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"Penggantian katup aorta dengan katup mekanik memerlukan biaya mahal, meningkatkan risiko endokarditis dan tromboemboli, serta memerlukan antikoagulan seumur hidup. Perikardium autolog merupakan alternatif untuk penggantian katup aorta. Tujuan penelitian ini adalah membandingkan luaran penggantian katup aorta antara katup mekanik dan perikardium autolog dengan teknik strip tunggal perikardium. Penelitian ini merupakan uji klinis terandomisasi di Pelayanan Jantung Terpadu Rumah Sakit Cipto Mangunkusumo (PJT-RSCM). Subjek dibagi ke dalam 2 kelompok berdasarkan jenis katup yang diterima, yaitu katup mekanik (kelompok mekanik) dan strip perikardium (kelompok strip). Luaran left ventricular reverse remodeling (LVRR), 6 minute walking test (6MWT), dan kadar soluble suppression of tumorigenicity-2 (sST-2) diperiksa preoperasi, 3 bulan, dan 6 bulan pascabedah. Terdapat 34 subjek yang ikut serta dari Juli 2016-Februari 2022, 17 subjek pada masing-masing kelompok. Tidak terdapat beda kejadian LVRR pada kedua kelompok, yaitu 26,7% pada kelompok mekanik dan 29,4% pada kelompok strip (p = 0,703). Pada pemeriksaan jarak 6 minute walking test (6MWT) tidak terdapat perbedaan bermakna jarak 6MWT antara kelompok strip perikardium dan kelompok mekanik pada 6 bulan pascabedah, yaitu 431,93 (SB 93,41) m vs. 404,28 (SB 79,25) m, p = 0,427 pascabedah. Kadar sST-2 kelompok mekanik 16,12 (SB 5,92) pg/mL secara bermakna lebih tinggi dibandingkan kelompok strip 11,52 (SB 6,96) pg/mL, p = 0,023) pada 6 bulan pascabedah. Disimpulkan teknik strip tunggal perikardium memiliki luaran yang sebanding dengan katup mekanik sehingga dapat digunakan sebagai alternatif penggantian katup aorta.

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Aortic valve replacement with mechanical valves are quite expensive, increased the risk of adverse events such as endocarditis and thromboembolism, and requires patients to take anticoagulants for the rest of their life. Autologous pericardium is an alternative for aortic valve replacement. This study aims to compare outcomes of aortic valve replacement using mechanical valve and prosthetic valve with single-strip pericardium technique. This was a randomized clinical trial conducted at the Cipto Mangunkusumo Hospital (PJT-RSCM). Eligible subjects were randomized to either receive mechanical valve (mechanical group) or single-strip pericardium (single-strip group). Outcome assessments of left ventricular reverse remodeling (LVRR), 6 minute walking test (6MWT), and soluble suppression of tumorogenicity-2 (sST-2) were carried out at preoperation, 3 months, and 6 months postoperation. There were 34 subjects recruited from July 2016 to February 2022, 17 subjects in each groups. There was no difference in postoperative LVRR incidence between both groups, 26.7% in mechanical group vs. 29.4% in single strip group (p = 0.703). There was no significant difference of 6MWT between the mechanical and pericardial strip at six months post-operation, 404.28 (SD 79.25) m vs. 431.93 (SD 93.41) m, p = 0.427. The sST-2 level is significantly higher in mechanical group 16.12 (SD 5.92) pg/mL compared to single strip group 11.52 (SD 6.96) pg/mL, p = 0.023 at six months post-operation. We concluded that single strip pericardium technique showed comparable outcomes to mechanical valve and is considered a feasible alternative for aortic valve replacement."

"The success of the first edition of Percutaneous treatment of left side cardiac valves has convinced us of the need to update this book in order to keep pace with the continuing rapid and dynamic evolution in the discipline. Once again, this practical guide is designed to provide the reader with complete state of the art information on the techniques and approaches to percutaneous treatment of left side cardiac valve disease. Numerous images will help the reader to understand in detail the steps of each procedure. The potential complications and expected or potential morbidity from each procedure are discussed in depth, and the best ways to manage them are carefully explained. The book is also intended as a reference covering the up-to-date knowledge contained in the literature on the application of transcatheter techniques to cardiac valves."

