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"Indonesian Journal of Dentistry 2006; Edisi Khusus KPPIKG XIV: 120-123Congenital heart disease is a condition of heart anomaly found since birth. The most common is ventricular septal defect whereby an aperture is found in the partition of heart chamber. It is estimated that 40,000 newborn in Indonesia have this defective condition. Dental treatment for patient with such condition must be undertaken in a very cautious way. Tooth with multiple caries can potentially lead to endocarditis bacteria. As such, dentist must be watchful on dental treatment that may worsen the patient's condition. To prevent endocarditis bacteria, a prophylaxis antibiotic is required as recommended by the American Heart Association (AHA). In this particular case, a dental treatment was undertaken to a child patient with congenital heart disease. Previously, the patient has undergone dental treatment in the form of multiple extraction under general anesthesia before conducting cardiac surgery. ln this case the treatment includes mortal pulpotomy, GIC restoration, and fissure sealant - all conducted in one visit under general anesthesia. After a year after the treatment,here are no complaint from the patient and no irregularity in x-ray results."

"Latar belakang: DSV (Defek Septum Ventrikel) adalah satu dari banyak kasus penyakit jantung bawaan dengan angka 2,6 per 1000 kelahiran di Dunia. Salah satu komplikasi DSV yang sering ditemukan adalah DSV dengan hipertensi pulmonal. Diagnosis intervensi terhadap hipertensi arteri pulmonal menjadi perhatian pada 2-10% kasus DSV, sehingga pasien DSV yang bermanifestasi hipertensi pulmonal dilakukan pemeriksaan kateterisasi. Pasien usia 6 bulan menjadi pedoman batas usia untuk dilakukan kateterisasi di RSPJDNHK (Rumahsakit Pusat Jantung dan Pembuluh darah Nasional Harapan Kita). Sehingga antrean operasi menjadi lebih lama. Penelitian ini bertujuan untuk melihat pengaruh usia terhadap nilai PARi pascates oksigen dan mencari kelompok usia yang tidak memiliki hasil nonreaktif terhadap tes oksigen. Metode: Dilakukan studi Observasional retrospektif pada pasien DSV usia di bawah 5 tahun di RSPJDNHK tahun 2015 - 2020. Pengumpulan data melalui rekam medis pasien di divisi bedah jantung pediatrik RSPJDNHK. Pengambilan sampel dilakukan secara acak dengan perhitungan besar sampel mengikuti perhitungan besar sampel untuk uji komparatif numerik lebih dari dua kelompok dengan satu kali pengukuran. Analisis deskriptif dan analisis bivariat dilakukan dengan bantuan SPSS v 20.0. Hasil: Terdapat 178 sampel penelitian pada penelitian ini. Dari hasil penelitian diketahui bahwa usia berpengaruh atau berhubungan dengan nilai PARi pascates oksigen (p<0,05) pada pasien DSV usia di bawah 5 tahun. Simpulan: Terdapat hubungan usia dengan nilai PARi pascates oksigen dan usia ≤2 tahun memiliki nilai mutlak reaktif terhadap tes oksigen.

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Background: Ventricular Septal Defect (VSD) is one of the many cases of congenital heart disease with a rate of 2.6 per 1000 births in the world. One of the complications of VSD is pulmonary hypertension, with the prevalence of interventional diagnosis of pulmonary hypertension is about 2 – 10 % of VSD. Those who manifest pulmonary hypertension are undergone right heart catheterization. Patients aged six months are the limit for catheterization in National Cardiovascular Center Harapan Kita Hospital leads to a long waiting list. The study aimed to determine the effect on the PARi value of oxygen delivery and find age groups that have reactive results on oxygen tests.

Methods: A retrospective crossectional study was carried out in the pediatric cardiac surgery division of the National Cardiovascular Center Harapan Kita Hospital. Data were taken from the medical record, enrolling those treated from January 2015 to December 2020 with subjects under five years old with VSD pulmonary hypertension who underwent cardiac catheterization. Samples were taken randomly by calculating the sample size following the sample size calculation for the comparative numerical test of more than two groups with one measurement. Descriptive analysis and bivariate analysis were carried out using SPSS v 20.0.

Results: There were 178 subjects enrolled in this study. The age correlated to the post-oxygen test PARi value (p<0.05) on VSD patients under five years of age.

