Category: News

Dr. Petya Dinovska, Executive Director of ‘Heart and Brain’

Open days, campaigns for access to specialized medical care in small towns, schools for patients, high-tech medical procedures, long-term follow-up of patients after COVID-19 – this is just a small part of the activities of the hospitals of the Bulgarian Heart Institute. And although we are often copied, no one has yet reached our advanced expertise, work dynamics, way of organization and, most of all, the attitude to the patient. Of course, we are very happy just today, on Trifon Zarezan and Valentine’s Day, to congratulate all colleagues dedicated to the profession with great love and to note that all of us in Bulgarian healthcare together raise its quality to a European level.

17 years ago, with the launch of the first specialized cardiology hospitals in Pleven, Varna, Yambol, Shumen and Veliko Tarnovo and the introduction of the so-called “golden hour” in a total of 16 districts, we significantly reduced the mortality rate from acute myocardial infarction in the country, improved the quality and prolonged the lives of patients with cardiovascular diseases.
Emergency care must be comprehensive, because no country in the world has been able to address 100% of life-threatening conditions alone.

This success was noticed by the leading European and world cardiologists from the United States, Czech Republic, France, Italy, Switzerland and Germany, who accepted to pass on their knowledge and skills to their Bulgarian colleagues. Legendary luminaries such as Professors: Eugene Braunwald, Toby Cosgrove, Frans Van de Werf, Jean-Pierre Bassand, Petr Widimsky, Tomislav Mihaljevic, Steven Nissen, Luigi Martinelli, Ladislav Groch, Francesco Bedogni, Zbyňěk Straka, Bijoy Khandheria, Antonio Pezzano, Robert Hobbs, Christian Matter and many others have supported us and continue to help us in advanced medical science and practice. World renowned cardiac surgeon prof. Thierry Carrel, the renowned vascular surgeon prof. Chang Shu, the renowned orthopaedic endoprosthetist prof. Heinz Roettinger, the star of breast surgery prof. Diego Rivas – all of them chose the high-tech hospital complexes ‘Heart and Brain’ in Pleven and Burgas to present the latest surgical techniques, inspect the work and confirm the expertise of our teams. The long list of legendary luminaries in medicine who have become part of the Bulgarian Heart Institute family continues to grow along with our ongoing advancements in over two dozen important specialty areas.

The long-term investment in new knowledge and skills of physicians from all specialties continues to this day. Heart and Brain physicians continue their training and qualifications in the most prestigious European university clinics and leading hospitals in Europe, the United States, Australia and Israel, learning the most advanced approaches to the treatment of socially important diseases from which Bulgarians suffer – cardiological, metabolic, neurological, etc.

Just seven months ago, the first newly built clinic for maternal and child health ‘Mama and I’ opened its doors in 55 years. A number of metropolitan families travel to Pleven to have genetic testing and receive first-class treatment and care for their children from the best neonatologists, pediatricians, surgeons, orthopedists, medical geneticists in the country. The results have not been long in coming – more than 180 babies have already been born at ‘Mama and I’, and our doctors often treat the most complex cases from all over the country.

In response to numerous inquiries from patients and colleagues, delighted by the modern treatment and individual approach at ‘Heart and Brain’, some of our leading specialists are now examining and consulting patients at the ‘Heart and Brain’ medical centre in Sofia: Lozenets district.

As with any success, only the gloss remains on the surface – hidden are the efforts, coordination, motivation and perseverance of each of us, dedicated to our work with great love and dedication. It is only natural that the way of working, the approach to patients and even the news from ‘Heart and Brain’ should be copied and emulated. This particularly pleases us and fills us with optimism – because we are leading the reform towards achieving European quality in healthcare!

On 12 February we celebrate the International Day of People with Epilepsy. This common neurological disorder affects over 70 thousand Bulgarians and about 60 million people worldwide. Prof. Dr. Plamen Bozhinov is a leading neurologist and head of the Heart and Brain Clinic for Neurological Diseases.

