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Abstrak :
ABSTRAK
Tujuan : Koreksi transatrial-transpulmonary tanpa transannular patch (TA-TP tanpa TAP) memiliki keuntungan berupa preservasi annulus katup pulmonal dan fungsi ventrikel kanan, Namun sering terjadi gradien RV-PA dan pRV/LV ratio yang masih tinggi sehingga terjadi low cardiac output syndrome (LCOS). Penelitian ini bertujuan untuk mencari batasan gradien RV-PA dan pRV/LV ratio yang merupakan nilai prediktif terbaik terhadap kejadian LCOS pascakoreksi tetralogi Fallot TA-TP tanpa TAP. Metode : Pada bulan Oktober 2012 sampai Maret 2013, sebanyak 30 pasien TF menjalani koreksi TF TA-TP tanpa TAP (mean usia 8,37±7,90 tahun). Dilakukan pengukuran gradien RV-PA dan pRV/LV ratio intraoperatif dan postoperatif di ICU. Evaluasi kejadian LCOS dilakukan selama perawatan di ICU. Sebelum pasien pulang, dilakukan pemeriksaan ekokardiografi untuk menilai gradien RV-PA, fungsi ventrikel kanan, defek septum ventrikel residual, derajat regurgitasi katup pulmonal dan katup trikuspid. Hasil : Sebanyak 30 (100%) subjek penelitian memiliki z-value ≥ -1, menjalani koreksi TF TA-TP tanpa TAP. Mean gradien RV-PA intraoperatif adalah 21,13±10,60 mm Hg dan mean pRV/LV ratio intraoperatif adalah 0,53±0,14. Mean gradien RV-PA di ICU adalah 20,83±7,10 mmHg dan mean pRV/LV ratio di ICU adalah 0,49±0,10. Tidak terjadi LCOS pada 30 (100%) subjek penelitian sehingga tidak dapat dilakukan analisis untuk mencari batasan nilai gradien RV-PA dan pRV/LV ratio sebagai nilai prediktif terbaik terhadap kejadian LCOS pascakoreksi TF TA-TP tanpa TAP. Mean gradien RV-PA sebelum subjek penelitian rawat jalan adalah 23,47±6,95 mmHg. Regurgitasi katup pulmonal ringan pada 15 (50%) subjek penelitian dan regurgitasi katup trikuspid trivialmild pada 16 (53%) subjek penelitian. Disfungsi ventrikel kanan ringan 3 (10%), sedang 20 (67%) dan berat pada 7 (23%) subjek penelitian. Mean TAPSE postoperatif adalah 1,03±0,19. DSV residual tidak dijumpai, aritmia tidak dijumpai, reoperasi dan mortalitas tidak ada. Simpulan : Koreksi TF TA-TP tanpa TAP memberikan hasil operasi dini yang baik pada pasien TF dengan z-value katup pulmonal ≥ -1, pRV/LV ratio < 0,5 dan gradien RV-PA < 25 mmHg pascakoreksi.

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ABSTRACT
Objective : The benefits of the transatrial-transpulmonary (TA-TP) without transannular patch (TAP) correction of tetralogy of Fallot (TOF) are preservation of pulmonary valve annulus and right ventricular function. However, TA-TP without TAP correction of TOF had a higher incidence of low cardiac output syndrome (LCOS) because of the high right ventricle and pulmonary artery (RV-PA) pressure gradient and right ventricle and left ventricle pressure (pRV/LV) ratio. The purpose of this study were to analyze the cut off value of RV-PA pressure gradient dan pRV/LV ratio as the best predictor value for postoperative LCOS in TA-TP without TAP correction of TOF. Methods : Between Oktober 2012 and Maret 2013, 30 patients with TOF underwent TATP without TAP correction (mean age 8,37±7,90 years, range 1-27 years). At the end of correction, all patients underwent intraoperative direct measurement of RV-PA pressure gradient and pRV/LV ratio. The patients were evaluated for postoperative LCOS at the Intensive Care Unit (ICU). All the patients underwent echocardiographic examination before hospital discharge. This included investigation of the presence RV-PA pressure gradien, RV function, residual VSD, pulmonary and tricuspid valve insufficiency. Results : Thirty patients with pulmonary valve annulus z-value ≥ -1, underwent TA-TP without TAP correction of TOF. Mean intraoperative RV-PA pressure gradient was 21,13±10,60 mmHg and mean intraoperative pRV/LV ratio was 0,53±0,14. Mean RV-PA pressure gradient measured 24 hours after correction at the ICU was 20,83±7,10 mmHg and mean pRV/LV ratio measured at 24 hours after correction at the ICU was 0,49±0,10. No patient had LCOS, we could not analyze the cut off value of RV-PA pressure gradient and pRV/LV ratio as the best predictor value for postoperative LCOS in this study. No patient had residual VSD. Mean RV-PA pressure gradient before hospital discharge was 23,47±6,95 mmHg. Fifteen (50%) patients had mild pulmonary valve insufficiency and 16 (53%) patients had trivial-mild tricuspid valve insufficiency. Three (10%) patients had mild RV dysfunction. Postoperative mean TAPSE was 1,03±0,19. No patient had arrhythmia, reoperation and mortality in this study. Conclusions : The TA-TP without TAP correction of TOF was applied successfully in 30 patients with pulmonary valve annulus z-value ≥ -1, post-correction RV-PA pressure gradient < 25 mmHg and pRV/LV ratio < 0,5.

