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Introduction. Pulmonary artery hypertension and right ventricular failure are potentially fatal complications that can develop in patients with portal hypertension. The objective of this case report was to report a patient with end-stage liver disease, and portal and pulmonary artery hypertension and right heart failure. Case outline. A 57-year-old man was admitted to the Cardiology Department of a tertiary referral hospital due to signs of right-sided heart failure, ascites, pleural effusions, and pretibial edema. The patient had the history of alcohol abuse, arterial hypertension, and gout. Just prior to the admission, abdominal ultrasound revealed granular liver structure, as well as ascites. Laboratory tests showed microcytic anemia, values of transaminases below referent, hypoalbuminemia, low creatinine clearance. Echocardiography revealed pulmonary hypertension, and right ventricle failure. Right heart catheterization unraveled precapillary pulmonary hypertension, but thoracic CT scan and thoracocentesis excluded underlying pulmonary illness. Treatment continued at the Gastroenterology Department of the tertiary hospital. Abdominal CT scan diagnosed cirrhotic liver, and signs of portal hypertension. The patient was treated with symptomatic therapy, but developed acute-on-chronic renal failure and eventually died. Conclusion. Multidisciplinary approach is very important to distinguish portopulmonary hypertension early in the course of liver disease, because evolution of right sided heart failure precludes these patients from adequate lifesaving therapy.

Introduction/Objective. Revascularization in multivessel coronary artery disease (MVD) in patients with ST elevation myocardial infarction (STEMI) is a matter of debate. We sought to compare outcomes between revascularization strategies based on angiographic lesion severity or inducible ischemia. Methods. In prospective study, first ever STEMI patients with MVD, defined as > 70% stenosis in non-culprit vessel, treated with culprit only primary PCI were randomized to: A. Complete revascularization of all nonculprit significant lesions during initial hospitalization; B. Complete revascularization after 30 days, or C. Revascularization based on non-invasive testing for inducible ischemia. The study explored occurrence of major adverse cardio-cerebral events (MACCE) (cardiac death, repeated MI, cerebrovascular event). Results. The study enrolled 120 patients with door to balloon time within appropriate limits (A 51 ± 26 vs. B 47 ± 33 vs. C 44 ± 29 min, p = 0.604) The patients in group A underwent complete revascularization at 6 [4–7] days after primary PCI, while in the group B it was 35 [32–39] days. In group C, 16/43 (37.2%) patients underwent PCI at 82 [66–147] days after infarction (p < 0.001). The patients were followed for 2.7 ± 0.8 years. The events occurred less frequently in patients that underwent planned complete revascularization compared to those who underwent ischemia testing (7.8 vs. 20.9%, p = 0.040). Kaplan–Meier analysis favored complete delayed revascularization (MACCE A 8.8 vs. B 6.9 vs. C 20.9%, log rank p = 0.041). Conclusions. Planned, angiography guided, complete revascularization after initial event may be favorable strategy compared to single stress test for MVD in STEMI.

Introduction/Objective. The purpose of the current Echocardiographic Society of Serbia (ECHOS) survey was to assess echocardiography practice in Serbia during the Coronavirus disease 2019 (COVID-19) pandemic. Methods. An online survey consisting of 12 questions about the usa of echocardiography, the availability of portable ultrasound devices and personal protective equipment (PPE) was sent to all ECHOS members. Results. Overall, 126 ECHOS members (43%) answered the survey. One-third of respondents (36%) were physicians from specialized COVID-19 centers. During the pandemic, indications for echocardiographic examination were restricted in both COVID-19 and non-COVID-19 centers. In COVID-19 centers, 41% of respondents performed lung ultrasound to each patient versus 26% in non-COVID-19 centers. Transesophageal echocardiography was not performed in suspected or confirmed COVID-19 cases in any center. Portable ultrasound devices were available to 66% of respondents from COVID-19 versus 44% of respondents from non-COVID-19 centers (p = 0.018). The respondents reported regular use of PPE, regardless of the patient’s COVID-19 status and found their personal knowledge about protective measures and use of PPE satisfactory. Conclusion. During the COVID-19 pandemic in Serbia, indications for echocardiography were restricted to clinical scenarios in which the results of examination were expected to alter patient management. In both COVID-19 and non-COVID-19 centers, the use of PPE was in line with national and international recommendations. A wider availability of portable ultrasound devices and application of lung ultrasound could improve patient management in similar situations in the future.

Introduction/Objective. The purpose of the Echocardiographic Society of Serbia (ECHOS) national survey was to assess current echocardiography practice in Serbia, the availability of different echocardiographic techniques and self-perceived need for improvement at personal and institutional level. Methods. A survey comprising 20 questions about demographics, numbers and distribution of echocardiographic equipment and techniques, image acquisition and reporting standards as well as future educational preferences was sent to all ECHOS members via email. Results. A total of 106 members (42%) answered the survey. Echocardiographic examinations are most frequently performed by cardiologists and internal medicine specialists. Transesophageal echocardiography (TOE), stress echocardiography (SECHO) and speckle tracking echocardiography (SpTE) are available in approximately 20% of centers, three-dimensional echocardiography in 11%, while contrast echocardiography is practiced in only two centers. Less than a third of respondents always attach electrocardiographic electrodes and archive examinations. Almost all respondents (96%), always evaluate both systolic and diastolic function of the left ventricle (LV), although systolic LV function is frequently assessed (55%) using non-standard methods. The newer echocardiographic machines are more often available at university than non-university centers (87 versus 44%, p < 0.01). SECHO was perceived as the most needed technique at the institutional level, while SpTE and TOE were most often reported personal aspirations of the respondents. Conclusion. Advanced techniques, SECHO and TOE are needed but rarely performed outside the university hospitals in Serbia. In order to achieve a better adherence to standards of practice in echocardiography, the development of national guidelines and personal and laboratory accreditation seem warranted.

Introduction. Dysgerminomas are germ cell ovarian tumors. They affect young females, prevalently during childhood. The problem arises when dysgerminoma is diagnosed in women of reproductive age who have never given birth and require a surgical procedure. Case outline. A 28-year-old patient was admitted to hospital in week 26 of her first pregnancy. The reason for patient hospitalization was the growth of the isthmic myoma diagnosed by her obstetriciangynecologist in the primary care unit. By examining the medical history of the patient, the following was revealed: A year and a half before pregnancy she was diagnosed with left ovary dysgerminoma. The patient’s medical history led us to conclude that uterine myoma was a misdiagnosis and that the actual diagnosis was dysgerminoma of the right ovary. The surgery was performed after the fetal viability had been achieved. Conclusion. Malignant ovarian tumours may occur in young women during pregnancy and increase in size significantly in a short period of time, although their recurrence is not expected in such a short period of time after surgical treatment. This poses a great challenge for obstetricians.