Conclusions: This study showed that age correlated to the PARi value after oxygen test, and age ≤2 years old has absolute reactive value to oxygen test."

"Latar belakang: Kekurangan gizi merupakan penyebab umum morbiditas pada anak dengan penyakit jantung bawaan (PJB). Data dari negara berkembang memperlihatkan prevalensi malnutrisi penderita dengan PJB sebelum dioperasi mencapai 45%. Penelitian ini bertujuan untuk mengetahui profil anhropometrik dan prevalensi kekurangan gizi pada anak dengan PJB dengan melakukan pengukuran anthropometrik.Metode: Penelitian ini merupakan penelitian dengan rancang bangun cross sectional pada anak berusia 0-2 tahun dengan PJB di RSCM. Pengukuran antropometri (berat badan, panjang badan, lingkar kepala) dilakukan pada seluruh pasien. Kekurangan gizi, failure to thrive/FTT, perawakan pendek, mikrosefali dinilai dengan menggunakan rekomendasi WHO tahun 2006, berupa perhitungan z-skor BB/PB, BB/U di 2 titik, PB/U dan LK/U < -2 SD.Hasil: Total subyek dalam penelitian ini berjumlah 95 orang, 73 orang dengan asianotik dan 22 orang dengan PJB sianotik. Prevalensi kekurangan gizi sebesar 51,1% dengan 22,3% diantaranya adalah gizi buruk. FTT terdapat pada 64,9%, perawakan pendek pada 49,5% dan mikrosefali pada 37% pasien. FTT ditemukan lebih banyak pada pasien dengan lesi asianotik (72,2%) dibandingkan dengan lesi sianotik (42,9). Pada lesi asianotik, berat badan lebih dipengaruhi daripada panjang badan (72,2% dengan 49,3%). Pasien dengan lesi sianotik, berat dan panjang badan akan dipengaruhi secara seimbang (42,9% dengan 54.5%). Konsultasi diet diberikan kepada pasien dengan kekurangan gizi. Terapi obat-obatan, intervensi transkateter atau bedah diindikasikan pada pasien tertentu.Kesimpulan: Prevalensi FTT lebih tinggi dibandingkan dengan kekurangan gizi pada anak dengan kelainan jantung kongenital. FTT ditemukan lebih banyak pada pasien dengan lesi asianotik. Pada lesi asianotik, berat badan lebih dipengaruhi daripada panjang badan. Pada lesi asianotik, berat badan lebih dipengaruhi daripada panjang badan.

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AbstractBackground: Undernutrition is a common cause of morbidity in children with CHD. Previous data from developing country showed prevalence of preoperative undernutrition in children with CHD was up to 45%. The aim of this study are to determine the anthropometric profi les and prevalence of undernutrition in children with CHD by using the anthropometric measurement.Methods: A cross-sectional study was carried out in children aged 0-2 years old with CHD in Cipto Mangunkusumo hospital. All patients underwent an anthropometric evaluation (weight, length and head circumference) at presentation. Undernutrition, failure to thrive /FTT, short stature and microcephaly were determined according to WHO, weight-forlength, weight-for-age at 2 points, length-for-age, head circumference-for-age z-score < -2SD accordingly.Results: We had total of 95 patients, 73 patients with acyanotic and 22 patients with cyanotic lesions. Prevalence of undernutrition in CHD was 51.1%, with 22.3% severe undernutrition. FTT was found in 64.9%, short stature in 49.5% and microcephaly in 37% patients. FTT was found higher in acyanotic (72.2%) compared to cyanotic lesions (42.9%). In acyanotic, weight was affected more than length (72.2% vs 49.3%). In cyanotic, weight and length affected equally (42.9% vs 54.5%). Diet counseling were done in patients with undernutrition. Medicines, transcatheter or surgery intervention were indicated in selected patients.Conclusions: Prevalence of FTT was higher than undernutrition in children with CHD. FTT was found higher in acyanotic lesions. In acyanotic, weight was affected more than length. In cyanotic, weight and length affected equally. "

"[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.]"

