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"Latar belakang: Bedah jantung terbuka pada anak merupakan pembedahan dengan tingkat stress respon yang tinggi. Salah satu komplikasi tersering adalah infeksi pascabedah yang berkaitan dengan hiperglikemia yang terjadi pascabedah dan diperberat oleh resistensi insulin yang terjadi akibat respon stress dan perubahan neurohormonal akibat pembedahan dan puasa. Salah satu cara yang dipikirkan dapat mengurangi resistensi insulin dan kadar gula darah pascabedah adalah pemberian karbohidrat oral prabedah. Beberapa penelitian telah membuktikkan pemberian karbohidrat oral prabedah dapat mengurangi respon stress tubuh akibat puasa dan mengurangi resistensi insulin pascabedah. Pemberian karbohidrat oral prabedah akan meningkatkan kadar insulin pada kadar tidak puasa sehingga menurunkan resistensi insulin yang terjadi pascabedah. Namun, belum ada penelitian pada bedah jantung terbuka pada anak.Metode: Penelitian ini merupakan uji klinis acak tersamar tunggal untuk mengetahui efek pemberian karbohidrat oral prabedah dalam mengurangi resistensi insulin dan kadar gula darah pascabedah jantung terbuka pada anak. Terdapat 19 subjek pada masing-masing kelompok. Kedua kelompok menjalani puasa 6 jam prabedah, kelompok pertama mendapatkan maltodekstrin 12,5% dan kelompok kedua mendapatkan air putih hingga 2 jam prabedah. Dilakukan pengukuran HOMA-IR, kadar gula darah, procalcitonin dan pencatatan lama ventilasi mekanik. Hasil: Median kadar HOMA IR kelompok karbohidrat oral prabedah didapatkan selalu lebih tinggi dibandingkan kelompok air putih pada pengukuran saat prabedah, setelah induksi, dan 24 jam pascabedah, namun tidak bermakna secara statistik. Didapatkan perbedaan bermakna penggunaan ventilasi mekanik pada kelompok kontrol dibanding kelompok perlakuan (p=0,001). Kadar prokalsitonin 24 jam pascabedah didapatkan lebih tinggi pada kelompok kontrol (p=0,018). Simpulan: Karbohidrat oral prabedah dapat menurunkan infeksi dan lama penggunaan ventilasi mekanik pascabedah, namun tidak terbukti menurunkan resistensi insulin pascabedah.

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Background: Open heart surgery in children causes metabolic stress and insulin resistance lead to postoperative complication such as infection and prolonged mechanical ventilation. These can be exacerbated by preoperative fasting. One of the measures to improve postoperative outcome is preoperative oral carbohydrate (OCH). Preoperative OCH changes the patient from a fasted state to a fed state and minimize insulin resistance. Many studies have evaluated the effect of preoperative oral carbohydrate on postoperative outcomes, but no study yet on open heart surgery in children. This study was designed to examine the effect of postoperative oral carbohydrate on postoperative insulin resistance, blood sugar level, and postoperative outcome including infection and mechanical ventilation time. Methods: 38 children undergoing elective cardiac surgery were randomly allocated into 2 groups. The control group receive water and the study group receive maltodextrin 12,5% 10 cc/kgBW 2 hours before induction. Blood glucose and HOMA-IR were measured before fasting, after induction, 6 hour and 24 hours postoperative. Procalcitonin as a marker for infection was measured 24 hours after surgery. Time for extubation was recorded.

Results: HOMA-IR in CHO group were higher than control group before fasting, after induction and 24 hours after surgery but not statistically different. Procalcitonin level was significantly lower in OCH group (23.1[0.66-212.8] vs 83.82[0.7-553] (p=0,0180). Patient from treatment group had shorter mechanical ventilation time 1380 [300-14000] vs 5460 [900-17200] (p=0,001).

Conclusion: Preoperative oral carbohydrate in children undergoing cardiac surgery reduce infection and length of mechanical ventilation postoperative. But does not decrease insulin resistance postoperative."

