Category: News

The gynecology department, headed by Dr. Alexander Lyubenov, is one of the fastest growing structures at Mama and Me, according to the results reported on the occasion of its third anniversary.

Since its opening in 2022, more than 4,000 patients have been treated. More than 3,800 surgical procedures have been performed, 85% of which were minimally invasive. More than 450 robot-assisted surgeries have been performed, including total and radical hysterectomies, surgeries preserving reproductive function in women with cancer (radical trachelectomy), pelvic lymph node dissection, myomectomy, and cystectomy, as well as surgery for genital prolapse.

The team

The department’s vision is built by a young, qualified, and motivated team that strives daily to improve its expertise and provide high-quality medical care. There are six specialists working in the department, six residents, and 12 midwives. The unit is a preferred place for the development of young doctors and healthcare specialists because it performs the full range of gynecological surgery, including laparoscopic and robot-assisted surgery, open surgery, vaginal surgery, the entire range of urogynecological surgery, and correction of static gynecological diseases (using mesh and meshless techniques). Dr. Alexander Lyubenov, MD, Dr. Atanas Alexandrov, and Dr. Desislava Kiprova, MD, are certified to work with da Vinci and, in addition to their surgical work, provide ongoing training for young doctors.

High-tech equipment

Medical equipment is a key factor behind the excellent postoperative results. The department has two robotic systems – Da Vinci X and Da Vinci Xi. The indisputable advantages of robot-assisted surgery are greater precision, better visualization, less blood loss, and faster recovery. This makes it the preferred method for patients with benign gynecological neoplasms with a BMI (Body Mass Index) above 35.0 kg/m2, as well as for proven malignant gynecological diseases.

The department’s arsenal is complemented by the Rubina laparoscopic system, which provides the highest image quality with 4K resolution, a 3D image, and the option of using infrared filters to visualize the fluorescent dye indocyanine green (ICG). Surgical procedures with Rubina allow the surgeon to perform highly complex interventions, dissection of anatomical areas, detection and removal of sentinel lymph nodes, as well as reduced intraoperative blood loss. The system is used daily to perform laparoscopic hysterectomies, myomectomies, cystectomies, and correction of static disorders.

The latest technological addition is the Biolitec laser. The advantages of using it are greater precision, thus preserving reproductive capacity, especially in women with endometriosis. In the gynecology department, laser surgery is used to perform a number of minimally invasive procedures, including the removal of endometriotic cysts, pelvic adhesions, and myoma nodes. It is also effective in the treatment of mild, moderate, and severe forms of cervical dysplasia. Hysteroscopy is an integral part of daily surgical practice. The department has a full range of hysteroscopic equipment, including a Bigatti shaver and two bipolar resectoscopes.

With their help, under visual control, formations from the uterine cavity and cervical canal are removed.

Scientific research

The team focuses both on surgical activities and on the creation and development of scientific research. One of the latest achievements of the gynecology department is the recognition of “Heart and Brain” as a training center of the European Society of Gynecological Endoscopy (ESGE) with five certified instructors from the team. Over the past year, five courses have been held under the auspices of the GESEA Educational Programme, attended by a total of 30 doctors from various surgical specialties. The team actively participates in a number of Bulgarian and international congresses.

Since 2024, Dr. Atanas Alexandrov has been a member of the ESGE advisory board, and at the association’s last congress in Marseille, he moderated two of the scientific sessions and was a mentor in one of the certification sessions in the GESEA training program.

We provide high-quality and accessible gynecological care, prevention and early diagnosis of gynecological diseases, improvement of women’s reproductive health, and continuous professional development of our team.

Medical genetics specialists from Heart and Brain, led by Assoc. Prof. Elitsa Becheva-Kraychir, gave an outstanding presentation at the annual conference of the European Society of Human Genetics (ESHG). It took place from May 24 to 27 at AlianzMiCo – Milan Convention Center, one of the largest congress centers in the heart of Milan. More than 5,600 participants from over 90 countries took part in the large-scale event. The Medical Genetics Laboratory participated in the conference with three posters based on the results of the hospital’s molecular genetics and cytogenetics laboratories and medical-genetic consultations by specialists.

