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[ABSTRAK
Latar Belakang: Pada anak dengan penyakit jantung bawaan (PJB) yang menjalani operasi jantung terbuka, sepsis merupakan salah satu komplikasi pascaoperasi. Lama prosedur pintas jantung paru, usia, status gizi, timektomi, dan variasi genetik, seperti polimorfisme toll-like receptor (TLR) 2 dan tollinteracting protein (TOLLIP) dapat memengaruhi respons imun. Informasi mengenai peran faktor tersebut terhadap kejadian sepsis dan respons imun pascaoperasi jantung terbuka masih terbatas. Tujuan: Mengetahui peran polimorfisme TLR2, TOLLIP, dan faktor lainnya terhadap kejadian sepsis dan respons imun pascaoperasi jantung terbuka untuk memperoleh strategi paling tepat dalam penanganan kasus bedah jantung pada anak. Metodologi: Studi longitudinal dengan non-probability consecutive sampling dilakukan pada anak <1 tahun yang menjalani operasi jantung terbuka. Pemeriksaan polimorfisme TLR2 Arg677Trp, TLR2 N199N, TOLLIP rs5743867, sel CD4 dan CD8 yang menyekresikan IFN-γ intraselular, sel Dendritik yang mengekspresikan TLR2, dan sel NK. Pasien menjalani operasi jantung terbuka. Setelah operasi, pasien dimonitor untuk menilai sepsis dan respons imun pascaoperasi. Hasil: Dari 108 subjek yang terlibat, 21,3% diantaranya mengalami sepsis. Seluruh subjek adalah mutan TLR2 Arg677Trp, 92,6% pasien adalah mutan TLR2 N199N, dan 52,8% pasien adalah mutan TOLLIP rs5743867. Polimorfisme TLR2 N199N dan timektomi total tidak diikutkan dalam model analisis multivariat. Polimorfisme TOLLIP rs5743867 (p = 0,358) menurunkan resiko sepsis, lama prosedur pintas jantung paru ≥90 menit (p = 0,002), usia neonatus (p = 0,032), dan gizi buruk (p = 0,558) meningkatkan risiko sepsis pascaoperasi. Jumlah respons imun bervariasi antara kategori, namun secara umum komponen respons imun lebih rendah pada pasien yang mengalami sepsis dibanding pada pasien yang tidak mengalami sepsis. Simpulan: Lama prosedur pintas jantung paru dan usia neonatus secara signifikan memengaruhi risiko dan kecepatan sepsis pascaoperasi. Peran polimorfisme TLR2 N199N dan TOLLIP rs5743867 terhadap kejadian sepsis dan respons imun pascaoperasi memerlukan studi komprehensif lebih lanjut.

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ABSTRACT
Background: Sepsis is one of the complications in children with congenital heart defect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time, age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor (TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immune response. Information regarding those factors in the development of sepsis and immune response after open heart surgery is still limited. Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as well as other risk factors, in the development of sepsis and immune response following open heart surgery to develop the best strategy in open heart surgery in children. Methods: Longitudinal study with consecutive sampling were done in children <1 year old who underwent open heart surgery. Blood sample was obtained to check for TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIP rs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8, TLR2 expression in Dendritic cells, and NK cells. Patient then underwent open heart surgery. Thymectomy was done as indicated and CPB time was recorded. After surgery, patient was monitored for signs of sepsis and immune response was checked. Results: Out of 108 patients involved in this study, 21.3% developed postoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients, TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIP rs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199N polymorphism and thymectomy were not included in multivariate analysis. TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPB time ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p = 0.558) increased the risk of postoperative sepsis. Immune response?s counts vary in each category, but were generally lower in patients who developed postoperative sepsis. Conclusion: Cardiopulmonary bypass time and neonates significantly influenced the risk and hazard of postoperative sepsis. Further investigation on the role of TLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to provide more comprehensive explanation on the development of postoperative sepsis and the immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heart defect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time, age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor (TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immune response. Information regarding those factors in the development of sepsis and immune response after open heart surgery is still limited. Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as well as other risk factors, in the development of sepsis and immune response following open heart surgery to develop the best strategy in open heart surgery in children. Methods: Longitudinal study with consecutive sampling were done in children <1 year old who underwent open heart surgery. Blood sample was obtained to check for TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIP rs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8, TLR2 expression in Dendritic cells, and NK cells. Patient then underwent open heart surgery. Thymectomy was done as indicated and CPB time was recorded. After surgery, patient was monitored for signs of sepsis and immune response was checked. Results: Out of 108 patients involved in this study, 21.3% developed postoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients, TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIP rs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199N polymorphism and thymectomy were not included in multivariate