"Peran NT-proBNP sebagai penanda biologis untuk mengetahui terjadinya sindrom curah jantung rendah pada pasien pediatrik dengan penyakit jantung bawaan sianotik pascabedah jantung terbuka belumlah diketahui. NT-proBNP diharapkan dapat menjadi penanda sindrom curah jantung rendah sehingga dapat mengurangi morbiditas dan mortalitas. Penelitian cross sectional ini melibatkan 40 pasien pediatrik dengan penyakit jantung bawaan sianotik yang menjalani pembedahan jantung terbuka di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, selama bulan Maret 2019-April 2019. Terdapat perbedaan bermakna antara kadar NT-proBNP prabedah, 4 jam pascabedah, 24 jam pascabedah dan 72 jam pascabedah terhadap kejadian sindrom curah jantung rendah (p<0,001). Kadar NT-proBNP tertinggi pada 24 jam pasca bedah dengan perbedaan bermakna terhadap kadar NT-proBNP prabedah (p<0,001), 4 jam pascabedah dan 72 jam pascabedah (p<0,001). Diperoleh pula variabel lain yang berhubungan secara bermakna dengan NT-proBNP yaitu usia, berat badan, jenis penyakit jantung bawaan sianotik, lama aortic cross clamp, lama cardiopulmonary bypass, lama ventilasi mekanik dan lama rawat PICU. Dapat disimpulkan bahwa kadar NT-proBNP yang tinggi sebagai penanda kejadian sindrom curah jantung rendah.

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The role of NT-proBNP as a biological marker to determined the occurrence of low cardiac output syndromes in pediatric patients with cyanotic congenital heart disease after open heart surgery was unknown. NT-proBNP was expected to be a marker of low cardiac output syndrome so that it can reduce morbidity and mortality. This cross-sectional study involved 40 pediatric patients with cyanotic congenital heart disease who underwent open heart surgery at National Cardiovascular Centre Harapan Kita, during March 2019-April 2019. There were significant differences between pre-operative levels of NT-proBNP, 4 hours postoperatively, 24 hours postoperatively and 72 hours postoperatively with the incidence of low cardiac output syndrome (p <0.001). The highest NT-proBNP level was 24 hours postoperatively with a significant difference in preoperative levels of NT-proBNP (p <0.001), 4 hours postoperatively and 72 hours postoperatively (p <0.001). Other variables that were significantly associated with NT-proBNP were age, body weight, type of cyanotic congenital heart disease, duration of aortic cross clamp, duration of cardiopulmonary bypass, duration of mechanical ventilation and length of stay of PICU. It can be concluded that high NT-proBNP level as a marker of low cardiac output syndrome."

"Latar belakang: Prosedur Fontan merupakan prosedur paliatif pada penyakit jantung bawaan univentrikel atau pada penyakit jantung bawaan dengan struktur intra kardiak yang kompleks yang tidak dapat reparasi secara biventrikel. Usia tua saat dilakukan prosedur Fontan memengaruhi kesintasan pascaoperasi. Berdasarkan basis data bedah jantung pediatrik Rumah sakit pusat jantung nasional harapan kita (RSPJNHK) di Indonesia, sebagian besar pasien yang manjalani prosedur Fontan berada pada usia tua. Dengan mengetahui faktor risiko yang memengaruhi keluaran pascaoperasi jangka pendek pada pasien usia tua diharapkan dapat menurunkan lama rawat, komplikasi, dan mortalitas, serta meningkatkan kesintasan pascaoperasi Fontan. Metodologi: Penelitian ini adalah studi kohort retrospektif berdasarkan pada pasien usia tua yang telah menjalani operasi Fontan  pada periode 2017-2021. Variabel yang dinilai antara lain fungsi ventrikel, rasio McGoon, indeks resistensi arteri pulmonalis, gradient transpulmonalis, lama penggunaan mesin jantung paru, penggunaan klem silang aorta, dan tekanan sirkulasi Fontan terhadap lama rawat, mortalitas, dan komplikasi pasca operasi. Hasil: Hasil penelitian terdapat total 93 anak diatas enam tahun yang menjalani operasi Fontan; usia 10,2 ± 4,6, laki-laki 43(46,2%) dan perempuan 50(53,8%), tidak didapatkan hubungan antara variable penelitian terhadap lama rawat.  Terdapat hubungan antara rasio McGoon (p = 0,011) terhadap kejadian mortalitas dini. Komplikasi pasca operasi lebih tinggi pada kelompok dengan indeks resistensi arteri pulmonalis >2 WU(70,6%) dibanding <2 WU( 40,7%) (p = 0,008) OR 0,22(0,73-0,68), dan pada kelompok dengan rasio McGoon <1,8(78,8%) dibanding >1,8(78,8%) ( p = 0,002) OR 0,15(0,05-0,48) dan juga didapatkan hubungan lama penggunaan mesin jantung paru (p = 0,003) OR 1,03(1-1,05) terhadap komplikasi secara keseluruhan.Simpulan: Berdasarkan penelitian beberapa variabel memilki hubungan yang bermakna secara statistik terhadap keluaran pascaoperasi Fontan pada anak usia diatas 6 tahun. Rasio McGoon memiliki korelasi yang bermakna terhadap mortalitas pascaoperasi. Tidak terdapat hubungan yang bermakna antara variable penelitian dengan lama rawat pascaoperasi. Indeks resistensi arteri pulmonalis >2 WU, rasio McGoon  < 1,8, dan lama penggunaan mesin jantung paru memiliki hubungan yang bermakna terhadap komplikasi pascaoperasi.

