Papers by Ljiljana Jovović
International Journal of Cardiology Congenital Heart Disease, 2021
Abstract Background Maternal congenital heart disease (CHD) is the most common cardiac condition ... more Abstract Background Maternal congenital heart disease (CHD) is the most common cardiac condition to complicate pregnancy and women now become pregnant even with complex CHD. The Registry Of Pregnancy And Cardiac disease (ROPAC) examines the relationship between maternal heart disease and pregnancy outcome. Methods The ESC EORP ROPAC is a worldwide prospective registry of pregnancies in women with structural heart disease (n=5739, recruiting between 2007-2018), including CHD. Maternal and fetal outcomes were examined in all women with CHD. Multivariable regression was used to identify associations with a composite endpoint of maternal mortality and/or heart failure. Results In CHD pregnancies (n=3295, mean age 29 years), maternal mortality was 0.3% and heart failure occurred in 6.6%. Preterm births (16%) and Caesarean section (46.3%) were higher than global averages, but otherwise cardiac, obstetric and fetal outcomes were good. The composite endpoint was highest in complex CHD: Eisenmenger syndrome (58.1%), congenitally corrected transposition of the great arteries (12.8%), Fontan circulation (11.2%), double outlet right ventricle (11.1%). Pre-pregnancy signs of heart failure (OR 10.6, 95% CI 7.1-16), multiple gestation (4.6, 2-10.8), pulmonary hypertension (2.5, 1.5-4), estimated LVEF Conclusion Overall pregnancy outcomes for women with CHD are good but women with complex CHD are at increased risk of complications. Pre-pregnancy assessment can identify women at increased risk of an adverse outcome and should be used to counsel women appropriately.
International Journal of Cardiology Congenital Heart Disease, 2021
Abstract Background Maternal congenital heart disease (CHD) is the most common cardiac condition ... more Abstract Background Maternal congenital heart disease (CHD) is the most common cardiac condition to complicate pregnancy and women now become pregnant even with complex CHD. The Registry Of Pregnancy And Cardiac disease (ROPAC) examines the relationship between maternal heart disease and pregnancy outcome. Methods The ESC EORP ROPAC is a worldwide prospective registry of pregnancies in women with structural heart disease (n=5739, recruiting between 2007-2018), including CHD. Maternal and fetal outcomes were examined in all women with CHD. Multivariable regression was used to identify associations with a composite endpoint of maternal mortality and/or heart failure. Results In CHD pregnancies (n=3295, mean age 29 years), maternal mortality was 0.3% and heart failure occurred in 6.6%. Preterm births (16%) and Caesarean section (46.3%) were higher than global averages, but otherwise cardiac, obstetric and fetal outcomes were good. The composite endpoint was highest in complex CHD: Eisenmenger syndrome (58.1%), congenitally corrected transposition of the great arteries (12.8%), Fontan circulation (11.2%), double outlet right ventricle (11.1%). Pre-pregnancy signs of heart failure (OR 10.6, 95% CI 7.1-16), multiple gestation (4.6, 2-10.8), pulmonary hypertension (2.5, 1.5-4), estimated LVEF Conclusion Overall pregnancy outcomes for women with CHD are good but women with complex CHD are at increased risk of complications. Pre-pregnancy assessment can identify women at increased risk of an adverse outcome and should be used to counsel women appropriately.
PubMed, 1984
Primary tumors of the heart are uncommon lesions that can mimic any other type of cardiovascular ... more Primary tumors of the heart are uncommon lesions that can mimic any other type of cardiovascular disease, so such tumors were rarely diagnosed before autopsy until the 1950's. Recent advances in echocardiography have enabled rapid and precise diagnosis of cardiac tumors to be made noninvasively. In diagnosing cardiac tumors by echocardiography, we must recognize fully the anatomical features of the four chambers of the heart. Cardiac tumors can be differentiated from other intracavitary mass lesions and ultrasonic artifacts. In this paper we described the echocardiographic features of cardiac tumors and their differential diagnosis. Present methods cardiac surgery have made the excision of cardiac tumors a safe therapeutic procedure providing an early and precise diagnosis of the cardiac tumor is made by echocardiography.
