Author: BCI

The head of the orthopedics and traumatology department – Dr. Petyo Bratoev, and his team placed artificial knee joint implants, made on a completely individual model.

The high-tech Heart and Brain is the third hospital in the country to apply these modern and patient-friendly surgical interventions. The man sought help due to severe degenerative changes in his knee, after several previous surgical interventions due to sports injuries. The surgery was extremely successful within a shortened operating time, with the patient back on his feet and starting rehabilitation on the first post-operative day.

The specificity of this case is that the joint and the instruments for its placement were made specifically for the patient, and the implant follows as closely as possible the anatomical features of the operated joint based on a pre-made 3-D model.

The technique is extremely precise, with pre-operative 3-D planning and subsequent individual fabrication, which brings a number of advantages for patients. Compared to standard joint implants, the individual joint follows a pattern almost identical to the actual anatomical organ.

The intervention takes place in a much shorter operating time. The technical instrumentation is minimized, and this reduces the risk of intraoperative infection many times.

The team is trained to the latest quality and safety standards

Less than a year after its launch, the imaging department at the high-tech Heart and Brain Hospital in Burgas has completed 10,000 radiographs, more than 7,000 scanners and more than 2,500 magnetic resonance imaging (MRI) scans.

“We provide quality and advanced imaging – computed tomography (CT) and magnetic resonance imaging (MRI) of diseases of the brain, spine, lungs, abdominal organs and extremities. Specialized software allows precise visualization of all vascular examinations, e.g. aortography, angiography of lung and abdominal vessels, as well as cerebral vessels and peripheral arteries. We perform high-quality CT diagnostics of the heart and coronary arteries and have state-of-the-art equipment for ultrasonography and conventional X-ray diagnostics.

Highly informative reconstructions and detailed evaluation of the images by our imaging physicians facilitate dynamic monitoring of the development of various diseases and enable adequate planning of subsequent treatment. Our team is young and trained according to the latest quality and safety standards,” said Assoc. Prof. Lachezar Manchev,  head of the department.

A total of 305 women were screened, 16 of whom were referred for follow-up examinations for a definitive diagnosis, is the final tally of the traditional campaign for free breast cancer screening organized by Heart and Brain Hospital, Pleven in the World Breast Cancer Awareness Month. For four weeks, the team of the Oncological and General Surgery Clinic, headed by Prof. Tashko Deliiski, examined patients free of charge every day, after prior registration.

“Screening is the best way for early detection and successful treatment of breast cancer. Early diagnosis of breast carcinoma significantly reduces adverse effects. In order to improve access to specialized medical care and to help more women, we have developed a screening program,” said Dr. Maya Balabanova, a specialist in surgery. She stressed that the team of the General Surgery Clinic has modern equipment and all the possibilities for research.

Breast cancer is the most common oncological disease in women, with an incidence of 70 per 100 000 people in Europe. Unfortunately, Bulgaria is no exception to this statistic. Experts are adamant that regular preventive examinations are the most significant measure to reduce the adverse effects of this disease and that this diagnosis has long ceased to be a “sentence”. Doctors from the Oncological and General Surgery Clinic remind that they work closely with the Medical Oncology Clinic and the Radiotherapy Department to achieve optimal therapeutic results.

The Heart and Brain Hospital also has the only Gamma Knife in the country and the latest generation linear accelerator and offers patients a comprehensive multidisciplinary approach to the diagnosis and treatment of cancer.

Dr. Valentin Hristov is Executive Director of the Cardiology Hospital in Pleven and a specialist in invasive cardiology

Dr. Hristov, the end of the year is a time for reflection. What have you achieved?

That’s right. My review is not only for the past year. It is for the fifteen years since the hospital was launched, because I have witnessed its development first-hand. In the now distant year 2007, the Cardiology Hospital opened its doors. It is a peer of my elder daughter. She was born the day I signed my employment contract. De facto, they both grew up before my eyes.

15 years – is this a long or a short period for a hospital?

What matters is what has been achieved. Historically, the Pleven Hospital was the first hospital of the Bulgarian Cardiac Institute (BCI) family. We have come a long way in 15 years.

The full article is available here in Bulgarian

Robotic systems with built-in artificial intelligence provide the ability for non-contact, non-chemical disinfection of all surfaces by ultraviolet bactericidal irradiation. The robot’s blue light causes irreversible damage to pathogens and has a guaranteed success rate of 99.9%.

The equipment is extremely useful for complete sterilization of operating rooms, isolation rooms for infectious patients, rooms such as hospital registries and reception areas with high concentrations of patients and areas with over-exposure of viral and bacterial organisms.

Within 3 to 8 minutes are required to completely disinfect a hospital room. The robots in the Heart and Brain hospitals in Pleven and Burgas are an indispensable assistant in the prevention of nosocomial infections and the non-spread of pathogenic bacteria.

The hospital establishes itself as one of the first and main pain treatment centres in the country

An implantation of a device affecting chronic spinal pain was performed for the first time in the neurosurgery clinic of the high-tech , Heart and Brain’ in Pleven. The innovative method gives patients with long-standing spinal pain a chance to live a normal life without constant medication and its side effects.

“I am happy that we have laid the foundation for a revolutionary category in the treatment of chronic pain, namely the implantation of spinal cord stimulation devices. This is the most innovative and cutting-edge treatment possible for chronic neuropathic pain that affects the spine and extremities, and most often occurs after a series of surgical interventions or spinal trauma,” commented Assoc. Prof. Dimitar Haritonov, head of the clinic.

The leading indicator for the application of the method is the need for such treatment and the results of mandatory test stimulation, on the basis of which the doctor assesses whether the intervention is applicable to the particular patient.

