Dnevni Izveštaj 03.03.2015.
dr Marko Banović
dr Marko Banović

The last day of congress also brought very dynamic and vivid sessions,
together with plenty of new information given by lecturers.
The sessions were very visited and with great enthusiasm from both,
lectures and the crowd. Similar to first two days of congress, the today’s
selected lectures represented the most compelling topics of relevance to a
broad array of clinical practitioners.

Morning started with a teaching session were prof Z. Markovic delivered
some thoughts on indications for MSCT in asymptomatic patients with suspected
coronary artery disease. He and other lecturers gave us an insight of improved
safety, reduced radiation (due to the new pulse XT generators) by new CT machines
and lower – cost/effectiveness ratio compared to older machines. As a matter of fact,
new CT machines have pediatric radiation doses, which might enable the MSCT to become
screening method in detection of ischemic heart disease in asymptomatic patients.
The new machines even have a mechanism to perform exam in patients with sinus tachycardia
and even in patients with irregular heart rhythm, which was unthinkable until recently.

Next session gave us a detailed review and state-of-the art knowledge of acute aortic
syndrome. Prof M Petrovic spoke about clinical presentation and pathophysiological
characteristics of AAS. He especially emphasized the significance of transthoracic and
transoesophageal diagnostics of acute aortic syndrome, especially aortic dissection.
Dr Ivanovic from Sremska Kamenica emphasized the significance and accuracy of MSC|T in
diagnosis of AAS. He made special effort to introduce to audience all the questions that
have to be answered by MSCT which are important to surgeons, especially in the context
of aortic dissection. Prof Lazarevic from Banja-Luka spoke about chronic aneurysms of
abdominal aorta, their pathohystological characteristics, incidence and prevalence of this
disease, as well as genetic disorders often accompanied with this condition. He particularly
emphasized importance in number of lameral units (and their decreased number in abdominal aorta),
which are, according to him, main factors influencing the occurrence of aneurysm. He also listed
the indications for surgery in the setting of AA aneurysm in general population and in patients
with Marfan syndrome. As last speaker in this session, Dr Koncar, vascular surgeon, introduced
new visual techniques for detecting the risk of AA aneurysm rupture. He showed a new machine,
still used only in scientific purposes, but expecting soon to be introduced into clinical practice,
that measure the tension I the wall of aortic aneurysm. In future, this machine should significantly
increase our capability to recognize patients who have high risk for aneurysm rupture. According to
Dr Koncar the other significant factor that influences possible aneurysm rupture is the strength
of aortic wall.

The spot light topic of this day in room 2 were presented during the session about challenges
in aortic stenosis. Prof Obrenovic and Dr Banovic gave us detailed pathophysiological and
echocardiographic assessment of patients with low-flow, low-gradient AS, as well as technical
and diagnostic considerations for Dobutamine testing in these patients. In addition, Prof Obrenovic
has described all subgroups of AS patients according to amount of flow and gradient across the aortic
valve. Dr Ivanov explained to audience the reasons why stress-testing should be used in patient with
AS, as well to encourage the audience to do the stress-testing in this setting as it is quite safe.
Professors Beleslin and Nedeljkovic showed to audience in details all indications for percutaneous
implantation of aortic valve in AS patients. They also showed us all 5 cases of patients implanted with
TAVI in Serbia so far. Dr Tesic explained the significance of meticulous screening of patients and
measuring the parameters of aortic annulus via echo and MSCT, as correct choice of patients and valve
dimensions are only path to successful percutaneous implantation of aortic valve. However, the
postimplantation aortic regurgitation is still an Achilles heel of this procedure.

After so many very interesting and successful sessions it seems to author of this text that
vast majority of people/doctors/medical practitioners were said that congress does not last at least
another day, and that all of them are looking forward and hoping very much that this kind of congress
will open series of traditional congresses of Imaging Society of Serbia. The organization, topics and
lecturers at this congress has set the bar very high, but that can only be stimulating and beneficial
for successors.

Best regards,
Marko Banovic MD, PhD\
Department for cardiology,
University clinical centre of Serbia