Cardiology, 2016
A double-chambered right ventricle (DCRV) is an uncommon congenital anomaly: the right ventricle ... more A double-chambered right ventricle (DCRV) is an uncommon congenital anomaly: the right ventricle (RV) is divided into two chambers due to the presence of an abnormally located muscular band or anomalous muscle hypertrophy in the subinfundibular part of RV outflow tract, with a variable degree of obstruction. Generally, DCRV is well recognized in childhood and misdiagnosed in adult patients. Transthoracic and/or transesophageal echocardiography are the mеthods of choice for the diagnosis of DCRV. Due to limitations of echocardiography in adult patients, this entity may be missed, particularly if it presents concomitant with other congenital defects, and therefore additional imaging methods such as MRI or cardiac catheterization are required for a definitive diagnosis.
The Annals of Thoracic Surgery, Oct 1, 2008
The residual aortic prosthetic valve paravalvular space beneath the left coronary artery is very ... more The residual aortic prosthetic valve paravalvular space beneath the left coronary artery is very difficult and risky to repair. To improve visualization of this area, we transected the ascending aorta and mobilized both the aortic root and the left coronary artery from the surrounding tissue. Subsequently, we retracted the left coronary artery aside and pulled the posterior aortic root upwards. This maneuver has provided enough space for the safe placement of stitches and the closure of the paraprosthetic defect in this very delicate area.
Interactive Cardiovascular and Thoracic Surgery, Feb 3, 2016
When intracardiac or extracardiac shunts, chronic heart or lung disease, arterial disease of the ... more When intracardiac or extracardiac shunts, chronic heart or lung disease, arterial disease of the pulmonary artery (PA) or an extensive atheromatosis or arteriosclerosis are excluded, idiopathic pulmonary artery aneurysm (PAA) is taken into consideration. Sporadic individual cases of idiopathic PAA [1-3] can be found in the literature [1-3]. Natural course of idiopathic PAA (which can reach enormous dimensions) or the corresponding therapeutic procedures are not clearly defined. In asymptomatic patients, no guidelines can be found indicating whether surgical or conservative treatment should be applied [1-4]. The incidence of PAA is 1 case per 13 700 autopsy cases [2]. Several cases can be found in the literature (with follow-up from 24 years [3] to 39 years [4]) with idiopathic PAA and without rupture. There are no data about cutoff dimensions of PAA diameters, which indicate the risk of rupture and, even more importantly, the potential risk of doing surgery in these cases. CASE DESCRIPTION A case of idiopathic asymptomatic PAA with associated coronary artery disease is reported. The patient is a 72-year old male with Figure 1: MDCT showed an aneurysm of the main trunk and the left branch of PA. PA: pulmonary artery.
Journal of the American College of Cardiology, Dec 1, 1998
Belgrade, Yugoslavia Objectives. This study sought to assess the effects of partial left ventricu... more Belgrade, Yugoslavia Objectives. This study sought to assess the effects of partial left ventriculectomy (PLV) on left ventricular (LV) performance in a series of consecutive patients with nonischemic dilated cardiomyopathy. Background. Reduction of LV systolic function in patients with heart failure is associated with an increase of LV volume and alteration of its shape. Recently, PLV, a novel surgical procedure, was proposed as a treatment option to alter this process in patients with dilated cardiomyopathy. Methods. We studied 19 patients with severely symptomatic nonischemic dilated cardiomyopathy, before and 13 ؎ 3 days after surgery, and 12 controls. Single-plane left ventriculography with simultaneous measurements of femoral artery pressure was performed during right heart pacing. Results. The LV end-diastolic and end-systolic volume indexes decreased after PLV (from 169 to 102 ml/m 2 , and from 127 to 60 ml/m 2 , respectively, p < 0.0001 for both). Despite a decrease in LV mass index (from 162 to 137 g/m 2 , p < 0.0001), there was a significant decrease in LV circumferential end-systolic and enddiastolic stresses (from 277 to 159 g/cm 2 , p < 0.0001 and from 79 to 39 g/cm 2 , p ؍ 0.0014, respectively). Ejection fraction improved (from 24% to 41%, p < 0.0001); the stroke work index remained unchanged. Conclusions. The PLV improves LV performance by a dramatic reduction of ventricular end-systolic and end-diastolic stresses. Further studies are needed to assess whether this effect is sustained during long-term follow-up and to define the role of PLV in the treatment of patients with dilated cardiomyopathy.
