocardium. In post surgery period treatment of these patients demands maximal medication support and use of IABP which implantation, in this case, been very useful.

The tehniques of myocardial protection in cardiac surgery are innumerable. In this trial we tried to compare two established cardioplegic strategies in elective on-pump surgery (Intermittent antegrade warm blood cardioplegia--Calafiore--) and Kirsch-Solution with Haes). We took the data from our medical documentaton for 115 patients who underwent elective on-pump surgery in time period from February 2005 to July 2005.