Month: April 2023

A multidisciplinary team from the clinics of cardiology and vascular surgery of the ‘Heart and Brain’ Center of Clinical Excellence in Pleven, performed a unique procedure for the country for the placement of a resynchronizing pacemaker in a patient in whom surgical access by the classical route is impossible. The system was implanted through the left femoral vein (of the leg) instead of through the chest veins as in the standard procedure. The method has been applied only a few times worldwide and never before in Bulgaria, said cardiologist Dr Nikolay Petrov.

The procedure was carried out on a 65-year-old patient with lung cancer squeezing the chest veins to the point where the device could not be implanted. The man was admitted to the cardiology clinic with extremely slow heart rate and severely reduced pumping function of the left ventricle.

“In view of the lack of a standard medical approach to address the patient’s slow heart rate, we determined that a workable solution was to implant a pacemaker. There were two possible options for this – an innovative procedure where the implantation would be done through the femoral vein, and the second option was cardiac surgery where the electrodes would be implanted on the heart. Due to the patient’s severe general condition and his co-morbidities, we judged that general anaesthesia and cardiac surgery would be high risk,” Dr Petrov explained the details of the case.

Dr. Nikolay Petrov and Dr. Georgi Voynov managed to implant a resynchronizing pacemaker by inserting the three electrodes through the patient’s left femoral vein. A challenge in the procedure is the use of consumables and devices designed and adapted for implantation by a classical method – through the chest veins. The complex intervention lasted nearly two hours.

“The fact that no one in Bulgaria has experience with such a procedure did not prevent our team from making the only right decision in this case. I dare to say that in ‘Heart and Brain’, Pleven we have the knowledge, experience and high-tech capabilities to apply innovative procedures and surgeries that have the best effect and with the least risk for patients”, Dr. Petrov is adamant.

The team of doctors has great clinical and research experience gained in leading clinics in the country and abroad

A few days ago, a 79-year-old man was admitted to the urology clinic at Heart and Brain Hospital Burgas. He had long-standing complaints of pain in the left lumbar region and the presence of blood in the urine. Imaging studies were immediately performed, after which a scan revealed hydronephrosis, with no evidence of a concrement (stones) in the ureter.

The patient had critically low haemoglobin and marked consumptive syndrome (weight loss). After performing a repeat imaging study – scanner with contrast – with no apparent cause of obstruction of the left ureter and viscous retention of urine in the left kidney, the specialists appointed ureteroscopy, which revealed complete blockage of the ureter by a solid formation. After a biopsy was taken, the histological result showed a transitional cell carcinoma.

Dr. Toni Statelov and his team perform a laparoscopic intervention to remove the kidney and ureter down to bladder level. The patient was discharged in excellent health after a short postoperative stay

The Department of Urology performs highly specialised diagnostic and surgical work-up of diseases of the kidney, ureters, bladder, prostate, penis and testes. It is equipped with latest generation surgical equipment to apply the most sparing and precise minimally invasive surgical techniques. Intraoperative ultrasonographic and radiographic monitoring is routinely applied when indicated.

The team of doctors has extensive clinical and research experience gained in leading clinics in the country and abroad. All doctors are engaged in research activities, teaching activities are also carried out

Since January 2022, Dr. Statelov is the head of the Urology Clinic in ‘Heart and Brain’ Burgas.

– Dr. Statelov, how did you come to urology as a specialty?

– I have always had an interest in surgical specialties, and urology uses mainly surgical methods, although we also apply conservative treatment in certain circumstances. Besides, the specialty is very modern, new devices are being introduced all the time. Urologists were among the first to use laser systems, laparoscopic methods and robotic treatment. This combination is very attractive to me because I believe in modern, bloodless treatment. I am happy to be part of the team of ‘Heart and Brain’ Burgas, where I can confidently say – every doctor would dream of working. The hospital has excellent specialists and equipment.

– Dr. Statelov, what are the “signal lights” that we should not ignore when we talk about urological diseases.

– Definitely blood in the urine, especially when present without additional symptomatology – alerts to a problem. The condition requires immediate consultation with a urologist. The symptom can be due to several causes, but we recommend patients not to make their diagnosis only on the basis of information provided by the Internet. Urine turns red in the presence of more than 1ml of blood in 1l of urine.

