A multidisciplinary team of doctors from the cardiac surgery and obstetrics and gynaecology clinics performed a unique operation to remove a 40-centimetre tumour originating from the uterus and reaching to the right ventricle of the heart. The case is extremely rare and probably unique in the country, the specialists said.

“The 72-year-old patient is from Dobrich. She came to us after having sought help many times before in other medical institutions. Initially, she was admitted to Heart and Brain in Burgas and after consultations with the obstetricians at Heart and Brain in Pleven, she was admitted to us for surgical treatment,” said Dr. Yordan Krasnaliev, Head of the Cardiac Surgery Clinic at Heart and Brain in Pleven.

Penka had non-specific cardiovascular complaints for 3 years, with her heart rate reaching 150-160 beats per minute (a normal resting heart rate for adults ranges from 60 to 100 beats per minute). Her complaints increased during the summer of this year. She consulted a cardiologist and was then found to have a tumour in the right atrium originating from the inferior vena cava. The hospital ordered further imaging studies which proved a tumour formation in the pelvis minor of genital origin.

“This is also called a large tumour thrombus, which is traced from the left ovarian vein – the vein that exits the ovary, drains into the renal vein, then into the inferior vena cava and thence into the right atrium and right ventricle. Preoperatively we performed coronarography, and no pathology was found. Once it became clear that we had a unique case of a tumor formation in the abdomen, which travels through the veins to reach the heart, we made the decision to have the patient operated on by a multidisciplinary team of cardiac surgeons and gynecologists,” explained Dr. Krasnaliev.

Thus, two days after the patient’s admission, Dr. Krasnaliev, Dr. Alexander Lyubenov – head of the Department of General and Oncological Gynaecology and the cardiac surgeons Dr. Alexander Georgiev and Dr. Nedyalko Nedyalkov entered the operating room. Initially, sternotomy was performed – access to the heart, with extracorporeal circulation, also called “heart-lung” machine. The heart was opened and freed from the tumor formation. The intervention was continued by opening the patient’s abdominal area, where doctors continued with the release of the tumor. The vein through which the growth runs was severed and it was released from its walls. After its final release, the tumor was removed from the side of the heart. It is 40 cm long. Finally, the primary uterine and left ovarian myoma was removed with the entire adjacent vein.

“I dare say that this case was a real challenge for us as doctors. We have had similar cases before, but they were mostly of tumors localized in the right kidney, through the inferior vena cava and reaching to the heart. This is the first time we have come across a tumour localised from the uterus to the heart,” Dr Krasnaliev said.

Dr. Alexander Lyubenov also describes the surgery as unique in his medical practice, “To be in a joint team with our cardiac surgeons is a dream come true for me. The case is extremely interesting as it is really quite rare. There are very few publications about similar interventions. This condition is extremely rare and life-threatening, so we had to implement the best strategy for the patient.”

From a gynaecological point of view, Dr Lyubenov highlighted one key point during the operation and that was the tracking of the entire left ovarian vein until it entered the renal vein. The complicated operation lasted nearly 5 hours, and two days after that the patient was already discharged from intensive care. Today she is feeling well and cannot hide her gratitude to the doctors:

“Thanks to the doctors from ‘Heart and Brain’ Pleven I am living a new life. I have no words to express my immense gratitude to them. Unique people, unique specialists, Bulgaria needs them,” Penka said.

“A key point in the treatment of patients with lung cancer is the complex approach – from the beginning of the diagnosis to the therapy and follow-up of the disease, in a specialized hospital facility that has all the specialists and the necessary high-tech equipment. This complexity and teamwork at ‘Heart and Brain’, Pleven guarantees our patients full follow-up of the therapeutic process and, consequently, better treatment results.”

This is what Assoc. Prof. Natalia Chilingirova – Head of the Medical Oncology Clinic at the high-tech ‘Heart and Brain’ Centre of Medical Excellence in the lung cancer awareness month. November, when we celebrate the month to fight one of the most common cancers aims to raise public awareness and highlight the importance of early diagnosis

“Lung cancer is one of the leading causes of death from malignant  diseases in our country. According to Globocan (WHO Global Cancer Surveillance Organization) data for 2020, lung cancer is the second most frequently diagnosed cancer (11.4% of all cases) and the leading cause of cancer death, and these trends are continuing. One of the main causes is late diagnosis. It is therefore extremely important to know the symptoms, avoid risk factors, have regular check-ups and, if necessary, timely consultations with a specialist,” says Assoc. Prof. Chilingirova. She adds that today, when we talk about lung cancer, we invariably associate it with innovation – not only in medicine, but in oncology in particular.