Dr. Lilia Nikolova-Georgieva presented a clinical case of severe congenital transfusion-dependent hemolytic anemia resulting from a newly detected homozygous deletion in the PKLR gene. The poster by Dr. Todor Vassilev describes an inherited Alagille syndrome in a patient with a predisposition to NEXN-associated cardiomyopathy. The third poster, presented by Dr. Petya Angelova, is the result of the work of the cytogenetic laboratory and describes a rare hereditary chromosomal aberration in chromosome 11 affecting relatives from three generations.

Dr. Natalia Todorova joined the course “Clinical Genomics and NGS” at the University Residential Center of Bertinoro at the University of Bologna just days before. The course program included lectures by leading experts in the field of genetics and bioinformatics, followed by afternoon workshops. The clinically oriented seminars with an interactive discussion format and the bioinformatics seminars with practical exercises in the analysis and interpretation of biological data complemented the excellent theoretical training provided by the lectures.

“By presenting at major European forums, our specialists demonstrate their extensive clinical experience in identifying rare and complex genetic syndromes, the early detection of which could be of paramount importance for the appropriate selection and timely initiation of treatment for our patients,” said Assoc. Prof. Kraichir, head of the genetic laboratory.

A high-tech gynecological operating room ensures more precise surgical procedures

The high-tech Heart and Brain Hospital in Pleven now has a second da Vinci Xi robotic system, which is the latest technological development in the field of robot-assisted surgery in Europe. The system is used for a range of benign and malignant gynecological cancers and has been integrated into the hospital’s work to meet the needs of a large number of patients from all over Bulgaria.

“The advantages of robot-assisted surgery over conventional minimally invasive and open surgery are undeniably great. It provides surgeons with significantly improved visibility and precision thanks to a three-dimensional image that is magnified 10 times,” said Dr. Desislava Kiprova, a leading specialist in the department.

The new robotic system is located in the recently renovated gynecology ward, equipped according to the latest European standards. This provides excellent conditions for both patients and the medical team performing the operations.

Impressive results in 2024

The gynecology department at Heart and Brain has established itself as a leader in Bulgaria in modern gynecological and gynecological oncology surgery. Over the past year, more than 1,400 operations have been performed there, with over 85% of them using minimally invasive techniques. More than 200 robot-assisted gynecological operations were performed in 2024.

Key advantages of robotic surgery

The four robotic arms of the da Vinci Xi system mimic the movement of the human wrist, but with a greater range of motion, allowing for more precise and flexible handling of instruments. This is particularly important in gynecological oncology, where precision is crucial.

“Today, robot-assisted surgery is used in many types of gynecological surgeries and for a number of diagnoses, both benign and malignant. It is ideal for cases where great precision and delicate work are required,” adds Dr. Alexander Lyubenov, head of the gynecology department.

For patients, the advantages include less post-operative pain, shorter recovery times and a quicker return to normal daily life, reduced blood loss and fewer scars compared to traditional surgery.

The certified team at the gynecology department at Heart and Brain Pleven is already a symbol of quality and standard in robotic surgery in the country.

On May 13, European Stroke Awareness Day, ,Heart and Brain’ Center of Excellence is joining the campaign of the (AIA). Neurology specialists will answer questions from citizens and inform them about the symptoms of stroke and the need for a quick and adequate response to this life-threatening emergency.

According to the AIA, an average of 4,000 people suffer a stroke every month. This diagnosis is also among the most common causes of death in the country—cardiovascular and cerebrovascular diseases account for a total of 59.8% of deaths in 2023.

“Although survival rates are increasing and we are able to save the lives of many patients with heart attacks or strokes, there is still a need for public awareness about prevention and adequate response. This is why the teams at the Heart and Brain Clinic have decided to join the campaign,” says Prof. Ivan Dimitrov.

The World Health Organization (WHO) says that one in four adults is at risk of having a stroke. It can be fatal or disabling and changes the lives of not only the victim but also their loved ones. Stroke is preventable and treatable, and its severity, including its long-term effects, can be reduced.

