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"Latar Belakang: Terdapat perdebatan mengenai strategi operasi modified Fontan/TCPC pada PJB univentrikel yaitu pendekatan primer atau bertahap pada pasien yang memenuhi kriteria operasi untuk memperoleh luaran pascaoperasi yang paling baik.Tujuan: Tinjauan sistematik ini disusun untuk membuktikan bahwa operasi modified Fontan secara bertahap pada pasien PJB dengan fisiologi jantung univentrikel dan memenuhi kriteria operasi memberikan luaran pascaoperasi yang lebih baik dibandingkan secara primer.Metode: Penelitian ini dilakukan dengan menerapkan protokol PRISMA-P. Identifikasi terhadap penelitian yang relevan terhadap tujuan studi dilakukan melalui pencarian literatur pada Cochrane Library, PubMed, dan CINAHL (EBSCO) database. Setiap penelitian dinilai sesuai dengan tingkat bukti klinis sesuai dengan kriteria National Health and Medical Research Council (NHMRC).Hasil: Tiga puluh artikel diikutsertakan dalam tinjauan sistematik ini. Morfologi ventrikel yang dilaporkan dari kelainan jantung univentrikel menunjukkan proporsi malformasi yang lebih besar dengan ventrikel sistemik kiri di sebagian besar studi yang disertakan. Data hemodinamik yang dilaporkan sebelum operasi Fontan menunjukkan distribusi yang hampir sama pada rerata tekanan arteri pulmonal (mean pulmonary arteriolar pressure, mPAP), tekanan diastolik akhir ventrikel sistemik (systemic ventricular end-diastolic pressure, EDPSV), dan tekanan transpulmonal (transpulmonary pressure gradient, TPG). Pendekatan operasi primer telah banyak ditinggalkan. Dijumpai mortalitas yang lebih tinggi pada pasien yang menjalani operasi primer dengan kesintasan jangka panjang yang cukup sebanding. Tromboemboli lebih sering terjadi pada strategi operasi primer dengan insiden sebanyak 5,6% vs. 4,8% dibandingkan dengan operasi secara bertahapSimpulan: Prosedur modified Fontan secara bertahap memberikan luaran pascaoperasi yang lebih baik dibanding dengan pendekatan primer

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Background: Definitive palliation for univentricular heart usually involves different modifications of Fontan surgery / total cavopulmonary connection (TCPC). However, whether it should be done as a primary or staged procedure with an initial bidirectional Glenn shunt remains an area of debate.

Objective: This systematic review has been undertaken to prove that staged TCPC in Fontan candidates delivers better post-surgical results than the primary approach.

Method: This study was carried out according to the PRISMA-P protocol. Systematic searches identified studies in the Cochrane Library, PubMed, and CINAHL (EBSCO) database. According to the National Health and Medical Research Council (NHMRC) guideline, each study was critically appraised.

Results: A total of 30 studies were included in this systematic review. In most of the included studies, the reported ventricular morphology of univentricular heart defects showed a more significant proportion of the left systemic ventricle malformations. The hemodynamic data before Fontan surgery showed almost the same distribution of mean pulmonary arteriolar pressure (mPAP), systemic ventricular end-diastolic pressure (EDPSV), and transpulmonary pressure gradient (TPG). The primary surgical approach has mostly been abandoned because of its higher mortality rate than staged surgery. Long term survival has been comparable in both strategies. Thromboembolism was more common in the primary approach than in the staged surgery, with an incidence of 5.6% vs. 4.8%, respectively.

Conclusion: Staged modified Fontan procedure results in better post-surgical outcomes than the primary approach."

