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"Indonesian Journal of Dentistry 2006; Edisi Khusus KPPIKG XIV: 120-123Congenital heart disease is a condition of heart anomaly found since birth. The most common is ventricular septal defect whereby an aperture is found in the partition of heart chamber. It is estimated that 40,000 newborn in Indonesia have this defective condition. Dental treatment for patient with such condition must be undertaken in a very cautious way. Tooth with multiple caries can potentially lead to endocarditis bacteria. As such, dentist must be watchful on dental treatment that may worsen the patient's condition. To prevent endocarditis bacteria, a prophylaxis antibiotic is required as recommended by the American Heart Association (AHA). In this particular case, a dental treatment was undertaken to a child patient with congenital heart disease. Previously, the patient has undergone dental treatment in the form of multiple extraction under general anesthesia before conducting cardiac surgery. ln this case the treatment includes mortal pulpotomy, GIC restoration, and fissure sealant - all conducted in one visit under general anesthesia. After a year after the treatment,here are no complaint from the patient and no irregularity in x-ray results."

"Pendahuluan: Ventricular septal defect (VSD) adalah penyakit jantung bawaan (PJB) ditandai dengan terdapatnya lubang atau foramen di dinding yang memisahkan bilik kiri dan kanan. Profil pasien antara lain umur, berat badan, tinggi badan, tanda-tanda vital, jumlah anggota keluarga, keluhan utama, ukuran VSD, klasifikasi VSD, adanya kardiomegali, komplikasi, riwayat penyakit jantung bawaan di keluarga, dan tata laksana VSD. Terdapat pula beberapa faktor risiko dari VSD antara lain jenis kelamin, berat lahir, usia kehamilan, status nutrisi, status sosio-ekonomi, kondisi genetik seperti sindrom Down, usia ibu ketika hamil, riwayat ibu merokok selama kehamilan, kebiasaan ibu minum-minuman beralkohol selama kehamilan, riwayat ayah merokok, dan riwayat diabetes ibu selama kehamilan. Namun, faktor risiko dan profil dari VSD di Rumah Sakit Cipto Mangunkusumo masih belum diketahui. Maka dari itu, penelitian ini diperlukan untuk menginvestigasi informasi ini. Metode: Studi potong lintang ini melibatkan 40 pasien VSD terisolasi dan 40 pasien kontrol yang datang ke Rumah Sakit Cipto Mangunkusumo pada tahun 2020. Data diperoleh dari rekam medis dan/atau wawancara pasien setelah dilakukan pemilihan sampel dengan metode acak sederhana. Data tersebut kemudian dianalisis menggunakan Statistical Package for Social Sciences (SPSS) versi 24 untuk Mac. Pearson Chi-squared test dan Fisher's exact test, digunakan untuk menyelidiki asosiasi variabel. Hasil: Dari 40 pasien VSD mayoritas balita, median berat badan 8,4 kg, rerata tinggi badan 85 cm, rerata tekanan darah, laju nadi dan laju napas dalam batas normal, keluhan utama tersering adalah berat badan sulit naik, jenis VSD terbanyak perimembranosa, ukuran VSD terbanyak ukuran besar, tidak ada komplikasi, tidak ada PJB dalam keluarga, dan terapi utama adalah operasi. Untuk faktor risiko, keberadaan kondisi genetik seperti sindrom Down terbukti secara bermakna [RP 2,143 (95% IK: 1,682-2,729), P= 0,02] sebagai satu-satunya faktor risiko VSD pada penelitian ini. Namun, beberapa faktor risiko lain termasuk status sosio-ekonomi (P=0,491), usia ibu saat hamil (P= 0,745), merokok ayah (P= 0,370), diabetes ibu saat hamil (P= 0,494), riwayat merokok ibu selama kehamilan (P= 1), dan riwayat asupan alkohol ibu selama kehamilan (P = 1) tidak terbukti sebagai faktor risiko VSD pada penelitian ini. Simpulan: Studi ini menemukan hubungan antara kondisi genetik seperti sindrom Down dengan VSD. Penelitian ini juga menemukan profil pasien VSD yang datang ke RSCM selama tahun 2020. Penelitian lebih lanjut diperlukan untuk mencari faktor risiko yang belum terbukti bermakna dan untuk menyelidiki faktor risiko lain yang tidak dieksplorasi dalam penelitian ini. Studi di masa depan harus mencakup populasi yang lebih besar untuk menghasilkan data profil pasien yang lebih baik.