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Background: The Fontan procedure is a palliative procedure in univentricular congenital heart disease or in congenital heart disease with complex intracardiac structures that cannot be repaired biventricularly. Older age at the time of the Fontan procedure affects postoperative survival. Based on the pediatric cardiac surgery database at the Harapan Kita National Cardiovascular Center Hospital in Indonesia, most of the patients undergoing the Fontan procedure are of old age. Knowing the risk factors that affect short-term postoperative outcomes in older patients is expected to reduce length of stay, complications, and mortality, and increase Fontan's postoperative survival.

Method: This study is a retrospective cohort study based on secondary data from the medical record section of the Harapan Kita National Cardiovascular Center Hospital in  patients who had undergone Fontan surgery in older age in the 2017-2021 period. The variable assessed included ventricular function, McGoon ratio, pulmonary artery resistance index, transpulmonary gradient, duration of cardiopulmonary bypass, use of aortic cross clamp,  and Fontan circulation pressure on length of stay, postoperative complications, and mortality.

Result: The results of the study were a total of 93 children over six years who underwent Fontan surgery; age 10,2 ± 4,6, male 43 (46,2%) and female 50 (53,8%), there was no relationship between study variables and length of stay. There is a relationship between McGoon's ratio (p = 0,011) to the incidence of early mortality. Postoperative complications were higher in the group with pulmonary artery resistance index >2 WU (70,6%) than <2 WU(40,7%) (p = 0,008) OR 0,22(0,73-0,68), and in the group with McGoon ratio <1,8(78,8%) compared to >1,8(78,8%) (p = 0,002) OR 0,15(0,05-0,48) and duration of cardiopulmonary bypass (p = 0.003) OR 1.03(1-1.05) on composite complications.

Conclusion: Based on the research, several variables had a statistically significant relationship with the short-term postoperative outcome of Fontan in children aged over six years. McGoon's ratio <1,8 has a significant correlation with postoperative mortality.  Pulmonary artery resistance index >2 WU, McGoon ratio < 1.8, and duration of  cardiopulmonary bypass had a significant relationship to postoperative complications. There was no significant relationship between the study variables and postoperative length of stay."