"Pada pasien dengan penyakit jantung terutama pada pasien pasca Intervensi Koroner Perkutan (IKP) penting dilakukan perawatan lanjutan yaitu rehabilitasi jantung. Data menunjukkan bahwa jumlah partisipasi pada rehabilitasi jantung menurun, terutama pada fase II. Padahal banyak manfaat yang didapatkan dari mengikuti rehabilitasi jantung salah satunya adalah mengurangi tingkat mortalitas dan meningkatkan kesehatan jantung. Tujuan dari Penelitian ini adalah untuk mengidentifikasi faktor-faktor yang berpengaruh terhadap partisipasi rehabilitasi jantung fase II pada pasien pasca Intervensi Koroner Perkutan (IKP). Desain penelitian menggunakan cross sectional study. Sampel dalam penelitian ini berjumlah 84 responden yang telah melakukan IKP dan sudah mengikuti rehabilitasi jantung Fase I. Teknik pengambilan sampel menggunakan metode consecutive sampling. Hasil penelitian menunjukkan bahwa partisipasi rehabilitasi jantung fase II dipengaruhi oleh usia, tingkat pendidikan, riwayat merokok, efikasi diri, dan dukungan keluarga dengan efikasi diri menjadi faktor dominan. Penelitian ini merekomendasikan untuk dilakukan pengkajian keperawatan untuk mengetahui faktor-faktor yang berpengaruh terhadap rehabilitasi jantung fase II dan melakukan edukasi serta memberi pilihan untuk melakukan rehabilitasi jantung di rumah.

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Cardiac Rehabilitation was important for patient with cardiac disease especially patient post Percutaneous Coronary Intervention. Data shows that participation of cardiac rehabilitation in Phase II was decreasing, whereas a lot of benefit from cardiac rehabilitation, including decrease mortality rate and increase the cardiac health. Aim of this study was to identify factors that Affecting Participation of Cardiac Rehabilitation phase II at Patient Post Percutaneous Coronary Intervention. The research configuration utilized a cross sectional review. The example in this study added up to 84 individuals who had percutaneous coronary intervention and already participate in cardiac rehabilitation phase I. Result shows that participation of cardiac rehabilitation phase II was affected by age, education level, smoking history, self efficacy and family support. The dominant factor was self efficacy. This research recommend to do nursing assesment to know the factors that affecting participation of cardiac rehabilitation phase II and made health education for patient and give them choises to do cardiac rehabilitation at home."

"Latar Belakang. Depresi pasca SKA memiliki prevalensi sebesar 20-37 , yaitu sekitar tiga kali lipat lebih tinggi dibandingkan pada populasi umum. Pasien pasca SKA yang mengalami depresi dalam waktu 2 tahun pertama memiliki risiko mortalitas sebesar 2.5 kali lipat lebih tinggi dibandingkan dengan pasien yang tidak mengalami depresi. Meskipun prevalensinya cukup tinggi, namun kondisi ini seringkali tidak terdeteksi sehingga sulit untuk ditatalaksana. Kuesioner CDS telah terbukti andal dan sahih untuk mendeteksi depresi pasca SKA di beberapa negara, namun belum ada penelitian yang menguji keandalan dan kesahihan kuesioner tersebut di Indonesia. Penelitian ini bertujuan untuk menguji keandalan dan kesahihan kuesioner CDS berbahasa Indonesia sebagai alat ukur untuk mendeteksi depresi pasca SKA di Indonesia. Metode. Penelitian ini merupakan studi potong lintang yang dilakukan dalam dua tahap, yaitu tahap adaptasi lintas bahasa dan budaya serta tahap uji keandalan dan kesahihan. Subjek penelitian terdiri atas pasien rawat jalan pasca SKA yang berobat di Polikilinik Kardiologi PJT RSCM pada bulan Juli-September 2017. Uji keandalan dilakukan dengan menilai Intraclass Correlation Coefficient ICC melalui metode test-retest dan menilai Cronbach-alpha untuk mengetahui konsistensi internal. Uji kesahihan dilakukan dengan menilai kesahihan konstruksi melalui multitrait multimethod analysis dan kesahihan eksternal dengan cara membandingkan CDS dengan kuesioner BDI-II sebagai alat ukur standar untuk menilai depresi. Hasil. Penelitian ini diikuti oleh 56 subjek dengan rerata usia 58.39 8.38 tahun. Sebagian besar subjek berjenis kelamin laki-laki 64.3 dan sudah menikah 80.4 . Uji keandalan memberikan hasil yang baik, terbukti dengan nilai ICC r 0.944; p