International Journal of Cardiology, Oct 1, 2007
Interactive Cardiovascular and Thoracic Surgery, Apr 25, 2016
European Heart Journal Open
AimsWomen’s participation is steadily growing in medical schools, but they are still not sufficie... more AimsWomen’s participation is steadily growing in medical schools, but they are still not sufficiently represented in cardiology, particularly in cardiology leadership positions. We present the contemporary distribution of women leaders in cardiology departments in the World Health Organization European region.Methods and resultsBetween August and December 2020, we applied purposive sampling to collect data and analyse gender distribution of heads of cardiology department in university/third level hospitals in 23 countries: Austria, Azerbaijan, Belgium, Bosnia-Herzegovina, Croatia, France, Germany, Greece, Italy, North Macedonia, Morocco, Poland, Portugal, Russia, Serbia, Slovakia, Slovenia, Spain, Switzerland, Tunisia, Turkey, Ukraine, and the UK. Age, cardiology subspecialty, and number of scientific publications were recorded for a subgroup of cardiology leaders for whom data were available. A total of 849 cardiology departments were analysed. Women leaders were only 30% (254/849)...
Journal of Cardiac Surgery, 2019
Coronary artery fistula is a rare congenital or acquired anomaly. It involves an abnormal connect... more Coronary artery fistula is a rare congenital or acquired anomaly. It involves an abnormal connection between the coronary artery and the cardiac chambers or the large thoracic vessels. In some cases, the feeding coronary artery can become extremely dilated. The treatment includes a transcatheter or a surgical intervention depending on the complexity of the anomaly. We present the surgical treatment of the coronary artery to coronary sinus fistula, which includes the complete exclusion of the giant right coronary artery and followed by triple bypass surgery.
Interactive CardioVascular and Thoracic Surgery, 2016
European Journal of Echocardiography, 1999
Vojnosanitetski pregled, 2007
Nedovoljno formiran miokard je atipicna forma kardiomiopatije koju treba poznavati i na koju treb... more Nedovoljno formiran miokard je atipicna forma kardiomiopatije koju treba poznavati i na koju treba misliti pri rutinskim ehokardiografskim pregledima. Novija istrazivanja ukazuju da LVNC ima vecu prevalenciju zahvaljujuci poboljsanju imaging tehnika. Kako su kriterijumi za dijagnozu LVNC prvenstveno ehokardiografski, potrebno je upoznati lekare koji se bave ultrazvucnim pregledima srca sa osnovnim karkteristikama ovog oboljenja, kako bi ga u buducnosti lakse prepoznali. Nedovoljno formiran miokard je udruzen sa drugim nesrcanim oboljenjima, kao sto su neuromuskularna oboljenja. Predlaze se skrining bolesnika, narocito u porodicama sa neuromuskularnim oboljenjima da bi se pronasli bolesnici sa LVNC, kao i skrining bolesnika sa LVNC kako bi se otkrila neuromuskularna oboljenja. Kod familijarnog javljanja bolesti utvrdjena je genetska osnova nasledjivanja. Zbog pretpostavke da postoji dug preklinicki period, potrebno je da se otkriju bolesnici u asimptomatskoj ili oligosimptomatskoj fa...
