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"ABSTRAKTujuan : Koreksi transatrial-transpulmonary tanpa transannular patch (TA-TP tanpaTAP) memiliki keuntungan berupa preservasi annulus katup pulmonal dan fungsiventrikel kanan, Namun sering terjadi gradien RV-PA dan pRV/LV ratio yang masihtinggi sehingga terjadi low cardiac output syndrome (LCOS). Penelitian ini bertujuanuntuk mencari batasan gradien RV-PA dan pRV/LV ratio yang merupakan nilai prediktifterbaik terhadap kejadian LCOS pascakoreksi tetralogi Fallot TA-TP tanpa TAP.Metode : Pada bulan Oktober 2012 sampai Maret 2013, sebanyak 30 pasien TF menjalanikoreksi TF TA-TP tanpa TAP (mean usia 8,37±7,90 tahun). Dilakukan pengukurangradien RV-PA dan pRV/LV ratio intraoperatif dan postoperatif di ICU. Evaluasi kejadianLCOS dilakukan selama perawatan di ICU. Sebelum pasien pulang, dilakukanpemeriksaan ekokardiografi untuk menilai gradien RV-PA, fungsi ventrikel kanan, defekseptum ventrikel residual, derajat regurgitasi katup pulmonal dan katup trikuspid.Hasil : Sebanyak 30 (100%) subjek penelitian memiliki z-value ≥ -1, menjalani koreksiTF TA-TP tanpa TAP. Mean gradien RV-PA intraoperatif adalah 21,13±10,60 mm Hgdan mean pRV/LV ratio intraoperatif adalah 0,53±0,14. Mean gradien RV-PA di ICUadalah 20,83±7,10 mmHg dan mean pRV/LV ratio di ICU adalah 0,49±0,10. Tidak terjadiLCOS pada 30 (100%) subjek penelitian sehingga tidak dapat dilakukan analisis untukmencari batasan nilai gradien RV-PA dan pRV/LV ratio sebagai nilai prediktif terbaikterhadap kejadian LCOS pascakoreksi TF TA-TP tanpa TAP. Mean gradien RV-PAsebelum subjek penelitian rawat jalan adalah 23,47±6,95 mmHg. Regurgitasi katuppulmonal ringan pada 15 (50%) subjek penelitian dan regurgitasi katup trikuspid trivialmildpada 16 (53%) subjek penelitian. Disfungsi ventrikel kanan ringan 3 (10%), sedang20 (67%) dan berat pada 7 (23%) subjek penelitian. Mean TAPSE postoperatif adalah1,03±0,19. DSV residual tidak dijumpai, aritmia tidak dijumpai, reoperasi dan mortalitastidak ada.Simpulan : Koreksi TF TA-TP tanpa TAP memberikan hasil operasi dini yang baik padapasien TF dengan z-value katup pulmonal ≥ -1, pRV/LV ratio < 0,5 dan gradien RV-PA <25 mmHg pascakoreksi.

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ABSTRACTObjective : The benefits of the transatrial-transpulmonary (TA-TP) without transannularpatch (TAP) correction of tetralogy of Fallot (TOF) are preservation of pulmonary valveannulus and right ventricular function. However, TA-TP without TAP correction of TOFhad a higher incidence of low cardiac output syndrome (LCOS) because of the high rightventricle and pulmonary artery (RV-PA) pressure gradient and right ventricle and leftventricle pressure (pRV/LV) ratio. The purpose of this study were to analyze the cut offvalue of RV-PA pressure gradient dan pRV/LV ratio as the best predictor value forpostoperative LCOS in TA-TP without TAP correction of TOF.Methods : Between Oktober 2012 and Maret 2013, 30 patients with TOF underwent TATPwithout TAP correction (mean age 8,37±7,90 years, range 1-27 years). At the end ofcorrection, all patients underwent intraoperative direct measurement of RV-PA pressuregradient and pRV/LV ratio. The patients were evaluated for postoperative LCOS at theIntensive Care Unit (ICU). All the patients underwent echocardiographic examinationbefore hospital discharge. This included investigation of the presence RV-PA pressuregradien, RV function, residual VSD, pulmonary and tricuspid valve insufficiency.Results : Thirty patients with pulmonary valve annulus z-value ≥ -1, underwent TA-TPwithout TAP correction of TOF. Mean intraoperative RV-PA pressure gradient was21,13±10,60 mmHg and mean intraoperative pRV/LV ratio was 0,53±0,14. Mean RV-PApressure gradient measured 24 hours after correction at the ICU was 20,83±7,10 mmHgand 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 gradientand pRV/LV ratio as the best predictor value for postoperative LCOS in this study. Nopatient had residual VSD. Mean RV-PA pressure gradient before hospital discharge was23,47±6,95 mmHg. Fifteen (50%) patients had mild pulmonary valve insufficiency and16 (53%) patients had trivial-mild tricuspid valve insufficiency. Three (10%) patients hadmild RV dysfunction. Postoperative mean TAPSE was 1,03±0,19. No patient hadarrhythmia, reoperation and mortality in this study.Conclusions : The TA-TP without TAP correction of TOF was applied successfully in 30patients with pulmonary valve annulus z-value ≥ -1, post-correction RV-PA pressuregradient < 25 mmHg and pRV/LV ratio < 0,5."