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Background. Prevalence of post Acute Coronary Syndrome ACS depression reached 20 37 which is three times higher than in general population. Depressed post ACS patients have 2.5 times higher risk of mortality within 2 years after ACS compared with non depressed patients. Despite the high prevalence, this condition often go unrecognized and untreated. Cardiac Depression Scale CDS has been demonstrated to be valid and reliable in detecting post ACS depression in other countries. However it has not been validated in Indonesian population. This study was designed to evaluate the validity and reliability of Indonesian version CDS as a screening tool for post ACS depression in Indonesia. Method. A cross sectional study was conducted in two phases a the language and cultural adaptation phase and b the validity and reliability test. The study participants were recruited from post ACS outpatients attending Cardiology Clinic in PJT RSCM between July September 2017. Reliability of the CDS was evaluated by calculating Intraclass Correlation Coefficient ICC using test retest method and by calculating Cronbach alpha to determine internal consistency.Validity of the CDS was evaluated by examining construct validity using multitrait multimethod analysis and by comparing CDS with BDI II as gold standard measurement to determine external validity. Result. Fifty six patients were included in this study. The mean age was 58.39 8.38 years. Of these patients, 64.3 were male and 80.4 were married. Indonesian CDS demonstrated good result for test retest reliability r 0.944 p"

"Cardiac arrhythmias are a major cause of death (7 million cases annually worldwide; 400,000 in the U.S. alone) and disability. Yet, a noninvasive imaging modality to identify patients at risk, provide accurate diagnosis and guide therapy is not yet available in clinical practice. Nevertheless, there are various applications of electrophysiologic imaging in humans from ECG/CT reconstructions, MRI to tissue Doppler investigations that provide supplimentary diagnostic data to the cardiologist. EP laboratories are experiencing an increase in volume, for both diagnostic and interventional electrophysiology studies, including mapping, ablation, and pacemaker implants. The equipment requirements for these procedures are stringent, include positioning capabilities, and dose management. This book is designed to review all of the current imaging methodologies that assist in diagnosis within the electrophysiology department."

"ABSTRAKLatar belakang: Kardioplegia merupakan komponen penting dalam proteksi miokard operasi jantung. Meskipun telah banyak penelitian yang mencoba membuktikan keunggulan kardioplegia darah dibanding kardioplegia kristaloid, namun kesepakatan kardioplegia terbaik untuk operasi jantung bawaan asianotik belum tercapai. Metode: Penelitian eksperimental dengan simple randomization pada 54 populasi pasien VSD, AVSD dan gangguan katup mitral yang dibagi menjadi dua kelompok, yaitu 24 pasien kelompok crystalloid cardioplegia CC sebagai kontrol, dan 30 pasien kelompok blood cardioplegia BC . Dilakukan pemeriksaan selisih kadar laktat darah arteri dan sinus koronarius, serta ekstraksi oksigen koroner segera, menit ke-15 dan menit ke-30 setelah CPB dihentikan. Dilakukan observasi terhadap durasi ventilasi mekanik, penggunaan inotropik, aritmia jantung, lama rawat icu dan lama rawat rumah sakit. Hasil: Selisih kadar laktat darah dan ekstraksi oksigen koroner tidak berbeda bermakna p>0,05 . Pada pasien tutup VSD, penggunaan intoropik lebih sedikit pada kelompok BC. Pasien tanpa inotropik kelompok BC dan CC yaitu 9/25 dan 2/22, 1 jenis inotropik 12/25 dan 13/22, dan lebih dari satu jenis inotropik 4/25 dan 7/22