"Penyakit Jantung Bawaan (PJB) sering dikaitkan dengan malnutrisi yang dipengaruhi oleh berbagai faktor yang mengakibatkan peningkatan morbiditas dan mortalitas, penatalaksana yang tepat dapat menurunkan infeksi, lama rawat, bahkan kematian. Penelitian ini dilakukan untuk mengidentifikasi faktor-faktor yang berhubungan dengan status gizi kurang pada anak dengan PJB. Penelitian ini menggunakan observasional analitik dengan rancangan case control.  Sampel penelitian berjumlah 114 anak PJB di Rumah Sakit Jantung Jakarta periode Juli 2020 hingga Juni 2023. Uji statistik menunjukkan tidak ada hubungan antara usia, jenis kelamin, riwayat BBLR, pemberian ASI eksklusif, jenis PJB dan penyakit penyerta terhadap status gizi kurang pada anak PJB, terdapat hubungan antara kelengkapan imunisasi dengan status gizi kurang pada anak PJB (p value <0,05). Simpulan: dari penelitian ini yaitu faktor nutrisi dan organik tidak berhubungan dengan status gizi kurang anak PJB. Oleh karena itu pelayanan perlu memberikan perhatian terkait status nutrisi dan imunisasi disamping masalah jantung.

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Congenital Heart Disease (CHD) is often associated with malnutrition which is influenced by various factors resulting in increased morbidity and mortality, appropriate management can reduce infection, length of stay, and even death. This research was conducted to identify factors associated with malnutrition status in children with CHD. This study used an analytical observational with a case control design. The research sample consisted of 114 CHD children at the Jakarta Heart Hospital for the period July 2020 to June 2023. The result of this study showed that there was no relationship between age, gender, history of LBW, exclusive breastfeeding, type of CHD and comorbidities on malnutrition status in CHD children, there is a relationship between complete immunization and malnutrition status in CHD children (p value <0.05). Conclusion from this research, nutritional and organic factors are not related to the malnutrition status of CHD children. Therefore, services need to pay attention to nutritional status and immunization in addition to heart problems."

"Latar belakang: Penyakit jantung bawaan (PJB) adalah kelainan kongenital dengan insidens tertinggi dan memerlukan pemantauan berkala. Pemeriksaan ekokardiografi memerlukan fasilitas dan tenaga ahli yang belum tersedia secara luas di Indonesia. Troponin I merupakan biomarker spesifik jantung yang terdeteksi pada awal terjadinya kerusakan miokardium. Data mengenai penggunaan biomarker jantung pada pasien anak dengan PJB masih terbatas.Tujuan: Mengetahui korelasi antara kadar troponin I dengan parameter hemodinamik pasien PJB asianotik dengan pirau kiri ke kanan.Metode: Penelitian ini merupakan studi potong lintang terhadap 53 subyek dengan PJB asianotik pirau kiri ke kanan yang berobat di Rumah Sakit dr. Cipto Mangunkusumo (RSCM). Pemeriksaan ekokardiografi dilakukan untuk menilai jenis PJB, ukuran defek, dan parameter hemodinamik yaitu Qp/Qs, tekanan sistolik arteri pulmoner, fraksi ejeksi ventrikel kiri, dan tricuspid annular plane systolic excursion (TAPSE). Kadar troponin I dinilai melalui enzyme linked fluorescent assay (ELISA) dengan sampel darah diambil pada hari yang sama dengan ekokardiografi..Hasil: Median usia subyek adalah 16 (3-135) bulan dengan jenis kelamin perempuan 54,7% (n=53). Diagnosis PJB terbanyak adalah ASD (45,3%), dengan proporsi terbanyak defek berukuran sedang (43,4%). Peningkatan kadar troponin I didapatkan pada 7 (13,2%) subyek. Tidak ada perbedaan bermakna kadar troponin I pada berbagai jenis PJB. Ada korelasi negatif lemah antara kadar troponin I dengan fraksi ejeksi ventrikel kiri (r=-0,391, p=0,002).Kesimpulan: Terdapat korelasi negatif lemah antara kadar troponin I dengan fraksi ejeksi ventrikel kiri, sementara tidak ada korelasi bermakna dengan parameter hemodinamik lainnya

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Background: Congenital heart disease (CHD) is the most frequent congenital abnormality and requires regular monitoring. Echocardiographic examination requires facilities and experts which are not widely available in Indonesia. Troponin I is a heart-specific biomarker that is detected early in myocardial damage. Data regarding the use of cardiac biomarker in pediatric CHD patients are still limited.

Objective: To determine the correlation between troponin I level and hemodynamic parameters in acyanotic CHD patients with left-to-right shunts.