In the words of the medical oncology specialist, today cancer is also considered a disease of the genome and genetic tests are logically an integral part of routine diagnostics. They allow for more precise therapy and better results. ‘Heart and Brain’, Pleven has a modern equipped genetic laboratory, which guarantees more accurate diagnosis of patients with lung cancer and better therapeutic results. The highly specialized clinics and departments of imaging diagnostics, pulmonology, thoracic surgery, medical oncology and radiotherapy are also part of the comprehensive treatment approach.

“As the majority of patients with lung cancer are diagnosed at an advanced stage, the main therapeutic approach remains drug treatment,” comments Assoc. Chilingirova. She is adamant that the Medical Oncology Clinic applies all modern and innovative approaches to the treatment of patients with lung cancer, such as targeted therapies, combination regimens and chemotherapy based on the individual characteristics of each patient’s tumor, and accordingly, patients have immediate access to these therapies and excellent therapeutic outcomes.

“Discoveries in the field of lung cancer have spurred studies that have directed treatment toward an individualized approach. In the fight against this socially important disease, the challenges for the next decade are focused on screening, improving the effectiveness of diagnosis and therapy, and thus patient survival through the means of precision medicine,” say the Heart and Brain specialists in conclusion.

An innovation for painless treatment of disc disease is applied for the first time in Pleven. The method is available at the high-tech hospital ‘Heart and Brain’ and has helped the first patients, the hospital team said.

Assoc. Prof. Dimitar Haritonov – head of the Neurosurgery Clinic, explained that it is a new generation implant – the so-called discogel. Discogel treatment has been successfully applied in the USA and Europe for several years, and now also in our country – for the time being in the Heart and Brain Center of Clinical Excellence in Pleven. So far it has been applied to more than 10 patients between 20 and 40.

Assoc. Prof. Hritonov noted that the substance is polymerized in the nucleus of the intervertebral disc, improves its functions and strengthens its structure. It is an extremely minimally invasive method, where the patient does not feel any pain and can return to his normal rhythm of life hours after the procedure, he pointed out.

“The indications for the application of the discogel are relatively limited, with the application mainly targeted at patients up to 45 years of age. The method is particularly recommended for the initial stage of disc disease”, clarified Assoc. Prof. Haritonov. He defines the implant as a breakthrough in the treatment of the disease, which is faced by more and more young patients.

“The intervention takes about 30 minutes and is called a surgical procedure, but in practice it is an injection. It is done under general intravenous and local anaesthesia. The injection is placed directly into the nucleus of the intervertebral disc itself, where the appropriate amount of discogel is inserted under X-ray control. Half an hour after the procedure, the patient is able to get up and move about on his own without the need for any help. The only restriction is the fine-tuning of physical exertion within 3 to 4 weeks after the procedure,” the doctor said.

Nearly 60 medical physicists and specialists involved in radiotherapy from almost all radiotherapy centers in the country gathered in Pleven for a two-day national meeting on “Modern Challenges in Medical Physics – Dosimetry and Control”.

Nearly 60 medical physicists and specialists involved in radiotherapy from almost all radiotherapy centers in the country gathered in Pleven for a two-day National Meeting on “Modern Challenges in Medical Physics – Dosimetry and Quality Control in Radiotherapy and Radiosurgery”. The forum was co-organized and hosted by the high-tech hospital Heart and Brain, Pleven, together with the Bulgarian Society of Biomedical Physics and Engineering (BdBFI), IBA Dosimetry and Ferromed 97.

The full article is available here in Bulgarian.

80% of COVID-19 survivors have high blood pressure and rapid pulse long after infection, observation by Pleven cardiologists has found. There are also residual symptoms such as easy fatigue, shortness of breath, palpitations and chest pain, according to their analysis of the Bulgarian Cardiology Institute’s “Life after COVID-19” campaign, the largest in the country aimed at patients with so-called long COVID-19. The authors of the studies are medics from the high-tech hospital ‘Heart and Brain’ in Pleven, the hospital told Bulgarian News Agency.

The results were presented to the XVII National Congress of Cardiology 2022 by the team of the Clinic of Cardiology of the hospital in Pleven. Five doctors from the team of prof. Dr. Denis Nikolov, Dr. Borislava Ninova, Dr. Denislava Hristova, Dr. Martina Samardzhieva and Dr. Anyuta Ivanova. Three of the presented topics were focused on patients who had undergone COVID-19.

