Download 2009. - Udruženje kardiologa u BiH

CONGRESS OF
CARDIOLOGISTS &
ANGIOLOGISTS
BOSNIA & HERZEGOVINA
WITH INTERNATIONAL
PARTICIPATION
Acc.Prof.dr. Senka Mesihović-Dinarević
SARAJEVO 28.05.2010.
PAEDIATRIC CARDIOLOGY
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embryological knowledge
morphological anatomy
segmental analysis
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Developmental biology from
conception up to the end of the second
month of life, allows the solution of
morphogenesis (pathogenesis) and
etiology of cardiac malformations.
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Morphological anatomy is essential for the
recognition of heart chambers as well as to
define a real diagnosis.
The language of segmental analysis
(1976.god):
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the relation of visceral organs towards atriums
(visceroatrial relation)
interrelation of the heart chamber (heart loop)
the relation of the heart towards great vessels
(conotruncal relation)
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On the basis of segmental analysis, it is
possible to make an anatomical and
physiological diagnosis.
Detail clinical evaluation is essential for
patinet’s judgement with congenital heart
anomalies.
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Modern diagnostic and therapeutical approach
in paediatric cardiology means early
application of foetal echocardiography
(independently of child’s position intrauterine)
starting from 18 to 20 weeks of intrauterine
life;
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Detection of CHD
Rhythm disorders
Transcatheter therapy of certain lesions and
disorders.
Paediatric clinic of CCU Sarajevo is
organised through:
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Hospital part and
Out pts clinics
Total surface: 6 500 m kvadratnih.
Mini laboratory and X ray department
Clinic has 12 departments:
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gastroenterology,
nepfrology,
cardiology,
neonatology,
paediatric Int.care and therapy,
neonatal Int. Care nad therapy,
pulmology,
neuropediatry,
endocrinology,
hematooncology,
fiziatry,
alergoimmunorheumatology
addmision, triage and urgent department
+day hospital
Cardiology department:
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12 beds
Out pts department:
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ECHO laboratory
Cardiology out pts
Rhythm laboratory
PAEDIATRIC and NEONATAL
INTENSIVE CARDIOLOGY
DEPARTMENT
Pediatric Educational Center of Sarajevo
(PECS) founded in 2003.
Activities:
1.
2.
3.
4.
5.
Asthma school
Paediatric summer school
Ultrasound school
Ressuscitation school
Endocrinology school
6.Phatmacologic
houses in
child’s service,
7.Courses,
8.Lectures,
9.Publishing
Publishing services:
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Annual Publication as a result of
Paediatric Summer schoool: “News
from Paediatrics“:2003-2009;
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Book 60.years of Paediatric clinic of
CCU Sarajevo
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Textbooks + CD for 3 medical
schools (2005.)
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Bilten no.1-7.
Lecturs/Education:
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Medical school
Dentistry school
School for health sciences
Specialisations
Subspecialisations
Further educations
Trenings
Pediatric clinic of CCU Sarajevo
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Admissions: 2003: 2895
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Admissions 2009: 4984
Pediatric clinic of CCU Sarajevo
Number of pts in 12 out pts clinics:
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2003: 25 921
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2009: 41 372
Mortality
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2009. was (number of pts 4948) 1,7%,
in relation to 2008. when mortality was 2%
(number of pts 4278)
As in years before, there is decrease tendency, despite
extremly difficulte and complicate cases as well as
stage of patient’s illness, from whole B&H.
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Highly
specialise tertiery institution functions with
capacity of 130 beds + 30 intensive care.
Staff (225): 38 specialists paediatricians
(3 proffesors, 3 PhD, 5 doctors of medical sciences,
12 masters), 7 residents, 2 cl.psihologists, 9 high
medical nurses, 4 dipl.med.nurses, 131 ordinary med.
nurses & 27 workers in additional services.
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The mirror of one country development is refflected
in the degree of pediatric cardiology and
cardiosurgrey development, which in Sarajevo in
past several years achieves good results thanks to
cooperation with colleagues from Austria.
Cardiosurgery 1996.-2010.:
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1996-1999: Samaritan’s purse evacuated: 150 pts
Foreign teams:
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USA (prof.Novick)
Austria (prof.Wollenek)
Sweden (prof.Johanson)
Local team
From 1996-2010:
1996-1999:
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Samaritans’ purse:
150 pts
1996.
24 pts
1997.
43 pts
1998.
55 pts
1999
28 pts
Treatment in Austria
2008-2009:
 Austria team+Federal
Insurance company:
2008.
30 pts
2009.
33 pts
2009.
27/33 pts
operated
2009
6/33 pts
Follow up
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Total number of cardiosurgical paediatric
patinets from 1997.till 25.04.2010. is 421.
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From May 1998-25.04.2010. total number of
CC was 180:
154/180 diagnostic and 25 interventional.
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421 pts operated
ASD
67
VSD
69
PDA
57
TOF
49
More than 1 simple lesion (2-5)=44
VCC complexus without ToF=43
pacemaker, other CHD=7
CoA
28
AS
12
PS
11
AVSD
25
PAPVR 5
TAPVR 4
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Preoperative & postoperative treatment is
allways done by Sarajevo team:Pediatric
clinic and+Centre for heart of CCU Sarajevo.
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2009. 43 pts had cardiosurgery: Austrian
team done 14 pts, 3 CC, Sweedish team
operated on 12 pts, in Italy operated 3 pts
LOCAL CARDIOSURGICAL TEAM:
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2009=4OP (ASD1+1DAP)
2008=3OP
2007=0
2006=12 (9PDA+3ASD)
2005=0
2004=0
2003=2 (ASD)
2002=0
2001=0
2000=4 (1PDA,1ASD, 2CoA)
Total:25
Cardiosurgery & CC
2008-2009.god
45
40
35
30
25
20
15
10
5
0
OP
CC
CC
OP
2008
2009
2008
2009
OP
24
43
CC
3
3
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Transthoracal echocardiography in B&H
has a long tradition.
First US machine in Sarajevo 1977.
2009.
Cardiology department:
485 addmisions, 4540 out pts
The pressure for obtaining ultrasound
examination in our laboratory is
extraordinary.
50%
32%
8%
L-D shunt
Obstructivne L.
10%
Cyanotic L.
Mixed L.
DIAGNOSTIC PROCEDURES
(2009):
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ECG: 3024
Echocardiography: 3768
Holter ECG:245
Holter BP 43
Ergometry 60
Fonocardiography: 56
Tilt-table test: 26
Cardiosurgery:
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How does it work?
Diagnosis is made at Paediatric clinic Sarajevo and in :
Bihać, Mostar, Banja Luka, Travnik, Zenica, Tuzla by
subspecialists of cardiology
Transffer to Sarajevo
Addmission at Paediatric clinic-Cardiology department
Transffer to Centre for heart CCU Sarajevo/CC
Postoperatively at PICU Paediatric than
Post intensive Cardiology department
Discharge home
Follow up by local subspecialists and cardiologists in
Sarajevo
At present:
Local team: ASD, PDA
Foreign teams:
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Austrian (3 x times a year;
in 2009 x1 arrival,
in 2008 x1 arrival),
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Sweeden (3 x times a year)
Humanitarien evacuation to Italy: 2pts per month
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An average number of pts with CHD is
50-60 in FBiH
Plan: to develop foetal echocardiography in
order to reduce CHD
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CC: th: closure of PDA, ASD
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Local team to operate independetly
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In years to come: Regional paediatric cardiosurgery:
Kosovo....
THANKS FOR YOUR ATTENTION!