analysis. TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPB time ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p = 0.558) increased the risk of postoperative sepsis. Immune response?s counts vary in each category, but were generally lower in patients who developed postoperative sepsis. Conclusion: Cardiopulmonary bypass time and neonates significantly influenced the risk and hazard of postoperative sepsis. Further investigation on the role of TLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to provide more comprehensive explanation on the development of postoperative sepsis and the immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heart defect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time, age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor (TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immune response. Information regarding those factors in the development of sepsis and immune response after open heart surgery is still limited. Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as well as other risk factors, in the development of sepsis and immune response following open heart surgery to develop the best strategy in open heart surgery in children. Methods: Longitudinal study with consecutive sampling were done in children <1 year old who underwent open heart surgery. Blood sample was obtained to check for TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIP rs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8, TLR2 expression in Dendritic cells, and NK cells. Patient then underwent open heart surgery. Thymectomy was done as indicated and CPB time was recorded. After surgery, patient was monitored for signs of sepsis and immune response was checked. Results: Out of 108 patients involved in this study, 21.3% developed postoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients, TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIP rs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199N polymorphism and thymectomy were not included in multivariate analysis. TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPB time ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p = 0.558) increased the risk of postoperative sepsis. Immune response?s counts vary in each category, but were generally lower in patients who developed postoperative sepsis. Conclusion: Cardiopulmonary bypass time and neonates significantly influenced the risk and hazard of postoperative sepsis. Further investigation on the role of TLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to provide more comprehensive explanation on the development of postoperative sepsis and the immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heart defect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time, age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor (TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immune response. Information regarding those factors in the development of sepsis and immune response after open heart surgery is still limited. Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as well as other risk factors, in the development of sepsis and immune response following open heart surgery to develop the best strategy in open heart surgery in children. Methods: Longitudinal study with consecutive sampling were done in children <1 year old who underwent open heart surgery. Blood sample was obtained to check for TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIP rs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8, TLR2 expression in Dendritic cells, and NK cells. Patient then underwent open heart surgery. Thymectomy was done as indicated and CPB time was recorded. After surgery, patient was monitored for signs of sepsis and immune response was checked. Results: Out of 108 patients involved in this study, 21.3% developed postoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients, TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIP rs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199N polymorphism and thymectomy were not included in multivariate analysis. TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPB time ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p = 0.558) increased the risk of postoperative sepsis. Immune response?s counts vary in each category, but were generally lower in patients who developed postoperative sepsis. Conclusion: Cardiopulmonary bypass time and neonates significantly influenced the risk and hazard of postoperative sepsis. Further investigation on the role of TLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to provide more comprehensive explanation on the development of postoperative sepsis and the immune response after open heart surgery, Background: Sepsis is one of the complications in children with congenital heart defect who underwent open heart surgery. Cardiopulmonary bypass (CPB) time, age, nutritional status, thymectomy, and genetic variants, such as toll-like receptor (TLR) 2 and toll-interacting protein (TOLLIP) polymorphism affect immune response. Information regarding those factors in the development of sepsis and immune response after open heart surgery is still limited. Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as well as other risk factors, in the development of sepsis and immune response following open heart surgery to develop the best strategy in open heart surgery in children. Methods: Longitudinal study with consecutive sampling were done in children <1 year old who underwent open heart surgery. Blood sample was obtained to check for TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIP rs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8, TLR2 expression in Dendritic cells, and NK cells. Patient then underwent open heart surgery. Thymectomy was done as indicated and CPB time was recorded. After surgery, patient was monitored for signs of sepsis and immune response was checked. Results: Out of 108 patients involved in this study, 21.3% developed postoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients, TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIP rs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199N polymorphism and thymectomy were not included in multivariate analysis. TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPB time ≥90 menit (p = 0.002), neonates (p = 0.032), and severe malnutrition (p = 0.558) increased the risk of postoperative sepsis. Immune response’s counts vary in each category, but were generally lower in patients who developed postoperative sepsis. Conclusion: Cardiopulmonary bypass time and neonates significantly influenced the risk and hazard of postoperative sepsis. Further investigation on the role of TLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to provide more comprehensive explanation on the development of postoperative sepsis and the immune response after open heart surgery]

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ABSTRAK
Latar Belakang: Kecemasan praoperasi selalu menjadi perhatian bagi pasien maupun dokter anestesiologis dan dokter bedah. Pasien-pasien yang dihadapkan pada kenyataan harus menjalani operasi khususnya operasi jantung mungkin akan mengalami kecemasan yang lebih tinggi karena keadaan jantung mereka yang tidak baik, konsep operasi jantung yang menakutkan dan ketidakpastian terhadap hasilnya. Kecemasan akan mengaktifkan stres respon yang menyebabkan stimulasi sistem saraf simpatis yang kemudian akan menstimulasi kardiovaskular dengan meningkatkan jumlah katekolamin darah yang menyebabkan takikardi, hipertensi, iskemik dan infark miokardial. Respon tersebut mungkin mempunyai efek merugikan pada sirkulasi koroner, yang menyebabkan peningkatan morbiditas dan mortalitas. Berbagai penanganan telah dikembangkan, salah satunya adalah dengan pemberian informasi (edukasi). Dengan pemberian edukasi melalui komunikasi efektif, informatif dan empati diharapkan terjadi penurunan tingkat kecemasan pasien sebelum menjalani pembiusan dan pembedahan. Penelitian ini secara umum ingin mengetahui pengaruh edukasi pra-anestesia terhadap tingkat kecemasan pasien dewasa yang akan menjalani operasi jantung terbuka di Instalasi PJT RSUPN Cipto Mangunkusumo. Metode: Penelitian ini menggunakan uji kuasi eksperimen pada pasien dewasa yang akan menjalani operasi jantung terbuka di Instalasi PJT RSUPN Cipto Mangunkusumo. Setelah mendapatkan ijin komite medik dan informed consent, sebanyak 36 subyek didapatkan dengan consecutive sampling pada bulan Maret 2016. Sebelum dilakukan penilaian tingkat kecemasan sebelum edukasi dengan menggunakan instrumen APAIS, terlebih dahulu dilakukan pengukuran tanda vital, kemudian dilanjutkan dengan pemberian edukasi dan diskusi. Jika subyek tidak mengalami gaduh gelisah dan atau tanda bahaya kardiovaskular, maka keesokan hari sebelum subyek dibawa ke ruang operasi, akan dilakukan penilaian ulang tingkat kecemasan subyek dengan menggunakan instrumen yang sama. Hasil: Uji Wilcoxon menunjukkan terdapat penurunan bermakna rerata tingkat kecemasan sebelum edukasi dibandingkan dengan sesudah edukasi (p<0,001). Simpulan: Edukasi pra-anestesia menurunkan tingkat kecemasan pasien dewasa yang akan menjalani operasi jantung terbuka di Instalasi PJT RSUPN Cipto Mangunkusumo.

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ABSTRACT
Background: Preoperative anxiety is always a concern for patients, anesthetist and surgeon. Patients are faced with the reality had to undergo surgery, especially heart surgery may experience higher anxiety because their heart condition is not good, scary concept of heart surgery and uncertainty of the results. Anxiety will activate the stress response that causes stimulation of the sympathetic nervous system, which then stimulates the cardiovascular by increasing the amount of blood catecholamines that cause tachycardia, hypertension, ischemia and myocardial infarction. The response may have detrimental effects on the coronary circulation, which leads to increase morbidity and mortality. Various handling have been developed, one of which is the provision of information (education). With the provision of education through effective and informative communication with empathy are expected to decline the level of anxiety of patients before undergoing anesthesia and surgery. The objective of this study is to determine the effect of preanesthesia education to the level of anxiety in adult patients undergoing open heart surgery in the Installation of PJT Cipto Mangunkusumo. Methods: This study used a quasi-experimental trials of adult patients undergoing open heart surgery in the Installation of PJT Cipto Mangunkusumo . After getting permission from the medical committee and getting informed consent, a total of 36 subjects is obtained by consecutive sampling in March 2016. Prior to the assessment of the level of anxiety before education using APAIS instrument, first performed measurements of vital signs, and then continued with education and discussion. If the subject is not experiencing restless and rowdy or cardiovascular distress signal, then the next day before the subject is taken to the operating room, the level of anxiety of the subject will be reassessed using the same instrument. Results: Wilcoxon test showed that there was a significant decrease in the average level of anxiety before education compared with after education (p<0.001). Conclusion: Preanesthesia education lowers the level of anxiety in adult patients undergoing open heart surgery in the Installation of PJT Cipto Mangunkusumo.

