Hasil Pencarian  ::  Simpan CSV :: Kembali

"Tetralogi Fallot (TF) merupakan penyakit jantung bawaan (PJB) sianotik terbanyak. Terapi definitifnya berupa koreksi total melalui operasi jantung terbuka, namun usia terbaik koreksi masih menjadi perdebatan. Operasi saat usia < 3 tahun disebut koreksi dini. Angka kesintasan jangka panjang pasien TF pasca-operasi mencapai 90%. Masalah baru yang muncul adalah gangguan neurodevelopmental yang dapat mempengaruhi kualitas hidup pasien.Tujuan: Mengetahui sebaran pasien TF pasca-operasi jantung terbuka, serta membandingkan perkembangan, kognitif dan kualitas hidup pasien TF pasca-operasi jantung terbuka yang menjalani koreksi dini dibandingkan koreksi terlambat.Metode: 29 subjek kelompok koreksi dini dan 34 subjek kelompok koreksi terlambat dipilih secara konsekutif. Penilaian perkembangan menggunakan Denver II. Tingkat kognitif dinilai dengan the Capute scales dan uji intelegensi Wechsler. Kualitas hidup dinilai dengan laporan PedsQLTM. Perbedaan antar kedua kelompok subjek dianalisis dengan menggunakan uji Kai kuadrat, uji Fischer, dan uji t tidak berpasangan.Hasil: Median usia operasi kelompok koreksi dini adalah 1,8 tahun dan kelompok koreksi terlambat adalah 5,3 tahun. Sebesar 54% subjek menjalani koreksi terlambat. Mikrosefal terjadi pada 15% keseluruhan subjek. Pada kedua kelompok subjek ditemukan masalah perkembangan. Sebesar 75% subjek kelompok koreksi dini memiliki developmental quotient normal. Kelompok koreksi dini memiliki nilai verbal intelligence quotient (IQ) (p 0,002; IK 95% 5,8-24,6) dan full-scale IQ (p0,003; IK 95% 4,7-21,3) yang lebih tinggi dibandingkan kelompok koreksi terlambat. Laporan PedsQLTM anak menunjukkan rendahnya kualitas hidup pada fungsi emosi (p=0,02) dan sekolah (p=0,03) pada kelompok koreksi terlambat.Simpulan: Pasien TF yang menjalani koreksi dini memiliki dan kualitas hidup yang lebih tinggi dibandingkan kelompok koreksi terlambat, sehingga diperlukan sosialisasi usia operasi koreksi dini.

---

Background: Tetralogy of Fallot (TF) is the most common cyanotic congenital heart disease. The definitive treatment is complete repair thru open heart surgery. At present, the most effective age category for repair is still being debated. Complete repair for children who are younger than 3 years is called early repair. Recent technological advancement has allowed the early repair to be performed earlier and improve the survival rate of the patients. However, these survivors risk having neurodevelopmental disorder which affect their health-related quality of life.

Objective: To describe the characteristics of post open heart surgery TF patients and compare the TF patients who undergo early correction to ones who undergo late correction within the aspects of development, cognitive outcomes, and health-related quality of life.

Design : Twenty nine subjects from early correction group and 34 subjects from late correction group were compared in development (Denver development screening II), cognitive outcomes (The Capute scales and Wechsler test), and health-related quality of life (PedsQLTM).

Result : Median age of the subjects in early correction group is 1,8 years and in late correction group is 5,3 years. Fifty five percent undergo late correction. The prevalence of microcephaly is 15%. Developmental delay is found in both group. Seventy five percent of subject who undergo early correction have normal developmental quotient. Early correction group have higher verbal intelligence quotient (IQ) (p=0.002; CI 95% 5.8-24.6) and full scale IQ (p=0.003; CI 95% 4.7-21.3). Child report PedsQLTM showed lower quality of life in late correction group.

Conclusions : Tetralogy of Fallot patients who undergo early correction have higher IQ and better health-related quality of life compared to late correction group. The age of early complete repair (< 3 years) needs to be disseminated."