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Introduction: Ventricular septal defect (VSD) is a congenital heart disease (CHD) caused by a hole or foramen in the septum between the left and right ventricles. For profile, there are age, body weight, body height, vital signs, family size, main complaint, VSD size, VSD classification, presence of cardiomegaly, complications, familial congenital heart disease, and treatments of isolated VSD. There are also several risk factors of isolated VSD including gender, birth weight, gestational age, nutritional status, socio-economic status, genetic syndrome such as Down syndrome, maternal age when pregnant, maternal smoking history during pregnancy, maternal alcohol intake history during pregnancy, paternal smoking, as well as maternal gestational diabetes. However, the risk factors and profile of isolated VSD patients at Cipto Mangunkusumo Hospital are still unknown. As a result, research is required to investigate this information. Method: This cross-sectional study included 40 isolated VSD patients and 40 control patients from Cipto Mangunkusumo Hospital in 2020. Data were obtained from medical records and/or patient interviews following a simple random number sampling. The data was then analyzed using the Statistical Package for Social Sciences (SPSS) version 24 for Mac. The Pearson Chisquared Test and Fisher's Exact Test were used to investigate the variables' association. Results: From 40 patients, the majority was toddler, median body weight was 8.4 kg, mean body height was 85 cm, mean blood pressure, heart rate and respiratory rate were normal, the main complaints was difficulty gaining weight, types of VSD was perimembranous, most of patient had large VSD, there was no complications, there was no the presence of familial congenital heart disease and surgery was a most prevalent definitive VSD. For the risk factors, the presence of genetic syndrome such as Down syndrome [PR 2.143 (CI 95%: 1.682-2.729), P= 0.02] is confirmed as the only risk factor of isolated VSD in this population. However, several other parameters including socio-economic status (P= 0.491), maternal age when pregnant (P= 0.745), paternal smoking (P= 0.370), maternal gestational diabetes (P= 0.494), maternal smoking history during pregnancy (P= 1), and maternal alcohol intake history during pregnancy (P= 1) have not been shown to raise the risk of isolated VSD in this population. Conclusion: This study found a relation between genetic conditions like Down syndrome and isolated VSD. Furthermore, this study detailed the profile of isolated VSD patients in this population. However, more research is needed to establish stronger evidence and to investigate risk factors that were not explored in this study, and future studies should include a larger population to produce better patient profile data."

"Latar belakang: DSV (Defek Septum Ventrikel) adalah satu dari banyak kasus penyakit jantung bawaan dengan angka 2,6 per 1000 kelahiran di Dunia. Salah satu komplikasi DSV yang sering ditemukan adalah DSV dengan hipertensi pulmonal. Diagnosis intervensi terhadap hipertensi arteri pulmonal menjadi perhatian pada 2-10% kasus DSV, sehingga pasien DSV yang bermanifestasi hipertensi pulmonal dilakukan pemeriksaan kateterisasi. Pasien usia 6 bulan menjadi pedoman batas usia untuk dilakukan kateterisasi di RSPJDNHK (Rumahsakit Pusat Jantung dan Pembuluh darah Nasional Harapan Kita). Sehingga antrean operasi menjadi lebih lama. Penelitian ini bertujuan untuk melihat pengaruh usia terhadap nilai PARi pascates oksigen dan mencari kelompok usia yang tidak memiliki hasil nonreaktif terhadap tes oksigen. Metode: Dilakukan studi Observasional retrospektif pada pasien DSV usia di bawah 5 tahun di RSPJDNHK tahun 2015 - 2020. Pengumpulan data melalui rekam medis pasien di divisi bedah jantung pediatrik RSPJDNHK. Pengambilan sampel dilakukan secara acak dengan perhitungan besar sampel mengikuti perhitungan besar sampel untuk uji komparatif numerik lebih dari dua kelompok dengan satu kali pengukuran. Analisis deskriptif dan analisis bivariat dilakukan dengan bantuan SPSS v 20.0. Hasil: Terdapat 178 sampel penelitian pada penelitian ini. Dari hasil penelitian diketahui bahwa usia berpengaruh atau berhubungan dengan nilai PARi pascates oksigen (p<0,05) pada pasien DSV usia di bawah 5 tahun. Simpulan: Terdapat hubungan usia dengan nilai PARi pascates oksigen dan usia ≤2 tahun memiliki nilai mutlak reaktif terhadap tes oksigen.