"ABSTRAK Latar belakang. Pada pasien SA fraksi ejeksi ventrikel kiri dapat normal bahkan supra normal untukjangka waktu yang lama walaupun proses remodeling ventrikel kiri sudah mulai terjadi..Ekokardiografi speckle tracking dua dimensi (EST) mempunyai kelebihan untukdigunakan dalam menilai penurunan fungsi kontraktilitas miokard subklinis, dimanakeadaan tersebut dapat mempengaruhi prognosis pasien SA. sST2 merupakan biomarkeryang relatif baru, dapat meningkat pada regangan otot jantung (myocardial stretch),fibrosis, inflamasi, dan injuri miokard, apakah berhubungan dengan disfungsi diniventrikel kiri masih belum diketahui.Tujuan. Mengetahui korelasi sST2 terhadap nilai GLS EST pada pasien SA berat denganFEVK normalMetode. Merupakan studi potong lintang. Evaluasi dilakukan pada 29 pasien stenosisaorta berat dengan fraksi ejeksi normal yang datang ke poliklinik RS Jantung HarapanKita periode Februari 2015 sampai November 2015. Dilakukan pengambilan figurekokardiografi untuk menilai severitas SA dan untuk perhitungan nilai global longitudinalstrain speckle tracking kemudian dilakukan pengambilan sampel darah di laboratoriumRS Jantung Harapan Kita untuk menilai sST2.Hasil Penelitian. Dua puluh sembilan subjek ikut dalam penelitian ini dengan rerata usiaadalah 59.7±12.1 tahun. Fungsi intrinsik ventrikel kiri pasien SA berat pada penelitian inimengalami penurunan dengan nilai rerata GLS -11±4.5%. Hasil uji korelasi menunjukanterdapat korelasi positif dengan kekuatan korelasi sedang yang bermakna (r=0.429,p=0.02). Analisis multivariat tetap menunjukkan adanya hubungan antara kadar sST2dengan nilai GLS EST (r=0,282 p=0.036). Kesimpulan. Terdapat korelasi sST2 dengan global longitudinal strain speckle trackingpada pasien SA berat dengan fraksi ejeksi normal.ABSTRACT Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. ;Background. In severe aortic stenosis (AS), cardiac performance measured at theventricular chamber is typically normal or supranormal, whereas Global LongitudinalStrain providing comprehensive information on LV myocardial contractility and issuperior in detecting subtle deteriorations. Impaired LV GLS is associated mortality riskand reflect fibrosis. sST2 is a novel biomarker of mechanical stress, fibrosis, inflamation,and myocardial injury. Whether sST2 is increased in relation to the subclinical LVdysfunction assessed by GLS in AS is unknown.Objectives. To study correlation beetwen sST2 and GLS in patients with AS severeMethods. This is a correlation study with cross sectional design. The subject was aorticstenosis severe patient (aortic valve area <1.0 cm2) with preserved EF (>50%) at ouroutpatient clinic in Harapan Kita Hospital from February 2015 until Novenber 2015. Acomprehensive transthoracic echocardiography was performed to evaluate severity ofaortic stenosis. and echocardiographic figure recordings were stored in digital for off-linesubsequent GLS analysis. sST2 measurements were drawn after echocardiography.Results. Twenty nine patient were enrolled in this study. The mean ages was 59.7±12.1years. left ventricle intrinsic function in aortic stenosis patient was decreased with GLS 11±4.5%.APearsoncorrelaterevealedsignificantpositivecorrelationbetweensST2andGLS(r=0.429, p=0.02). Multivariate analysis with introduced confounding factor stillshowed a positive correlation between sST2 and GLS (r=0,282 p=0.036). Conclusion. This cross sectional study demonstrated a moderate correlation betweensST2 with left ventricle global longitudinal strain speckle tracking in patients with severeaortic stenosis with preserved EF. "

