Search

Abstract Background Minimally invasive transcatheter approaches were usually done for patent ductus arteriosus (PDA) with duct-dependent pulmonary circulation. There are two ways to establish vascular access, by using transfemoral either femoral vein (FV) or femoral artery (FA) and transcarotid artery (CA) with surgical cutdown approach to access the PDA and then provide good support for the balloon and the stent to be safely deployed. This study aims to compare the efficacy and safety of transcarotid with surgical cutdown compared to the transfemoral approach of patent ductus arteriosus stenting in duct-dependent cyanotic heart disease. Results Overall procedural complication rates were higher in the FA/FV approach than in the CA approach (51% vs. 30%). The incidence of acute limb ischemia in the FA approach is significantly higher than in the CA approach (P

IntroductionSince the first successful percutaneous closure under transesophageal echocardiographic (TEE) guidance, many centers explored transcatheter procedures without fluoroscopy. This single-center study is aimed to show the feasibility and safety of percutaneous patent ductus arteriosus (PDA) closure under echocardiography-only guidance during our 1-year experience.MethodsPatients with PDA were recruited for percutaneous PDA closure guided by either fluoroscopy or echocardiography-only in National Cardiovascular Center Harapan Kita (ClinicalTrials.gov Identifier: NCT05321849, clinicaltrials.gov/ct2/show/NCT05321849). Patients were evaluated clinically and radiologically using transthoracic echocardiography (TTE) at 6, 24, and 48 h after the procedure. The primary endpoint was the procedural success. Secondary endpoints were the procedural time and the rate of adverse events.ResultsA total of 60 patients underwent transcatheter PDA closure, 30 patients with fluoroscopy and 30 patients with echocardiography guidance. All patients had successful PDA closure. There were only residual shunts, which were disappeared after follow-up in both groups, but one patient with a fluoroscopy-guided procedure had moderate tricuspid regurgitation with suspected thrombus in the tricuspid valve. The procedural time was not significantly different between the fluoroscopy and echocardiography groups.

Background: Critical pulmonary stenosis (PS) is one of the life-threatening congenital heart diseases which present during the neonatal period with cyanosis. Surgical valvotomy was once the procedure of choice for critical PS; however, balloon pulmonary valvuloplasty (BPV) has now become the standard treatment. Although the procedure is usually simple, crossing the pulmonary valve from the femoral vein can be difficult, especially when severe tricuspid regurgitation and right atrium dilatation are present. In such patients, the maneuver can be simplified by using the right internal jugular vein approach. However, many operators are reluctant to use this approach because of unfamiliarity with the technique, potential complications, and paucity of reports. Until now, there is no literature describing BPV using the transjugular approach in neonates, also none directly comparing the transfemoral and transjugular approaches. Objective: We compared transjugular with the transfemoral approach in terms of procedure time and complications. Materials and Methods: This was a retrospective cohort study. Participants were neonates with critical PS undergoing BPV in the National Cardiovascular Center Harapan Kita from 2013 to 2018. Results: Of 15 neonates undergoing BPV, eight were done using the transjugular approach and seven using the femoral approach. Mean age and weight in both groups was similar. In all eight patients using transjugular approach, crossing the pulmonary valve was consistently quick and easy. The total procedural time, pulmonary crossing time, and fluoro time was significantly shorter using the transjugular approach (65 ± 8 vs. 108 ± 17.8 min, P < 0.05; 22 ± 3.1 vs. 45 ± 14.8 min, P < 0.01; 29 ± 13 vs. 67 ± 35 min, P < 0.05). There were no complications relating to vascular access. Moreover, the BPV procedure itself demonstrated comparable results in both groups. Conclusion: BPV using the transjugular approach is safe and effective to relieve critical PS in neonates compared to the transfemoral approach.