May has been declared Melanoma Awareness Month by the World Health Organization. Melanoma is the most aggressive form of skin cancer. It is known that around 600 people in Bulgaria are diagnosed with malignant melanoma every year. In the US, 200,000 new cases are registered annually with over 8,000 deaths, while in the EU, over 100,000 people hear the terrible diagnosis every year, and deaths related to this disease exceed 15,000. There is an alarming trend of a 3-5% annual increase in incidence worldwide, including in Bulgaria.

Interview with Assoc. Prof. Natalia Chilingirova, Head of the Complex Oncology Center at the Heart and Brain Hospital in Pleven

– Assoc. Prof. Chilingirova, is there a trend toward younger patients, and what trends have been observed in recent years by age group?

– Yes, unfortunately, in recent years we have observed an alarming trend toward “younger” melanoma patients. Young people, including those under 30, are being diagnosed more and more often. The main reason for this is excessive sun exposure during childhood, as well as the use of tanning beds. In the past, melanoma was typical for people over 50-60 years of age, but this is no longer the case. Current epidemiological data show an increase in cases among young people. Therefore, regular preventive check-ups are crucial, and excessive sun exposure without sunscreen should not be taken lightly.

– In this context, what are the risk factors?

– The main risk factor is excessive and unprotected exposure to ultraviolet (UV) radiation, both from the sun and from artificial sources such as solariums. Other risk factors include fair skin, multiple moles (especially if they are unusual), a family history of melanoma, and a history of severe sunburn during childhood. Genetic predisposition also plays a role, albeit to a small extent.

– What are the symptoms and when do they appear?

– Melanoma most often begins as a change in an existing mole or the appearance of a new, unusual lesion on the skin. Any change in the color, shape, size, or outline of a mole should be cause for concern. Itching, bleeding, inflammation, or asymmetry are also warning signs. This is why regular self-examination and preventive check-ups with an oncologist are important. In advanced disease, symptoms are usually associated with the organs and systems in the body affected by metastases.

– In which area of the skin is melanoma most commonly found?

– In men, it is most commonly found on the back, and in women, on the lower legs. But in practice, melanoma can appear anywhere, including on the scalp, under the nails, in the mucous membranes, and even in the eye. It is this “unpredictability” that makes the disease such a challenge for specialists.

– What is the multidisciplinary approach to the diagnosis and treatment of melanoma at Heart and Brain?

– At our comprehensive cancer center, we rely on close collaboration between different specialists—dermatologists, oncologists, pathologists, surgeons, and imaging specialists. This allows for a quick and accurate diagnosis, timely treatment planning, and patient follow-up. We provide a personalized approach and use all modern therapies, including targeted and immunotherapy. This significantly increases the chances of successful treatment. Patient follow-up is also carried out according to modern standards.

– Is the disease treatable and should it be considered a terminal diagnosis?

– Melanoma is definitely a serious diagnosis, but it should not be considered automatically fatal. When detected at an early stage, it is completely curable in over 90% of cases. The problem is that it is often diagnosed late and at an advanced stage. That is why early detection is crucial. As already mentioned, modern medicine is advancing and has powerful modern weapons in the fight against melanoma, both surgical and medical, and increasingly innovative therapies are being developed.

– What is the prevention?

Prevention plays a key role in the successful fight against this disease. In Bulgaria and Europe, there are a number of initiatives for prevention and early diagnosis, as well as local campaigns for free skin examinations. However, the most important elements remain education about risk factors and symptoms, regular dermatological examinations, as health is primarily a personal responsibility. It is important to encourage the use of sunscreen products and avoid solariums. At Heart and Brain, we also run prevention campaigns and teach patients how to monitor their own skin. However, a national prevention campaign is a cross-institutional initiative and depends on each country’s National Cancer Plan.