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Latar Belakang : Fungsi Kognitif meliputi fungsi pemusatan perhatian, bahasa, daya ingat, motorik serta fungsi eksekutif fungsi perencanaan, pengorganisasian, pelaksannaan dan pemantauan . Postoperative Cognitive Dysfunction POCD didefinisikan sebagai gangguan fungsi kognitif yang baru muncul setelah prosedur pembedahan. POCD pascabedah jantung terbuka yang menggunakan teknologi pintas jantung paru CPB merupakan sekuele yang secara teoritis sering terjadi. Belum ada penelitian POCD serta faktor-faktor yang mempengaruhinya di Indonesia sehingga penelitian ini dirasakan perlu dilakukanTujuan : Mengetahui kekerapan terjadinya penurunan fungsi kognitif pada subjek yang menjalani bedah jantung terbuka di RSUPN Dr. Cipto Mangunkusumo serta faktor-faktor yang mempengaruhinya.Metode : Penelitian ini adalah penelitian kohort prospektif. Dilakukan penilaian fungsi kognitif terhadap 60 pasien yang menjalani operasi bedah jantung terbuka dengan menggunakan test neuropsikologik. Hasil data pra dan pascabedah akan dibandingkan. Fungsi kognitif dikatakan turun bila terdapat penurunan 20 pada salah satu alat uji. Kriteria penerimaan adalah usia >18 tahun yang menjalani operasi bedah jantung di RSUPN Dr. Cipto Mangunkusumo Jakarta, dapat berbahasa Indonesia, membaca dan menulis, bersedia menjadi subjek penelitian. Hasil penelitian diolah dengan uji bivariat dan analisis regresi logistic.Hasil : Penurunan fungsi kognitif terjadi pada 40,7 subjek yang menjalani operasi jantung terbuka dengan menggunakan teknologi pintas jantung-paru. Faktor usia merupakan faktor yang berpengaruh melalui analisis bivariat dan regresi logistik p 0,001 .Kesimpulan : Terjadi penurunan fungsi kognitif pada subjek yang menjalani bedah jantung terbuka di RSUPN Dr. Cipto Mangunkusumo yang dipengaruhi oleh usia, namun tidak dipengaruhi tingkat pendidikan, diabetes melitus, lama CPB dan klem silang.Kata Kunci : POCD, cardiopulmonary bypass, operasi bedah jantung terbuka

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Background Cognitive functions include the function of attention, language, memory, motoric and executive functions planning, organizing, and monitoring . Postoperative Cognitive Dysfunction POCD is defined as a cognitive dysfunction that arises after a surgical procedure. POCD after open heart surgery with cardiopulmonary bypass CPB is frequent theoretically. There was no research on POCD and the factors that influence it in Indonesia so that this research was necessary to be done.Purpose To know the frequency of POCD in subjects underwent open heart surgery at Dr. Cipto Mangunkusumo and the factors that influence it.Methods This study was a prospective cohort study. Cognitive function assessment was performed in 60 patients underwent open heart surgery by using neuropsychological tests. Pre and postoperative data were compared. Cognitive decline was defined if there was a 20 decrease in cognitive function in at least one of the tests. Inclusion criteria were age 18 years old who underwent open heart surgery at Dr. Cipto Mangunkusumo Jakarta, could speak Indonesian language, were able to read and write, and were willing to become the subject of the research. The result of this research was analyzed by bivariate test and logistic regression analysis.Results POCD occured in 40.7 of subjects who underwent open heart surgery using cardiopulmonary bypass. Age was the only influential factor through bivariate test and logistic regression analysis p 0.001 .Conclusion POCD occured in subjects who underwent open heart surgery at Dr. Cipto Mangunkusumo which was influenced by age, but not by education level, diabetes, CPB and cross clamp time.Keywords POCD, cardiopulmonary bypass, open heart surgery.