Bladder cancer is in the top five most common cancers – after prostate, lung and colon cancer. Haematuria (the presence of red blood cells in the urine) in this case is painless and requires urgent referral to a specialist. Bleeding is the only symptom of this type of cancer, which most often affects men but also occurs in women. Bladder tumors in over 95% of cases are malignant and very often recur. If detected at an early stage, they can be successfully treated by transurethral (‘bloodless’, through the urinary canal) surgery without having to remove the bladder.

The key to successful treatment of bladder cancer is having an experienced and highly skilled team of medical professionals and having modern equipment to detect it at an early stage. We at ‘Heart and Brain’ Burgas pride ourselves on both of these factors.

Within the first hours of the start of the work, the team of the high-tech neonatal intensive care unit of ‘Mama and I’ Pleven went to Sevlievo Hospital with a specialized neonatal ambulance to take a newborn in critical condition. The baby had severe polyorgan failure and required complex intensive therapy. The doctors from ‘Mama and I’ Pleven provided specialized care already during the transport. Thanks to the experienced specialists and state-of-the-art equipment, all modern treatment methods were applied for several days and the newborn was stabilized. The paediatricians carried out an “exchange blood transfusion”, changing the baby’s blood twice with blood from a suitable donor.

Dr. Andrei Hristov added: “Today I feel fine, the child is already extubated and is breathing calmly. It is out of danger, it is fed. I would like to thank my colleagues, the midwives and the hospital management who spared no effort and brought things to a successful end. I am happy that the parents trusted us!”

According to the WHO, over the past 20 years cardiovascular disease, in particular ischaemic heart disease, has continued to be the leading cause of death worldwide. According to the NSI for 2021, more than half of deaths in Bulgaria are caused by diseases of the circulatory organs. The recorded figures in our country (54%) are far higher than the average cardiovascular mortality rate across Europe (45%) and in the EU (37%).

World-renowned specialist in robot-assisted thoracic surgery, Prof. Diego Gonzalez Rivas: “You have a great future because you believe, invest and make mass, modern and crucial medicine.”

There are ten medical institutions with cardiac surgery clinics in the country, spread across the six most populated districts – Sofia (city), Sofia (region), Plovdiv, Varna, Burgas and Pleven. In 2022, according to NHIF data, a total of 5682 cardiac surgery interventions were performed under the four main clinical pathways in this specialty. 24% out of these, or nearly 1500 surgeries, were performed by the Heart and Brain teams in Pleven and Burgas, with the lowest hospital mortality rates recorded. One third of all major operations for complex malformations requiring particularly high expertise were performed in these two cardiac surgeries. In third place is another private hospital owned by a foreign investor in the capital.

Medicine is an applied science. Cardiac surgery is a great manifestation of this fact. The more it is practiced, the more surgeons improve and so patients choose the best ones who have saved the most lives.

The number of cardiac surgical procedures performed at Heart and Brain exceeds the standard 150 surgeries per year by a factor of ten, making them the leader and first choice of patients in the country. The knowledge and skills applied every day in the large number of successful, complex cardiac surgical interventions maintain and build on the expertise of the teams. It is no coincidence that just since the beginning of the year, two of the luminaries of cardiac surgery and thoracic minimally invasive surgery arrived from Switzerland and Spain to work with the specialists in Pleven and Burgas. Visits by world-renowned clinicians from the United States and Germany are forthcoming.

The world-famous Swiss cardiac surgeon Prof. Thierry Carrel: “It is a great miracle how, with these very low Bulgarian prices for your clinical pathways, you achieve European, even world quality in hospital care”.

Healthcare is a national, beyond party boundaries, existential and pan-European priority. Competition in healthcare and forward-looking strategic private investment are crucial drivers of innovation in the sector and a major reason for keeping young doctors in the country and attracting specialists from abroad. There are also excellent examples of good synergies between municipal, state and private hospitals in individual regions and can easily be achieved across the country. In this way, competition on quality and cooperation in functions and between levels of competence increases the efficiency and attractiveness of health services, significantly expands access to medical care and, most importantly, in the long term, reduces mortality and mitigates the demographic crisis.