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Background: Ventricular Septal Defect (VSD) is one of the many cases of congenital heart disease with a rate of 2.6 per 1000 births in the world. One of the complications of VSD is pulmonary hypertension, with the prevalence of interventional diagnosis of pulmonary hypertension is about 2 – 10 % of VSD. Those who manifest pulmonary hypertension are undergone right heart catheterization. Patients aged six months are the limit for catheterization in National Cardiovascular Center Harapan Kita Hospital leads to a long waiting list. The study aimed to determine the effect on the PARi value of oxygen delivery and find age groups that have reactive results on oxygen tests.

Methods: A retrospective crossectional study was carried out in the pediatric cardiac surgery division of the National Cardiovascular Center Harapan Kita Hospital. Data were taken from the medical record, enrolling those treated from January 2015 to December 2020 with subjects under five years old with VSD pulmonary hypertension who underwent cardiac catheterization. Samples were taken randomly by calculating the sample size following the sample size calculation for the comparative numerical test of more than two groups with one measurement. Descriptive analysis and bivariate analysis were carried out using SPSS v 20.0.

Results: There were 178 subjects enrolled in this study. The age correlated to the post-oxygen test PARi value (p<0.05) on VSD patients under five years of age.

Conclusions: This study showed that age correlated to the PARi value after oxygen test, and age ≤2 years old has absolute reactive value to oxygen test."

"Latar belakang: Defek septum ventrikel DSV adalah salah satu penyakitjantung bawaan yang paling sering ditemukan. DSV dapat menutup secaraspontan atau harus dilakukan tindakan untuk penutupan defek. Penutupan DSVmelalui operasi masih menjadi baku emas, namun saat ini telah berkembangpenutupan DSV secara transkateter yang dinilai lebih efisien dan memilikiefektivitas yang hampir sama.Tujuan: Penelitian ini bertujuan membandingkan luaran jangka menengah ataupanjang pasca-penutupan DSV secara transkateter dengan pasca-penutupan DSVsecara operasi. Metode: Penelitian potong lintang ini dilakukan dari 1 Maret-31 Mei 2017terhadap 68 pasien DSV yang telah menjalani penutupan penutupan DSV secaratranskateter atau operasi di RSUPN Dr. Cipto Mangunkusumo dari 1 Januari 2010-30 April 2017. Subyek adalah pasien DSV perimembranosa outlet PMO atau doubly committed subarterial DCSA lesi tunggal, usia 2-18 tahun, beratbadan di atas 8 kg, dan tidak ada aritmia. Data dikumpulkan dari rekam medikpasien serta dari pemeriksaan elektrokardiografi dan ekokardiografi. Luaranjangka menengah atau panjang aritmia, regurgitasi katup, dan sisa pirau dianalisis dengan uji Chi square atau Fisher exact dan T independen denganinterval kepercayaan 95 dan nilai kemaknaan 0,05. Hasil: Rerata waktu prosedur penutupan DSV secara transkateter dan operasimasing-masing 108,2 37,8 menit dan 157,2 23 menit. Incomplete RBBB,complete RBBB, blok AV derajat I, serta junctional rhythm ditemukan pada10,3 , 2,9 , 2,9 , dan 1,5 pasien secara berurutan. Aritmia dijumpai pada14,7 pasien transkateter dan 20,6 pasien operasi, serta tidak ditemukanperbedaan bermakna antara kedua prosedur p>0,05. Proporsi peningkatanderajat regurgitasi katup lebih banyak pada prosedur transkateter dibandingkanoperasi 47,1 vs. 32,4 dan tidak terdapat perbedaan bermakna secara statistik p>0,05 . Sisa pirau trivial ditemukan pada 5,9 pasien pasca-penutupan secaratranskateter dan 8,8 secara operasi, dan tidak ditemukan perbedaan bermaknasecara statistik p>0,05. Simpulan: Luaran jangka menengah atau jangka panjang pasca-penutupan DSVsecara transkateter tidak berbeda dibandingkan secara operasi.

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Background: Ventricle septal defect VSD is the most common congenital heartdisease VSD may close spontaneously or a procedure must be performed to closethe defect. Surgical closure of VSD has been the gold standard, but transcatheterclosure of VSD has been developed that seem to be more efficient with similareffectivity.

Objective: To compare mid term or long term outcomes between transcatheterclosure and surgical closure of VSDs.