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ABSTRACTBackgrounds Cardioplegia is an important myocardial protection in cardiac surgery. Many studies conducted to prove blood cardioplegia rsquo s superiority to crystalloid cardioplegia, but no agreement established for which cardioplegia is the best for acyanotic cardiac surgery. Methods Experimental study with simple randomization in 54 VSD, AVSD, and mitral valve disease patients, 24 crystalloid cardioplegia CC , and 30 blood cardioplegia BC . Lactate levels in arterial blood and coronary sinus, also coronary oxygen extractions were measured immediate, 15 and 30 minutes after CPB deactivated. Postoperative mechanical ventilation durations, inotropic administrations, arrhytmias, ICU and hospital length of stay were observed. Results No significant difference in the difference of lactate levels and coronary oxygen extractions immediate, 15 and 30 minutes after CPB P 0.05 . Less inotropics needed in VSD closure patients in BC group. No inotropic needed in 9 25 BC group to 2 22 in CC group, 1 inotropic needed in 12 25 BC group to 13 22 in CC group, and more than 1 intropic needed in 4 25 BC group to 7 22 in CC group p"

"ABSTRAKStroke iskemik merupakan salah satu komplikasi penting dan berdampak negatif pada operasi jantung yang menggunakan MPJP. Faktor intraoperatif dianggap berpengaruh terhadap kejadian stroke iskemik diantaranya mean arterial pressure (MAP), kecepatan rewarm, kadar glukosa darah, durasi bypass, durasi klem silang aorta, hemoglobin dan hematokrit. Penelitian ini merupakan studi analitik retrospektif dengan disain kasus-kontrol. Subjek dengan komplikasi stroke pascaoperasi jantung dengan MPJP selama periode januari 2016 sampai desember 2018 sebagai kelompok kasus dan pasien tanpa stroke iskemik pada periode yang sama sebagai kontrol. Jenis kelamin, usia, diabetes melitus dan hipertensi tidak memiliki perbedaan yang bermakna antara kelompok kasus dan kontrol (p >0,05). Hematokrit (p = 0,015, OR 0,939 [0,885-0,996]) dan durasi bypass (p = 0,027, OR 1,011 [1,001-1,021]) merupakan faktor intraoperatif yang berpengaruh terhadap kejadian stroke pascaoperasi. Prosedur operasi katup (p = 0,024, OR 3,127 [1,161-8,427]) dan aorta (p = 0,038, OR 3,398 [1,070-10,786]) memiliki hubungan yang bermakna dengan kejadian stroke pascaoperasi. Disimpulkan bahwa faktor intraoperatif yang memengaruhi kejadian stroke iskemik pascaoperasi jantung dewasa yang menggunakan MPJP di RSJPDHK adalah durasi bypass dan nilai hematokrit. Prosedur operasi aorta dan katup memiliki risiko lebih tinggi terhadap kejadian stroke dibandingkan prosedur operasi jantung lain.

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ABSTRACTIschemic stroke is one of the important complications and has a negative impact on cardiac surgery with cardiopulmonary bypass. Intraoperative factors were considered to have an effect on ischemic stroke events including mean arterial pressure (MAP), rewarm speed, blood glucose levels, bypass duration, aortic cross clamp duration, hemoglobin and hematocrit. The study was a retrospective analytic study with case-control design. Subjects with stroke complications following cardiac surgery with cardiopulmonary bypass during January 2016 to December 2018 as a case group and patients without stroke in the same period as controls. Gender, age, diabetes mellitus and hypertension did not have a significant difference between the case and control groups (p> 0.05). Hematocrit (p = 0.015, OR 0.939 [0.885-0.996]) and bypass duration (p = 0.027, OR 1.011 [1,001-1,021]) were an intraoperative factors that influences the incidence of postoperative stroke. Valve surgery (p = 0.024, OR 3.127 [1,161-8,427]) and aorta (p = 0.038, OR 3.398 [1,070-10,786]) had a significant association with postoperative stroke. It was concluded that intraoperative factors affecting the incidence of postoperative cardiac ischemic stroke using cardiopulmonary bypass in RSJPDHK were duration of bypass and hematocrit. Aortic and valve surgery procedures have a higher risk of stroke than other cardiac surgery procedures."