Journal of Medical Case Reports, 2012
Introduction: A parachute mitral valve is defined as a unifocal attachment of mitral valve chorda... more Introduction: A parachute mitral valve is defined as a unifocal attachment of mitral valve chordae tendineae independent of the number of papillary muscles. Data from the literature suggests that the valve can be distinguished on the basis of morphological features as either a parachute-like asymmetrical mitral valve or a true parachute mitral valve. A parachute-like asymmetrical mitral valve has two papillary muscles; one is elongated and located higher in the left ventricle. A true parachute mitral valve has a single papillary muscle that receives all chordae, as was present in our patient. Patients with parachute mitral valves during childhood have multilevel leftside heart obstructions, with poor outcomes without operative treatment. The finding of a parachute mitral valve in an adult patient is extremely rare, especially as an isolated lesion. In adults, the unifocal attachment of the chordae results in a slightly restricted valve opening and, more frequently, valvular regurgitation. Case presentation: A 40-year-old Caucasian female patient was admitted to a primary care physician due to her recent symptoms of heart palpitation and chest discomfort on effort. Transthoracic echocardiography showed chordae tendineae which were elongated and formed an unusual net shape penetrating into left ventricle cavity. The parasternal short axis view of her left ventricle showed a single papillary muscle positioned on one side in the posteromedial commissure receiving all chordae. Her mitral valve orifice was slightly eccentric and the chordae were converting into a single papillary muscle. Mitral regurgitation was present and it was graded as moderate to severe. Her left atrium was enlarged. There were no signs of mitral stenosis or a subvalvular ring. She did not have a bicuspid aortic valve or coarctation of the ascending aorta. The dimensions and systolic function of her left ventricle were normal. Our patient had a normal body habitus, without signs of heart failure. Her functional status was graded as class I according to the New York Heart Association grading. Conclusions: A recently published review found that, in the last several decades, there have been only nine adult patients with parachute mitral valve disease reported, of which five had the same morphological characteristics as our patient. This case presentation should encourage doctors, especially those involved in echocardiography, to contribute their own experience, knowledge and research in parachute mitral valve disease to enrich statistical and epidemiologic databases and aid clinicians in getting acquainted with this rare disease.
International Journal of Cardiology, 2007
The Annals of Thoracic Surgery, 2008
The residual aortic prosthetic valve paravalvular space beneath the left coronary artery is very ... more The residual aortic prosthetic valve paravalvular space beneath the left coronary artery is very difficult and risky to repair. To improve visualization of this area, we transected the ascending aorta and mobilized both the aortic root and the left coronary artery from the surrounding tissue. Subsequently, we retracted the left coronary artery aside and pulled the posterior aortic root upwards. This maneuver has provided enough space for the safe placement of stitches and the closure of the paraprosthetic defect in this very delicate area.
Interactive cardiovascular and thoracic surgery, Jan 3, 2016
When intracardiac or extracardiac shunts, chronic heart or lung disease, arterial disease of the ... more When intracardiac or extracardiac shunts, chronic heart or lung disease, arterial disease of the pulmonary artery (PA) or an extensive atheromatosis or arteriosclerosis are excluded, idiopathic pulmonary artery aneurysm (PAA) is taken into consideration. Sporadic individual cases of idiopathic PAA [1-3] can be found in the literature [1-3]. Natural course of idiopathic PAA (which can reach enormous dimensions) or the corresponding therapeutic procedures are not clearly defined. In asymptomatic patients, no guidelines can be found indicating whether surgical or conservative treatment should be applied [1-4]. The incidence of PAA is 1 case per 13 700 autopsy cases [2]. Several cases can be found in the literature (with follow-up from 24 years [3] to 39 years [4]) with idiopathic PAA and without rupture. There are no data about cutoff dimensions of PAA diameters, which indicate the risk of rupture and, even more importantly, the potential risk of doing surgery in these cases. CASE DESCRIPTION A case of idiopathic asymptomatic PAA with associated coronary artery disease is reported. The patient is a 72-year old male with Figure 1: MDCT showed an aneurysm of the main trunk and the left branch of PA. PA: pulmonary artery.
Vojnosanitetski pregled, 2016
Introduction. Double orifice mitrol valve (DOMV) is a very rare congenital heart defect. Case rep... more Introduction. Double orifice mitrol valve (DOMV) is a very rare congenital heart defect. Case report. We reported 20-year-old male referred to our center due to evaluation of his cardiologic status. He was operated on shortly after birth for a tracheoesophageal fistula. Accidentally, echocardiography examination at the age of 4 years revealed double orifice mitral valve (DOMV) without the presence of mitral regurgitation, as well as mitral stenosis, with normal dimensions of all cardiac chambers. The patient was asymptomatic, even more he was a kick boxer. His physical finding was normal. Electrocardiography showed regular sinus rhythm, incomplete right bundle branch block. Transthoracic echocardiography (TTE) examination revealed the normal size of the left atrial, mitral leaflets were slightly more redundant. The left and right heart chambers, aorta, tricuspid valve and pulmonary artery valve were normal. During TTE examination on a short axis view two asymmetric mitral orifices w...
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Papers by Ljiljana Jovović