Methods: A cross sectional study was performed from March 1st until May 31st 2017 to 68 patients with VSDs who underwent transcatheter or surgical closure ofVSD in Dr. Cipto Mangunkusumo hospital from January 1st 2010 until April 30th2017. Subject were patient with single lesion outlet perimembranous VSD ordoubly committed subarterial DCSA, aged 2 to18 years old, body weight morethan 8 kgs, without arrhythmia. Data was collected from patient medical record,electrocardiography and echocardiography examination. Mid term or long termoutcomes arrhythmia, valve regurgitation, and residual shunt was analyzed byChi square or Fisher's exact test and independent T test with 95 confidenceinterval and significance level of 0.05.

Results: The procedure mean time for transcatheter closure and surgical closureof VSDs was 108.2 37,8 minutes and 157.2 23 minutes. Incomplete RBBB,complete RBBB, first degree AV block, and junctional rhythm occurred in 10.3 ,2.9 , 2.9 , and 1.5 patients, respectively. Arrhytmia occurred in 14.7 trancatheter closure patients and 20.6 in surgical closure patients p 0,05. Thedegree of regurgitation proportion in transcatheter closure is higher compared tothe degree of valve regurgitation proportion surgical closure, although there is nostatistical significant difference 47.1 vs. 32.4 , p 0.05 . Trivial residual shuntwas found in 5.9 patients after transcatheter closure and 8.8 surgical closure, also without statistical significant difference p 0,05.

Conclusion: There are no mid term or long term difference outcomes betweenVSDs post transcatheter and surgery closure."

"Approximately 120 different surgical procedures are used to correct congenital heart diseases, and the burden that this places on the surgeon is compounded by the exceptional complexity of the techniques and the rarity of many of the lesions. Training is problematic, not least because of legal issues, and currently available texts, drawings, and images are no substitute for real ‘live’ surgery.Against this background, the authors have set out to create an interactive multimedia manual that covers many aspects of congenital heart surgery. Each heart defect is addressed in an individual chapter, elaborating specific surgical anatomy and indication for surgery of heart defect first, followed by video clips depicting the operative approach and technique. The clips are accompanied by a clear descriptive narrative, and patient history and diagnostic images are available to provide a clear backdrop to the operation. "

"ABSTRAKLatar belakang: Penyakit jantung bawaan (PJB) yang tersering adalah defek septum ventrikel (DSV), defek septrum atrium (DSA) dan duktus arteriousus paten (DAP). Keterlambatan koreksi defek dapat menyebabkan gangguan tumbuh kembang dan kualitas hidup. Tujuan: Mengetahui perbedaan status gizi dan kualitas hidup pada anak PJB asianotik sebelum dan 6 bulan-2tahun setelah koreksi dan apakah terdapat hubungan dengan jenis PJB, status gizi awal, metode dan usia koreksi.Metode: Penelitian kohort retrospektif pada 79 anak berusia 0-18 tahun dengan DSV, DSA, DAP, dan kombinasi ketiganya. Usia, jenis kelamin, jenis PJB, usia koreksi, metode koreksi, BB dan TB dinilai sebelum dan setelah koreksi.Hasil: Subyek penelitian berusia 0-15 tahun dengan mayoritas 1-5 tahun, diagnosis terbanyak adalah DSV (58,2%), dan status nutrisi awal adalah gizi kurang (50,6%). Secara keseluruhan terdapat kenaikan persentil BB/U (p<0,001), TB/U (p=0,004), dan BB/TB (p<0,001) yang bermakna sebelum dan sesudah koreksi. Tidak ada perubahan status gizi yang bermakna sebelum dan sesudah koreksi (p=0,851). Tidak ada hubungan perubahan status gizi dengan status gizi awal (p=0,451), metode koreksi (p=0,454), dan usia tindakan (p=0,861). Terdapat hubungan antara perubahan status gizi dengan ukuran defek (p=0,035). Sebanyak 29,1% memiliki gangguan kualitas hidup, 45,4% memiliki gangguan aspek emosi. Tidak ada hubungan antara gangguan kualitas hidup dengan diagnosis, metode koreksi, dan ukuran defek.Simpulan: Status gizi awal terbanyak anak dengan PJB asianotik adalah gizi kurang. Terdapat peningkatan persentil BB/U, TB/U, dan BB/TB yang bermakna 6 bulan-2 tahun setelah koreksi. Terdapat hubungan antara perubahan status gizi dengan ukuran defek. Sepertiga subyek memiliki gangguan kualitas hidup setelah koreksi. Hampir separuhnya memiliki gangguan aspek emosi.

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ABSTRACT

Background: The most common congenital heart disease (CHD) is ventricular septal defect (DSV), atrial septal defect (ASD), and patent ductus arteriosus (DAP). Delayed correction is correlated with disturbance of growth, development and quality of life (QOL).