Methods: A cross-sectional study of 53 subjects with left-to-right shunt acyanotic CHD as inpatient or outpatient at dr. Cipto Mangunkusumo (RSCM) Hospital. Echocardiography was performed to assess the type and size of CHD, as weel as hemodynanic parameters (Qp/Qs, pulmonary artery systolic pressure, left ventricular ejection fraction/EF, and tricuspid annular plane systolic excursion/TAPSE). Troponin I level was determined by enzyme linked fluorescent assay (ELISA) with blood samples taken on the same day as echocardiography.

Results: The median age of the subjects was 16 (3-135) months, with 54.7% female (n=53). Most prevalent of the CHD type was ASD (45.3%), most of the defect were medium-sized (43.4%). Increased troponin I levels were found in 7 (13.2%) subjects. There was no significant difference in troponin I level in various CHD types. There was a weak negative correlation between troponin I level and EF (r=-0.391, p=0.002).

Conclusion: There was a weak negatif correlation between troponin I level and EF, while there was no significant correlation with other hemodynamic parameters."

"Sekitar 1% anak terlahir dengan penyakit jantung bawaan (PJB). Sebagian akan memerlukan kateterisasi jantung baik diagnosis maupun terapeutik. Prosedur ini memerlukan kooperasi pasien dan imobilisasi sehingga dibutuhkan anestesia yang mungkin berulang. Penelitian ini bertujuan melihat efek anestesia umum terhadap fungsi kontraktilitas jantung anak dengan PJB. Kontraktilitas jantung dilihat dari fraksi ejeksi dan TAPSE yang diukur dengan ekokardiografi. Pengukuran dilakukan sebelum anestesia umum, 5 menit pascaintubasi dan akhir tindakan kateterisasi. Metode penelitian kohort observasional dengan consecutive sampling telah dilakukan. Analisis dilakukan terhadap 42 anak berusia 6 bulan hingga 18 tahun dengan PJB yang menjalani kateterisasi jantung dalam anestesia umum pada periode Juni – Agustus 2018. Uji T-test berpasangan dilakukan untuk analisis perubahan fraksi ejeksi dan TAPSE dan analisis multivariat untuk melihat pengaruh usia, jenis PJB, lama dan jenis tindakan kardiologi terhadap perubahan kontraksi. Perubahan fraksi ejeksi turun bermakna pada 5 menit pascaintubasi dan akhir tindakan kardiologi dan TAPSE turun bermakna hanya pada 5 menit pascaintubasi. Pengaruh usia, jenis PJB, lama dan jenis tindakan kardiologi tidak bermakna terhadap perubahan fraksi ejeksi dan TAPSE. Dengan demikian diharapkan kewaspadaan dalam penanganan pasien PJB, termasuk ketika memberikan informasi sebelum persetujuan tindakan medis (informed consent), dan jika memungkinkan menghindari tindakan anestesia umum yang berulang.

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Approximately 1% of children borned with congenital heart disease (CHD). Some will require cardiac catheterization which repeated anesthesia may be needed. This study aims to see the effect of general anesthesia on the cardiac contractility in children with CHD. Cardiac contractility seen from ejection fraction and TAPSE as measured by echocardiography. Measurements were taken before general anesthesia, 5 minutes post-intubation and at the end of the catheterization. An observational cohort with consecutive sampling was conducted. Analysis was carried out on 42 children aged 6 months to 18 years with CHD who underwent cardiac catheterization under general anesthesia in the period June - August 2018. Paired T-test was performed to analyze changes in ejection fraction and TAPSE and multivariate analysis to analyze the effect of age, type of CHD, duration and type of cardiology intervention. Ejection fraction decreased significantly at 5 minutes post-intubation and at the end of cardiology intervention and TAPSE decreased significantly only at 5 minutes post-intubation. Changes of contratility was not significant affected by age, type of CHD, duration and type of cardiology intervention. Therefore, alertness in handling patients with CHD is expected, including when providing information prior to informed consent, and if possible avoid repeated general anesthesia."