The word epilepsy is of Greek origin and means ‘to grasp, seize, overwhelm’. This term was first used by Aristotle to define conditions accompanied by seizure manifestations. John Hughlings Jackson (1835-1911) contributed to the scientific description of various types of epilepsy. Some of these descriptions were based on his observations of his own wife’s epileptic seizures. These seizures always began in the same way: with involvement of the wrist and subsequent spread to the shoulder, face and finally the leg on the same side of the body. Later, epileptic seizures with similar spread were called Jacksonian, and their spread was defined as Jackson’s march.

Can we briefly tell what epilepsy is?

Epilepsy is a disease affecting the central nervous system (CNS) that is characterized by an individual predisposition to recurrent manifestations called epileptic seizures. They are characterised by intermittent, unprovoked, identical for each patient and in most cases unpredictable disturbances of consciousness, behaviour, emotional state, motor functions, perception or a combination of these. These clinical manifestations are the result of a suddenly occurring, deviating from normal (abnormal) hyperexcitability of brain neurons, called crisis (paroxysmal). In a combination of various genetic and acquired conditions, this hyperexcitability may begin to recur after some time (become chronic) and lead to the development of the disease epilepsy.

The incidence of the disease varies between 4 and 10 per 1000 people. Epilepsy in Bulgaria occurs in about 3% of the population, with an average of 240-3600 new cases diagnosed annually (30-45 cases per 100 000 population). About 50% of epilepsies begin in childhood, before the child reaches the age of 10, and a total of 75% occur by the age of 20. The peak of manifestations in children is around the fourth year, and in adults over 65 years. The mortality rate is between 0.4 and 4 per 100,000 patients, with the most common cause related to the onset of status epilepticus.

When it comes to epilepsy, we should not forget about the stigma associated with this disease.

Yes, it is. Even patients with a mild disease, without accompanying forms of disability, feel stigmatised (marked) and their illness leads to serious social disadvantages. Epilepsy is responsible for significant medical and social impairment and therefore requires medical, neuropsychological, psychiatric and social interventions. In about 60-70% of patients with epilepsy, medication response is good and the active phase of the disease (with the presence of seizures) covers a short period. These patients need short-term rehabilitation, but at the same time a full evaluation and varying degrees of long-term psychological and social support. For the remaining patients with refractory epilepsy, a more prolonged and intensive rehabilitation is needed, especially as 10% of patients with epilepsy have persistent learning problems and the presence of other debilitating conditions.

What are the specifics in diagnosis?

Diagnosing epilepsy and determining the type of epileptic seizures is an important part of the medical art, and specialists are called epileptologists. These are neurologists who have a great deal of practical experience and are familiar with all the steps involved in making or rejecting a diagnosis of epilepsy. Important stages in the diagnostic plan are: recognition and description of epileptic seizures; differential diagnosis (DD) with conditions other than epilepsy but presenting with changes in consciousness, motor, sensory, autonomic or psychic manifestations; proof of the chronic course of the disease in the absence of an obvious seizure provoking factor; proof of the type and aetiology of epilepsy. To make a correct diagnosis, the first step is to take a correct history (accompanying conditions; symptoms during and after the seizure). Secondly, a good assessment of the somatic condition helps to differentiate epilepsy from other diseases that may have similar clinical manifestations. Neurological examination may reveal signs of local or diffuse brain damage, but in most cases there may be no apparent neurological symptomatology.

What else helps specialists?

Epilepsy can arise secondary to various pathological conditions, for example, traumatic or inflammatory changes in the structure of the brain, infectious diseases affecting structures of the nervous system, metabolic disorders, autoimmune diseases in which the immune system reacts against its own structures of the nervous system, and last but not least – to genetic defects. In some cases, even with the use of all the possibilities of modern medicine, the cause of epilepsy can not be established.

After carrying out a wide range of standard tests to exclude the most common causes of secondary epilepsy (imaging, laboratory analyses, immunological tests), genetic analyses can be extremely useful in clarifying the aetiology in some cases. To date, more than 200 genes have been identified that are directly associated with the onset of epilepsy, and dozens of others are known to be associated with the development of diseases in which epilepsy or epileptic seizures are part of the symptoms.

What is the role of genetics here?

Establishing the genetic cause of epilepsy is important because it not only confirms and clarifies a patient’s diagnosis, but can be critical for making therapeutic decisions, allowing assessment of prognosis and prediction of the course of the disease, as well as assessing the risk of affecting other relatives. Making an accurate diagnosis has social, economic and normative implications, allowing those affected to find an adapted place in society, obtain an adequate assessment of their ability to work and to relate to others with the same illness.