Introduction: Rheumatic heart disease (RHD) remains a major public health issue affecting children and young adults in developing countries. This study aimed to evaluate the clinical characteristics, management, and reactivation of RHD among children and young adults.Patients and Methods: This was a hospital-based retrospective study conducted at the National Cardiovascular Center Harapan Kita, Indonesia; we retrieved relevant data from patients diagnosed with RHD between 2012 and 2018.Results: Two hundred and seventy-nine patients were diagnosed with rheumatic heart disease, of whom 108 were children (mean age of 12.02 ± 3.36 years) and 171 were young adults (mean age was 24.9 ± 3.84). RHD was more common in female than in male young adults (1.5:1). Hospitalization due to RHD complications such as congestive heart failure was seen in 11.11% of cases in children, while pulmonary hypertension was present in 19.95% young adult cases. Reactivation of RHD occurred in 17.2% (48/279) cases, significantly in children (p < 0.001). Overall, the mitral valve (either isolated or combined) was the organ most affected in children (39.13%) and young adults (44.81%). Isolated mitral regurgitation was more common in children (13/21, 61.9%), while isolated mitral stenosis was more common in young adults (19/47, 40.42%). There was a high rate of rheumatic tricuspid valve disease in all populations (193/279, 69.17%) and reported involvement of pulmonary regurgitation (46/279, 16.48%). Multivalve lesions were more common than single lesions in both groups, with a combination of mitral and tricuspid regurgitation the predominant type in children (32/43, 74.41%) and mixed mitral lesion and tricuspid regurgitation in young adults (22/72, 30.56%). We observed a significant occurrence of quadrivalve lesions in children (p = 0.039). Valve repair was more common in children (49.07%) and replacement in young adults (32.16%), with low in-hospital mortality. Compliance with secondary prophylaxis was a significant challenge.Conclusion: Chronic RHD often presented with complications of the disease or reactivation of rheumatic fever (RF). Inadequate treatment of RF/RHD leads to extensive valvular damage and consequent disabilities. Efforts toward active early diagnosis and prompt treatment of RF/RHD and effective preventive measures are essential.

Kawasaki disease is an acute, self -limited vasculitis of unknown etiology that occurs predominantly in infants and young children. The major sequele of Kawasaki disease are related to the coronary arterial system. Cardiac imaging is a critical part in evaluation of all patients with suspected Kawasaki disease. Multi Detector CT (MDCT) provides a safe non-invasive approach to accurately delineate coronary artery anatomic structure. We report a case of a 6 years old boy with history of Kawasaki disease. Multi detector CT scan showed giant aneurysm at proximal LAD, proximal RCA and medium aneurysm at proximal LCX. Patient then treated with the anticoagulant therapy.

Sejak tahun 1921 penyakit jantung merupakan penyebab kematian utama di Amerika Serikat (USA), sedangkan stroke merupakan penyebab kematian nomor tiga mulai tahun 1938; kedua penyakit ini menduduki proporsi 40% dari seluruh penyebab kematian. Namun, pada tahun 1950 angka kematian akibat penyakit kardiovaskular turun 60%; keberhasilan yang luar biasa dari program kesehatan masyarakat USA di abad 20. Keberhasilan ini tercapai berkat pemahaman masyarakat yang lebih mendalam tentang faktor risiko penyakit kardiovaskular, intervensi prevensi yang dikembangkan untuk menurun-kan faktor risiko tersebut, dan tentunya juga berkat teknologi pengobatan yang semakin maju. Masyarakat di negara-negara maju kini banyak berpaling pada makanan dan minuman yang telah dibuktikan ber-manfaat untuk kesehatan kardiovaskular. Para ahli semakin faham bahwa disfungsi endotel dan aktivasi platelet, merupakan patogenesis utama aterotrombosis, yang mendorong terjadinya vasokonstriksi, pembentukan trombus dan inflamasi.