"Prevalensi aritmia ventrikel maligna pasca koreksi Tetralogi Fallot (TOF) masih tinggi. Deteksi dini aritmia pasca operasi dilakukan dengan perekaman holter EKG. Modalitas ini tidak tersedia luas di seluruh pelayanan kesehatan. Perlu adanya studi yang menilai hubungan antara fragmentasi QRS berat yang dinilai dengan menggunakan EKG 12 sadapan dengan kejadian aritmia ventrikel pasca koreksi TOF. Studi observasional (potong lintang) pada 59 pasien pasca koreksi TOF >1 tahun dari waktu operasi. Dilakukan pemeriksaan EKG  12 sadapan untuk menilai derajat fragmentasi QRS dan dinilai hubungannya dengan temuan aritmia ventrikel berpotensi maligna dari holter EKG 24 jam. Fragmentasi QRS pada penelitian ini diklasifikasikan sebagai berat (fragmentasi >5 sadapan) dan tanpa fragmentasi berat (0–5 sadapan).  Sebesar  37,3% pasien menjalani operasi koreksi TOF  pada usia >3 tahun. Terdapat 89,8% subyek dengan fragmentasi QRS, dan 57,6% diantaranya dengan fragmentasi QRS berat. Kejadian aritmia ventrikel berpotensi maligna ditemukan pada 40,7% subyek, dan 45,8% diantaranya tidak mempunyai keluhan. Berdasarkan analisis multivariat, fragmentasi QRS derajat berat (OR 8,6[95% IK1,9 – 39,5]) dan interval operasi >7 tahun (OR 8,9[95% IK2,2 – 35,9]) merupakan faktor independen aritmia ventrikel (p<0,05). Terdapat hubungan antara derajat fragmentasi QRS berat dengan kejadian aritmia ventrikel berpotensi maligna, dengan besar risiko delapan kali dibanding pasien tanpa fragmentasi QRS berat.

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The prevalence of malignant ventricular arrhythmias after Tetralogy of Fallot (TOF) repair is high. Through ECG holter monitoring, early detection for post-operative arrhythmia can be achieved. Unfortunately, this modality is not widely available. Further study is necessary to evaluate the association between severe QRS fragmentation from 12-leads ECG and incidence of ventricular arrhythmias after TOF repair. This cross-sectional study was done in 59 repaired TOF patients >1 year from time of surgery. QRS fragmentation was defined as notches in QRS complex and classified as severe QRS fragmentation (>5 leads) and none-to-moderate QRS fragmentation (0 – 5 leads). Mean age of 193 + 151 months, 37.3% of patients underwent surgery > 3 years of age. QRS fragmentation was found in 89.8% of subjects, and 57.6% presented with severe QRS fragmentation. The incidence of potentially malignant ventricular arrhythmias was 40.7%, but 45.8% were asymptomatic. On multivariate analysis, severe QRS fragmentation (OR 8,6[95% CI1,9 – 39,5]) and over than 7 years of operating intervals (OR 8,9[95% CI2,2 – 35,9]) were found as independent factors for ventricular arrhythmia occurrence (p <0.05). There is an association between severe QRS fragmentation and incidence of potentially malignant ventricular arrhythmias, with eight times greater risk in patients with none-to-moderate QRS fragmentation."

