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PAEDIATRIC CARDIOLOGY

CONGRESS OF CARDIOLOGISTS & ANGIOLOGISTS BOSNIA & HERZEGOVINA WITH INTERNATIONAL PARTICIPATION Acc.Prof.dr. Senka Mesihović-Dinarević SARAJEVO 28.05.2010. PAEDIATRIC CARDIOLOGY. embr y olo gical knowledge mor ph olo gical anatom y segmental anal ys i s.

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PAEDIATRIC CARDIOLOGY

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  1. CONGRESS OF CARDIOLOGISTS & ANGIOLOGISTS BOSNIA & HERZEGOVINA WITH INTERNATIONAL PARTICIPATIONAcc.Prof.dr. Senka Mesihović-DinarevićSARAJEVO 28.05.2010.

  2. PAEDIATRIC CARDIOLOGY • embryologicalknowledge • morphological anatomy • segmental analysis

  3. Developmental biologyfrom conception up to the end of the second month of life, allows the solution of morphogenesis (pathogenesis) and etiology of cardiac malformations.

  4. Morphological anatomyis essential for the recognition of heart chambers as well as to define a real diagnosis. • Thelanguage of segmental analysis (1976.god): • the relation of visceral organstowards atriums (visceroatrial relation) • interrelation of the heart chamber (heart loop) • the relation of the heart towards great vessels (conotruncal relation)

  5. On the basis of segmental analysis, it is possible to make an anatomical and physiological diagnosis. • Detail clinical evaluation is essential for patinet’s judgementwith congenital heart anomalies.

  6. Modern diagnosticand therapeutical approach in paediatriccardiology means early application of foetal echocardiography (independently of child’s position intrauterine)starting from 18 to 20 weeks of intrauterine life; • Detection of CHD • Rhythm disorders • Transcatheter therapy of certain lesions and disorders.

  7. Paediatric clinic of CCU Sarajevo is organised through: • Hospital part and • Out pts clinics • Total surface: 6 500 m kvadratnih. • Mini laboratory and X ray department

  8. Clinic has 12 departments: • 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

  9. Cardiology department: • 12 beds Out pts department: • ECHO laboratory • Cardiology out pts • Rhythm laboratory

  10. PAEDIATRIC and NEONATAL INTENSIVE CARDIOLOGY DEPARTMENT

  11. Pediatric Educational Center of Sarajevo (PECS) founded in 2003. Activities: • Asthma school • Paediatric summer school • Ultrasound school • Ressuscitation school • Endocrinology school

  12. 6.Phatmacologic houses in child’s service, 7.Courses, 8.Lectures, 9.Publishing

  13. Publishing services: • Annual Publication as a result of Paediatric Summer schoool: “News from Paediatrics“:2003-2009; • Book 60.years of Paediatric clinic of CCU Sarajevo • Textbooks + CD for 3 medical schools (2005.) • Bilten no.1-7.

  14. Lecturs/Education: • Medical school • Dentistry school • School for health sciences • Specialisations • Subspecialisations • Further educations • Trenings

  15. Pediatric clinic of CCU Sarajevo • Admissions: 2003: 2895 • Admissions 2009: 4984

  16. Pediatric clinic of CCU Sarajevo Number of pts in 12 out pts clinics: • 2003: 25 921 • 2009: 41 372

  17. Mortality 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.

  18. Staff of clinic • . • 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.

  19. 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.

  20. Cardiosurgery 1996.-2010.: • 1996-1999: Samaritan’s purse evacuated: 150 pts Foreign teams: • USA (prof.Novick) • Austria (prof.Wollenek) • Sweden (prof.Johanson) Local team

  21. From 1996-2010: 1996-1999: • Samaritans’ purse: 150 pts

  22. Treatment in Austria 2008-2009: • Austria team+Federal Insurance company:

  23. Total number of cardiosurgical paediatric patinets from 1997.till 25.04.2010. is 421. • From May 1998-25.04.2010. total number of CC was 180: • 154/180 diagnostic and 25 interventional.

  24. 421 pts operated

  25. More than 1 simple lesion (2-5)=44VCC complexus without ToF=43pacemaker, other CHD=7

  26. Preoperative & postoperative treatment is allways done by Sarajevo team:Pediatric clinic and+Centre for heart of CCU Sarajevo. • 2009. 43 pts had cardiosurgery: Austrian team done 14 pts, 3 CC, Sweedish team operated on 12 pts, in Italy operated 3 pts

  27. LOCAL CARDIOSURGICAL TEAM: • 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

  28. Cardiosurgery & CC 2008-2009.god

  29. Transthoracal echocardiographyin B&H has a long tradition. • First USmachinein Sarajevo 1977.

  30. 2009. Cardiology department: 485 addmisions, 4540 out pts

  31. The pressure for obtaining ultrasound examination in our laboratory is extraordinary.

  32. DIAGNOSTIC PROCEDURES (2009): • ECG: 3024 • Echocardiography: 3768 • Holter ECG:245 • Holter BP 43 • Ergometry 60 • Fonocardiography: 56 • Tilt-table test: 26

  33. Cardiosurgery: • 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

  34. At present: Local team: ASD, PDA Foreign teams: • Austrian (3 x times a year; in 2009 x1 arrival, in 2008 x1 arrival), • Sweeden (3 x times a year) Humanitarien evacuation to Italy: 2pts per month

  35. An average number of pts with CHD is 50-60 in FBiH Plan: to develop foetal echocardiography in order to reduce CHD • CC: th: closure of PDA, ASD • Local team to operate independetly • In years to come: Regional paediatric cardiosurgery: Kosovo....

  36. THANKS FOR YOUR ATTENTION!

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