A tremendous progress has been made in the management of patients with ST elevation myocardial infarction (STEMI) over the last 20 years. Primary percutaneous coronary intervention (PPCI) is the preferred option for treating STEMI patients, but offering an easy, direct and fast access to this procedure is still difficult due to geographic and structural medical services differences, especially in developing countries such as Indonesia. Analysis of Jakarta Acute Coronary Syndrome registry 2010 showed a proportion of patients not recieving acute repercusion therapy of 59% from 654 STEMI patients and majority of them (52%) were from inter-hospital referral. The time from onset of infarction to hospital admission was more than 12 hours in almost 80% cases. Network organization is central to optimize patient care at the acute stage of an MI and there is a strong need to build a cardiovascular care unit network system that is well organized in Jakarta. This involves a multidisciplinary approach that should give an appropriate diagnosis and initial treatment with rapid and safe transport to a PCI capable hospital. Thus, harmonizing the activities of all hospitals in Jakarta that will give the best cardiovascular services to the community by providing two acute reperfusion therapy options (PPCI or pharmaco-invasive strategy) depending on the time needed for the patient to reach the cath-lab.

Malnutrisi Energi Protein (MEP) didefinisikan sebagai kondisi dimana simpanan protein tubuh berkurang baik dengan atau tanpa disertai penurunan lemak tubuh. Kondisi ini sering disebabkan oleh asupan nutrisi yang tidak mencukupi kebutuhan untuk pertumbuhan atau pemeliharaan tubuh. Data Riset Kesehatan Dasar Kementerian Kesehatan RI (Riskesdas) tahun 2010, mencatat 13,2% anak Indonesia mengalami kekurangan gizi kronis, dan 29,4% balita masih kekurangan berat badan. Meskipun dalam kurun waktu 3 tahun terakhir (2007-2010) anggaran untuk perbaikan gizi masyarakat terus meningkat, namun angka prevalensi gizi kurang pada balita hanya turun sedikit, yakni dari 18,4% (2007) menjadi 17,9% (2010); berarti ada sekitar 3,7 juta balita Indonesia masuk dalam kategori gizi kurang. Prevalensi kekurangan berat badan pada anak bervariasi antar propinsi, tertinggi di Nusa Tenggara Timur mencapai 33,6%, lebih dari tiga kali lipat Yogyakarta yang hanya 10,9%. Indonesia kini menghadapi beban ganda dalam hal gizi. Selain masalah gizi kurang yang masih menonjol, juga ancaman gizi lebih pada anak-anak.

Dokter adalah suatu profesi yang dikenal mempunyai moralitas tinggi.Seorang dokter harus siap setiap saat untuk memberi pertolongan kepada siapa saja, kapan saja, dimana saja, dengan sebaik-baiknya dan sejujur-jujurnya.Pertolongan dokter didasari perikemanusiaan, diberikan tanpa memperhitungkan terlebih dahulu untung-ruginya. Profesional kedokteran mempunyai etika profesi sebagai panduan dalam bersikap dan berperilaku. Nilai-nilai dalam etika profesi tercermin di dalam sumpah dokter dan kode etik kedokteran. Sumpah dokter berisikan suatu kontrak moral antara dokter dengan Tuhan sang penciptanya, sedangkan kode etik kedokteran berisikan kontrak kewajiban moral antara dokter dengan kelompok profesinya. Keluhuran dan kemuliaan sifat dokter tercermin dalam 6 sifat dasar dokter, yaitu: 1)berketuhanan, 2) kemurnian niat, 3) keluhuran budi, 4) kerendahan hati, 5) kesungguhan bekerja, dan 6) integritas ilmiah dan sosial.