"[ABSTRAKLatar Belakang: Pada anak dengan penyakit jantung bawaan (PJB) yangmenjalani operasi jantung terbuka, sepsis merupakan salah satu komplikasipascaoperasi. Lama prosedur pintas jantung paru, usia, status gizi, timektomi, danvariasi genetik, seperti polimorfisme toll-like receptor (TLR) 2 dan tollinteractingprotein (TOLLIP) dapat memengaruhi respons imun. Informasimengenai peran faktor tersebut terhadap kejadian sepsis dan respons imunpascaoperasi jantung terbuka masih terbatas.Tujuan: Mengetahui peran polimorfisme TLR2, TOLLIP, dan faktor lainnyaterhadap kejadian sepsis dan respons imun pascaoperasi jantung terbuka untukmemperoleh strategi paling tepat dalam penanganan kasus bedah jantung padaanak.Metodologi: Studi longitudinal dengan non-probability consecutive samplingdilakukan 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 yangmengekspresikan TLR2, dan sel NK. Pasien menjalani operasi jantung terbuka.Setelah operasi, pasien dimonitor untuk menilai sepsis dan respons imunpascaoperasi.Hasil: Dari 108 subjek yang terlibat, 21,3% diantaranya mengalami sepsis.Seluruh subjek adalah mutan TLR2 Arg677Trp, 92,6% pasien adalah mutan TLR2N199N, dan 52,8% pasien adalah mutan TOLLIP rs5743867. Polimorfisme TLR2N199N dan timektomi total tidak diikutkan dalam model analisis multivariat.Polimorfisme TOLLIP rs5743867 (p = 0,358) menurunkan resiko sepsis, lamaprosedur pintas jantung paru ≥90 menit (p = 0,002), usia neonatus (p = 0,032), dangizi buruk (p = 0,558) meningkatkan risiko sepsis pascaoperasi. Jumlah responsimun bervariasi antara kategori, namun secara umum komponen respons imunlebih rendah pada pasien yang mengalami sepsis dibanding pada pasien yang tidakmengalami sepsis.Simpulan: Lama prosedur pintas jantung paru dan usia neonatus secara signifikanmemengaruhi risiko dan kecepatan sepsis pascaoperasi. Peran polimorfisme TLR2N199N dan TOLLIP rs5743867 terhadap kejadian sepsis dan respons imunpascaoperasi memerlukan studi komprehensif lebih lanjut.

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ABSTRACTBackground: Sepsis is one of the complications in children with congenital heartdefect 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 immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥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 varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heartdefect 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 immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥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 varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heartdefect 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 immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥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 varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery;Background: Sepsis is one of the complications in children with congenital heartdefect 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 immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥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 varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery, Background: Sepsis is one of the complications in children with congenital heartdefect 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 immuneresponse. Information regarding those factors in the development of sepsis andimmune response after open heart surgery is still limited.Objectives: To understand the role of TLR 2 and TOLLIP polymorphism, as wellas other risk factors, in the development of sepsis and immune response followingopen heart surgery to develop the best strategy in open heart surgery in children.Methods: Longitudinal study with consecutive sampling were done in children <1year old who underwent open heart surgery. Blood sample was obtained to checkfor TLR2 Arg677Trp polymorphism, TLR2 N199N polymorphism, TOLLIPrs5743867 polymorphism, the numbers of intracellular interferon γ CD4 and CD8,TLR2 expression in Dendritic cells, and NK cells. Patient then underwent openheart surgery. Thymectomy was done as indicated and CPB time was recorded.After surgery, patient was monitored for signs of sepsis and immune response waschecked.Results: Out of 108 patients involved in this study, 21.3% developedpostoperative sepsis. TLR2 Arg677Trp polymorphism was found in all patients,TLR2 N199N polymorphism was found in 92.6% of the patients, and TOLLIPrs5743867 polymorphism was found in 52.8% of the patients. TLR2 N199Npolymorphism and thymectomy were not included in multivariate analysis.TOLLIP rs5743867 polymorphism (p = 0.358) reduced the risk of sepsis, CPBtime ≥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 varyin each category, but were generally lower in patients who developedpostoperative sepsis.Conclusion: Cardiopulmonary bypass time and neonates significantly influencedthe risk and hazard of postoperative sepsis. Further investigation on the role ofTLR2 N199N and TOLLIP rs5743867 polymorphism are necessary to providemore comprehensive explanation on the development of postoperative sepsis andthe immune response after open heart surgery]"