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Latar belakang: Sepsis pascabedah jantung terbuka merupakan kondisi yang jarang terjadi tetapi memiliki mortalitas yang cukup tinggi. Gejala sepsis yang muncul pascabedah seringkali sulit dibedakan dengan kondisi inflamasi sistemik sehingga menimbulkan keterlambatan dalam menegakkan diagnosis maupun overtreatment pada pasien. Presepsin merupakan salah satu penanda sepsis yang mulai banyak digunakan terutama pada populasi dewasa. Penelitian ini bertujuan untuk melihat peran presepsin dalam menegakkan diagnosis sepsis pascabedah jantung terbuka pada anak. Tujuan: Untuk menguji performa diagnostik presepsin sebagai penanda sepsis pada anak pascabedahjantung terbuka dibandingkan dengan prokalsitonin (PCT). Metode: Studi potong lintang terhadap 49 pasien anak pascabedah jantung terbuka yang dirawat di RSCM. Penelitian ini mencari nilai batas optimal presepsin untuk mendiagnosis sepsis pascabedah jantung terbuka pada anak yaitu pada hari pertama dan ketiga pascabedah, kemudian membandingkannya dengan prokalsitonin. Analisis kurva ROC dikerjakan untuk menentukan nilai batas optimal presepsin. Hasil: Kadar presepsin hari pertama (T1) dan ketiga (T3) lebih tinggi pada subyek dengan sepsis daripada subyek yang tidak sepsis (median 415 pg/mL vs. 141,5 pg/mL pada hari pertama dan 624 pg/mL vs. 75,9 pg/mL pada hari ke tiga). Titik potong presepsin pada T1 dengan nilai 404 pg/mL memiliki performa untuk mendiagnosis sepsis dengan AUC 0,752 sedangkan presepsin T3 dengan nilai 203,5 pg/mL dengan AUC 0,945 yang lebih baik dibandingkan T1. Simpulan: Presepsin dapat dijadikan suatu modalitas untuk memberikan nilai tambah dan pertimbangan bagi klinisi untuk menegakkan diagnosis sepsis pada pasien anak pascabedah jantung terbuka. ......Background: Postoperative open-heart sepsis is a rare condition but has a fairly high mortality. Symptoms of sepsis that appear postoperatively are often difficult to distinguish from systemic inflammatory conditions, causing delays in establishing diagnosis and overtreatment in patients. Presepsin is one of the markers of sepsis that is starting to be widely used, especially in the adult population. This study is to identify the role of presepsin for diagnosing sepsis in post open-heart surgery in pediatric population. Aim: To perform diagnostic test of presepsin as sepsis screening markers compares to procalcitonin (PCT) in post open-heart surgery. Methods: Cross-sectional study of 49 postoperative open-heart pediatric patients treated at RSCM. This study looked for optimal cut-off values of presepsin for diagnosing open-heart postoperative sepsis in children on the first and third postoperative days, then compared it with procalcitonin. ROC curve analysis is performed to determine the optimal limit value of presepsin. Result: First (T1) and third day (T3) PSP levels were higher in subjects with sepsis than non- sepsis (median 415 pg/mL vs. 141.5 pg/mL on first day and 624 pg/mL vs. 75.9 pg/mL on third day). ). T1 presepsin cut off 404 pg/ml had AUC of 0.772, while T3 presepsin cut off 203.5 og/ml had better AUC of 0.945. T3 is better for diagnosing sepsis. Conclusion: Presepsin can be used as a modality to provide added value and consideration for clinicians to establish the diagnosis of sepsis in pediatric patients after open-heart surgery.

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Latar belakang: Penyakit jantung bawaan merupakan jenis kelainan bawaan lahir paling umum, dan merupakan penyebab kematian tersering pada bayi. Sindrom curah jantung rendah masih merupakan masalah yang dihadapi pada subjek pediatrik pascaoperasi jantung terbuka. Deteksi sindrom curah jantung rendah dengan kriteria klinis dan indikator laboratorik masih dirasa belum cukup, yang terbukti dengan masih adanya angka morbiditas dan mortalitas. Peranan penanda biologis NT-proBNP diharapkan dapat digunakan untuk dapat mendeteksi sindrom curah jantung rendah pada pediatrik. Metode: Penelitian pendahuluan kohort retrospektif dengan jumlah 47 subjek yang memenuhi kriteria inklusi dan eksklusi yang menjalani pembedahan jantung terbuka paliatif; PA banding, Bidirectional cavopulmonary shunt, BT-shuntdan Fontan, pada periode Oktober 2019 hingga Maret 2020 di Rumah Sakit Jantung dan Pembuluh darah Nasional Harapan Kita, Indonesia. Data prabedah, intrabedah dan pascaoperasi termasuk kejadian sindrom curah jantung rendah dicatat. Kadar NT-proBNP akan diambil prabedah, 4 jam, 24 jam dan 72 jam pascaoperasi. Analisis data menggunakan uji Mann-Whitney. Hasil: Kadar NT-proBNP pada prosedur palitif khususnya Fontan pada prabedah (137 pg/ml), 4 jam pascaoperasi (685 pg/ml), 24 jam pascaoperasi (5.715 pg/ml), dan 72 jam pascaoperasi (970 pg/ml). Kadar NT-proBNP prabedah, 4 jam pascaoperasi, 24 jam pascaoperasi, dan 72 jam pascaoperasi tidak berbeda bermakna dengan kejadian sindrom curah jantung rendah (nilai p >0,05). Kesimpulan: Ditemukan peningkatan nilai NT-Pro BNP pada subjek pascaoperasi jantung paliatif khususnya Fontan dan bidirectional cavopulmonary shunt yang mengalami sindrom curah jantung rendah pada jam ke-24. Namun