Genetic studies to establish the cause of epilepsy are varied, as they offer a search for fundamentally different genetic disorders – there is no universal method of analysis. The choice of the appropriate tests and the order in which they should be carried out is individual and tailored to the disease history of the particular patient. It is done with the help of a medical geneticist who, in the context of a genetic consultation, explains to the patient the advantages and limitations of the different methods and the meaning of genetic analyses so that the patient can make an informed decision about his or her own health.

These and other types of analyses, as well as expert genetic counselling by a team of specialists with high qualifications and clinical experience, are offered for patients with genetically determined epilepsy in the medical genetics laboratory at , Heart and Brain’. The laboratory has state-of-the-art equipment and operates to established European standards. The ability to work collaboratively with specialists from all medical specialties within the hospital allows for a multidisciplinary individualized approach to each patient’s care. In this way, patients with rare genetic syndromes whose clinical picture includes epilepsy can receive an accurate diagnosis and possibly specific treatment without long delays.

The highly specialised hospitals , Heart and Brain’ employ some of the best epileptologists and neurologists in our country. In the high-tech hospital complexes in Pleven and Burgas, specialists can make the most accurate diagnosis of the type of epilepsy and epileptic seizures, conduct genetic testing and drug monitoring, and prepare an individual treatment plan for each patient.

The life-saving approach applied is unique for Bulgaria and the world

Six complex operations, three of which were performed on an emergency basis using the method of a customized and physiologically modeled prosthesis, were performed by vascular surgeons at ‘Heart and Brain’, Pleven. “The technique is extremely complex and specific. Literally on the fingers of the hand are counted the hospital centers in the world that have successfully implemented this type of surgery in a state of emergency,” informed Dr. Todor Samardzhiev, head of the department of vascular surgery at the high-tech hospital. The operated patients were admitted to Pleven from other hospitals in the country. Although transportation carries an additional risk, the survival rate of patients with ruptured aneurysms increases when they are treated in a hospital where the necessary specialists and equipment are available.”

“Five of the interventions we had to do in a very short time were on patients with abdominal aortic aneurysm, three of them with rupture (rupture). The sixth was on a patient with a renal artery aneurysm. These conditions are some of the most life-threatening, and rupture requires immediate measures because it involves the effusion of a large amount of blood into the abdominal cavity. The only treatment is surgical intervention. Any delay could be fatal for the patient, and the risk of a fatal outcome in classic open surgery for a ruptured aneurysm is over 90%.”

Endovascular aortic aneurysm repair (EVAR) is routinely performed at ‘Heart and Brain’, Pleven, both in elective and emergency patients. The challenge in these three cases was that the nature of the aneurysm did not allow standard endovascular surgery. Therefore, in three of the cases we inserted a customized and physiologically modeled prosthesis. An extremely complex method, requiring impeccable precision, team preparation and technique,” explains Dr. Samardzhiev.

The condition of the patients necessitated the placement of a fenestrated endoprosthesis. Fenestrations are openings in endoprostheses through which vital organs are supplied with blood. However, such prostheses are not available in the country and their cost exceeds BGN 70 000. “Making a ready-made custom prosthesis would take a lot of time and money. We have successfully modified an existing graft, which is covered by the NHIF,” says the head of vascular surgery. The multidisciplinary team decided to apply the approach, which is new for our country and was first successfully implemented in ‘Heart and Brain’ half a year ago. Through precise measurements and calculations, the vascular surgeons modify the implant for the patient’s specific needs by 3D imaging in a sterile environment. This is followed by an extremely delicate process of placing stents in the renal and iliac arteries. The surgery is minimally invasive and requires careful advance preparation, a great deal of knowledge and additional skill on the part of the physicians.

“We did all the surgeries as per the global time requirements – from the entry into the room, anaesthesia to the intervention itself. The aneurysms were asymptomatic and the only thing the patient could feel as a kind of warning was pulsations in the abdominal area, but no pain. The appearance of sharp and sharp pain is already a sign of rupture and a state of emergency. Unfortunately, the hospitals in the country where these emergency conditions can be operated are still few,” the experts add.