"Pendahuluan : Prevalensi penyakit katup jantung telah mengalami penurunan hingga mencapai 0,5-2 per 100,000 penduduk di negara maju seperti Amerika Serikat saat ini, namun masih merupakan masalah di negara berkembang. Berbagai penelitian telah dilakukan selama ini mencoba mencari modalitas radiologi lain selain pemeriksaan ekokardiografi (baku emas) sebagai modalitas penapisan kelainan katup mitral, namun pemeriksaan yang ada merupakan pemeriksaan mahal dan ketersediaannya yang masih terbatas. Tujuan : menghitung nilai sensitivitas, spesifisitas dan predicitve value dari radiografi toraks proyeksi posteroanterior dibandingkan ekokardiografi dalam mendeteksi kelainan katup mitral pada pasien dengan pembesaran atrium kiri. Metode : Penelitian ini merupakan penelitian uji diagnostik cross sectional secara retrospektif dengan menggunakan data sekunder pasien yang mengalami pembesaran atrium kiri di Rumah Sakit Jantung Harapan Kita. Hasil : Tingkat sensitivitas dan spesifisitas radiografi toraks proyeksi posteroanterior dibandingkan dengan ekokardiografi dalam mendeteksi kelainan katup mitral pada pasien dengan pembesaran atrium kiri adalah 85,7% dan 43%. Nilai positif predictive value adalah 94,7% dan nilai negatif predictive value adalah 20%. Kesimpulan : Pemeriksaan radiografi toraks proyeksi posteroanterior dengan pembesaran atrium kiri dapat digunakan untuk penapisan pada pasien dengan kecurigaan kelainan katup mitral stadium dini, sedangkan pada stadium lanjut dapat digunakan sebagai pengganti pemeriksaan ekokardiografi.

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Prevalence of valvular heart disease has been decreasing in the past few decade approximately 0,5-2 over 100.000 population in the country like USA. However this still be a problem in the developing countries. Many research already done to search an alternative radiology modality besides echocardiography (gold standard) as a modality for screening mitral stenosis but the modality is expensive and not well distributed.

Objective : to assess the sensitivity, specificity and predictive value of radiography thorax posteroanterior projection in patient with enlargement of left atrium to detect mitral valve diseases compared with echocardiography findings.

Methods : This study is a diagnostic study by cross sectional design with retrospective approach by using secondary data from patient with enlargement of left atrium in Jantung Harapan Kita Hospital.

Results : The sensitivity and specificity of radiography thorax posteroanterior projection in patient with enlargement of left atrium in detecting mitral valve disease compared with echocardiography is 85,7% and 43%. Positive predictive value is 94,7% and negative predictive value is 20%.

Conclusions : Radiography thorax posteroanterior projection with enlargement of left atrium can be used as a screening in patient with mitral valve disease in the early stage, meanwhile in late stage can be used to replace echocardiography examination."

"Regurgitasi Aorta (RA) merupakan penyakit jantung katup terbanyak ketiga setelah stenosis aorta dan regurgitasi mitral dengan prevalensi sebesar 0.5% dari total populasi global. Berbagai faktor prediktor mortalitas dan kesintasan pada pasien RA telah banyak dipelajari diberbagai negara. Akan tetapi, studi yang mempelajari mengenai faktor prognostik terhadap kesintasan paska PKA pada pasien RA berat belum pernah dilakukan di Indonesia. Studi ini merupakan penelitian prognostik eksploratif dengan pendekatan kohort retroprospektif melibatkan 964 pasien dengan RA Berat yang berobat di RS Pusat Jantung Nasional Harapan Kita sejak Januari 2016 sampai Desember 2022. Dilakukan pengambilan data klinis, data ekokardiografi transtorakal, data prosedur pembedahan. Luaran primer adalah angka kesintasan dan angka mortalitas. Sebanyak total 383 pasien berhasil dilakukan analisis akhir. Sebagian besar subjek laki-laki (73,1%) dengan median usia 44 tahun (15-81). Prediktor bermakna terhadap angka kesintasan dan mortalitas pasien RA berat adalah penyakit ginjal kronis (OR 1,81, 95% CI 1,11-2,96; p<0,017), DASVKi ≥48,2 mm (OR 1,54, 95% CI 0,94-2,52;p<0,087), IMVK ≥173,5 g/m2 (OR 2,22, 95% CI 1,14-4,33;p<0,019), IVAK >34 mm/m2 (OR 2,38, 95% CI 1,18-4,79;p<0,015), Tanpa PKA (OR 4,33, 95% CI 2,68-7,00;p<0,001). Variabel Tanpa PKA merupakan prediktor angka kematian bermakna paling tinggi dengan peningkatan risiko kematian sebesar 4,33 kali (95% IK 2,688-7,00), p<0,001. Penyakit Ginjal Kronis, DASVKi ≥48,2 mm, IMVK ≥173,5 g/m2 IVAK >34 mm/m2 dan Tanpa PKA merupakan prediktor mortalitas bermakna pada pasien RA berat. Penyakit Ginjal Kronis merupakan prediktor kematian bermakna dari faktor klinis, ukuran DASVKi, IVMK, dan IVAK merupakan prediktor kematian bermakna dari faktor ekokardiografi serta Tanpa PKA merupakan prediktor kematian bermakna dari faktor prosedur bedah. Tanpa PKA merupakan prediktor angka kematian bermakna paling tinggi dengan peningkatan risiko kematian sebesar 4,33 kali.