"Latar belakang: Operasi jantung membutuhkan larutan kardioplegia untuk menghentikan jantung. Saat ini sebagian besar larutan kardioplegia menggunakan mekanisme depolarisasi membran yang berisiko menyebabkan gangguan keseimbangan ion transmembran, aritmia, vasokonstriksi koroner, gangguan kontraktilitas, dan sindrom curah jantung rendah. Menunjukkan proteksi miokardium masih belum optimal. Henti jantung melalui polarisasi membran secara teori dapat memberikan proteksi miokardium yang lebih baik.Tujuan: Diketahui kualitas proteksi miokardium henti jantung terpolarisasi dibandingkan dengan henti jantung terdepolarisasi.Metode: Tinjauan sistematik dengan menerapkan protokol PRISMA-P. Data didapatkan melalui pencarian dalam basis data Cochrane Library, PubMed, Scopus, ScienceDirect, dan Embase.Hasil: Dari penelusuran diperoleh empat studi yang memenuhi kriteria. Tiga studi dengan desain uji acak terkontrol, satu studi dengan desain kohort retrospektif. Jumlah sampel bervariasi dari 60 sampai 1000 subjek. Kualitas proteksi miokardium dinilai dari kejadian aritmia pascaoperasi, infark miokardium pascaoperasi, dan sindrom curah jantung rendah pascaoperasi. Satu studi melaporkan angka kejadian aritmia pascaoperasi yang lebih rendah secara bermakna pada kelompok henti jantung terpolarisasi (p 0,010). Tidak ada perbedaan yang bermakna pada kejadian infark miokardium pascaoperasi. Tiga studi melaporkan angka kejadian sindrom curah jantung rendah pascaoperasi yang lebih rendah pada kelompok henti jantung terpolarisasi namun tidak bermakna secara statistik.Kesimpulan: Henti jantung terpolarisasi berpotensi memberikan kualitas proteksi miokardium yang lebih baik dibandingkan dengan henti jantung terdepolarisasi.

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Background: Cardioplegia is needed in cardiac surgery to arrest the heart to achieve a quiet and bloodless field. Depolarized cardiac arrest is widely used despite the risk of ionic imbalances, arrhythmias, coronary vasoconstriction, contractility dysfunction, and low cardiac output syndrome leading to suboptimal myocardial protection. Polarized cardiac arrest has a more physiological mechanism to arrest the heart, thus giving better cardioprotection qualities.

Objective: To assess the myocardial protection quality of polarized cardiac arrest compared with depolarized cardiac arrest.

Method: Systematic review with PRISMA-P protocol. The literature search was performed using Cochrane Library, PubMed, Scopus, ScienceDirect, and Embase databases.

Result: Three randomized controlled trials and one retrospective cohort study were identified, with sample sizes varied between 60 to 1000 subjects. The quality of myocardial protection was assessed from postoperative arrhythmias, postoperative myocardial infarction, and postoperative low cardiac output syndrome. One study reported significantly lower postoperative arrhythmias in the polarized arrest group (p 0.010). There were no differences in postoperative myocardial infarction between the two intervention groups. Three studies reported lower postoperative low cardiac output syndrome in the polarized arrest group although not statistically significant.

Conclusion: Polarized cardiac arrest may give better myocardial protection than depolarized cardiac arrest."

"Redo cardiac surgeries are challenging cases with a myriad of influential factors, ranging from the patient's pathology to the whimsy of the previous surgeon. Redo Cardiac Surgery in Adults, 2nd Edition clearly outlines practical approaches, surgical techniques, and management of associated conditions such as perioperative stroke and acute kidney function. It covers the spectrum of redo cardiac operations, including coronary artery bypass, mitral valve repair, reoperation for prosthetic mitral valve endocarditis, aortic arch reoperation, descending and thoracoabdominal aortic reoperation, and reoperations following endovascular aortic repair. All redo cardiac surgeries present a complex array of challenges beyond what the original procedure demands. "