kesimpulan diatas masih berdasarkan jumlah sampel dengan kekuatan penelitian <80% sehingga hanya berlaku sebagai kesimpulan sementara berdasarkan studi pendahuluan. ...... Background: Congenital heart disease is the most common type of birth defects, and is the most common cause of death in infants. Cardiac syndrome is still a problem faced by pediatric patients after heart surgery. Detection of Low Cardiac Output Syndrome with clinical criteria and laboratory indicators is still considered insufficient, which is proven to still contain morbidity and mortality rates. The role of NT-proBNP biological markers is expected to be used to support the detection of low cardiac output syndrome in pediatrics. Methods: A Preliminary retrospective cohort with 47 subjects fulfilling the inclusion and exclusion criteria who underwent palliative open heart surgery PA banding, Bidirectional cavopulmonary shunt, BT-shunt and Fontan from October, 2019 to March, 2020 at the Harapan Kita National Heart and Vascular Hospital, Indonesia. Preoperative, operative and postoperative data including the incidence of low cardiac output syndrome were recorded. NT-proBNP levels will be taken pre-surgery, 4 hours, 24 hours and 72 hours after surgery. Data analysis using the Mann-Whitney test. Results: NT-proBNP levels in the cardiac palliative surgery especially Fontan procedure at pre-surgery (137 pg/mL), 4 hours after surgery (685 pg/mL), 24 hours after surgery (5,715 pg/mL), and 72 hours after surgery (970 pg/mL). NT-proBNP levels at pre-surgery, 4 hours after surgery, 24 hours after surgery, and 72 hours after surgery were not significantly different from the incidence of low cardiac output syndrome (p value> 0.05). Conclusion: There is an increase in NT-Pro BNP values ​​in subjects with Fontan palliative heart surgery and bidirectional cavopulmonary shunt. However, the above conclusions are still based on the number of samples with research powers<80% and can only be taken as a provisional conclusion based on preliminary studies.

Abstrak :
Kecemasan dan nyeri merupakan masalah paling umum pada pasca operasi bedah jantung terbuka. Kedua hal tersebut akan menimbulkan efek negatif seperti meningkatkan penggunaan analgetik, komplikasi paru, gangguan tidur, waktu penyembuhan luka, lama serta biaya perawatan rumah sakit. Pranayama alternate nostril breathing merupakan terapi non-farmakologi yang dapat menurunkan kecemasan dan nyeri pasca bedah jantung. Evidence based nursing practice (EBNP) bertujuan menilai pengaruh pranayama alternate nostril breathing terhadap kecemasan dan nyeri pada pasien pasca bedah jantung. Subjek penelitian sebanyak 44 orang dibagi menjadi kelompok intervensi sejumlah 22 orang dan kelompok kontrol 22 orang. Kelompok intervensi mendapat perlakuan pranayama alternate nostril breathing sedangkan kelompok kontrol berupa relaksasi napas dalam. Penilaian kecemasan menggunakan The State-Trait Anxiety Inventory (STAI) sedangkan penilaian nyeri menggunakan Visual Analog Scale (VAS) 0-100 mm. Uji statistik penelitian menggunkan analisis bivariat dengan uji paired t test dan independent t test. Hasil penelitian menunjukkan pranayama alternate nostril breathing dapat menurunkan intensitas kecemasan dan nyeri pada kelompok intervensi (p-value <0,05) dibandingkan kelompok kontrol. Pranayama alternate nostril breathing merupakan intervensi non-farmakologi dalam menurunkan kecemasan dan nyeri pasien pasca bedah jantung yang bersifat sederhana, murah, efektif, efesien, dan fleksibel. Penelitian lanjutan perlu dilakukan dengan menggunakan sampel lebih besar serta instrumen penilaian kecemasan pasca operasi yang lebih spesifik. ......Anxiety and pain are the most common problems after open heart surgery. Both of them causes negative effects such as increasing the use of analgesics, pulmonary complications, sleep disturbances, wound healing time, hospital length of stay and cost. Pranayama alternate nostril breathing is a non-pharmacological therapy that can reduce anxiety and pain in post-cardiac surgery patients. Evidence based nursing practice (EBNP) aims to assess the effect of Pranayama alternate nostril breathing on anxiety and pain in post-cardiac surgery. The subjects were 44 people who divided into an intervention group of 22 people and a control group of 22 people. The intervention group received Pranayama alternate nostril breathing while the control group was get deep breathing relaxation. The State-Trait Anxiety Inventory (STAI) was used for anxiety assessment while the Visual Analog Scale (VAS) for pain assesment. The statistic test used bivariate analysis with paired t test and independent t test. Pranayama alternate nostril breathing could reduce the intensity of anxiety and pain in the intervention group (p-value <0.05) compared to the control group. Pranayama alternate nostril breathing is a non-pharmacological intervention for reducing anxiety and pain in post-cardiac surgery patients that is simple, inexpensive, effective, efficient, and flexible. Further research needs to be done using a larger sample and a more specific postoperative anxiety assessment instrument.