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Aortic Regurgitation (AR) is the third most common valvular heart disease after aortic stenosis and mitral regurgitation, with a prevalence of 0.5% of the global population. Various predictors of mortality and survival in AR patients have been extensively studied in different countries. However, studies focusing on prognostic factors for survival post-AVR in severe AR patients have not been conducted in Indonesia. To investigate clinical, echocardiographic, and AVR procedure predictors of survival in patients with severe AR. Methods: This is an exploratory prognostic study with a retrospective cohort approach involving 964 patients with severe Aortic Regurgitation treated at the National Heart Center Harapan Kita from January 2016 to December 2022. Data collection included clinical data, transthoracic echocardiographic data, and surgical procedure data. Primary outcomes analyzed were survival and mortality rates assessed over >1 year. A total of 383 patients were included in the final analysis. The majority of subjects were male (73.1%) with a median age of 44 years (15-81). Significant predictors of survival and mortality rates in severe RA patients are chronic kidney disease (OR 1.81, 95% CI 1.11-2.96; p < 0.017), LVESD ≥ 48.2 mm (OR 1.54, 95% CI 0.94-2.52; p < 0.087), LVMI ≥ 173.5 g/m2 (OR 2.22, 95% CI 1.14-4.33; p < 0.019), LAVI > 34 mm/m2 (OR 2.38, 95% CI 1.18-4.79; p < 0.015), and No AVR (OR 4.33, 95% CI 2.68-7.00; p < 0.001). The No AVR variable exhibits the highest significant mortality prediction with OR 4,33, 95% CI 2.688-7.00 and p < 0.001. Chronic kidney disease, LVESD ≥ 48.2 mm, LVMI ≥ 173.5 g/m2, LAVI > 34 mm/m2, and No AVR are significant mortality predictors in severe RA patients. Chronic kidney disease is a predictor of significant mortality among clinical factors, while LVEDS, LVMI, and LAVI are predictors among echocardiographic factors, and No AVR is a predictor of procedural factors. No AVR represents the highest significant mortality predictor with a 4.33-fold increased risk of death."

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Kebutuhan akan dukungan sirkulasi mekaniksecara diniuntuk meningkatkan perfusi organ harus dipertimbangkandalam manajemen pasien pasca henti jantung. Pompa Balon Intra-Aorta (PBIA)merupakan alat bantu sirkulasi mekanik yang paling mudah dipakai dan tersedia di negara berkembang seperti Indonesia.Tujuan penelitian ini adalah untuk mengetahui efektivitas insersi diniPBIA terhadap mortalitas pasien pasca henti jantungkarena sindrom koroner akut (SKA).

Penelitian uji klinis yang melibatkan 60 pasieninidilakukan pada pasca henti jantung karena SKA di dilakukan RSJPDHKperiodeOktober 2017–Desember 2018K.Kriteria inklusi adalah semua pasien pasca henti jantung karena sindrom koroner akut, berusia 18–75 tahun.Kriteria eksklusi adalah terdapat riwayat strokeberdasarkan anamnesis, pupil anisokor, sudah menggunakan PBIA sebelumnya, regurgitasi aorta, sindrom brugada dan congenital long QT.Pasien dirandomisasi menjadi kelompok pelakuan dan kontrol.. Pasien dibagi menjadi dua kelompok yaitu perlakuan (n= 30) dan kontrol (n =30). Kelompok perlakuan diberikan intervensi insersi PBIA sedini mungkin dalam 3 jam pertama setelah sirkulasi spontan kembali.Pemeriksaan kadar interleukin-6, bersihan laktat efektif (BLE), beklin-1, kaspase-3, curah jantung (CJ), VTI, TAPSE, fraksi ejeksi (FE), a-vO2 diff, dan ScvO2 dilakukan di jam ke-0 dan jam ke-6 pasca kembali sirkulasi spontan.Luaran primer yang dinilai adalah mortalitas rumah sakit.,Luaransekunder yang dinilai adalahperbaikan hemodinamik, dan marka apoptosisdan kemampuanprediksi beklin-1, kaspase-3, interleukin-6 dan laktat jam ke-0 terhadap kematian. Analisisregresi cox dilakukan untuk menilai kesintasan pasien di RSdengan prinsip intention-to treat.