In just three years, the centre has managed to establish itself as the preferred choice among thousands of patients

Around 3 million Europeans hear the diagnosis of cancer every year. More than half suffer from breast, colon, lung or prostate cancer or malignant haematological diseases. And although cancer is the second most common cause of death in the EU, up to 40% of cases are curable. 4 February is World Cancer Day and it is an occasion to remind people that early detection, prevention and quality care can save thousands of lives.

Oncologists and cancer specialists agree that innovation at all stages, from diagnosis and treatment to patient follow-up, is the cornerstone of successful therapy and improved quality of life. And at the heart of good outcomes is a comprehensive multidisciplinary approach.

Multidisciplinary treatment

Heart and Brain’s multidisciplinary teams include surgeons, pathologists, medical oncologists, clinical haematologists, radiotherapists, neurosurgeons, cardiologists, orthopaedists, pulmonologists, gastroenterologists, neurologists, medical geneticists, obstetricians, endocrinologists, haematologists, clinical psychologists – all in one place. Together they determine the therapeutic strategy for each patient according to their individual characteristics, the biology (type) of the tumour, taking into account comorbidities, family history and other risk factors.

The country’s first cardio-oncology team works in the high-tech hospital complex. Thanks to it, a number of patients with cardiovascular diseases or cardiovascular toxicity from the conducted oncological or oncohematological therapy, who otherwise would not be able to start anti-tumor therapy, actually not only conduct such therapy, but also achieve outstanding results. Guaranteeing this success is the close collaboration between cardiologists and oncologists and clinical haematologists.

Individual approach

The patient is at the centre of modern oncological, or oncohaematological, treatment, so the type of therapy and the sequence of treatment methods are strictly individual.

Target therapy and immunotherapy mark an exceptional advance in the therapeutic algorithms applied at Heart and Brain. Our medical geneticists routinely test biomarkers for predictive, prognostic and diagnostic purposes and determine a patient’s mutational profile so that the optimal individually tailored (personalized) therapeutic approach can be selected. The testing of certain molecular genetic markers provides information on the effectiveness and possible benefit of immunotherapy and the administration of targeted drugs. Timely molecular genetic analysis is part of successful treatment in patients.

Experienced specialists and high technology

The work of the centre is further enhanced by a state-of-the-art radiotherapy complex, equipped with the most technologically advanced linear accelerator in the country, a 4D computed tomography simulator for radiotherapy and radiosurgery planning and the country’s only latest generation gamma knife.

Stereotactic radiosurgery (SRS) is used to treat benign and malignant brain tumors, vascular diseases in the brain (arteriovenous malformations and trigeminal neuralgia), and in recent years, increasingly, brain metastases that some patients develop despite initial cancer therapy. The accumulated experience with the device shows that acute side effects associated with radiotherapy, such as nausea, vomiting, headaches, are in practice extremely rare in patients treated with gamma knife.

Radiosurgery is usually performed as a one-time procedure during a one-day hospital stay. It is much safer and less toxic than both standard neurosurgery, which involves incisions in the scalp, skull, brain membranes and tissue, and other types of radiotherapy, which require multiple exposures. The treatment is paid for by the National Health Insurance Fund.

Robotic oncogynaecology is the trademark of the clinic for maternal and child health “Mom and Me” – part of “Heart and Brain” in Pleven. For a year and a half, the specially trained specialists have performed more than 1,500 surgical interventions, one third of them related to gynaecological oncological diseases.

In addition to standard open and classic laparoscopic surgery, the clinic routinely performs surgery with the da Vinci robotic system. For the robotic gynaecological surgery the hospital has a contract with the NHIF. It brings a number of advantages – minimally invasive, with the lowest levels of trauma and postoperative pain, recovery is fast and patients can return to their normal routine in the shortest possible time. The hospital has a contract with the NHIF for robotic gynaecological surgery.

Breast cancer accounts for a quarter of all cancers and is the most common malignancy in women. In Bulgaria, only Heart and Brain performs sentinel axillary lymph node biopsy – the absolute standard in the treatment of early breast cancer. The method allows during the surgery to detect the lymph nodes that are first in the path of lymphatic drainage and metastasis. If these nodes are metastasis-free, it is assumed that the remaining nodes are also metastasis-free, i.e. that the lymphatic status is negative. There is no need to remove them, which makes the operation much more sparing. The specialists have the most advanced equipment for oncoplastic surgery.

