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Abstrak :
Latar belakang: Demam rematik dan komplikasinya masih merupakan masalah kesehatan pada banyak negara berkembang. Katup mitral merupakan katup yang paling sering terlibat oleh proses rematik, dengan derajat keparahan yang tinggi (60-70% pasien), baik stenosis dan/atau regurgitasi. Tatalaksana pada pasien dengan stenosis katup mitral berat telah digunakan sebagai modalitas terapi sejak hampir tiga dekade terakhir. Pemilihan kandidat KMTP yang telah umum digunakan adalah dengan Skor Wilkins. Skor Wilkins yang dinilai dari TTE memiliki beberapa kelemahan dibandingkan modalitas TEE. Keterbatasan lain Skor Wilkins adalah terdapat variabel morfologi katup mitral yang tidak dimasukkan dalam Skor Wilkins antara lain area katup mitral, morfologi komisura, kalsifikasi komisura, dan area katup mitral awal. Selain itu angka keberhasilan dini KMTP di Indonesia masih tergolong rendah dibandingkan dengan negara lain di dunia. Tujuan: Penelitian ini bertujuan untuk mengetahui hubungan morfologi katup mitral (area katup mitral, ketebalan katup, tebal fusi komisura, tebal kalsifikasi komisura, fusi korda) terhadap luaran keberhasilan dini KMTP. Metode: Penelitian ini merupakan studi potong lintang pada pasien stenosis mitral berat akibat penyakit jantung rematik yang menjalani tindakan KMTP. Luaran keberhasilan dini yang optimal adalah tercapainya ukuran area katup mitral ≥ 1,5 cm2 tanpa disertai regurgitasi mitral sedang atau lebih yang dievaluasi paska tindakan KMTP dengan ekokardiografi. Penilaian katup mitral dilakukan secara detil dengan TEE meliputi Skor Wilkins dari TEE (pliabilitas, ketebalan ketup, kalsifikasi, fusi korda), area katup mitral (AKM) 3D pra tindakan, tebal fusi komisura anterolateral dan posteromedial, tebal maksimal kalsifikasi komisura. Semua variabel dilakukan uji statistik bivariat, dan selanjutnya dilakukan analisis multivariat. Hasil: Total terdapat 41 pasien yang menjalani KMTP. Sebanyak 18 (43,9%) pasien mencapai hasil luaran dini optimal. Didapatkan rerata AKM 3D pra 0,6 cm2 pada sampel. Dari uji analisis multivariat didapatkan AKM 3D pra dan tebal fusi komisura anterior merupakan faktor morfolgi katup yang secara independen berhubungan dengan keberhasilan dini KMTP. Kesimpulan: Pada populasi dengan Skor Wilkins yang rendah, AKM pra KMTP dan ketebalan komisura anterolateral berhubungan dengan keberhasilan dini KMTP. Sedangkan Skor Wilkins yang rendah itu sendiri tidak lagi berhubungan dengan keberhasilan dini KMTP.

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Background: Rheumatic fever and its complication is still a major health problem in developing countries. The mitral valve is the most commonly and severely affected (65%-70% of patients) by rheumatic process by stenosis and/or regurgitation. Percutaneous Transcatheter Mitral Comisurotomy (PTMC) has been used for almost 3 last decades. Wilkins Score has been used for choosing candidates for PTMC. There are several mitral valve features that is not included in the Wilkins score. Nevertheless, the success rate of PTMC in Indonesia still considered lower than other countries. Aim: This study aims to know the association of mitral valve morphology (mitral valve area, valve thickness, thickness of commissural fusion, thickness of commisure calsification, subvalvar involvement) with immediate success of PTMC. Methods: This is a cross-sectional study, data was taken procpectively in patients with rheumatic heart disease whom undergone PTMC. Optimal immediate success was defined as mitral valve area ≥ 1,5 cm2 without mitral regurgitation moderate or more, which was evaluated after PTMC using echocardiography. Detailed assessment of mitral valve using TEE including Wilkins Score from TEE (pliability, valve thickness, calsification, chordal fusion), mitral valve area (MVA) 3D, thickness of anterolateral and posteromedial commissural fusion, maximum thickness of commissural calsification were taken before the PTMC procedure. All morphological variables undergone bivariate analysis and whichever is eligible to multivariate analysis. Results: Forty-one patients undergone PTMC procedure. Eighteen patients (43,9%) achieved optimal immediate result. Mean MVA by 3D echo before PTMC was 0,6 cm2. After multivariate analysis, MVA 3D and thickness of anterolateral commisure were the only morphological features which independently associated with early success of PTMC. Kesimpulan: In population with low Wilkins score, the score is no longer associated with the immediate optimal outcome of PTMC. Instead, MVA 3D pre-PTMC and thickness of anterolateral commissure are associated with immediate optimal outcome of PTMC.

Abstrak :
This book is a practical guide to the use of TEE (transoesophageal echocardiography) in the diagnosis of congenital heart disease (CHD). Beginning with an introduction to TEE for CHD, the following chapters describe procedures to be used for different cardiac conditions. 3D TEE allowing multi-dimensional perspectives is also covered.

Abstrak :
This book is a true asset for any physician, resident, nurse, or other healthcare professional looking to master perioperative transesophageal echocardiography. Spanning 2- and 3-D imagining, as well as Doppler modalities for assessing ventricular performance and valvular disease, this book guides you through the physics, principles, and applications of each technique.

Abstrak :
Three-dimensional (3D) transesophageal echocardiography (TEE) is a powerful visual tool which the novice or experienced echocardiographer, cardiologist, or cardiac surgeon can use to achieve a better understanding and assessment of normal and pathological cardiac function and anatomy. A complement to traditional 2D imaging, 3D TEE enables visualization of any cardiac structure from multiple perspectives. For the echocardiographer, it demands a different set of skills for image acquisition and manipulation. Real-time three-dimensional transesophageal echocardiography is a practical illustrated step-by-step guide to the latest in 3D technology and image acquisition. Each chapter systematically focuses on different cardiac structures with practical tips to image acquisition. Features : Up-to-date Synoptic presentation of essential “how-to” and relevant clinical information More than 300 color figures Practical fundamentals, including altered knobology, and how to acquire and manipulate image datasets Systematic identification of special diagnostic issues Normal and abnormal cardiac pathology Supplemented by the Virtual TEE Perioperative Interactive Education (PIE) website which provides free access to online resources for teaching and learning TEE : http://pie.med.utoronto.ca/TEE

Abstrak :
Transesophageal echocardiography (TEE) is a valuable diagnostic modality now routinely used during cardiac surgery and in the intensive care unit. Increasingly, anesthesiologists trained in TEE provide the service in both settings where they face the challenge of integrating numerous current TEE guidelines into day-to-day practice. Perioperative two-dimensional transesophageal echocardiography : a practical handbook has been designed to be a concise, portable guide for using TEE to recognize cardiac pathology during the perioperative period. This compact guide has a diverse appeal for anesthesiologists, cardiac surgeons, and cardiologists desiring comprehensive up-to-date echocardiographic information at their fingertips. Features : - More than 450 full-color, high quality clinical images and illustrations - Synopsis of cardiac pathology commonly encountered in cardiac surgery patients - Convenient spiral binding - On-the-spot reference for echocardiographers with a wide range of experience, from novice to expert