"Latar belakang: Defek atrium septal atrium  (DSA) merupakan salah satu penyakit jantung bawaan (PJB) yang sering ditemukan dan 75% diantaranya adalah defek septal atrium sekundum (DSAS). Pasien DSAS akan mengalami hipertensi pulmonal (HP), yang jika defeknya tidak dikoreksi, kondisi ini berlanjut dan menimbulkan penyakit vaskular paru (PVP). Saat ini standar emas diagnosis PVP adalah pemeriksaan invasif katerisasi jantung kanan (KJK) yang mempunyai komplikasi pneumotoraks, aritmia, hematoma, dan episode hipotensi. Ekokardiografi merupakan modalitas yang murah, tersebar luas, dan mudah dikerjakan. Saat ini ekokardiografi dipakai sebagai alternatif noninvasif untuk menilai anatomi dan hemodinamik kardiovaskular pada pasien dengan kelainan jantung struktural. Berbagai studi mendapatkan karakteristik notch pada right ventricular outflow tract (RVOT) berkorelasi baik dengan tekanan rerata arteri pulmonal (TRAP) yang tinggi dan komplians vaskular paru (KVP) yang rendah pada berbagai jenis kategori HP dan kedua hal ini, terutama KVP berhubungan dengan diagnosis PVP. Oleh karena itu, perlu ada studi yang melihat salah satu parameter notch yang mudah didapatkan, yakni time-to-notch untuk mendiagnosis PVP pada pasien DSAS dengan HP.Tujuan: Mengetahui apakah time-to-notch RVOT dapat mendiagnosis PVP pada pasien DSAS dengan HP yang dibandingkan dengan KJK sebagai standar emas.Metode: Dengan consecutive sampling, dilakukan pemeriksaan time-to-notch dengan ekokardiografi transtorakal dalam jarak pemeriksaan 24 jam dengan KJK. Uji vasodilator oksigen (UVO) dilakukan jika hasil rasio resistensi vaskular paru dengan sistemik > 0,33. Diagnosis PVP ditegakkan jika hasil rasio resistensi akhir adalah > 0,33. Dilakukan uji diagnostik dengan cara perhitungan area di bawah kurva dan dihitung nilai sensitivitas, spesifisitas, nilai prediksi positif (NPP), nilai prediksi negatif (NPN), likelihood ratio (LR), serta analisis reliabilitas.Hasil: Terdapat 89 subyek yang dilakukan analisis dengan 54 subyek dilakukan UVO. Sebanyak 24 subyek didiagnosis PVP dengan KJK. Mayoritas subyek adalah perempuan (85%) dengan median usia 38 tahun. Didapatkan area di bawah kurva sebesar 0,923 untuk time-to-notch terhadap diagnosis PVP. Titik potong <147,5 ms memiliki tingkat sensitivitas 88%, spesifisitas 87%, NPP 72%, NPN 95%, LR (+) 7,11 dan LR (-) 0,14.Kesimpulan: Time-to-notch dapat mendeteksi PVP pada pasien DSAS dengan HP dengan validitas dan reliabilitas yang baik.

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Background: Atrium septal defect (ASD) is one of the congenital heart diseases (CHD) that often found and 75% of them are ostium secundum ASD (OSASD) type. OSASD patients will experience pulmonary hypertension (PH) and if the defect not corrected, this condition persists and causes pulmonary vascular disease (PVD). Gold standard of PVD is right heart catheterization (RHC). It is an invasive procedure which has complications such as pneumothorax, arrhythmia, hematoma, and hypotension. Echocardiography is a cheap modality, widely available, and good reproducibility. Echocardiography is currently used as a non-invasive alternative to assess cardiovascular anatomy and hemodynamics in patients with structural heart disorders. Various studies stated that notch characteristic on the right ventricular outflow tract (RVOT) correlated well with the mean pressure and compliance of the pulmonary artery in different types of PH categories. Pulmonary artery compliance especially, have good correlation to diagnose PVD. Therefore comparing time-to-notch, an easier notch parameter, with RHC in diagnosing PVD as the gold standard is needed.

Aim: To assess whether time-to-notch RVOT from transthoracic echocardiography (TTE) can diagnose PVD compared to RHC as the gold standard in OSASD with PH patients.

Method: With consecutive sampling, time-to-notch was examined by TTE within 24-hour from RHC. An Oxygen vasodilator test (OVT) was performed when ratio of resistance arterial pulmonary to systemic is > 0.33. PVD was diagnosed if the final resistance ratio is > 0.33. Diagnostic test was carried out to obtain area under curve (AUC). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratio (LR) were calculated and a reliability analysis were conducted.

Result: We analyzed 89 subjects and OVT was performed in 54 subjects. PVD was diagnosed by RHC in 24 subjects. The majority of subjects were women (85%) with a median age 38 years. AUC was 0.923 for time-to-notch to diagnose PVD. A cut-off point < 147.5 ms has a sensitivity level of 88%, specificity 87%, PPV 72%, NPV 95%, LR (+) 7.11 and LR (-) 0.14 with good realibility.

Conclusion: Time-to-notch has a good validity and reliability to detect PVD in OSASD with PH."