Aim: To determine the difference in nutritional status and QOL for acyanotic CHD before and after 6 months-2 years correction and its association with diagnosis, initial nutritional status, method and age of correction.

Method: A retrospective cohort study on 79 children aged 0-18 years old with DSV, ASD, DAP, and a combination of the 3. Age, gender, type of CHD, age and method of correction, weight and height before and after correction were evaluated.

Result: The subjects are aged 0-15 years with majority of 1-5 years, most common diagnosis is DSV (58.2%) and initial nutritional status is moderate malnutrition (50.6%). There is significant increase in weight/age (p<0.001), height/age (p=0,004) and weight/height (p<0.001) percentiles. There is no increment of nutritional status (p=0.851). There is no association between nutritional status and initial nutritional status before correction (p=0.451), method (p=0.454) and age (p=0.861) of correction. There is a statistically significant association between growth status and defect size (p=0.035). Twenty nine percent have decreased QOL, 45.4% on emotional aspect. Decreased QOL was not associated with diagnosis, method of correction and defect size.

Conclusion: The most common nutritional status in acyanotic CHD children is moderate malnutrition. There is a statistically significant increase in the percentiles 6 months-2years post correction. There is an association between changes in growth status and defect size. One third of patients have decreased QOL after correction and almost half on emotional aspect"

"Latar Belakang Defek septum atrium (DSA) adalah kelainan jantung bawaan yang memengaruhi efisiensi jantung saat septum atrium tidak menutup saat lahir. Umum terjadi pada anak-anak dan terkait dengan faktor risiko seperti Sindrom Down, kelahiran prematur, berat badan lahir rendah, usia ibu muda, riwayat keluarga penyakit jantung bawaan, paparan rokok dan paparan alkohol ibu. Meskipun berbagai profil klinis anak dengan DSA terisolasi telah diteliti namum faktor risiko DSA di RSCM belum banyak diteliti. Metode Penelitian potong lintang ini melibatkan 39 pasien DSA terisolasi berusia 0-18 tahun di RSCM, bersama dengan 39 pasien pediatrik umum sebagai kontrol. Rekam medis dipilih secara acak, dan wawancara dilakukan untuk melengkapi data. SPSS versi 27 digunakan untuk analisis data melalui uji statistik, termasuk analisis univariat dan bivariat. Hasil Kelompok DSA terisolasi umumnya terdiri dari perempuan muda dengan berat badan rendah dan bising jantung derajat-III, dan berasal dari keluarga berpenghasilan menengah-rendah. Sindrom Down (nilai-p=0,007) dan kelahiran prematur (nilaip= 0,001) merupakan faktor risiko yang signifikan secara statistik untuk DSA terisolasi dalam populasi ini. Kesimpulan Sindrom Down dan kelahiran prematur terdapat hubungan signifikan dengan DSA. Diperlukan penelitian lebih lanjut dengan sampel yang lebih besar untuk memperkuat bukti faktor risiko yang tidak signifikan secara statistik.

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Introduction Atrial septal defect is a congenital heart defect that affects the efficiency of the heart when the atrial septum does not close at birth. It is common in children and is associated with risk factors such as Down Syndrome, premature birth, low birth weight, young maternal age, family history of congenital heart disease, smoking exposure and maternal alcohol exposure. Although various clinical profiles of children with isolated ASD have been studied, the risk factors for ASD in dr.Cipto-Mangunkusumo Hospital have not been widely studied. Method This cross-sectional study involved 39 isolated ASD patients aged 0-18 years at dr.Cipto- Mangunkusumo Hospital, along with 39 general pediatric patients as controls. Medical records were selected randomly, and interviews were conducted to complete the data. SPSS version 27 was used for data analysis through statistical tests, including univariate and bivariate analysis. Results The isolated ASD group generally consisted of young women with low body weight and grade-III heart murmurs, and came from middle/low-income families. Down syndrome (p-value=0.007) and preterm birth (p-value=0.001) were statistically significant risk factors for isolated ASD in this population. Conclusion Down syndrome and premature birth are significantly associated with isolated ASD. Further research with a larger sample is needed to strengthen the evidence for risk factors that are not statistically significant."