"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: 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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"[ASTRAKLatar Belakang: Pengetahuan seseorang yang tidak memadai terhadap risiko suatu tindakan medis berpotensi menimbulkan kecemasan dan tuntutan sehingga diperlukan upaya komunikasi dan pemberian edukasi dengan baik. Pembedahan penyakit jantung bawaan (PJB) anak berisiko tinggi terjadi morbiditas hingga mortalitas. Terdapat kesan pemahaman ibu yang tidak optimal terhadap pembedahan PJB anak mereka. Penelitian ini bertujuan untuk menilai pengetahuan ibu terhadap pembedahan PJB.Metode: Penelitian ini menggunakan uji eksperimen tidak murni (kuasi eksperimen) untuk mengetahui perubahan pengetahuan dan uji potong lintang untuk mengetahui proporsi pengetahuan yang rendah sebelum diberikan edukasi pada ibu anak yang akan menjalani pembedahan jantung pada bulan Mei hingga Juli 2014 di Instalasi Pelayanan Jantung Terpadu (PJT) RSUPNCM. Pengetahuan ibu dinilai menggunakan kuesioner dan edukasi menggunakan media edukasi mini flipchart. Kuesioner dan media edukasi dikembangkan sendiri oleh peneliti. Pengetahuan akan dinilai saat praedukasi dan pascaedukasi.Hasil: Sebanyak 57 subyek diikutsertakan dalam penelitian dan tidak ada subyek yang dikeluarkan saat penelitian. Analisis menggunakan stratifikasi untuk tiap diagnosis dan jenjang pendidikan. Total 47 subyek yang dapat dianalisis. Didapatkan 49% subyek memiliki pengetahuan rendah praedukasi dan seluruh subyek (100%) mengalami peningkatan pengetahuan pascaedukasi.Simpulan: Pemberian edukasi mampu meningkatkan pengetahuan ibu anak dengan PJB yang akan menjalani pembedahan jantung.

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ABSTRACTBackground : Inadequate knowledge about risk of upcoming medical intervention may raiseanxiety and demands. Therefore good communication and education are required. CongenitalHeart Disease (CHD) children surgery has high risk of morbidity and mortality. There is animpression that the mother has lack understanding of their children?s surgery. This studyaimed to assess the mother?s knowledge of CHD surgery.Method : This study used quasi-experimental design to determine changes in maternalknowledge and cross-sectional tests to assess the proportion of low knowledge prior theprovision of education on the mothers whose children underwent heart surgery in May to July2014 in RSUPNCM. Knowledge of mothers was assessed using questionnaires before andafter the education. Education was provided using ?mini flipchart? media. Questionnaires andeducational media were developed by the researchers.Result : A total of 57 subjects were included in the study and no subjects were excludedduring the research. Analysis was done by using stratification for each diagnosis. A total of47 subjects can be analyzed. We found that 49% of the subjects had low knowledge prior theprovision of education and all subjects (100%) had increasing knowledge after education.Conclusion : The provision of education is able to increase the knowledge of mothers whosechildren will undergo congenital heart disease surgery.;Background : Inadequate knowledge about risk of upcoming medical intervention may raiseanxiety and demands. Therefore good communication and education are required. CongenitalHeart Disease (CHD) children surgery has high risk of morbidity and mortality. There is animpression that the mother has lack understanding of their children’s surgery. This studyaimed to assess the mother’s knowledge of CHD surgery.Method : This study used quasi-experimental design to determine changes in maternalknowledge and cross-sectional tests to assess the proportion of low knowledge prior theprovision of education on the mothers whose children underwent heart surgery in May to July2014 in RSUPNCM. Knowledge of mothers was assessed using questionnaires before andafter the education. Education was provided using “mini flipchart” media. Questionnaires andeducational media were developed by the researchers.Result : A total of 57 subjects were included in the study and no subjects were excludedduring the research. Analysis was done by using stratification for each diagnosis. A total of47 subjects can be analyzed. We found that 49% of the subjects had low knowledge prior theprovision of education and all subjects (100%) had increasing knowledge after education.Conclusion : The provision of education is able to increase the knowledge of mothers whosechildren will undergo congenital heart disease surgery., Background : Inadequate knowledge about risk of upcoming medical intervention may raiseanxiety and demands. Therefore good communication and education are required. CongenitalHeart Disease (CHD) children surgery has high risk of morbidity and mortality. There is animpression that the mother has lack understanding of their children’s surgery. This studyaimed to assess the mother’s knowledge of CHD surgery.Method : This study used quasi-experimental design to determine changes in maternalknowledge and cross-sectional tests to assess the proportion of low knowledge prior theprovision of education on the mothers whose children underwent heart surgery in May to July2014 in RSUPNCM. Knowledge of mothers was assessed using questionnaires before andafter the education. Education was provided using “mini flipchart” media. Questionnaires andeducational media were developed by the researchers.Result : A total of 57 subjects were included in the study and no subjects were excludedduring the research. Analysis was done by using stratification for each diagnosis. A total of47 subjects can be analyzed. We found that 49% of the subjects had low knowledge prior theprovision of education and all subjects (100%) had increasing knowledge after education.Conclusion : The provision of education is able to increase the knowledge of mothers whosechildren will undergo congenital heart disease surgery.]"