Sebanyak 60 pasien pasca henti jantung karena SKA, 30 di kelompok perlakuan dan 30 di kelompok kontroldiikutsertakan dalam penelitian ini.Mortalitas pada kelompok perlakuan adalah 18 (60%) pasien, sedangkan pada kelompok kontrol adalah 17 (56,67%) pasien.  ([p=0,793; hazard ratio 1,29; [IK] 95% 0,66–2,52). Tidak terdapat perbedaan kadar IL-6, BLE, beclinbeklin-1, caspasekaspase-3, curah jantung (CJ), VTI, TAPSE, fraksi ejeksi (FE), a-vO₂ diff, dan ScvO₂di jam ke-6 pasca SSK antara dua kelompok.Laktat, IL-6, dan kaspase-3 dapat memprediksi mortalitas pasien pasca henti jantung karena SKA, sedangkan Beklin-1 tidak dapat memprediksi kematian.

Simpulan:Pemasangan PBIA dini tidakmemperbaiki mortalitas pasien SKA pasca henti jantung. .Laktat, IL-6, dan kaspase-3 dapat memprediksi mortalitas pasien pasca henti jantung karena SKA.

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The need formechanical circulatory support to improve organ perfusion may be considered inthemanagement of post cardiac arrest syndrome patients. Intra-Aortic Balloon Pump (IABP) is the most available and convenient used mechanical circulation aid especially in developing countries such as Indonesia.¹This study aimed to find out whether early insertion of IABP can reduce in-hospital mortality, length of stay and death markers of cardiac arrest complicating acute myocardial infarction.

A randomized trial conducted in National Cardiovascular Center Harapan Kita (NCCHK) Hospital from October 2017–December 2018. Inclusion criteria were all post cardiac arrest due to acute coronary syndrome (ACS) patients aged 18–75 years. Exclusion criteria were history of stroke, anisocoric pupil, previous IABP use, aortic regurgitation, brugada syndrome, and congenital long QT syndrome.The intevention group was given IABP inserted as early as possible in the first 3 hours after spontaneous circulation returned.  Patients were randomized into two groups, intervention and controls. Assessment of interleukin-6, lactate clearence, beclinbeclin-1, caspasecaspase-3, cardiac output, VTI, TAPSE, ejection fraction (EF), a-vO2 Diff, and ScvO2 was done in first hour and 6 hours afterreturn of spontaneous circulation (ROSC). Primary outcome was in-hospital mortality. Secondary outcome was improved hemodynamics, apoptotic markers, and predictive ability of beclin-1, caspase-3, IL-6 and lactate in first hour after ROSC to mortality. Cox regression analysis was performed to assess in-hospital survival with the intention-to-treat principle.

A total of 60 post cardiac arrest due to ACS patients, 30 in intervention group and 30 controls included in this study. In hospital mortality of intervention group vs control was 18 (60%) vs.17 (56.67%) respectively ([p=0.793; hazard ratio 1.29; [CI] 95% 0,66–2.52). There’s no difference in IL-6, lactate clearence, beclinbeclin-1, caspasecaspase-3, cardiac output, VTI, TAPSE, ejection fraction (EF), a-vO₂Diff, and ScvO₂in 6 hours after ROSC between two groups. Lactate, IL-6, and caspase-3 predicts mortality of post cardiac arrest due to ACS patients while beclin-1 does not.

Conclusion:Early insertion of IABP is not improvemortality outcome of post cardiac arrest complicating acute myocardial infarctionpatients. Lactate, IL-6, and caspase-3 predicts mortality of post cardiac arrest due to ACS patients.