Dr. Svetla Gecheva, leading clinical immunologist at Heart and Brain in Pleven and Burgas

• April 29 marks World Immunology Day, celebrating one of the most dynamically developing modern sciences. Immunology Day was first celebrated in Europe in 2005. Since 2007, this event has also been celebrated by the global immunology community.
• Immunologists around the world come together to present the achievements in clinical immunology to the public, its importance for the development of medicine and biology in the diagnosis and treatment of a number of diseases involving immune mechanisms – infections, immune deficiencies, tumors, autoimmune diseases, allergies, transplant and reproductive disorders.

– Dr. Gecheva, what is the motto of this year’s World Day and what messages does it convey?

– In 2025, World Immunology Day will be celebrated under the motto: “Brain and Immunity: Immunological Insights into Neurological Disorders.” The theme carries a very important message – we cannot view the brain and the immune system as completely separate worlds. Neuroimmunology studies this interaction in various aspects, for example, how infections, autoimmune diseases, and inflammatory processes can affect brain function and lead to symptoms such as fatigue, depression, or cognitive impairment. We are seeing how more and more neurological conditions—such as multiple sclerosis, autoimmune encephalitis, depression, and even autism—are beginning to be better understood through the lens of immunological mechanisms.

In recent years, the role of immunology in the diagnosis, prognosis, and treatment of socially significant diseases such as Alzheimer’s and other forms of dementia has grown significantly. New research shows that the immune system and inflammatory processes in the brain play a key role in the development and progression of these diseases. The role of microglia in neuroinflammation has been assessed and new biomarkers have been introduced. Specific anti-inflammatory therapies against microglial activity are being developed, as well as therapies with antibodies against beta-amyloid and tau proteins. Some of these have already been approved in the US (e.g., Lecanemab and Aducanumab).

– Why is immunology considered the most dynamic science in recent years?

– Immunology has established itself as one of the most dynamic medical sciences because it is fundamental to understanding and treating some of the major health challenges we face today. In my practice as a clinical immunologist at Heart and Brain, I see how advances in immunology are literally changing everyday medical practice. Discoveries about the role of the immune system are not limited to infections or autoimmune diseases—it is also proving to be key in oncology, neurology, metabolic diseases, and even psychiatry.

In recent years, we have witnessed real breakthroughs: the creation of innovative vaccines in record time, the development of immunotherapies that give cancer patients a new chance, new biomarkers for diagnosis, and personalized approaches to treatment. The immune system is no longer seen as just a “shield against infection,” but as a complex, intelligent network that participates in almost every physiological process. This dynamic is the result not only of scientific progress, but also of technological advances—modern bioinformatics, genomics, and proteomics allow us to peer into the depths of the immune response in ways that seemed unimaginable until recently. In this sense, I can categorically state that immunology is the driving force behind modern medicine. It is not just developing rapidly—it is advancing science and changing the lives of our patients in real time.

How does the multidisciplinary approach you apply in your work at Heart and Brain in Pleven and Burgas benefit patients?

The immunology laboratory works closely with almost all clinical medical specialties, providing timely and reliable immunological diagnosis, modern immunotherapeutic approaches, preventive care, and expert advice on immune-mediated disorders. The laboratory offers testing for a wide range of autoantibodies associated with rheumatological, gastroenterological, and hematological diseases, as well as conditions associated with an increased risk of thrombosis. In collaboration with other highly specialized diagnostic laboratories—genetic, clinical, and pathological—we ensure a high standard of diagnosis, supporting the modern and personalized treatment of our patients. In the spirit of the motto: “Brain and Immunity,” I will be more specific about research related to diseases of the nervous system. Immunological tests in cerebrospinal fluid (CSF) are extremely important in neurology, especially in the diagnosis of inflammatory, autoimmune, infectious, and oncological diseases of the central nervous system. We have recently added a new biomarker to the working algorithm for cerebrospinal fluid testing: free light chains κ and λ. Measuring their concentration provides valuable information about the presence of an inflammatory process in the nervous system, which, as we have said, is extremely important for a number of diseases. The data from this new biomarker is a valuable tool in the diagnosis and prognosis of multiple sclerosis, contributing to earlier detection and more precise management of the disease, which is essential for improving the quality of life of patients.