Abstrak :
Latar belakang: Penurunan curah jantung merupakan masalah yang penting dalam penatalaksanaan pasca-bedah jantung terbuka karena penurunan curah jantung ini meningkatkan morbiditas dan mortalitas pasien. Modalitas untuk pemantauan curah jantung bergeser dari invasif ke non-invasif. Alat ultrasonic cardiac output monitor (USCOM) dan ekokardiografi menjadi alat baru yang non-invasif. Bila dibandingkan dengan alat ekokardiografi yang membutuhkan keahlian khusus, alat USCOM dapat dijadikan alat pengukuran indeks curah jantung alternatif secara intermiten oleh tenaga medis terlatih. Tujuan: Untuk mengetahui kesesuaian hasil pengukuran indeks curah jantung dengan alat USCOM dibandingkan ekokardiografi pada anak pasca-bedah jantung terbuka dengan pintasan jantung paru. Metode: Studi potong lintang (cross sectional) pada anak pasca-bedah jantung terbuka dengan PJP dengan metode pengukuran simultan indeks curah jantung dengan alat USCOM dan ekokardiografi di Rumah Sakit Cipto Mangunkusumo, Jakarta, dari bulan Juni-Juli 2014. Hasil: Tiga belas pasien yang menjalani bedah jantung terbuka berhasil diukur dengan alat USCOM dan ekokardiografi secara simultan. Subyek terdiri atas 8 laki-laki dan 5 perempuan dengan median usia 3 tahun (1-12 tahun). Median berat badan, tinggi badan, dan luas permukaan tubuh berturut-turut 11 kg (5,5-29 kg), 82 cm (63-133 cm), dan 0,53 m2 (0,32- 0,98 m2). Diagnosis terbanyak berturut-turut adalah tetralogi Fallot (5 subyek), defek septum ventrikel (3 subyek), dan DORV (2 subyek). Pada analisis Bland-Altman indeks curah jantung yang diukur dengan alat USCOM dibandingkan ekokardiografi didapatkan perbedaan rerata sebesar 0,115 L/menit/m2 (IK95% -0,536 hingga 0,766) dan batas kesesuaian -3,616 hingga 3,846 L/menit/m2. Hasil tambahan penelitian ini berupa perbedaan rerata indeks isi sekuncup 0,03 mL/m2 (IK95% -5,002 hingga 5,065) dan batas kesesuaian -28,822 hingga 28,885 mL/m2. Perbedaan rerata diameter LVOT -0,017 cm (IK95% -0,098 hingga 0,064) dan batas kesesuaian -0,285 hingga 0,251 cm. Perbedaan rerata nilai VTI didapatkan sebesar -2,991 cm (IK95% -4,670 hingga -1,311) dan batas kesesuaian -12,616 hingga 6,635 cm. Kesimpulan: Pengukuran indeks curah jantung dengan alat USCOM dibandingkan ekokardiografi pada anak pasca-bedah jantung terbuka dengan PJP didapatkan perbedaan rerata kedua pengukuran kecil dan batas kesesuaian 95% yang lebar. Pada pengukuran indeks curah jantung yang makin rendah, perbedaan atau selisih rerata semakin kecil dan memiliki kesesuaiannya lebih baik.