Last year, world-renowned thoracic surgeon Prof. Dr. Diego Rivas and the Heart and Brain teams performed the country’s first uniportal robot-assisted lung resection. This minimally invasive intervention is highly suitable for lung cancer patients, especially those with hard-to-reach lung tumours.

The Heart and Brain Comprehensive Cancer Center’ also treats and diagnoses prostate, kidney, bladder, testicular, penile and ureteral malignancies. Urologists apply conventional and laparoscopic surgery of prostate and kidney, high-tech robotic da Vinci surgery, minimally invasive laser and bipolar surgery for bladder tumors. The teams also use a highly sensitive method to detect areas affected by bladder cancer. This approach allows 24% more tumours to be diagnosed, which is key to a better prognosis.

Starting in 2024, the high-tech Heart and Brain will launch a program to treat primary and metastatic malignancies of the peritoneum (the lining of the abdominal cavity). The hospital now has state-of-the-art equipment for the treatment of this type of disease. The HIPEC (hyperthermic intraperitoneal chemotherapy) and PIPAC (pressurised intraperitoneal aerosol chemotherapy) methods enable the control and, in some cases, complete cure of previously considered incurable primary and metastatic malignancies of the peritoneum. Patient fulfilment of strict criteria is key to inclusion in the programme and obtaining good treatment outcomes.

The doctor-patient relationship

Modern medicine offers hope, but it also poses new challenges for oncologists and their patients. With advances in science, experience, and the application of innovation to daily practice at every stage from diagnosis to treatment, physicians can offer better care and support to those battling cancer. And oncology and cancer treatment is a long-term process – in this challenge, the patient and the doctor are together all the way. Building trust is key to a good prognosis, and often doctors become part of the family.

Why Heart and Brain?

A team of skilled and established specialists, for whom patient trust and appreciation are of the utmost importance, work together in a high-tech environment. It is no coincidence that the Heart and Brain Comprehensive Cancer Centre is the first centre in the country to be certified as a member of the Organisation of European Cancer Institutes (OECI). This enables it to work within the European Cancer Network, sharing valuable experience to offer patients access to advanced personalised treatment based on evidence-based medicine.

Scientific contribution

From 26 to 28 January this year, the second national oncology scientific conference with international participation “The era of innovation in oncology: Innovation is our DNA” was held, organised by the Society of Oncopharmacology and Oncology. Heart and Brain’ specialists presented a number of their own studies that reflect the successes of their real clinical practice in areas such as medical genetics, cardio-oncology, stereotactic radiosurgery, breast cancer, peritoneal cancer and others.

 – Assoc. Prof. Kornovski, according to the data of the National Health Insurance Fund ‘Heart and Brain’ is the leader in major cardiac surgery interventions and the first choice of patients and cardiologists in the country for 2022. What will the data show for 2023?

– More of the same (laughs)! Of course, I don’t know exactly before the data is officially published, and I am only referring to the record workload of the excellent cardiac surgery clinics in Pleven and Burgas. We were individually in the top 2-3 clinics for major cardiac surgery interventions and we have probably retained the lead in the 2023. Probably also and especially our clinic in Burgas is also a national leader in minimally invasive cardiac surgery, which is very patient-friendly and is widely preferred in the advanced world.

– In the Burgas competition, you were nominated for “Person of the Year 2023” with the words, “The world-class cardiac surgeon who chose Burgas over Switzerland and every other place in the world to save our hearts”. What kept you in your homeland, what unlocked this immense motivation and generated this strong national impact? We also noticed that in the public vote you led convincingly in the competition.

– Undoubtedly, there is no more impartial and accurate testimonial to the professionalism of the teams of the modern hospital complexes in Burgas and Pleven than the statistics of the National Health Insurance Fund and especially the data on in-hospital mortality in major cardiac surgery. As the head of the cardiac surgery clinic in Burgas, I am extremely proud of the results achieved and the trust gained. I often work together in person or in telemedicine consultation with my very talented colleague Dr. Yordan Krasnaliev, head of the cardiac surgery clinic at Heart and Brain Pleven. He and I have many collective and team reasons to be proud and motivated, but working together in February 2023 in Pleven and Burgas under the critical inspection of the world renowned prof. Thierry Carrel was a great ‘injection’ to our confidence and performance over the past year.