"Latar belakang. Peningkatan morbiditas dan mortalitas pada bayi baru lahir dengan penyakit jantung bawaan (PJB) kritis berkaitan dengan diagnosis yang terlambat. Skrining pulse oksimetri sebelum bayi baru lahir pulang dari rumah sakit dapat membantu menegakkan diagnosis dini. Pulse oksimeter fingertip diharapkan menjadi alternatif pilihan alat pemeriksaan oksimetri karena murah, mudah, dan dapat digunakan secara luas. Tujuan. Penelitian ini bertujuan menilai sensitivitas, spesifisitas, nilai duga positif (NDP), nilai duga negatif (NDN), rasio kemungkinan positif (RKP), rasio kemungkinan negatif (RKN), pre-test probability, dan post-test probability pemeriksaan pulse oksimetri fingertip dibandingkan oksimetri generasi baru untuk deteksi dini PJB kritis pada bayi baru lahir sebelum pulang dari rumah sakit. Metode. Penelitian ini merupakan uji diagnostik yang dilakukan di Ruang Rawat Gabung RSCM pada semua bayi baru lahir bugar dengan usia gestasi ≥37 minggu dan berusia 24-72 jam. Pemeriksaan pulse oksimetri fingertip dan pulse oksimetri generasi baru dilakukan di tangan kanan (preduktal) dan kaki (postduktal). Subjek dengan saturasi oksigen <95% atau beda saturasi oksigen >3% antara tangan kanan dan kaki memerlukan pemeriksaan lebih lanjut. Ekokardiografi dikerjakan untuk diagnosis pasti. Hasil. Penelitian dilakukan selama enam bulan pada 442 bayi baru lahir bugar. Mayoritas subjek diperiksa pada usia 24-48 jam (59%), median usia gestasi 38 minggu. Terdapat enam subjek dengan kelainan kongenital. Tidak ada subjek dengan riwayat keluarga menderita PJB, didiagnosis PJB saat antenatal maupun melalui pemeriksaan fisis. Perolehan saturasi oksigen preduktal menggunakan dua jenis pulse oksimetri bervariasi secara statistik (Uji Bland-Altman) namun tidak bermakna secara klinis (hasil deteksi negatif 100%). Tidak ada subjek dengan hasil deteksi positif dan didiagnosis PJB kritis melalui pemeriksaan oksimetri. Pemeriksaan pulse oksimetri fingertip pada bayi baru lahir dipengaruhi gerakan bayi (67,6%) dan faktor alat (sinyal tidak terbaca dan hasil tidak stabil) 24,8%. Simpulan. Uji diagnostik pulse oksimetri fingertip dibandingkan generasi baru untuk deteksi dini PJB kritis pada penelitian ini belum dapat dinilai. Pemeriksaan kedua jenis pulse oksimetri tersebut memberikan hasil deteksi yang sama.

---

Background. Late diagnosis in the newborn with critical congenital heart disease (CCHD) is associated with increased morbidity and mortality. Pulse oximetry screening of newborn before hospital discharge can help early diagnosis. Fingertip pulse oximeter is expected to be an alternative option oximetry screening tool because it is affordable, easy, and can be widely used.

Objective. To estimate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), pretest odds, positive likelihood ratio (LR+), negative likelihood ratio (LR-), post-test odds, and post-test probability of fingertip pulse oximetry screening compared to a new generation to detect CCHD in the newborn before hospital discharge.

Methods. This is a diagnostic study held in newborn nursery of Cipto Mangunkusumo Hospital involving asymptomatic newborns aged 24-72 hours and gestational age ≥37weeks. Examination of fingertip and new generation pulse oxymetri was done in right hand (preductal) and foot (postductal). Subject had oxygen saturation <95% or difference of oxygen saturation between right hand and foot >3% requires further investigation. Echocardiography was performed for definitive diagnosis.

Results. The study was conducted during six months in 442 asymtomatic newborns. The majority of subjects were examined at age 24-48 hours (59%) and gestational age 38 weeks. There were six subjects with congenital abnormalities. No subjects with a family history of CHD nor diagnosed through antenatal and physical examination. Obtaining preductal oxygen saturation using two types pulse oximetry varied statistically (Bland-Altman test) but not clinically significant (100% negative detection results). No subject had positive detection result and was diagnosed CCHD through screening oximetry. Newborn examination using fingertip pulse oximetry were affected by movement (67.6%) and tool factors (signal unreadable and unstable results) 24.8%.

Conclusion. Diagnostic test of fingertip compared with new generation pulse oximetry in early detection of CCHD in this study can not be assessed. These two modalities show the same result of detection."

"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. "

"Park's Pediatric Cardiology for Practitioners is the essential medical reference book for the ever-changing field of pediatric cardiology. Comprehensive in its content, it provides the practical guidance you need to diagnose and manage children with congenital and acquired heart disease. From history and physical examination through preventative treatment and the management of special problems, the fully revised 6th edition incorporates all of the latest concepts in cardiology, distilled in a way that is understandable to pediatricians, family practitioners, NPs, and PAs alike. Apply the latest knowledge and methods with coverage of surgical techniques in pediatric cardiology, the application of interventional non-surgical techniques, blood pressure standards, and cardiac arrhythmia treatments. Easily grasp the latest techniques with helpful line drawings throughout. Select the best approaches for your patients with extensive coverage of special problems, including congestive heart failure and syncope.Clinical reference on the diagnosis and management of congenital and acquired heart disease in children."