"[ABSTRAKHipertrofi ventrikel kanan (HVKa) pada tetralogy fallot (TF) merupakan suatu respon adaptif akibat dari peningkatan tekanan di ventrikel kanan (VKa) dan hipoksia. HVKa yang berat vektor jantung akan mengarah ke kanan-posterior dapat menyebabkan gelombang S yang dalam di sadapan V6. Sementara itu pasien TF yang lama tidak dikoreksi akan mengalami paparan tekanan berlebih dan sianosis yang lebih lama juga, yang dapat menyebabkan perubahan-perubahan di tingkat seluler kardiomiosit yang pada akhirnya menyebabkan disfungsi VKa, dan sindrom curah jantung rendah (SCJR). Walaupun angka kesintasan pasca operasi baik, tapi perburukan SCJR dapat mengakibatkan kematian. Saat ini belum jelas bagaimana hubungan antara gelombang S di V6 dengan luaran total koreksi TF khususnya kejadian SCJR.MetodePenelitian dengan metode potong lintang. Subyek penelitian adalah TF yang menjalani total koreksi selama tahun 2013 sebanyak 150 pasien, 35 diantaranya dikeluarkan dari penelitian karena tidak memenuhi kriteri inklusi. Subyek dibagi menjadi 2 kelompok yaitu kelompok subyek dengan temuan kriteria S di V6 dan subyek yang untuk melihat hubungan temuan kriteria tersebut dengan variabel dasar. Kemudian dilakukan analisis bifariat terhadap kejadian SCJR, variabel dengan nilai p < 0.25 di masukkan dalam analisa multivariat. Nilai p< 0.05 dianggap bermakna.HasilUsia yang lebih muda, saturasi dan hematokrit yang lebih tinggi ditemukan pada kelompok subyek memenuhi kriteria gelombang S di V6. Kemudian, usia yag lebih muda, saturasi yang tinggi, kriteria gelombang R di aVR, kriteria gelombang S di I dan kriteria gelombang S di V6 berhubungan dengan kejadian SCJR. Analisis multivariat kriteria gelombang S di V6 berhubungan dengan kejadian SCJR dengan OR 3.2, interval kepercayaan 95% 1.2 - 8.5 dan nilai p=0.02KesimpulanKriteria EKG gelombang S di sadapan V6 untuk diagnosis HVKa berhubungan dengan kejadian SCJR pasca total koreksi pasien TF.

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ABSTRACTTetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. Right ventricular hypertrophy (RVH) is an adaptive response due to pressure overload and hypoxia in right ventricle (RV); it can be manifested as tall R wave in right precordial leads. This is due to changing direction of cardiac-vector to right In severe RVH, the cardiac vector rotated to right posterior causing deep S wave in V6. Uncorrected TF will expossed to prolong pressure overload and hypoxia, it can caused changes in cardiomyocite that can leads to RV dysfunction, low cardiac output syndrom (LCOS), and arrhythmias. Although the post operation survival rate was quite good, but worsening LCOS could increase mortality. In present time, the association between S wave in V6 and postoperative TOF outcomes, especially LCOS, has not been explained.MethodsThis is a cross sectional study. 150 TOF patients underwent total correction in 2013 included in this study. 35 patients who didn?t meet the inclusion criteria were excluded. Subjects divided in 2 groups: (1) patients who meets S in V6 criteria, and (2) control subjects as baseline characteristic. Bivariate analysis was done for incidence of LCOS, the variable with P<0.25 included in multivariate analysis. The significant value was p<0.5.ResultsMultivariate analysis showed S wave in V6 correlated with the incidence of LCOS with odds ratio 3.2, CI 95% (1.2-8.5), p=0.02.ConclusionThe ECG findings S wave in V6 leads to diagnose RVH correlated with incidence of LCOS in post total correction TOF. An S wave criterion in V6 of RVH patients? OR was 3.2 to predicts LCOS;Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. Right ventricular hypertrophy (RVH) is an adaptive response due to pressure overload and hypoxia in right ventricle (RV); it can be manifested as tall R wave in right precordial leads. This is due to changing direction of cardiac-vector to right In severe RVH, the cardiac vector rotated to right posterior causing deep S wave in V6. Uncorrected TF will expossed to prolong pressure overload and hypoxia, it can caused changes in cardiomyocite that can leads to RV dysfunction, low cardiac output syndrom (LCOS), and arrhythmias. Although the post operation survival rate was quite good, but worsening LCOS could increase mortality. In present time, the association between S wave in V6 and postoperative TOF outcomes, especially LCOS, has not been explained.MethodsThis is a cross sectional study. 150 TOF patients underwent total correction in 2013 included in this study. 