Penyakit kardiovaskular diklaim sebagai penyebab kematian nomor satu bagi perempuan diatas usia 65 tahun di benua Europa, masalah ini dikemukakan secara lengkap oleh Angela H.E.M. Maas, MD, PhD dan Harry Suryapranata, MD, PhD dari Isala Klinieken, Zwolle -The Netherlands, dalam jurnal edisi ketiga ini. Menurut survai di negeri kincir angin itu, perempuan kurang memahami ancaman penyakit kardiovaskular, umumnya mereka lebih jarang menjalani uji latih jantung, apalagi angiografi diagnostik dan intervensi. Hormon estrogen berperan melindungi perempuan dari PJK, oleh karenanya infark miokard akut terjadi pada usia yang lebih tua dibanding laki-laki. Mereka juga mempunyai risiko kematian lebih tinggi dan komorbiditas faktor risiko penyakit jantung koroner (PJK) yang lebih besar. Estrogen berperan dalam pengaturan faktor metabolisme, seperti lipid, petanda inflamasi, sistim trombotik, vasodilatasi reseptor adan . Oleh karena itu, terjadinya menopause berpengaruh terhadap kejadian PJK.

Background. QRS duration has long been established as a strong predic-tor of sudden cardiac death in patients after surgical correction of Tetral-ogy of Fallot (TOF). Several factors has been correlated to QRS duration, i.e severity of pulmonal regurgitation and right ventricular volume after TOF correction. But there is no established relation between right ven-tricular function and QRS duration after surgical correction TOF. Objectives. We aimed to investigate the relation between QRS duration and right ventricular function and whether patients after TOF repair with right bundle branch block have left ventricular dissynchrony. Methods.50 patients with repaired TOF were studied. Right ventricular function were derived from tissue Doppler imaging Tei index. Left ven-tricular dissynchrony were derived from tissue Doppler imaging. The time interval between the onset of QRS complex and the onset of systolic ejec-tion was measured for six left ventricular basal wall, i.e septal, lateral, anteroseptal, posterior, anterior and inferior wall. Mechanical delay from septal to lateral wall, antero-septal to posterior wall and anterior to infe-rior wall was calculated. Measured data were correlated with QRS dura-tion. Results.There was relation between QRS duration and right ventricular function (P = 0.028, r = 0.44). Ten (20%) of the examined patients after TOF repair had LV dissnynchrony particularly in patients with RBBB and prolonged QRS duration (160 9 ms). Conclusions.There is correlation between right ventricular function and QRS duration. Left ventricular dissynchrony may exist in patients after TOF repair with RBBB.

Elektrokardiografi (EKG) merupakan alat yang paling sering digunakan untuk menegakkan diagnosis dini dan stratifikasi risiko pada pasien infark miokard akut (IMA). Iskemia derajat I digambarkan sebagai gelombang T yang tinggi disertai elevasi segmen ST < 0.1 mV. Pada iskemia derajat II terlihat elevasi segmen ST dengan gelombang T yang positif tanpa distorsi terminal QRS. Sedangkan pada derajat III tampak elevasi segmen ST, dengan gelombang T yang positif disertai distorsi bagian akhir kompleks QRS, yang berakhir dengan infark miokard lebih luas dan ancaman kematian yang lebih besar. Kejadian kardiovaskular yang sering menyertai IMA inferior adalah hipotensi, bradikardi, blok atrioventrikular (AV) derajat 3 (blok AV total), henti jantung, takikardi atau fibrilasi ventrikel. Semakin proksimal sumbatan, semakin luas infark yang terjadi, maka semakin tinggi pula angka kejadian kardiovaskular tersebut.

Total Anomalous Pulmonary Venous Drainage (TAPVD) pertama kali dilaporkan oleh Friedkowsky pada tahun 1868, namun baru pada tahun 1942 TAPVD dikenal sebagai sebuah entitas penyakit. Penyakit ini jarang terjadi, insidensinya sekitar 1-3% dari semua penyakit jantung bawaan (PJB) atau sekitar 0,008% dari seluruh bayi lahir hidup. Di Pusat Jantung Nasional Harapan Kita (PJN-HK), selama tahun 2006 terdapat 8 kasus (5 laki-laki dan 3 perempuan) atau sekitar 0,7% dari total kasus PJB. Pasien dengan TAPVD sebagian besar akan menunjukkan gejala pada usia