"Latar Belakang. Terapi pembedahan telah menjadi baku emas dalam penutupan defek septum atrium (DSA) sekundum. Prosedur pembedahan mempunyai morbiditas yang terkait dengan torakotomi, pintasan jantung paru, komplikasi prosedur, jaringan parut bekas operasi, dan trauma psikologis. Oleh karena itu, timbul usaha pendekatan transkateter untuk menutup DSA yang bersifat relatif kurang invasif, salah satunya dengan alat Amplatzer septal occluder (ASO). Tujuan. Mengetahui perbandingan hasil penutupan DSA sekundum, komplikasi prosedur, lama rawat di rumah sakit, dan total biaya prosedur antara prosedur transkateter menggunakan ASO dengan prosedur pembedahan. Metode. Penelitian bersifat retrospektif analitik dengan sumber data berupa rekam medis pasien anak dengan DSA sekundum yang datang berobat ke Pelayanan Jantung Terpadu Rumah Sakit dr. Cipto Mangunkusumo dan dilakukan penutupan defek dengan salah satu prosedur dalam periode Januari 2005-Desember 2011. Hasil. Sebanyak 112 kasus anak dengan DSA sekundum masuk dalam penelitian, terdiri dari 70 kasus dengan prosedur pembedahan dan 42 kasus dengan prosedur transkateter. Prosedur pembedahan dan prosedur transkateter mempunyai tingkat keberhasilan yang serupa (98,6% vs 95,2%, p=0,555). Namun prosedur pembedahan mempunyai komplikasi yang lebih banyak dibandingkan prosedur transkateter (60% vs 28,6%, p=0,001, OR 1,61;95%IK,1,19-2,18). Prosedur pembedahan juga mempunyai lama rawat di rumah sakit yang lebih panjang dibandingkan prosedur transkateter (6 hari vs 2 hari, p<0,0001), dan semua prosedur pembedahan membutuhkan perawatan di ruang rawat intensif. Secara keseluruhan prosedur transkateter mempunyai total biaya prosedur yang lebih tinggi dibandingkan prosedur pembedahan (Rp.52.731.680,06 vs Rp.46.994.745,26, p<0,0001), dan biaya pengadaan alat ASO mempunyai porsi sekitar 58% dari total biaya prosedur. Analisis total biaya prosedur tanpa memperhitungkan biaya alat ASO menunjukkan prosedur transkateter mempunyai total biaya yang lebih rendah dibandingkan prosedur pembedahan. Simpulan. Prosedur transkateter dengan ASO mempunyai efektivitas yang sama dengan prosedur pembedahan dalam penutupan DSA sekundum dan mempunyai komplikasi yang lebih sedikit serta lama rawat di rumah sakit yang lebih pendek. Total biaya prosedur transkateter dengan ASO masih lebih tinggi dibandingkan prosedur pembedahan.

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Background. Surgery has become standard therapy for secundum atrial septal defect (ASD) closure, but it has significant morbidity related to sternotomy, cardiopulmonary bypass, complication, residual scar, and trauma. Non-surgical and less invasive approaches with transcatheter device were developed to occlude ASD. Amplatzer septal occluder (ASO) is one of the commonly used devices in transcatheter closure.

Objectives. This study sought to compare efficacy, complication, length of hospital stay, and total cost of secundum ASD closure procedure between transcatheter closure using ASO with surgery.

Methods. A retrospective analysis was performed on children with secundum ASD admitted to Cardiology Center of Cipto Mangunkusumo Hospital from January 2005-December 2011. The patients received transcatheter closure with ASO or surgical closure. Data were obtained from medical record.

Results. A total of 112 secundum ASD cases were included in study, consisted of 42 cases underwent transcatheter closure and 70 cases underwent surgical closure. The efficacy of both procedur were not statistically different (98.6% vs 95.2%, p=0.555). However, surgery procedure had more complication than transcatheter closure (60% vs 28.6%, p=0.001, OR 1.61;95%CI 1.19 to 2.18). Hospital stay were also significantly longer for surgery procedure than transcatheter closure (6 days vs 2 days, p<0.0001), and all surgical subjects requiring intensive care. Transcatheter closure had mean total cost Rp.52,731,680.06 as compared with Rp.46,994,745.26 for surgery procedure (p<0.0001), and cost of ASO represents 58% of the total cost of transcatheter closure. Mean total cost of transcatheter closure without including cost of device is less costly than surgery procedure.