35 patients who didn’t meet the inclusion criteria were excluded. Subjects divided in 2 groups: (1) patients who meets S in V6 criteria, and (2) control subjects as baseline characteristic. Bivariate analysis was done for incidence of LCOS, the variable with P<0.25 included in multivariate analysis. The significant value was p<0.5.ResultsMultivariate analysis showed S wave in V6 correlated with the incidence of LCOS with odds ratio 3.2, CI 95% (1.2-8.5), p=0.02.ConclusionThe ECG findings S wave in V6 leads to diagnose RVH correlated with incidence of LCOS in post total correction TOF. An S wave criterion in V6 of RVH patients’ OR was 3.2 to predicts LCOS;Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. Right ventricular hypertrophy (RVH) is an adaptive response due to pressure overload and hypoxia in right ventricle (RV); it can be manifested as tall R wave in right precordial leads. This is due to changing direction of cardiac-vector to right In severe RVH, the cardiac vector rotated to right posterior causing deep S wave in V6. Uncorrected TF will expossed to prolong pressure overload and hypoxia, it can caused changes in cardiomyocite that can leads to RV dysfunction, low cardiac output syndrom (LCOS), and arrhythmias. Although the post operation survival rate was quite good, but worsening LCOS could increase mortality. In present time, the association between S wave in V6 and postoperative TOF outcomes, especially LCOS, has not been explained.MethodsThis is a cross sectional study. 150 TOF patients underwent total correction in 2013 included in this study. 35 patients who didn’t meet the inclusion criteria were excluded. Subjects divided in 2 groups: (1) patients who meets S in V6 criteria, and (2) control subjects as baseline characteristic. Bivariate analysis was done for incidence of LCOS, the variable with P<0.25 included in multivariate analysis. The significant value was p<0.5.ResultsMultivariate analysis showed S wave in V6 correlated with the incidence of LCOS with odds ratio 3.2, CI 95% (1.2-8.5), p=0.02.ConclusionThe ECG findings S wave in V6 leads to diagnose RVH correlated with incidence of LCOS in post total correction TOF. An S wave criterion in V6 of RVH patients’ OR was 3.2 to predicts LCOS;Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. Right ventricular hypertrophy (RVH) is an adaptive response due to pressure overload and hypoxia in right ventricle (RV); it can be manifested as tall R wave in right precordial leads. This is due to changing direction of cardiac-vector to right In severe RVH, the cardiac vector rotated to right posterior causing deep S wave in V6. Uncorrected TF will expossed to prolong pressure overload and hypoxia, it can caused changes in cardiomyocite that can leads to RV dysfunction, low cardiac output syndrom (LCOS), and arrhythmias. Although the post operation survival rate was quite good, but worsening LCOS could increase mortality. In present time, the association between S wave in V6 and postoperative TOF outcomes, especially LCOS, has not been explained.MethodsThis is a cross sectional study. 150 TOF patients underwent total correction in 2013 included in this study. 35 patients who didn’t meet the inclusion criteria were excluded. Subjects divided in 2 groups: (1) patients who meets S in V6 criteria, and (2) control subjects as baseline characteristic. Bivariate analysis was done for incidence of LCOS, the variable with P<0.25 included in multivariate analysis. The significant value was p<0.5.ResultsMultivariate analysis showed S wave in V6 correlated with the incidence of LCOS with odds ratio 3.2, CI 95% (1.2-8.5), p=0.02.ConclusionThe ECG findings S wave in V6 leads to diagnose RVH correlated with incidence of LCOS in post total correction TOF. An S wave criterion in V6 of RVH patients’ OR was 3.2 to predicts LCOS, Tetralogy of Fallot (TOF) is a common cyanotic congenital heart disease. Right ventricular hypertrophy (RVH) is an adaptive response due to pressure overload and hypoxia in right ventricle (RV); it can be manifested as tall R wave in right precordial leads. This is due to changing direction of cardiac-vector to right In severe RVH, the cardiac vector rotated to right posterior causing deep S wave in V6. Uncorrected TF will expossed to prolong pressure overload and hypoxia, it can caused changes in cardiomyocite that can leads to RV dysfunction, low cardiac output syndrom (LCOS), and arrhythmias. Although the post operation survival rate was quite good, but worsening LCOS could increase mortality. In present time, the association between S wave in V6 and postoperative TOF outcomes, especially LCOS, has not been explained.MethodsThis is a cross sectional study. 150 TOF patients underwent total correction in 2013 included in this study. 35 patients who didn’t meet the inclusion criteria were excluded. Subjects divided in 2 groups: (1) patients who meets S in V6 criteria, and (2) control subjects as baseline characteristic. Bivariate analysis was done for incidence of LCOS, the variable with P<0.25 included in multivariate analysis. The significant value was p<0.5.ResultsMultivariate analysis showed S wave in V6 correlated with the incidence of LCOS with odds ratio 3.2, CI 95% (1.2-8.5), p=0.02.ConclusionThe ECG findings S wave in V6 leads to diagnose RVH correlated with incidence of LCOS in post total correction TOF. An S wave criterion in V6 of RVH patients’ OR was 3.2 to predicts LCOS]"