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"Latar belakang: Waktu yang tepat untuk pembedahan katup aorta masihmerupakan tantangan saat ini. Pasien sering datang dengan kondisi lanjut denganperubahan geometri ventrikel kiri sebagai mekanisme kompensasi terhadappeningkatan beban tekanan dan volume berkepanjangan yang akan mempengaruhiluaran klinis pascabedah. Tujuan: Penelitian ini bertujuan untuk mengetahuiapakah terdapat pengaruh karakter ventrikel kiri meliputi ukuran dimensi ventrikelkiri EDD, ESD, FEVKi, indeks massa ventrikel kiri LVMI terhadapmorbiditas dan mortalitas di rumah sakit pascabedah katup aorta pada pasiendengan regurgitasi aorta kronik serta luaran klinis jangka menengah. Metode: 168 pasien dengan regurgitasi aorta kronik yang menjalani pembedahankatup aorta terseleksi sesuai kriteria inklusi dan eksklusi, pascapembedahandilakukan follow-up terhadap luaran klinis morbiditas dan mortalitas di rumahsakit, kemudian diikuti 1 tahun hingga 5 tahun setelah operasi, morbiditas danmortalitas dievaluasi, Hasil: Tidak terdapat perbedaan bermakna pada tiap tiapparameter ventrikel kiri EDD, ESD, FEVKi, LVMI terhadap morbiditas danmortalitas saat di rumah sakit p>0,05, terdapat faktor-faktor yang mempengaruhimorbiditas intrahospital yaitu laju filtrasi ginjal p< 0,001 dan usia p=0,001 ,riwayat Penyakit Jantung Koroner PJK, riwayat PPOK dan riwayat stroke, sedangkan morbiditas jangka menengah dipengaruhi oleh kejadian aritmia pascapembedahan p=0,009, terdapat perbaikan pada NYHA functional class.Mortalitas di rumah sakit dipengaruhi oleh usia p=0,001 dan laju filtrasi ginjal p

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Background: The optimal timing of aortic valve replacement is still challenging.The patients often come to hospital in end stage clinical performance withalteration in left ventricular LV geometry due to compensatory mechanism tovolume and pressure overload in long term period.

Objective: This study soughtto determine the effect of left ventricular characters diameter of the left ventricle,end diastolic diameter EDD, end systolic diameter ESD, left ventricularejection fraction LVEF, left ventricular mass index LVMI to in hospitalmorbidity and mortality following aortic valve replacement in patients withchronic aortic regurgitation and postoperative mid term outcome.

Methods: 168 patients with chronic aortic regurgitation underwent aortic valve replacementselected according to inclusion and exclusion criteria. Outcomes morbidity andmortality were observed during hospitalization and 1 year until 5 years aftersurgery. Mid term outcomes consisted of NYHA functional class, rehospitalizationand redo operation.

Results: There was no significant difference to in hospitalmorbidity and mortality for each of left ventricular characters p 0,05. Other factors which influenced in hospital morbidity were glomerularfiltration rate p"

"Latar Belakang : Penyakit jantung katup khususnya katup mitral dengan etiologirematik sering berakhir dengan fibrilasi atrium FA. Stenosis mitral SM maupun regurgitasi mitral RM, ditambah dengan fibrosis atrium pada prosesrematik menyebabkan terjadinya remodeling struktural dan remodeling elektrisyang diduga berperan dalam timbulnya FA. Bedah reduksi atrium kiri pada pasienFA yang menjalani operasi katup mitral, merupakan prosedur yang relatifsederhana, tidak memakan waktu operasi yang lama, dan relatif murah yangdiduga memiliki pengaruh terhadap konversi irama.Tujuan : Menilai pengaruh bedah reduksi atrium kiri terhadap konversi iramajangka pendek dan jangka panjang pada pasien fibrilasi atrium dengan penyakitkatup mitral rematik yang menjalani pembedahan.Metode : Telah dilakukan studi kohort retrospektif pada pasien fibrilasi atriumdengan penyakit katup mitral rematik yang menjalani operasi katup mitral selamaperiode Mei 2012 sampai dengan Mei 2016 di RS Jantung dan Pembuluh DarahHarapan Kita. Tindakan bedah reduksi atrium kiri dalam hal ini menjadi variabelindependen yang diperkirakan memiliki pengaruh terhadap konversi irama padapasien fibrilasi atrium dengan penyakit katup mitral rematik. Variabel dependenpada penelitian ini adalah konversi irama, yang dinilai melalui pengamatan jangkapendek dan jangka panjang.Hasil : Total sampel penelitian ini adalah 257 sampel, terdiri dari 131 orang yangmenjalani bedah reduksi dan 126 orang tanpa bedah reduksi. Pada kelompokbedah reduksi, didapatkan 42 subjek 32,1 yang mengalami konversi iramajangka pendek dan 37 subjek 28,2 yang mengalami konversi irama jangkapanjang. Dari hasil analisis multivariat, variabel yang bermakna terhadap konversiirama jangka pendek yaitu bedah reduksi atrium kiri dengan OR 0,56 IK 95 0,31 ndash; 0,98 dan nilai p=0,044 serta penggunaan penyekat beta dengan OR 0,56 IK 95 0,31 ndash; 0,99 dan nilai p=0,047. Sementara variabel yang bermaknaterhadap konversi irama jangka panjang yaitu bedah reduksi atrium kiri denganOR 0,51 IK 95 0,28 ndash; 0,94 dan nilai p=0,031, penggunaan penyekat betadengan OR 0,53 IK 95 0,28 ndash; 0,98 dan nilai p=0,042, dan indeks volumeatrium kiri prabedah le;146 ml/m2 dengan OR 0,47 IK 95 0,26 ndash; 0,87 dan nilaip=0,017.Kesimpulan : Bedah reduksi atrium kiri memiliki pengaruh terhadap konversiirama jangka pendek maupun jangka panjang pada pasien fibrilasi atrium denganpenyakit katup mitral rematik yang menjalani pembedahan.