Despite the state-of-the-art equipment, leading specialists and reimbursement of treatment by the NHIF, paradoxically some patients are still subjected to open operations or sent abroad for treatment.

For the first time in Bulgaria, the Heart and Brain Hospital in Pleven operates a comprehensive oncology center that makes possible state-of-the-art diagnostics, high-tech treatment and long-term follow-up at the highest level, as offered only by the largest cancer centers in the United States and Western Europe.

The Comprehensive Cancer Center is the first and only member from our country of the European Cancer Institutes organization, which enables it to work in the European cancer network, to offer patients access to personalized treatment based on evidence-based medicine. It is a practice at the hospital for doctors from different specialties to work in sync and form multidisciplinary teams to seek the best treatment for the patient. Thus, within minutes, surgeons, cardiologists, gastroenterologists, pediatricians, oncologists, orthopedists, urologists, neurologists and pulmonologists can offer an adequate solution to a complex case.

The work of the centre is also enhanced by a modern molecular pathology and genetics laboratory, the country’s first cardio-oncology sector, and a state-of-the-art radiotherapy complex equipped with the country’s only Gamma Knife.

It is used for stereotactic radiosurgery to treat tumors and vascular diseases in the brain. The technology is applied for successful treatment of benign and malignant brain tumors, arteriovenous malformations in the brain, trigeminal neuralgia.

How does it work?

The Gamma Knife focuses very small beams of radiation on the tumor with extreme precision. Each such beam has a clinically insignificant effect on the healthy brain tissue through which it passes. The intersection point of all the beams is right on the tumor, where a strong dose of radiation is delivered to destroy it. There is no pain or discomfort with the procedure.

Radiosurgery is performed with ultra-high precision on the order of 0.1-0.2 millimeters (by comparison, it is 1-2 millimeters for most linear accelerator techniques), and this precision is checked and confirmed daily by medical physicists before the radiosurgery is performed and is monitored automatically, continuously and in real time while the radiation therapy session is being performed. Compared to other radiosurgery systems, the Gamma Knife enables a tenfold reduction in the radiation dose to the body, allowing brain radiosurgery to be performed even on pregnant women.

Why Gamma Knife?

Gamma Knife radiosurgery is usually performed in a single, one-day hospital stay. It is much safer both compared to standard neurosurgery, which involves incisions in the scalp, skull, brain membranes and tissue, and compared to other types of radiation therapy, which involve repeated radiation with much less precision.

So far, nearly 500 patients have been treated with stereotactic robotic radiosurgery at Heart and Brain Pleven, mainly with brain metastases (including multiple brain metastases at the same time), benign tumours, some cases of primary malignant brain tumours, vascular malformations and functional conditions (trigeminal neuralgia).

Despite the state-of-the-art equipment, leading specialists and reimbursement of treatment by the NHIF, paradoxically some patients are still subjected to open operations or sent abroad for treatment.

HIPEC and PIPAC methods enable control and in some cases complete cure of previously considered incurable primary and metastatic peritoneal malignancies

Beginning in 2024, the ‘Heart and Brain’ Center of Excellence in Pleven will launch a program for the treatment of primary and metastatic malignancies of the peritoneum (the lining of the abdominal cavity). As part of the program, a team from the General and Oncological Surgery Clinic received training at one of the certified centers in Europe in Castelfranco Veneto, Italy. The hospital now also has state-of-the-art equipment for the treatment of this type of disease.

The medical centre on “Krum Popov” Str. in Sofia, Lozenets, provides faster access to the best specialists in the country

“In response to a number of recommendations from colleagues and patients who have received modern treatment and medical care at the high-tech hospital complexes ‘Heart and Brain’, leading specialists will examine and consult patients in Sofia,” said the medical director of ‘Heart and Brain’ Medical Center Dr. Radka Alexandrova.