Abstrak :
[Latar Belakang : Iskemia yang terjadi pada lokasi di tubuh mengakibatkan cedera otot reversible sampai ireversibel. Tindakan reperfusi ternyata dapat memperburuk keadaan yang disebabkan oleh kondisi iskemik. Beberapa penelitian terdahulu mencoba mencari teknik proteksi untuk mengurangi efek iskemik reperfusi diantaranya teknik iskemik prekondisi dan teknik hipotermi. Metode : Dilakukan penelitian eksperimental pada kelinci New Zealand White (n=18) dengan satu kelompok kontrol (iskemia) dan dua kelompok perlakuan (preconditioning dan hipotermia). Dilakukan ligasi a. iliaka komunis selama 4 jam, hipotermia sedang (28oC), dan iskemik prekondisi pada masing-masing kelompok. Kemudian kelinci dibiarkan hidup selama 8 jam. Sampel jaringan otot femoralis di ambil untuk pemeriksaan derajat kerusakan otot secara histopatologi. Hasil : Terdapat penurunan secara histopatologi derajat kerusakan otot yang di berikan perlakuan IPC dan perlakuan Hipotermi terhadap kelompok control. Analisis statistik tampak perbedaan bermakna pada sebagian parameter. Kesimpulan : Iskemik Prekondisi dan Hipotermi memberikan efek protektif pada otot dari akibat iskemik reperfusi tungkai bawah akut.;Introduction.Ischemia in certain location in the body could give muscle injury with certain severity from reversible to irreversible. Reperfusion turns out to give more injury than ischemic alone. Previous research try to find the best protective technic to reduce I/R injury including ischemic precondition and hypothermia technic. Method. This prospective, randomized, controlled, experimental animal study was performed in a university-based animal research facility with 18 New Zealand White Rabbit. The rabbits were randomized (n=6 per group) into three groups: I/R group (4 hours of hind limb ischemia and 8 hours of reperfusion), IPC group (three cycles of 5 minutes of ischemia/5 minutes of reperfusion immediately preceding I/R), and hypothermia ( 28oC) together with 4 hours of hind limb ischemia and 8 hours of reperfusion. Muscle tissue were examined based for their histopathological changes. Result.The histopathologic muscle damage score is decreased both in ischemic precondition group and hypothermia group.Although both groups show improvement in histological finding, this finding was statistically significant in few parameters Conclusion. Ischemic preconditioning and hypothermia have shown protective effect for muscle from ischemic reperfusion injury induced by lower limb ischemia., Introduction.Ischemia in certain location in the body could give muscle injury with certain severity from reversible to irreversible. Reperfusion turns out to give more injury than ischemic alone. Previous research try to find the best protective technic to reduce I/R injury including ischemic precondition and hypothermia technic. Method. This prospective, randomized, controlled, experimental animal study was performed in a university-based animal research facility with 18 New Zealand White Rabbit. The rabbits were randomized (n=6 per group) into three groups: I/R group (4 hours of hind limb ischemia and 8 hours of reperfusion), IPC group (three cycles of 5 minutes of ischemia/5 minutes of reperfusion immediately preceding I/R), and hypothermia ( 28oC) together with 4 hours of hind limb ischemia and 8 hours of reperfusion. Muscle tissue were examined based for their histopathological changes. Result.The histopathologic muscle damage score is decreased both in ischemic precondition group and hypothermia group.Although both groups show improvement in histological finding, this finding was statistically significant in few parameters Conclusion. Ischemic preconditioning and hypothermia have shown protective effect for muscle from ischemic reperfusion injury induced by lower limb ischemia.]

Abstrak :
Pendahuluan Keputusan untuk melakukan ligasi Patent Ductus Arteriosus pada saat operasi modifikasi pintas Blalock Taussig pada pasien neonatus dengan duct dependent masih diperdebatkan. Tujuan penelitian ini adalah mencari hubungan antara melakukan ligasi patent ductus arteriosus durante operasi modifikasi pintas Blalock Taussig dengan luaran klinis pada pasien neonatus dengan duct dependent. Metode Penelitian retrospektif ini mencakup neonatus dengan duct dependent yang menjalani operasi modifikasi pintas Blalock Taussig di Pusat Jantung Nasional Harapan Kita antara Januari 2009 sampai Desember 2014. Lama rawat, lama penggunaan ventilator, skor inotropik, kejadian low cardiac output syndrome, kejadian resusitasi, reintervensi dan mortalitas pasca operasi menjadi luaran klinis yang diteliti. Hasil Tujuh puluh enam neonatus (usia rata rata 11 ± 5,5 hari) menjalani operasi modifikasi pintas Blalock Taussig. Tindakan ligasi patent ductus arteriosus dilakukan pada 31 pasien. Pada kelompok pasien yang dilakukan ligasi patent ductus arteriosus ditemukan angka kejadian low cardiac output syndrome lebih tinggi (32,2 % versus 13,3%, p = 0,047) dan skor inotropik yang lebih tinggi (median 10,1 versus 7,9; p = 0,049). Tidak ada perbedaan yang signifikan antara lama rawat, lama penggunaan ventilator, kejadian resusitasi, kejadian reintervensi dan mortalitas antara kedua kelompok. Kesimpulan Pada neonatus dengan duct dependent, ligasi PDA durante operasi modifikasi pintas Blalock Taussig berkaitan dengan peningkatan angka kejadian low cardiac output syndrome dan skor inotropik pada periode pasca operasi.