"Ruptur septum ventrikel merupakan komplikasi mekanik yang jarang namun mengancam nyawa infark miokard akut. Operasi perbaikan ruptur merupakan tatalaksana utama. Bedah Pintas Arteri Koroner (BPAK) direkomendasikan untuk dlakukan secara konkomitan untuk revaskularisasi jantung. Penelitian ini bertujuan mengetahui hubungan antara tindakan konkomitan BPAK terhadap mortalitas pasca operasi perbaikan rupture septum ventrikel. Penelitian ini menggunakan metode studi potong lintang pada pasien terdiagnosis ruptur septum ventrikel pasca infark miokard yang menjalan operasi perbaikan ruptur dengan atau tanpa tindakan konkomitan BPAK di Unit Bedah Jantung Dewasa PJNHK sejak Januari 2018 hingga Desember 2023. Data yang diambil meliputi karakteristik pasien seperti umur, jenis kelamin, komorbiditas, fraksi ejeksi jantung kiri, status syok kardiogenik, dan lokasi ruptur septum ventrikel. Sebanyak tiga puluh empat pasien termasuk dalam kriteria penelitian. Tindakan konkomitan BPAK dilakukan pada 22 pasien (64,7%). Insidens kematian pasca operasi konkomitan BPAK lebih rendah dibandingkan kelompok pasien yang menjalani operasi perbaikan ruptur septum saja. Perhitungan multivariat menunjukkan bahwa operasi konkomitan BPAK memberikan efek protektif terhadap pasien pasca operasi (Adjusted OR 0,3, p = 0,167). Walaupun secara statistik tidak bermakna, fraksi ejeksi jantung kiri, status syok kardiogenik, dan lokasi ruptur septum ventrikel diasosiasikan dengan peningkatan mortalitas pasca operasi. Tindakan konkomitan BPAK diasosiasikan dengan mortalitas pasca operasi yang lebih rendah and memberikan efek protektif. Faktor preoperatif seperti fraksi ejeksi jantung kiri, status syok kardiogenik, dan lokasi rupture septum ventrikel memengaruhi mortalitas pasca operasi perbaikan septum ventrikel.

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Post-infarction ventricular septal rupture (VSR) is a rare life-threatening complication of acute myocardial infarction (AMI). Surgical repair of VSR remains the treatment of choice. Concomitant CABG is recommended as an additional procedure as a way of revascularization. This study aims to investigate the association between concomitant CABG and early post-operative mortality in post-infarction VSR undergoing surgical repair. This is a retrospective cohort study which includes patients who underwent VSR surgical repair with and without concomitant CABG at the Adult Cardiac Surgery Unit, National Cardiovascular Center Harapan Kita from January 2018 to December 2023. Preoperative factors include preoperative left ventricular ejection fraction (LVEF), cardiogenic shock, location of rupture and concomitant CABG surgery. Post operative outcomes recorded were early mortality which includes in-hospital and thirty-day mortality. A total of thirty-four subjects were included in this study with 22 patients (64.7%) undergoing concomitant CABG. Incidence of mortality in patients undergoing concomitant CABG is lower than patients without CABG. Adjusted OR showed a slight protective effect of CABG towards post-operative mortality (Adjusted OR 0.3, p = 0.167). Although it is not statistically significant, preoperative LEVEF, preoperative cardiogenic shock, and location of rupture are also associated with post-operative mortality. In conclusion, VSR surgical repair in concomitant with CABG showed lower post-operative mortality and protective effect while preoperative LVEF, cardiogenic shock, location of rupture are associated with post-operative mortality in patients undergoing VSR surgical repair."