Dr. Alexandrova is a specialist in pneumology and phthisiology with a scientific degree “Doctor of Medicine” and acquired the right to work with ionizing radiation. She specialized in functional diagnostics at the leading university hospital “Henri Mondor” in Paris. She has 10 years of experience as head of the department of non-specific pulmonary diseases in a pulmonary hospital in Sofia. She is fluent in French and English and provides continuing education for GPs.

Some of the most sought-after experts in the country, with recognized experience at home and abroad, are available to Sofia patients. The center provides the opportunity for a second opinion, examination or consultation by the best surgeons, cardiologists, neurologists, gastroenterologists, urologists, geneticists, pediatricians, obstetricians, pulmonologists, endocrinologists, oncologists and quick access to the only in the country special Gamma Knife and the latest treatment technologies.

Widely known throughout the country and recognized abroad, the high-tech hospital complexes ‘Heart and Brain’ have been the first choice of patients in the North and Southeast in recent years. Consistency in the introduction of new treatment methods, continuous training of the teams from different medical specialties and long-term work to build trust and respect between specialists and patients have distinguished the medical facilities of the Bulgarian Cardiac Institute (BCI) from all other hospitals in the country for 15 years.

BCI’s achievements in reducing cardiovascular mortality, improving quality and prolonging life have been repeatedly recognized abroad. In the past year 2023 alone, the quality of treatment at ‘Heart and Brain’ was confirmed by Prof. Carrel – cardiac surgery, prof. Shu – vascular surgery, prof. Rivas – thoracic surgery, prof. Roettinger – Orthopaedics and by a number of other luminaries of world medical science and practice.

The neonatologists and paediatricians who will be consulting at the Heart and Brain Centre are leading the teams at the newest maternal and child health clinic, Mommy and Me. They take on the most complex cases in the North, increasingly from the capital and all areas of the country, and are established names in their specialties. Thanks to specialised neonatal ambulances equipped with the latest generation transport cuvettes, neonatologists tackle a multitude of challenges in the first hours of life for the youngest patients.

It’s no coincidence that the names of the leading doctors of ,Heart and Brain’ appear in national rankings such as “Doctors we trust” or are nominated for personalities of the year.

Checkups are by appointment only online or by calling 02 9631298. More information can be found on the Heart and Brain Medical Center Facebook page or at www.test.cardiacinstitute.bg.

“Time for direct donation to the able, the knowledgeable and the doers – to the creators of children’s healthcare in Bulgaria, to raise our national expertise to a global level and cover the country territorially.

We only accept named donations, transparently, by bank and electronic transfer only – with full accountability to donors.”

This is a campaign announced by the Maternity and Children Clinic “Mama and I”, Pleven.

The head of the clinic – Dr. Velimir Simov – announced to BNR that the mayors of Burgas and Pleven are the first donors:

“They are mayors of cities where our structures work and they know what they get from these structures. Many ordinary people, medium and small companies, many insurance companies have already donated money and this money is being used in a targeted and momentary way to improve services for children”.

Dr. Simov was adamant that the teams at the Mama and I provide urgent health care to children:

“We follow the laws and it is free for children up to the age of 7 and parents do not pay anything extra. And for children in critical condition undergoing intensive care, regardless of age, they pay nothing extra.”

“Every day, many parents raise funds through TV shows, social networks and foundations for their children’s treatment abroad. Some manage to meet the high costs, most – never. And why don’t we in Bulgaria develop our own network for paediatric help and care with world-leading expertise and make it fully accessible to all? N a t i o n a l Children’s Hospital. And there won’t be any soon, because after the ‘Mama and I’ project in Sofia 20 months ago brought together doctors and patient organisations, the state got around to choosing a site. The interests of politicians and parents still diverge. So we took the development into our own hands. We have never bothered the public with pitches, needs analysis and projects – we know it all, we do it ourselves – we practice state-of-the-art paediatric medicine on the evidence. Foreign experience is also important, even for our modest scale – a closer and an unattainable example:

More than 40 million euros have been raised by donations (350 thousand individuals and more than 8 thousand companies) in Romania for a specialized children’s oncology hospital with 187 beds. The project has been completed in four years and the facility is now operational.

More than 850 million Swiss francs have been raised by the private Eleonore Foundation in Zurich for a 230-bed children’s hospital that will open at the end of 2024. The hospital is neither state-owned nor belongs to the cantonal university hospital.