"Latar Belakang: Penyakit jantung bawaan (PJB) dikoreksi dengan bedah jantung terbuka dengan bantuan alat mesin pintas jantung paru (cardiopulmonary bypass). Namun teknik ini dapat menyebabkan inflamasi pada paru yang menghasilkan kondisi Acute Respiration Dysfunction Syndrome (ARDS). Meskipun insidensinya pada pasien bedah dengan mesin pintas jantung paru hanya rendah, tingkat mortalitasnya dapat mencapai 50%. Tujuan: Mengetahui hubungan antara durasi penggunaan mesin jantung paru dengan insidensi ARDS pada pasien anak dengan PJB pasca bedah jantung terbuka. Metode: Studi kohort retrospektif dilakukan terhadap 194 anak yang menjalani bedah jantung terbuka atas indikasi PJB di Unit Pelayanan Jantung Terpadu (UPJT) RSCM periode Januari 2014-September 2015. Hasil: 64 (32,99%) pasien mengalami ARDS pasca bedah jantung terbuka dan sisanya sebanyak 130 (67,01%) tidak mengalami ARDS. Median penggunaan mesin pada golongan ARDS dan non-ARDS masing-masing sebesar 80 menit (23-219, IK90%) dan 70 menit (18-320, IK90%). Insidensi ARDS pada kelompok dengan durasi pendek (≤60 menit) adalah 27,5% dan dengan durasi panjang (> 60 menit) adalah 36%. Secara statistik dan klinis tidak terdapat hubungan bermakna antara durasi penggunaan mesin dengan munculnya ARDS (p = 0,298, uji chi square). Kesimpulan: Tidak terdapat hubungan bermakna antara durasi penggunaan mesin pintas jantung paru dengan kejadian ARDS pada pasien PJB pasca bedah jantung terbuka.

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Background: Congenital heart disease (CHD) is corrected by open thoracic surgery with the help of cardiopulmonary bypass machine (CPB). This technique can cause pulmonary inflammation resulting in Acute Respiratory Distress Syndrome (ARDS). Even though its incidence is low, the mortality rate of is up to 50%.

Aim: To find whether the duration of CPB using is related with incidence of ARDS in pediatric patients underwent open thoracic surgery.

Methods: Retrospective cohort study was done involving 194 pediatric patients underwent open thoracic surgery with CHD indication at Unit Pelayanan Jantung Terpadu (UPJT) RSCM within January 2014 and 2015 September.

Results: 64 (32,99%) patients had ARSD after open thoracic surgery. The mean of CPB machine duration was 80 minutes (23-219, CI90%) in patients with ARDS and 70 minutes (18-320, CI90%) in patients with no ARDS. The incidence of ARDS in patients with short duration of CPB (≤60 minutes) was 27.5% and long duration (>60 minutes) was 36%. There was no such correlation statistically and clinically between duration of CPB and ARDS occurence (p = 0.298, chi square test).

Conclusion: Duration of CPB using is not related with ARDS occurrence in pediatric patients with CHD underwent open thoracic surgery."