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Objective The question of whether to ligate the patent ductus arteriosus when performing modified Blalock-Taussig shunt surgery in neonates is still a controversy. The aim of this report was to compare the results of ligate versus non ligate of the patent ductus arteriosus during modified Blalock Taussig shunt surgery in neonates with duct dependent. Patient and methods This retrospective study included neonates with duct dependent diagnosis who underwent modified Blalock Taussig shunt surgery at Harapan Kita National Cardiovascular Center from January 2009 to December 2014. Hospital stay, intubation time, inotropic score, low cardiac output syndrome event, resuscitation event, reintervention event, and mortality postoperative were studied as clinical outcomes. Results Seventy-six neonates (mean age 11 ± 5.5 days) underwent a modified Blalock Taussig procedure. The arterial duct was ligated in 31 patients. Compared with patients in whom the patent ductus arteriosus was left open, patients with a surgically closed arterial duct had a higher incidence of low cardiac output syndrome (32.2 % versus 13.3%, p = 0,047) and higher inotropic score (median 10.1 versus 7.9; p = 0.049). There were no significant difference between length of hospital stay, time to extubation, resuscitation event, reintervention event and mortality between the two groups. Conclusions In newborns with duct dependent, ductal ligation during Modified Blalock Taussig shunt procedure is associated with increased incidence of low cardiac output syndrome events and higher inotropic score during the postoperative period.

Abstrak :
Latar Belakang : Analgesia efektif dapat mengurangi morbiditas, mempercepat pemulihan, meningkatkan kondisi pasien dan mengurangi biaya rumah sakit. Teknik blok epidural sering digunakan untuk tatalaksana nyeri pascatorakotomi,namun beberapa keterbatasan ditimbulkan pada teknik ini. Teknik blok Paravertebral (PVB) dapat digunakan sebagai alternatif tatalaksana nyeri,pemasangan intraoperatif oleh dokter bedah Toraks Kardio Vaskular. Metode : Penelitian eksperimental, consecutive sampling, 22 subjek, dilakukan torakotomi posterolateral elektif, di Rumah Sakit Umum Pusat Persahabatan Jakarta. Subjek dibagi menjadi kelompok 1 (PVB) dan kelompok 2 (epidural). Diberikan regimen anestesi blok yang sama di kedua kelompok. Skor nyeri VAS diukur saat pasien telah di ekstubasi, pada jam ke-24, 36, dan 48. Dilakukan pengukuran terhadap waktu mobilisasi duduk, komplikasi dan analgetik tambahan. Hasil : Blok Paravertebral memberikan hasil lebih baik pada penilaian VAS jam ke-24 (p=0,029). Pada penilaian VAS jam ke-36 dan 48, tidak ada perbedaan signifikan dikedua kelompok. Pada pengamatan waktu mobilisasi didapakan kelompok1 lebih cepat mobilisasi (p=0,038). Pada pengamatan terhadap komplikasi dan penambahan analgetik tidak didapatkan perbedaan bermakna. Kesimpulan : Teknik blok Paravertebral dengan kateter yang dipasang oleh dokter BTKV dapat digunakan dengan beberapa keuntungan untuk manajemen tatalaksana nyeri pada pasien pascatorakotomi.

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Background : Analgesia can effectively reduce morbidity, recovery, emprove condition and reduce hospital cost. Epidural block is often used for pain treatment post thoracotomy, however, some limitation posed on this technique. Paravertebral block (PVB) can be used as an alternative to the treatment of pain, instalation intraoperatively by Cardio Vascular Thoracic Surgeon. Method : Experimental research, consecutive sampling, 22 subjects, performed elective posterolateral thoracotomy, in General Hospital Persahabatan Jakarta. Subjects were divided into group 1 (PVB) and group 2 (epidural). Given same regimen block anesthesia in both groups. VAS pain scores measured when the patient has extubated, at 24 hr, 36, and 48. Do measures of mobilization time sitting, complication and additional analgetics Results : PVB provides better result in VAS assessment 24 hr (p=0,029). On VAS assessment 36 hr and 48 h, there was no significant difference in both groups. Group 1 found faster mobilization (p=0,038). In observation of complications and additional analgetic not found significant differences Conclusion : PVB with catheter, placed by surgeon can be used with multiple advantages for pain management in post thoraotomy.