Diana Yankulova’s interview with Dr. Velimir Simov in the “12+3” programme can be heard in the audio file (available in Bulgarian).

On the eve of the Christmas all people are waiting for their miracle. Our Christmas miracle happened on Christmas Eve 2022 when I found out I was pregnant. It was the most beautiful gift I could have received. Pregnancy was easy and uneventful until at 24 gestational weeks I became the protagonist of my worst nightmare. We changed three hospitals to save our baby girl. In the first they gave up on her, in the second they fought for her until she was big enough to go to paediatrics, and in the third – ‘Mama and I’ in Pleven, Dr Simov believed in her and gave her a chance to live.

My baby was born 590 grams. In the first months of her life she went through so many difficult moments – she jumped over death several times, had laser surgery on her eyes, was transported from Sofia to Pleven by a specialized neonatal ambulance of ‘Mama and I’. She did not give up. My husband and I were close to her every day to give her strength. We trusted and prayed that our prayers would be answered and that fate would not take our baby away from us. And I, with all my soul, wanted her to be my daughter – Emilia.

A month passed, two, three, my heart was bleeding. The pain in me grew stronger and more hopeless. I lost myself. I couldn’t believe this was happening to me. I wanted my baby. I wanted to help her, but I didn’t know how. All I could do was pray, keep believing, and go to her every day – give her my love and support.

When she was unwell, I was experiencing her pain, experiencing absolutely real symptoms. At our most difficult time, I somehow found strength. I told myself that the despair couldn’t last and we were the ones who had to change the path! With the help of mothers who have gone through this ordeal and whose babies were saved by Dr. Velimir Simov, I made an attempt to contact him. I wrote him an email. I knew that he probably had so many commitments that he was unlikely to respond to me right away. So I found the first phone number he had under his name on the internet and prayed that luck would smile on me. To my greatest surprise I came across the nicest woman who could pick up the phone (a rarity in Bulgaria). When I told my story, crying and sobbing, she said she would do her best to put me in touch with Dr. Simov. She did, and I had a positive answer right away.

We were about to make the most important decision as parents – whether to keep our child in a Sofia hospital or move her to Pleven to the doctor who gave us hope. We took the risk. There was no telling if she would have made it all the way to Pleven even with the most special ambulance on earth. The chance of her surviving was minimal as she was intubated and at the same time sick with pneumonia.

Of course, she showed again that she was a hero and did not give up!

She was taken over by the team of the pediatric intensive care unit of ‘Mama and I’ in Pleven. For 2 months all the specialists fought for her life around the clock. During this period we were able to visit her every weekend. We travelled, saw her and returned. We knew she was in good hands.

The surprise came when Dr. Simov called me one morning and said, “Mama, come in, the child has been extubated and breathing for only 48 hours now. We are waiting for you, we will put you in a private room to take care of her”. That’s what I was waiting for. I immediately packed my bags and left for Pleven.

I wanted to kiss the doctor, take the baby in my arms and never let her go again! I was placed with her and the first days all the nurses helped me. I wanted to learn to do everything myself. I told them, ‘Please let me do it. I want I.” I quickly learned how to take care of my child. What to do under an hour, how to deal with her oxygen dependency. By the third or fourth day, we were completely on our own.

It was wonderful, it was fabulous! I was with my baby. The missing part of my heart had been found, had been filled. My love was complete. I felt happiest when my husband and I were with her and cuddling. We were a real family now. Our baby girl was already with us!

It’s a miracle of nature to go from 590 grams to a 4 pound man! To want life so badly. Emy has a mission and is here to fulfill it. And the doctors who saved her are her guiding archangels. We’re sure the best is yet to come, because we’re being discharged today, and we’ll be spending the Christmas holidays together.

On behalf of our happy family, I would like to say a huge thank you to everyone who has been a part of our happiness. Never change and above all – stay as dedicated doctors and people. Our Christmas will be complete. Believe in miracles and know that they happen to those who believe in them. Our miracle is Emilia! Because it has the phenomenon of ‘Mama and I’. Wishing you a happy holiday season. And love your loved ones. Separation is measured in days and love is boundless.