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L. Gancheva1
1Romania, Bucharest, Str. Dornei 2, sector 3
According to Encyclopedia Britannica, the Balkans
are usually said to consist of Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Kosovo, the Republic of Macedonia, Montenegro, Romania, Serbia, Slovenia, while Greece and Turkey are often included. After Post Cold War period the region is still an economically depressed area. In spite of this, the passion and willingness of the veterinary world to grow and improve to a higher level, is more than alive.
It is very hard to practice medicine when the economic situation does not allow you to do the best you can. In addition, your clients are not able to handle expencive examinations and procedures. The Balkan veterinarians are heroes. They work in hard envoirment and only their love and willingness to know more and do their best
for the animals keep them going. The veterinarians can go abroad to more developed countries to raise their knowledge and experience, but again the  nancial part of this educational experience stop them in a way. They are lucky to have strong and wonderful Associations which support their desire to further improve. All local associations, which in fact face the same dif cult economic and  nancial situation, do it on a high professional level. For example, RoSAVA ( Romanian Small Animal Association) makes huge veterinary event with 4 rooms every year, so veterinarians are able to choose the  eld and the subject of their interest. On the Balkans, we can take RoSAVA as a model for a job well done. All countries have their own Small Animal Association and all of them are working perfectly.
Today I will present several clinical reports from each country on the Balkans.
Open heart surgery for a left atrial mass extraction during cardio-pulmonary bypass (CPB) in a 9 yoa Labrador dog
Ranko Georgiev1, Stoyan Nikolov2, Nadezhda Petrova3 Georgi Ignatov4, MD Thoracic Surgery
Open heart surgery during a cardiopulmonary bypass
is the only effective approach for some diseases that require an access to the heart chambers or the great vessels; even when a temporary in ow occlusion is chosen as an alternative, only a very few “time restricted”
procedures could be done on a beating heart. However, when considering an open heart surgery, the high
risk of intra- and post- procedure complications often outweighs the bene ts. In veterinary medicine the  nancial weight of such a procedure is also a limiting factor.
Case presentation:
Arthur is a 9 year old MC Labrador, trained like a guide dog for a blind person, admitted because of increasingly frequent exercise intolerance episodes during the past few months. Furthermore, the last week the patient
was very weak and experienced several syncopal episodes. On a clinical presentation with the referring vet a tachycardia and dyspnea were noted and the patient was referred to us for a Cardiology consult.
Surgical approach
The surgical approach was through the left  fth intercostal space with a standard lateral thoracotomy. Additionally the left carotid artery was approached and prepared in case it is needed for the CPB blood return. The pericardium was excised and the left atrium, the
big vessels and the left ventricle visualized. Then three cannulas were put – the one collecting the venous blood inside the right atrium (through the right atrium auricle), the one returning the oxygenated blood from the CPB machine into the ascending aorta and one small cardioplegique cannula into the aortic root over the coronary arteries. Then a bolus of Heparin was injected iv in a dose of 800UI/kg and 5 minutes later the patient was switched to the heart-lung machine (Sorin
5 and a pediatric oxygenator with 360 ml prime). Then we started a controlled cooling of the patient using a chiller, connected to the CPB machine. When the target body temperature of 28o C was reached the ascending aorta was cross clamped and a 600 ml of cooled to 4o C crystalloid cardioplegique infusion rich in potassium was infused through the coronary cannula producing complete heart arrest. We stopped the active ventilation of the lungs and the patient became fully dependent of the heart-lung machine. The heart was open through a 5 cm cut into the left atrial wall starting from the auricle tip. The mass was directly visualized and excised. It
was connected to the intra atrial septum with a relatively small neck. We removed it without creating an ASD. The air from the heart was evacuated and the surgical cut closed with a 5-0 Polypropylene suture in a continuous way. The mass was a solid and well de ned structure with irregular shape and was admitted for histology. The size was 8/6/4 cm.
We started a slow rewarming of the patient with a target body temperature of 38o C. Two epicardial electrodes were embedded and connected with an external
An Urban Experience

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