Conclusion. Transcatheter closure using ASO had similar efficacy with surgical closure, complication rate was lower, and the length of hospital stay was shorter. However, transcatheter closure costs were higher compared with surgery procedure."

"Tetralogi Fallot (TF) merupakan penyakit jantung bawaan (PJB) sianotik terbanyak. Terapi definitifnya berupa koreksi total melalui operasi jantung terbuka, namun usia terbaik koreksi masih menjadi perdebatan. Operasi saat usia < 3 tahun disebut koreksi dini. Angka kesintasan jangka panjang pasien TF pasca-operasi mencapai 90%. Masalah baru yang muncul adalah gangguan neurodevelopmental yang dapat mempengaruhi kualitas hidup pasien.Tujuan: Mengetahui sebaran pasien TF pasca-operasi jantung terbuka, serta membandingkan perkembangan, kognitif dan kualitas hidup pasien TF pasca-operasi jantung terbuka yang menjalani koreksi dini dibandingkan koreksi terlambat.Metode: 29 subjek kelompok koreksi dini dan 34 subjek kelompok koreksi terlambat dipilih secara konsekutif. Penilaian perkembangan menggunakan Denver II. Tingkat kognitif dinilai dengan the Capute scales dan uji intelegensi Wechsler. Kualitas hidup dinilai dengan laporan PedsQLTM. Perbedaan antar kedua kelompok subjek dianalisis dengan menggunakan uji Kai kuadrat, uji Fischer, dan uji t tidak berpasangan.Hasil: Median usia operasi kelompok koreksi dini adalah 1,8 tahun dan kelompok koreksi terlambat adalah 5,3 tahun. Sebesar 54% subjek menjalani koreksi terlambat. Mikrosefal terjadi pada 15% keseluruhan subjek. Pada kedua kelompok subjek ditemukan masalah perkembangan. Sebesar 75% subjek kelompok koreksi dini memiliki developmental quotient normal. Kelompok koreksi dini memiliki nilai verbal intelligence quotient (IQ) (p 0,002; IK 95% 5,8-24,6) dan full-scale IQ (p0,003; IK 95% 4,7-21,3) yang lebih tinggi dibandingkan kelompok koreksi terlambat. Laporan PedsQLTM anak menunjukkan rendahnya kualitas hidup pada fungsi emosi (p=0,02) dan sekolah (p=0,03) pada kelompok koreksi terlambat.Simpulan: Pasien TF yang menjalani koreksi dini memiliki dan kualitas hidup yang lebih tinggi dibandingkan kelompok koreksi terlambat, sehingga diperlukan sosialisasi usia operasi koreksi dini.

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Background: Tetralogy of Fallot (TF) is the most common cyanotic congenital heart disease. The definitive treatment is complete repair thru open heart surgery. At present, the most effective age category for repair is still being debated. Complete repair for children who are younger than 3 years is called early repair. Recent technological advancement has allowed the early repair to be performed earlier and improve the survival rate of the patients. However, these survivors risk having neurodevelopmental disorder which affect their health-related quality of life.

Objective: To describe the characteristics of post open heart surgery TF patients and compare the TF patients who undergo early correction to ones who undergo late correction within the aspects of development, cognitive outcomes, and health-related quality of life.

Design : Twenty nine subjects from early correction group and 34 subjects from late correction group were compared in development (Denver development screening II), cognitive outcomes (The Capute scales and Wechsler test), and health-related quality of life (PedsQLTM).

Result : Median age of the subjects in early correction group is 1,8 years and in late correction group is 5,3 years. Fifty five percent undergo late correction. The prevalence of microcephaly is 15%. Developmental delay is found in both group. Seventy five percent of subject who undergo early correction have normal developmental quotient. Early correction group have higher verbal intelligence quotient (IQ) (p=0.002; CI 95% 5.8-24.6) and full scale IQ (p=0.003; CI 95% 4.7-21.3). Child report PedsQLTM showed lower quality of life in late correction group.

Conclusions : Tetralogy of Fallot patients who undergo early correction have higher IQ and better health-related quality of life compared to late correction group. The age of early complete repair (< 3 years) needs to be disseminated."