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Background : Valvular heart disease, especially rheumatic mitral valve diseaseoften coexists with atrial fibrillation AF. Mitral stenosis MS and mitralregurgitation MR with atrial fibrosis because of rheumatic process, resulting instructural remodeling and electrical remodeling of left atrium which contribute foroccurence of AF. Left atrial reduction surgery with mitral valve correction issimple procedure, takes relatively short operation time, and quite inexpensive asan alternative treatment for AF in rheumatic mitral valve disease.

Objective : Assessing the effect of left atrial reduction for short term and longterm rhythm conversion of AF in rheumatic mitral valve disease.

Method : We conducted a retrospective cohort study in atrial fibrillation patientswith rheumatic mitral valve disease who underwent mitral valve surgery duringthe period of May 2012 until May 2016 in the National Cardiovascular Center Harapan Kita. Left atrial reduction surgery became an independent variable whichexpected to have an influence on the rhythm conversion. The dependent variablewas the conversion of rhythm which was assessed through the observation in ashort term and long term.

Result : There were 257 subjects in this study, consisting of 131 subjects in theleft atrial reduction group and 126 subjects in the non left atrial reduction group.In left atrial reduction group, there were 42 subjects 32,1 with sinus rhythm inshort term observation and 37 subjects 28,2 with sinus rhythm during longterm observation. From multivariat analysis, the significant variable for the shortterm rhythm conversion were left atrial reduction with OR 0,56 CI 95 0,31 ndash 0,98 and p 0,044 and also beta blocker therapy with OR 0,56 CI 95 0,31 ndash 0,99 and p 0,047. While the significant variable for rhythm conversion in longterm were left atrial reduction with OR 0,51 CI 95 0,28 ndash 0,94 and p 0,031,beta blocker therapy with OR 0,53 CI 95 0,28 ndash 0,98 and p 0,042, and alsopre operation left atrial volume index le 146 ml m2 with OR 0,47 CI 95 0,26 ndash 0,87 and p 0,017.

Conclusion : Left atrial reduction has an effect for short term and long termrhythm conversion of AF in rheumatic mitral valve disease."