“The implantation of a device against chronic pain is the placement of permanent electrodes on the sheaths of the spinal cord. These electrodes are connected to a subcutaneous pulse generator and electrical impulses are transmitted to the spinal cord through them. This interrupts the transmission of the disease impulses to the brain. It is no coincidence that spinal cord stimulation, is called the “pacemaker for pain”, explained Assoc. Prof. Haritonov.

The first device against chronic pain in ‘Heart and Brain’ Pleven was placed in a patient with 7 spinal surgeries. After implantation of the device, the patient leads a full life without pain. The only limitation is within the first 4 to 5 weeks, when moderate physical exertion is recommended in order to position the electrodes stably in the epidural space.

“With the introduction of this innovative treatment, our hospital becomes one of the first and major pain management centers in the country. The method is extremely indicative of how the development of medicine and new technologies enable everyone responsible for their own health to lead a fulfilling lifestyle. In the developed world, the implantation of devices is a common but also costly treatment. We are happy that in our country it is completely free of charge for all insured patients”, add the Heart and Brain specialists.

The team of the Vascular Surgery Clinic of ‘Heart and Brain’ Pleven, headed by Dr. Ognyan Matkov, saved the life of a 65-year-old man with a ruptured abdominal aortic aneurysm through endovascular prosthetics. The innovative EVAR method (endovascular prosthetics for aneurysms) was applied for the first time in an emergency operation performed by Dr. Todor Samardzhiev, Dr. Valentin Velikov and their team. The patient was admitted to the hospital in critical condition, with severe abdominal pain and the intervention was life-saving.

“The patient is from the town of. The patient is from Vratsa and sought emergency help from doctors at the local hospital after he developed sudden severe abdominal pain. He had no similar complaints before, was unaware of his health problem and accordingly had no treatment prescribed. After a scan, it was found that the cause of the acute pain was a rupture of the abdominal aneurysm, which necessitated his emergency transport to the hospital in Pleven. The Heart and Brain Hospital is the only one in Northern Bulgaria that routinely performs elective EVAR surgeries,” said Dr. Samardzhiev.

Aneurysms are abnormal enlargement of the diameter of the abdominal (belly) aorta. When the enlargement reaches above a certain size, there is a danger of their rupture, leading to blood spillage into the abdominal cavity. Abdominal aneurysms remain asymptomatic for many years and their first manifestation may be rupture, which is critical and has a high mortality rate. with advancing age their incidence increases.

“The risk of a fatal outcome with open surgery for these conditions is over 90%, so we felt we should implement EVAR. In this method, a covered stent is inserted through the femoral arteries to isolate the ruptured aneurysm from the blood stream,” explained Dr. Matkov. He said that in the vascular surgery clinic they have accumulated a lot of experience in performing elective EVAR operations, but for the first time such an intervention is done in conditions of absolute urgency. In order to perform a standard EVAR procedure, prior preparation and provision of multiple conditions, including those specific to the patient’s own anatomy, are necessary. Time is therefore of the essence, and any delay can be critical.

Thanks to the minimally invasive nature of the method, the man is upright and mobile immediately after surgery, without the need for a stay in intensive care. His condition is stable. The postoperative scan showed complete isolation of the ruptured aneurysm from the endoprosthesis, proving the complete success of the operation.

The 70-year-old patient operated on at ‘Heart and Brain’ Pleven is back on his feet just a few hours after the intervention

A 70-year-old patient with a severe left limb contusion (crush) in the knee and hip area has a chance to lead a normal and full life – without pain, 21 years after suffering a serious road traffic accident. This was made possible after a navigational endoprosthesis operation performed by the team of the Clinic of Orthopaedics and Traumatology with Prof. Asparuh Asparuhov, of the high-tech , Heart and Brain’, Pleven.

“What is unique about this case is that after the severe trauma the patient’s leg had healed into a compromised position. After prolonged treatment, the limb was preserved with a shortening of 8 cm. and this shortening is also relative due to the deformity during healing. Eventually, the patient has a limb with which he can walk, but the extreme shortening has its adverse consequences – curvature and pain in the spine, limited mobility of the leg. In practice he used his leg sparingly, as a kind of support. He moved independently, but all these years the movement was accompanied by pain. New possibilities in medicine, and specifically navigational endoprosthetics, have made it possible for this patient to take the step of permanently solving his health problem 21 years after the accident, by choosing to trust our team,” explained the details Prof. Asparuhov.

Due to the severe deformities at the fracture site, it was not possible in this case to apply a standard intramedullary system to guide and determine the position of the implant. X-rays clearly show the axes of loading of the limb and the team of prof. Asparuhov made the only possible decision – surgery by navigational endoprosthesis. “The advantage of this technology is that with the help of navigation the implants are placed in the optimal position for each patient, according to his anatomy. The method guarantees long-term survival of the joint. I have already had the opportunity to say that, worldwide, with the advent of robotic and computerised surgery, navigational endoprosthesis has long since replaced classical surgical techniques. At the Heart and Brain hospitals in Pleven and Burgas we have had the new technology for nearly a year and we have highly trained teams who have specialised in Germany. This allows routine application of the innovative approach, which is many times more gentle for patients”, said prof. Asparuhov. He said that once again he and his colleagues are extremely pleased because they can see in practice how the new technology makes it possible to solve difficult patient cases.

The operated 70-year-old patient was up on his feet just a few hours after the intervention. He himself says he feels happy because he can now move his leg without pain.

The application of a navigational endoprosthesis depends entirely on the severity of the deformity in each individual case, and this is decided by the medical team. The operation is fully covered by the Health Insurance Fund for all insured patients.

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.