The laboratory also tests a panel of onco-neurological antibodies used primarily to diagnose paraneoplastic neurological syndromes. These are neurological conditions that arise as an immune response to a tumor, but this response mistakenly attacks the nervous system. In the presence of onconeural antibodies without an established tumor, the most common suspected conditions are: lung cancer, breast cancer, testicular or ovarian tumors, lymphomas, and others.

Another additional biomarker related to neurology is currently being introduced – neurofilaments. These are structural proteins of axons that are released into the interstitial space and then pass into the cerebrospinal fluid and blood when neurons are damaged. It has been found that levels of NfL (especially neurofilament light chain – NfL) are elevated in multiple sclerosis, neurodegenerative diseases, and acute neurological events.

The full news article can be found here.

Three young doctors from the cardiology clinic at ‘Heart and Brain’ actively participated and performed brilliantly in the 11th edition of the Sofia Echocardiography Days on 11 and 12 April.

Dr. Martina Samardzhieva, leading specialist and head of the department, was the speaker at the event with a presentation on “Imaging methods for mitral valve assessment”. In front of more than 500 participants, she presented the main imaging modalities for mitral valve assessment – transthoracic and transesophageal 2D and 3D echocardiography, computed tomography and cardiac magnetic resonance imaging for a more detailed assessment.

Again this year, a doctor from the ‘Heart and Brain’ clinic received a prestigious award. Dr. Teodora Stamenova, a specialist in the clinic, took second place for best clinical case at the Candle light session. “The case she presented is extremely innovative and is yet another proof of the success of the multidisciplinary team of specialists – cardiologists, cardiac surgeons and imaging specialists at our high-tech center of excellence”, informed Dr. Samardzhieva.

The topic was “Transcatheter closure of interatrial communication. Better late than never”. “A 46-year-old female patient presented to our clinic with frequent episodes of palpitations, flushing in front of the eyes, dizziness, nausea, feeling of head warming and tingling in the occiput. During hospitalization, the patient was found to have a persistent patent foramen ovale (PFO). It is the most common anatomical cause of interatrial septal defect, occurring in one quarter of the population. It is usually asymptomatic but can cause paradoxical embolism manifesting as stroke, transient ischemic attacks(TIA) or peripheral ischemia.

After performing multiple additional diagnostic tests such as transthoracic echocardiography with bubble test, transesophageal echocardiography with bubble test, transcranial Doppler sonography with bubble test, RoPE score system calculated, the association between the findings was established and the likelihood of PFO being an etiological factor for transient ischemic attacks was verified.

During cardiac surgery team decided to correct the defect by occluder closure, a device to close interatrial defects. Two days after closure of the defect, the patient was dehospitalized in good general condition,” informed Dr. Teodora Stamenova.

Dr. Vladimira Pavlova-Popova also presented a clinical case of a patient with a rare disease – amyloidosis, referred and diagnosed in the cardiology clinic.

Every year on 7 April we celebrate World Health Day. This year, the World Health Organization is focusing on the theme “Healthy Beginnings, Hopeful Futures”, with an emphasis on maternal and newborn care. On this occasion, we talk to Dr. Andrey Hristov – head of the neonatology department at the newest specialized hospital for maternal and child health in the country – ‘Mama and I‘.

Dr. Hristov is a long-standing national consultant in neonatology for Central Northern Bulgaria, intensive care therapist with extensive clinical experience in the resuscitation and treatment of newborns, including extremely premature babies. He is board certified in abdominal and transfontal ultrasonography and has introduced a number of innovative approaches to neonatology in our country. He has taught postgraduate and undergraduate students and today leads a team that works with a cause and a vision for the future. On World Health Day, we talk to the neonatologist:

What have you achieved in less than two years at , Mama and I’ Hospital?

Since the opening of the hospital on 1 June 2023, 477 babies have been born with us. We are glad that we are a preferred choice not only for the residents of Pleven region, but also for expectant mothers from neighboring and even more distant regions. Women today are looking for a modern, safe and human environment where they feel supported.

Our neonatology department concentrates high-risk pregnancies because of its high competence. With us, patients bring nothing from home – only faith and a smile. The rest is our care.