"Latar Belakang: Defek septum atrium (DSA) dengan hipertensi arteri pulmoner (HAP) mengakibatkan terjadinya kelebihan beban pada ventrikel kanan dan mencetuskan respon adaptif dan maladaptif sehingga ventrikel kanan mengalami fibrosis. Fibrosis ventrikel dapat dinilai melalui pemeriksaan MRI kardiak dan biopsi endomiokardium (BEM). Sampai saat ini, belum ada penelitian yang berfokus tentang hubungan dan evaluasi diagnostik BEM dibandingkan dengan MRI kardiak yang menilai fibrosis ventrikel kanan pada kelompok penyakit jantung bawaan khususnya pada DSA dengan HAP.Tujuan: Penelitian ini bertujuan mencari korelasi antara nilai native T1 dan extracellular volume (ECV) pada pemeriksaan MRI kardiak dengan biopsi endomiokardium ventrikel kanan sebagai penanda fibrosis ventrikel kanan pada pasien defek septum atrium dengan hipertensi arteri pulmoner.Metode: Penelitian ini merupakan studi observasional analitik dengan desain studi potong lintang pada pasien DSA sekundum dengan HAP berusia ≥18 tahun yang menjalani kateterisasi jantung kanan dan kemudian dilakukan pemeriksaan MRI kardiak dan biopsi endomiokardium untuk menilai fibrosis ventrikel kanan.Hasil: Studi ini melibatkan total 32 pasien DSA sekundum yang menjalani kateterisasi jantung kanan, pemeriksaan MRI kardiak dan biopsi endomiokardium, dengan median usia 32 tahun dan mayoritas berjenis kelamin perempuan (81,3%). Nilai native T1 rata-rata dan nilai native T1 poin insersio ventrikel kanan anterior memiliki korelasi positif kuat terhadap fibrosis berdasarkan biopsi endomiokardium dengan nilai korelasi r=0.763, p<0,001 dan r=0.703, p <0,001, sedangkan nilai native T1 septum dengan r=0.421 (p=0,026), posterior dengan r=0.525 (p=0,004) dan inferior dengan r= 0.442 (p=0,019) memiliki korelasi positif sedang terhadap fibrosis berdasarkan biopsi endomiokardium. Sedangkan, nilai ECV menunjukkan tidak adanya korelasi terhadap fibrosis berdasarkan biopsi endomiokardium dengan nilai korelasi ECV rata-rata r=0,185 (p=0,347).Kesimpulan: Pada pasien defek septum atrium sekundum dengan hipertensi arteri pulmoner, parameter fibrosis ventrikel kanan yang dinilai dari nilai native T1 berkorelasi positif kuat dengan persentase fibrosis berdasarkan biopsi endomiokardium. Sedangkan tidak terdapat korelasi antara parameter extracellular volume (ECV) dengan persentase fibrosis pada biopsi endomikardium.

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Background: Atrial septal defect (ASD) with pulmonary arterial hypertension (PAH) result in an increased load on the right ventricle thus triggering adaptive and maladaptive responses leading to the formation of right ventricular fibrosis. Right ventricular fibrosis can be assessed through cardiac MRI examinations and endomyocardial biopsy (EMB). There is a lack of focused research on the relationship and diagnostic evaluation of EMB compared to cardiac MRI assessing right ventricular fibrosis in congenital heart disease, particularly in ASD with PAH.

Objective: This study aims to find a correlation between native T1 values and extracellular matrix volume (ECV) in cardiac MRI examinations and right ventricular endomyocardial biopsy as markers of right ventricular fibrosis in patients with atrial septal defect with pulmonary arterial hypertension.

Methods: This is an analytical observational study with a cross-sectional design in patients with secundum ASD with PAH aged ≥18 years who undergo right heart catheterization, followed by cardiac MRI and endomyocardial biopsy to assess right ventricular fibrosis.

Results: A total of 32 patients with secundum ASD who underwent right heart catheterization, cardiac MRI, and endomyocardial biopsy are involved in this study, with a median age of 32 years and the majority are female (81.3%). The average native T1 values and anterior T1 showed a strong positive correlation with fibrosis based on endomyocardial biopsy (r=0.763, p<0.001, and r=0.703, p<0.001, respectively). The native T1 values of the septum, posterior, and inferior had a moderate positive correlation with correlation values of r=0.421, p=0.026; r=0.525, p=0.004; and r=0.442, p=0.019, respectively. There was no correlation between all ECV values and endomyocardial biopsy for all ECV parameters as right ventricle fibrosis’ parameter, with correlation values of average ECV of r=0.185 (p=0.347).

Conclusion: In patients with ASD with PAH, the right ventricular fibrosis parameter assessed from native T1 values strongly correlates with the percentage of fibrosis based on endomyocardial biopsy. Meanwhile, there was no correlation between ECV parameter and the percentage of fibrosis in endomyocardial biopsy."