Criss-cross heart is a rare congenital cardiac anomaly characterized by crossing of the inflow streams of the two ventricles. The anomaly seems to be due to abnormal twisting of the heart about its long axis and when the axis of the openings of the atrioventricular valves are not parallel. Thus in criss cross heart the abnormality is on the atrioventricular relation, not connection, which happened due to clockwise or counter-clockwise ventricular rotation. We report four cases of criss-cross heart, three cases had levocardia - situs solitus with superior inferior ventricles and one case had dextrocardia - situs inversus (mirror image) the ventricles were not in superior-inferior fashion. Subcostal and apical four-chamber views can be used to identify the ventricular morphology and position, the atrio-ventricular valves, the atrioventricular and ventriculo-arterial connection, and the characteristics of the great vessels. The artery connection can be seen more clearly in the parasternal window. All patients had concordance atrioventricular connection, ventricular septal defect and double outlet right ventricle with malposition of the great arteries. Other associated lesions included infundibular (subvalvular) and valvular pulmonary stenosis in three, atrial septal defect in two, and interrupted aortic arch with large persistent ductus arteriosus in one patient. The findings were confirmed by catheter-ization and angiography in three patients and multislice-CT in one. Conclusions.patients with criss-cross heart can be easily diagnosed by a careful, systematic segmental study with two-dimensional color-coded transthoracic echocardiography. The failure to obtain a characteristic four - chamber view in any cut and the presence of crossed atrioventricular inflow bloodstreams with each atrium draining into the ventricle located contralaterally were diagnostic for recognition of this complex anomaly. The presence of superior-inferior ventricles although suggestive, should not be regarded as diagnostic for criss cross anatomy.

Ketika bedah Fontan baru diperkenalkan pada tahun 1970, para ahli menaruh harapan besar. Mereka beranggapan sirkulasi Fontan merupakan ide besar, yang mampu mengatasi berbagai variasi penyakit jantung bawaan (PJB) dengan fisiologi ventrikel tunggal. Tetapi 20 tahun kemudian, mulailah Fontan dkk mengenali kelemahan prosedur yang ia inisiasi. Dari evaluasi jangka panjang yang ia lakukan terbukti bahwa, meskipun pada bedah Fontan yang sempurna, dalam jangka panjang kapasitas fungsional pasen menurun, dan ini tak berkaitan dengan masalah lain kecuali sirkulasi Fontan. Beberapa penelitian jangka menengah dan jangka panjang lainnya juga menemukan berbagai masalah, misalnya disfungsi hati, gangguan koagulopati yang berakibat tromboemboli, protein loosing enteropathy(PLE) yang menimbulkan hipoalbuminemia dengan segala akibatnya, aritmia, obstruksi pada jalur Fontan, fistula arteriovenous pulmonal dan lain-lain. Semua masalah ini tentu saja mengakibatkan berkurangnya kesintasan pasen-pasen tersebut.

Sebelum bedah Fontan diperkenalkan, penyakit jantung bawaan (PJB) kompleks yang tidak ideal untuk reparasi biventrikular dilakukan bedah paliatif pulmonar y ar ter y banding (PAB)atau systemic-to-pulmonary shunt. PAB adalah upaya untuk memperkecil lumen ar teri pulmonal sehingga alirannya berkurang, dengan memasang ikatan melingkari arteri pulmonal cabang utama. Sedangkan bedah systemic-to-pulmonar y shunt adalah memasang saluran penghubung antara cabang cranial aorta ke arteri pulmonal. Tetapi harapan hidup pasen-pasen ini hanya berlangsung dua hingga tiga dekade saja.

Mitral stenosis kongenital merupakan penyakit jantung bawaan (PJB) yang jarang terjadi. Laporan-laporan terdahulu menyebutkan angka insiden sekitar 0,4-0,8% dari seluruh pasien PJB. Keadaan ini dapat terjadi tersendiri (isolated), atau disertai dengan PJB lainnya, seperti pada Shones complex,atau sebagai bagian dari Hypoplastic Left Heart Syndrome.