What is the most complicated case you remember?

Challenges are a daily occurrence in our specialty. Recently, we were faced with a proven incurable disease – yet we worked with faith and never allowed the thought that we would not succeed. Parents often say, “As long as it’s in your hands, then it’s going to be okay,” which speaks volumes about the trust we have established for parents of children.

The biggest challenge in your job?

Most recently, we had to treat a 650-gram newborn who was in critical condition and had an acute vascular complication – a thromboembolism of an artery in the arm. Specifically, an acute arterial occlusion of an upper extremity.

Such cases are extremely rare worldwide. We immediately organized a multidisciplinary team, including vascular surgeons and specialists from other clinics. Dr. Samardzhiev, head of the vascular surgery department, and specialists from other clinics responded at the minute, and we discussed therapy options.

We had to apply a modified therapeutic approach, without established algorithms, and we succeeded – we saved the child’s arm. For our team, this was a real test and an important success. The graduate students saw a condition that they will likely not see the end of their careers.

Is there any truth in the statement about the increase of children with congenital malformations in Pleven?

Absolutely not. Since the opening of ‘Mama and I‘, the most severe cases from all over Northern Bulgaria and sometimes from other parts of the country have been concentrated here. This is not a sign of a local problem, but rather evidence of confidence in our capacity.

Colleagues know that this is the hospital for Bulgaria’s seriously ill children. They receive precise diagnosis and treatment here. The incredible range of solutions we have enables us to make an etiological and often genetic diagnosis for patients.

Our hospital has an extremely precise genetic laboratory. Medical genetic counseling, cytogenetic analysis, and DNA analysis of thousands of rare diseases and monogenic ones are performed. This is what brings parents to us – the opportunity for clarity and treatment.

What would you wish your colleagues on the occasion of the World Health Day?

I wish all my colleagues the chance to work in hospitals like ‘Heart and Brain’ and ‘Mama and I’ – modern, well equipped, with great respect for the teams and a vision for the future. I believe that more and more Bulgarian cities deserve such hospitals.

The first groundbreaking ceremony for the construction of the Heart and Brain Center of Clinical Excellence was held today in Kardzhali. The symbolic start of the construction was given by Mayor of Kardzhali Erol Mumün and Prof. Toni Vekov, chairman of the board of directors.

The hospital is not only expected to provide better medical services for the region, but also to attract highly qualified specialists and stimulate the development of the health sector in the Eastern region of Bulgaria.

The hospital is expected to be operational by the end of 2027 and will encompass one hospital facility, a separate building for a diagnostic-consulting centre and a separate building for a pharmacy. So it really is one big hospital complex. This investment is about BGN 100 million, or at least BGN 100 million, BGN 60 million for the construction of the facilities and BGN 40 million for the purchase of equipment. It is also very important to say that the hospital will be of the third, highest level, that is to say, it will allow truly state-of-the-art treatment.

The hospital will not rely on local specialists, but on those who are already trained and being trained – from Burgas, from Pleven.

A team of surgeons at ‘Heart and Brain’ have removed a huge inflammatory growth from high up in the back of a 50-year-old woman from Knezha. The growth weighed three kilograms and was 30 cm long, with multiple inflamed ulcers and sores, extremely painful for the woman.

The patient had neglected the growing ‘hump’ for years and only sought medical attention when the growth began to become inflamed, painful and the surface of the growth developed sores, blisters and ulcers which bled. She chose ‘Heart and Brain’ Pleven because of the leading specialists and the multidisciplinary approach to diagnosis and treatment.

Due to the size, inflammation and multiple blood vessels, the surgery lasted nearly three hours. The surgeons successfully removed the growth, but recommended the woman undergo a detailed clinical examination of the entire body due to the possibility of other similar formations.

“This is the first time in our practice that we have encountered such a formation, both in size and inflammatory process. Fortunately, the histological examination proved that it is benign and the woman will be able to continue her life without any problems – with self-confidence, without pain and heaviness,” informed Dr. Dimitar Georgiev, the lead surgeon and head of the team that performed the surgery.