Dr. Denis Nikolov presented a statistical analysis of patients with COVID-19 and myocardial infarction who have undergone ‘Heart and Brain’ in Pleven and how, based on clinical and laboratory data, the medical team can quickly navigate and make the correct diagnosis and prescribe treatment for the patient.

Dr. Borislava Ninova has collected data on patients who have undergoneCOVID-19, diagnosed with pulmonary thromboembolism, who were assumed to have no other provoking factor. The findings are that COVID-19 appears to be a significant provoking factor for this socially significant disease, which ranks fourth after heart attack, stroke and tumour disease, according to the analysis.

Dr Denislava Hristova has seen patients with so-called long COVID-19. It turned out that 80% of the sufferers had residual symptoms. The complaints were so severe that in half of the cases additional blood tests, X-ray, Holter electrocardiogram and cardiac ultrasonography had to be performed. Rhythm disturbances are the most common changes in electrocardiograms. Various organs and systems are affected, resulting in impaired concentration and memory, headaches, dizziness, insomnia, hair loss, etc. This requires further consultations with various specialists and a change in treatment. Due to presenting symptoms and changes in investigations, one out of ten COVID-19 survivors require readmission to a treatment facility.

Dr. Martina Samardzhieva has presented to the scientific community the only poster with data to determine the likelihood of atrial fibrillation following anti-tumour therapy using modern methods such as stress echocardiography and left atrial strain measurement. This raises the issue of the importance of monitoring cancer patients by a cardiologist before, during and after the administration of antitumor therapy (chemo, immuno, targeted and radiotherapy) and determining the risk of developing cardiotoxicity according to the latest European Society of Cardiology recommendations from 2022.

Dr. Anyuta Ivanova has created a project for early detection of patients with high blood cholesterol levels associated with the genetic disease familial hypercholesterolemia using an artificial intelligence method applied in the hospitals of the Bulgarian Heart Institute. The idea is to identify more and more patients with dyslipidaemia and to start treatment as quickly as possible to reduce the risk of cardiovascular events in this group.

The Cardiology Clinic of ‘Heart and Brain’ in Pleven specialises in the treatment of acute and chronic cardiovascular diseases in an emergency or elective manner. It is a national leader in the diagnosis and treatment of post-COVID syndrome as well as in the field of cardio-oncology. The hospital has both a cardiology and oncology clinic – the only one in the country where cardio-oncology is actually developed.

Specialists from urology and surgery clinics were involved in the treatment

A multidisciplinary team of doctors from the urology and surgery clinics at the Heart and Brain Hospital Burgas performed a life-saving operation on a patient with a severe oncological disease and combined pathology.

After examining a 66-year-old female patient, operated on for colon cancer 6 years ago, with subsequent radiation and chemotherapy, the team of the Abdominal Surgery Clinic sought further expert opinion of their colleagues from the Urology Clinic regarding bleeding during urination and an established formation in the bladder with impaired renal function. The patient was hospitalized for diagnosis and treatment.

The complex oncology and radiosurgery centre of the high-tech hospital ‘Heart and Brain’ in Pleven is among the first selected on a global level for pilot work with a new generation of dosimetric systems in radiotherapy and radiosurgery. The two prototypes provided are extremely valuable because they provide an even better opportunity for precise radiation dosing in each patient thanks to the higher resolution.

“Precise dosing in radiotherapy and radiosurgery is extremely important for the patient and for the results of the treatment. The key to success is good teamwork between the radiotherapists, medical physicists and X-ray lab technicians. However, it is also crucial to have precise modern equipment, which I am glad we have and are able to work with. This ensures the highest level of treatment quality and additional peace of mind for our patients,” commented Ivo Petrov, Head of the Medical Physics Unit at the hospital, part of the interdisciplinary team involved in radiotherapy and radiosurgery.

The radiotherapy and radiosurgery centre in ‘Heart and Brain’ Pleven has no analogue in the country and in the Balkans. It has the only Gamma Knife in Bulgaria – the most precise system for brain radiosurgery, with the latest generation of high-tech linear accelerator for radiotherapy and radiosurgery in the whole body, 4D CT scanner, top level dosimetry equipment and specialized planning systems.

The full article is available here in Bulgarian.