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Background: Low cardiac output is important problem in post-open heart surgery management because this condition increase morbidity and mortality. Modality of cardiac output monitoring shifted from invasive to non-invasive. Ultrasonic cardiac output monitor (USCOM) and echocardiography are new non-invasive tools. Echocardiography needs special skill, but USCOM can used by trained user because of fast learning curve of skill. Objectives: To determine the agreement of cardiac index measurement by USCOM and echocardiography in children after open heart surgery with cardiopulmonary bypass. Methods: Cross sectional study using simultaneous measurement of cardiac index by USCOM and echocardiography on post-open heart surgery patient in Cipto Mangunkusumo Hospital Jakarta, from Juni-Juli 2014. Results: Thirteen post-open heart surgery of pediatric patient were enrolled (8 male and 5 female, median of age 3 years old (1-12 years old). Median of body weight, height, and body surface area respectively were 11 kg (5,5-29 kg), 82 cm (63-133 cm), dan 0,53 m2 (0,32-0,98 m2). Diagnosis of patient were tetralogi Fallot (5 subject), ventricular septal defect (3 subject), dan double outlet right ventricle (2 subject). This study using Bland-Altman analysis of cardiac index measurement by USCOM and echocardiography. Mean bias was 0,115 L/minute/m2 (95%CI -0,536 to 0,766) and limit of agreement was -3,616 to 3,846 L/minute/m2. Secondary outcome of this study was mean bias of stroke volume index 0,03 mL/m2 (95%CI -5,002 to 5,065) and limit of agreement was -28,822 to 28,885 mL/m2. Mean bias of LVOT diameter was -0,017 cm (95%CI -0,098 to 0,064) and limit of agreement was -0,285 to 0,251 cm. Mean bias of VTI was -2,991 cm (95%CI -4,670 to -1,311) and limit of agreement -12,616 to 6,635 cm. Conclusion: Cardiac index measurement by USCOM and echocardiography in children after open heart surgery has narrow mean bias and wide limit of agreement. Mean bias was narrower and good agreement in patient with low cardiac index.

Abstrak :
Latar Belakang: Penggunaan cardiopulmonary bypass dalam bedah jantung terbuka pada anak yang berkepanjangan dapat memicu koagulopati dan hemodilusi, serta menyebabkan perdarahan pasca operasi. Pasien anak dengan penyakit jantung bawaan sianotik memiliki risiko lebih tinggi karena sistem koagulasi darah mereka yang imatur. Meskipun demikian, tidak ada penelitian serupa yang betujuan untuk menilai hubungan antara keduanya. Tujuan: Penelitian ini bertujuan untuk meneliti korelasi antara CPB time dan perdarahan pasca operasi jantung terbuka pada pasien anak dengan penyakit jantung bawaan sianotik. Metode: Penelitian ini bersifat descriptive-analytical dengan metode cross- sectional. Rekam medis 100 pasien anak dari Rumah Sakit Cipto Mangunkusumo dari Januari 2016 sampai dengan Maret 2018 digunakan sebagai sampel. Pasien anak berusia 0 sampai 17 tahun dengan penyakit jantung bawaan sianotik, yang telah melalui bedah jantung terbuka elektif digunakan sebagai sampel. Korelasi Spearman digunakan untuk meneliti hubungan antara CPB time dengan perdarahan pasca operasi. Hasil: Dari 100 data yang diperoleh, tidak terdapat korelasi antara CPB time dan perdarahan pasca operasi (p = 0.087). Median dari CPB time adalah 87 menit (29 – 230). Perdarahan pasca operasi pasien memiliki median 15.3/kgBB dalam 24 jam (3.0 – 105.6). Konklusi: Tidak ada hubungan antara CPB time dan post-operative bleeding pada pasien anak dengan penyakit jantung bawaan sianotik. Faktor lain dapat mempengaruhi kedua variabel diteliti, termasuk dari pasien sendiri dan dari tindakan operasi, seperti kemampuan operator menangani perdarahan serta jenis prosedur operasi. Maka dari itu, CPB time tidak dapat dianggap sebagai faktor tunggal yang dapat mempengaruhi perdarahan pasca operasi.

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Background: Prolonged use of cardiopulmonary bypass during open heart surgery can induce coagulopathy and hemodilution, contributing towards post-operative bleeding. Pediatric patients with cyanotic congenital heart disease are susceptible due to presence of immature coagulation system. However, no similar studies have been done to assess the relationship between the two. Aim: This study aims to assess correlation between CPB time and post-operative bleeding in pediatric patients with cyanotic congenital heart disease undergoing open heart surgery. Method: This is a descriptive-analytical study, utilizing cross-sectional method. Medical records of 100 pediatric patients from Cipto Mangunkusumo General Hospital between January 2016 to March 2018 were used. Patients aged 0 to 17 years old with cyanotic congenital heart disease, who underwent elective open heart surgery were included as sample. Spearman’s correlation was used to determine correlation between CPB time and post-operative bleeding. Result: Data from 100 patients were obtained. No correlation was observed between CPB time and post-operative bleeding (p = 0.087). Patients’ CPB time has a median of 87 minutes (29 – 230). Patients’ post-operative bleeding has a median of 15.3 ml/kgBW in 24 hours (3.0 – 105.6). Conclusion: CPB time and post-operative bleeding has no correlation in pediatric patients with cyanotic congenital heart disease. Presence of various factors can influence both variables, including from the patients or operative factors, including dexterity of operator and applied procedure. Thus, CPB time cannot be held responsible as a single determining factor for post-operative bleeding.