"Latar belakang: Penyakit katup mitral rematik akan menyebabkan remodeling struktural dan remodeling elektris pada atrium kiri, yang mengakibatkan perubahan irama sinus menjadi fibrilasi atrium (FA). Intervensi atrium kiri (IAK) berupa reduksi dinding posterior atrium kiri dan/atau isolasi apendiks atrium kiri pada bedah katup mitral rematik untuk mengurangi faktor substrat dan faktor pencetus FA dipikirkan mempunyai pengaruh terhadap konversi FA kembali ke irama sinus. Penelitian ini bertujuan untuk mengevaluasi pengaruh jangka pendek prosedur bedah mitral rematik dan IAK terhadap konversi irama sinus pada pasien FA valvular. Metode: Subjek penelitian adalah pasien FA dengan penyakit katup mitral rematik yang menjalani prosedur bedah mitral dan/atau IAK pada bulan Januari 2012-Maret 2018. Karakteristik dasar, parameter ekokardiografi prabedah dan pascabedah, jenis tindakan operasi, dan irama elektrokardiogram (EKG) pasca operasi dikumpulk melalui data rekam medis pasien. Analisa statistik dilakukan dengan perangkat lunak SPSS.Hasil: Terdapat 307 subjek yang terjaring dalam penelitian. Sebanyak 127 subjek masuk kedalam grup kontrol (bedah mitral) dan 180 subjek masuk kedalam grup intervensi (bedah mitral dengan IAK). Pada kelompok kontrol, 25 subjek (19,7%) mengalami konversi irama sinus sesaat pascabedah namun tidak terdapat subjek yang mengalami konversi irama sinus pada periode pengamatan selanjutnya. Pada kelompok intervensi terdapat 74 (41,1%), 10 (5,6%), 6 (3,3%), dan 4 (0,02%) subjek yang mengalami konversi irama sinus dalam periode segera pascabedah (p<0,001 dibandingkan grup kontrol), 1 minggu (p<0,01), 2 minggu (p<0,05) dan 4 minggu (p=0,142) pascabedah secara berurutan. Analisa multivariat menunjukkan bahwa IAK merupakan variabel yang secara independen berpengaruh terhadap konversi irama sinus sesaat pascabedah (RR 2,84; IK95% 1,68-4,83; p<0,001), namun tidak mempunyai pengaruh pada periode pengamatan selanjutnya. Kesimpulan: Pengaruh bedah mitral rematik dan IAK terhadap konversi irama sinus tampak pada periode sesaat pascabedah, namun tidak mempunyai pengaruh dalam periode pengamatan 1 minggu, 2 minggu dan 4 minggu pascabedah.

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Background: Rheumatic mitral valve diseases caused structural and electrical remodeling in the left atrium, resulting rhythm change from sinus to atrial fibrillation (AF). Left atrial surgical interventions (LASI) which consist of reduction of LA posterior wall to modify AF substrate and/or left atrial appendage (LAA) exclusion to isolate AF triggers may have beneficial effects on rhythm conversion during rheumatic mitral valve surgery. This study aimed to evaluate the short term effects of combined rheumatic mitral valve surgery and LASI for sinus rhythm conversion in patients with valvular AF. Methods: The subjects are AF patients with rheumatic mitral valve diseases undergoing mitral valve surgery from the period of January 2012-March 2018. Basic characteristics, preoperative and postoperative echocardiography parameters, surgical types, and ECG post-surgery were collected retrospectively from the patient's medical record. Statistical analysis were done using SPSS software.Results: There were 307 subjects who met the inclusion and exclusion criteria. They were divided into two groups: treatment group (combined mitral valve surgery plus LASI) consist of 180 patients, while control group (isolated mitral valve surgery) consist of 127 patients. In the control group, 25 (19.7%) subjects experienced sinus rhythm conversion immediately post-surgery, but no subjects maintained sinus rhythm conversion in the subsequent observation period (1-, 2-and 4-weeks post-surgery). While in the treatment group, there were 74 (41.1%), 10 (5.6%), 6 (3.3%), 4 (0.02%) subjects who experienced sinus rhythm conversion in the immediate (p<0.001 vs. control group), 1-week (p<0.01), 2-weeks (p<0.05) and 4-weeks (p=0.142) postoperative period, respectively. Multivariate analysis showed that LASI was an independent predictor of sinus rhythm conversion immediately post-surgery (RR: 2.84 95%CI 1.68-4.83; p<0.001), but not during the subsequent observations. Conclusions: The effects of combined rheumatic mitral valve surgery with LASI on rhythm conversion of valvular AF was observed during immediate postoperative period, but it had no significant effects during 1-week, 2-weeks and 4-weeks postoperative observations."

"Selama 2 dekade terakhir, telah terjadi perkembangan pesat terhadap teknik-teknik diagnostik, pemahaman perjalanan penyakit, kardiologi intervensional dan prosedur bedah pada penderitapenyakit jantung katup. Akhir-akhir ini dasar-dasar informasiyang digunakan untuk membuat keputusan klinis dalam penanganan penyakit jantung katup telah berkembang pesat meskipun dalam berbagai situasi pedoman penanganan masih kontrofersi sehingga belum terjadi keseragaman.Buku ini diharapkan menambah khasanah pemahaman bagi sejawat dalam menangani penderita kelainan katup jantung sebagai bentuk tanggung jawab pelayanan kepada masyarakat."