On the occasion of World Stroke Day – 29 October, the specialist gave detailed information and advice on proper treatment

Prof. Ivan Dimitrov is qualified in neuropsychology, electroencephalography, evoked potentials, Doppler sonography. His professional and scientific interests are in the field of cognitive disorders and dementias, multiple sclerosis, epilepsy, etc. He organized the first study on the prevalence of dementias in Bulgaria.

– Professor Dimitrov, what is stroke and how is this disease diagnosed?

– Cerebrovascular diseases are widespread in our country and are unfortunately among the causes of severe disability and significantly increased mortality. More prevalent are ischemic strokes, which are associated with blockage of blood vessels supplying the brain, and the result is death of brain tissue. This leads to paralysis, speech impairment and other neurological symptoms and, unfortunately, often to death.

– What are the first symptoms of the disease and can they mislead the patient and treating physicians in making the diagnosis?

– Common first symptoms include weakness of the limbs (often left arm and left leg or right arm and right leg), drooping of the lip, speech disorders, balance disorders, etc. It is important that these are recognised by people so that action can be taken quickly. Similar symptoms can occur in other neurological disorders, but timely examination by a specialist and appropriate investigations will determine the correct diagnosis.

– How can patients and their loved ones help doctors to better manage the disease?

– Prevention of risk factors is important. They are known to everyone – high blood pressure, poorly controlled diabetes mellitus, elevated cholesterol, smoking, etc. Very often, however, not enough attention is paid to them. It is also of paramount importance for physicians seeing a stroke patient in an emergency setting to quickly obtain adequate information about the exact time of onset of complaints, comorbidities, medications taken, including whether any are being taken to “thin” the blood.

– What opportunity does early diagnosis provide to counteract the disease? How is the treatment of patients with ischaemic stroke?

– In recent years, the motto “time is brain” has become popular in neurological circles. This is indeed a true statement because there is a greater chance of successful treatment of ischemic stroke in the first few hours after the onset of symptoms. If the patient is promptly transported to a specialized hospital facility within a time window of up to 4 hours and 30 minutes from the onset of the stroke, thrombolytic treatment can be administered to try to restore circulation to the affected area. Unfortunately, if this time is exceeded, thrombolysis cannot be performed, and the treatment is not as effective.

– What tests do you do at Heart and Brain to confirm such a diagnosis? Do you perform the thrombolysis already mentioned?

– At Heart and Brain, all the necessary tests are carried out. In addition to a general and specialized neurological examination, laboratory tests, computed tomography, if necessary – with imaging of cerebral vessels, radiographs are carried out in an urgent order. Doppler sonography, magnetic resonance imaging, etc. are also applied. Teamwork of neurologists with fellow cardiologists, vascular surgeons and doctors from other specialties is important. On admission of a patient with ischaemic stroke, we always assess and if appropriate – perform thrombolytic treatment.

Patient: This hospital is world class, the attitude of the doctors, nurses and orderlies to all of us patients is irreplaceable. Thank you very much!

A few days ago, a man was admitted to the emergency room of Heart and Brain in Burgas with deep injuries from angle grinder and heavy blood loss. The young man injured himself during repairs in the Tsarevo area. The damage to his limbs was not life-threatening, but he risked being bedridden for a very long time to recover. The team of specialists at the Heart and Brain Center of Medical Excellence processes performed various surgical interventions so that the patient recovered in the shortest possible time without permanent work disabilities.

Read the full article here in Bulgarian.

The initiative was launched in connection with the World Heart Restart Day, which is now traditionally celebrated worldwide on 16.10.2022. The main objective is to raise awareness among the public and our children about cardiac arrest and promote cardiac massage and artificial ventilation (CPR) skills. Seven out of ten cardiac arrests happen in public places in full view of the public, but less than 20% of witnesses provide first aid. Hundreds of thousands of lives could be saved each year if two hands help in the first minutes of an incident.

The meeting was with sixth grade children from Bacho Kiro Primary School in the city with the outstanding assistance of the school principal Mr. Nikolov. The young cardiologists Dr. Ivanov and Dr. Nedyalkova, with the ideas and support of Dr. Krastev, an invasive cardiologist, had prepared a multimedia presentation and a visual demonstration. Dozens of children practiced what they saw, enthusiasm shining in their eyes. The specially prepared dialogue unlocked many questions and enriched the children’s knowledge. All participants received badges, which mark initial training in first aid, and special children were awarded with T-shirts with the logo of the Cardiology hospital.