"Latar Belakang: Defek septum intraventrikel merupakan salah satu penyakit jantung bawaan yang paling sering ditemukan di Indonesia dengan angka kejadian 3,6-6,5 per 1000 kelahiran hidup atau sekitar 20%-30% dari penyakit jantung bawaan. Sebanyak 32% dari kasus memerlukan dilakukannya operasi penutupan defek septum intraventrikel. Pada operasi penutupan defek septum intraventrikel diperlukan penggunaan mesin pintas jantung-paru atau cardiopulmonary bypass (CPB) yang secara teoritis dihubungkan dengan inflamasi akibat penglepasan mediator proinflamasi yang dapat mengakibatkan kerusakan miokard. Hal ini menyebabkan praktisi dalam tim pembedahan jantung menggunakan strategi untuk mengatasi, antara lain dengan penggunaan steroid. Data dan uji klinis mengenai masalah tersebut masih terus dilakukan. Tujuan penelitian ini adalah untuk mengetahui efek deksametason 1mg/kg (max 15 mg) dibandingkan metilprednisolon 30 mg/kg (max 500 mg) dalam mencegah penurunan kontraktilitas miokard dan peningkatan kadar troponin I pascabedah penutupan defek septum intraventrikel.Metode: Telah dilakukan penelitian uji klinis acak tersamar tunggal pada 36 pasien anak yang menjalani operasi penutupan defek septum intraventrikel antara bulan Januari 2019 hingga April 2019, yang dialokasikan ke dalam kelompok metilprednisolon (kelompok standar) atau kelompok deksametason. Pemeriksaan ekokardiografi untuk menilai kontraktilitas miokard (fraksi ejeksi, fraksi pemendekan, peak E velocity, peak A velocity dan rasio E/A) dilakukan 1 hari sebelum operasi dan 8 jam pasca-CPB sedangkan pemeriksaan sampel darah untuk menilai kadar troponin I dilakukan pada awal induksi dan 8 jam pasca-CPB. Pemeriksaan troponin I dilakukan dengan metode ELISA. Data yang diperoleh dianalisis dengan uji statistik yang sesuai.Hasil: 36 pasien yang menjalani operasi VSD yang memenuhi kriteria penerimaan, 35 pasien dianalisis karena 1 pasien kelompok deksametason meninggal sebelum 8 jam pasca-CPB. Karakteristik demografi, data kontraktilitas miokard dan kadar troponin I praoperatif dan pascaoperatif seimbang pada kedua kelompok. Kontraktilitas miokard pada kelompok metilprednisolon dan deksametason turun bermakna pada 8 jam pasca-CPB. Kadar troponin I 8 jam pascabedah pada kelompok metilprednisolon naik bermakna sedangkan kadar troponin I pada kelompok deksametason berbeda naik tidak bermakna.Simpulan: Deksametason dapat digunakan dalam upaya mencegah inflamasi sistemik akibat operasi jantung terbuka. Ketersediaan deksametason cukup baik di seluruh Indonesia dan lebih ekonomis dibandingkan metilprednisolon.

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Background: Ventricular septal defect is one of the most common congenital heart disease found in Indonesia with an incidence of 3.6-6.5 per 1000 live births or around 20% -30% of congenital heart disease. 32% of cases require ventricular septal defect closure surgery. Surgical closure of the ventricular septal defect requires the use of a heart-lung bypass machine or cardiopulmonary bypass (CPB) which is theoretically associated with inflammation due to the release of proinflammatory mediators which can result in myocardial damage. This caused practitioners in the heart surgery team to use strategies to overcome, including the use of steroids. Data and clinical trials regarding these problems are still ongoing. The aim of this study was to determine the effect of dexamethasone 1mg/kg (max 15mg) versus methylprednisolone 30mg/kg (max 500mg) in preventing a decrease in myocardial contractility and an increase in troponin I levels after surgical closure of ventricular septal defects.

Methods: A single randomized clinical trial study was conducted in 36 pediatric patients undergoing ventricular septal defect surgery between January 2019 until April 2019, which were allocated into the methylprednisolone group (standard group) or dexamethasone group. Echocardiography (baseline) was carried out 1 day before surgery and 8 hours post-CPB to assess myocardial contractility (ejection fraction, shortening fraction, peak E velocity, peak A velocity and E/A ratio). Blood serum examination to assess troponin I levels was done at the beginning of induction and 8 hours post-CPB. Troponin I examination was carried out by the ELISA method. The data obtained were analyzed by the appropriate statistical test.

Results: 36 patients who undergoing VSD surgery who met the admission criteria, 35 patients were analyzed because 1 patient of the dexamethasone group died before 8 hours post-CPB. Demographic characteristics, myocardial contractility data and preoperative-postoperative troponin I levels were balanced in both groups. Myocardial contractility in the methylprednisolone and dexamethasone groups dropped significantly at 8 hours post-CPB. Troponin I levels 8 hours after surgery in the methylprednisolone group increased significantly but troponin I levels in the dexamethasone group increased no significant.

Conclusion: Dexamethasone can be used in an effort to prevent systemic inflammation due to open heart surgery. The availability of dexamethasone is quite good throughout Indonesia and is more economical than methylprednisolone.

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