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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."

"[Latar Belakang : Iskemia yang terjadi pada lokasi di tubuh mengakibatkan cedera otot reversible sampai ireversibel. Tindakan reperfusi ternyata dapat memperburuk keadaan yang disebabkan oleh kondisi iskemik. Beberapa penelitian terdahulu mencoba mencari teknik proteksi untuk mengurangi efek iskemik reperfusi diantaranya teknik iskemik prekondisi dan teknik hipotermi.Metode : Dilakukan penelitian eksperimental pada kelinci New Zealand White (n=18) dengan satu kelompok kontrol (iskemia) dan dua kelompok perlakuan (preconditioning dan hipotermia). Dilakukan ligasi a. iliaka komunis selama 4 jam, hipotermia sedang (28oC), dan iskemik prekondisi pada masing-masing kelompok. Kemudian kelinci dibiarkan hidup selama 8 jam. Sampel jaringan otot femoralis di ambil untuk pemeriksaan derajat kerusakan otot secara histopatologi.Hasil : Terdapat penurunan secara histopatologi derajat kerusakan otot yang di berikan perlakuan IPC dan perlakuan Hipotermi terhadap kelompok control. Analisis statistik tampak perbedaan bermakna pada sebagian parameter.Kesimpulan : Iskemik Prekondisi dan Hipotermi memberikan efek protektif pada otot dari akibat iskemik reperfusi tungkai bawah akut.;Introduction.Ischemia in certain location in the body could give muscle injury with certain severity from reversible to irreversible. Reperfusion turns out to give more injury than ischemic alone. Previous research try to find the best protective technic to reduce I/R injury including ischemic precondition and hypothermia technic.Method. This prospective, randomized, controlled, experimental animal study was performed in a university-based animal research facility with 18 New Zealand White Rabbit. The rabbits were randomized (n=6 per group) into three groups: I/R group (4 hours of hind limb ischemia and 8 hours of reperfusion), IPC group (three cycles of 5 minutes of ischemia/5 minutes of reperfusion immediately preceding I/R), and hypothermia ( 28oC) together with 4 hours of hind limb ischemia and 8 hours of reperfusion. Muscle tissue were examined based for their histopathological changes.Result.The histopathologic muscle damage score is decreased both in ischemic precondition group and hypothermia group.Although both groups show improvement in histological finding, this finding was statistically significant in few parametersConclusion. Ischemic preconditioning and hypothermia have shown protective effect for muscle from ischemic reperfusion injury induced by lower limb ischemia., Introduction.Ischemia in certain location in the body could give muscle injury with certain severity from reversible to irreversible. Reperfusion turns out to give more injury than ischemic alone. Previous research try to find the best protective technic to reduce I/R injury including ischemic precondition and hypothermia technic.Method. This prospective, randomized, controlled, experimental animal study was performed in a university-based animal research facility with 18 New Zealand White Rabbit. The rabbits were randomized (n=6 per group) into three groups: I/R group (4 hours of hind limb ischemia and 8 hours of reperfusion), IPC group (three cycles of 5 minutes of ischemia/5 minutes of reperfusion immediately preceding I/R), and hypothermia ( 28oC) together with 4 hours of hind limb ischemia and 8 hours of reperfusion. Muscle tissue were examined based for their histopathological changes.Result.The histopathologic muscle damage score is decreased both in ischemic precondition group and hypothermia group.Although both groups show improvement in histological finding, this finding was statistically significant in few parametersConclusion. Ischemic preconditioning and hypothermia have shown protective effect for muscle from ischemic reperfusion injury induced by lower limb ischemia.]"

"PendahuluanKeputusan untuk melakukan ligasi Patent Ductus Arteriosus pada saat operasi modifikasi pintas Blalock Taussig pada pasien neonatus dengan duct dependent masih diperdebatkan. Tujuan penelitian ini adalah mencari hubungan antara melakukan ligasi patent ductus arteriosus durante operasi modifikasi pintas Blalock Taussig dengan luaran klinis pada pasien neonatus dengan duct dependent.MetodePenelitian retrospektif ini mencakup neonatus dengan duct dependent yang menjalani operasi modifikasi pintas Blalock Taussig di Pusat Jantung Nasional Harapan Kita antara Januari 2009 sampai Desember 2014. Lama rawat, lama penggunaan ventilator, skor inotropik, kejadian low cardiac output syndrome, kejadian resusitasi, reintervensi dan mortalitas pasca operasi menjadi luaran klinis yang diteliti.HasilTujuh puluh enam neonatus (usia rata rata 11 ± 5,5 hari) menjalani operasi modifikasi pintas Blalock Taussig. Tindakan ligasi patent ductus arteriosus dilakukan pada 31 pasien. Pada kelompok pasien yang dilakukan ligasi patent ductus arteriosus ditemukan angka kejadian low cardiac output syndrome lebih tinggi (32,2 % versus 13,3%, p = 0,047) dan skor inotropik yang lebih tinggi (median 10,1 versus 7,9; p = 0,049). Tidak ada perbedaan yang signifikan antara lama rawat, lama penggunaan ventilator, kejadian resusitasi, kejadian reintervensi dan mortalitas antara kedua kelompok.KesimpulanPada neonatus dengan duct dependent, ligasi PDA durante operasi modifikasi pintas Blalock Taussig berkaitan dengan peningkatan angka kejadian low cardiac output syndrome dan skor inotropik pada periode pasca operasi.

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ObjectiveThe question of whether to ligate the patent ductus arteriosus when performing modified Blalock-Taussig shunt surgery in neonates is still a controversy. The aim of this report was to compare the results of ligate versus non ligate of the patent ductus arteriosus during modified Blalock Taussig shunt surgery in neonates with duct dependent.Patient and methodsThis retrospective study included neonates with duct dependent diagnosis who underwent modified Blalock Taussig shunt surgery at Harapan Kita National Cardiovascular Center from January 2009 to December 2014. Hospital stay, intubation time, inotropic score, low cardiac output syndrome event, resuscitation event, reintervention event, and mortality postoperative were studied as clinical outcomes.ResultsSeventy-six neonates (mean age 11 ± 5.5 days) underwent a modified Blalock Taussig procedure. The arterial duct was ligated in 31 patients. Compared with patients in whom the patent ductus arteriosus was left open, patients with a surgically closed arterial duct had a higher incidence of low cardiac output syndrome (32.2 % versus 13.3%, p = 0,047) and higher inotropic score (median 10.1 versus 7.9; p = 0.049). There were no significant difference between length of hospital stay, time to extubation, resuscitation event, reintervention event and mortality between the two groups.ConclusionsIn newborns with duct dependent, ductal ligation during Modified Blalock Taussig shunt procedure is associated with increased incidence of low cardiac output syndrome events and higher inotropic score during the postoperative period."

"Latar Belakang : Analgesia efektif dapat mengurangi morbiditas, mempercepat pemulihan, meningkatkan kondisi pasien dan mengurangi biaya rumah sakit. Teknik blok epidural sering digunakan untuk tatalaksana nyeri pascatorakotomi,namun beberapa keterbatasan ditimbulkan pada teknik ini. Teknik blok Paravertebral (PVB) dapat digunakan sebagai alternatif tatalaksana nyeri,pemasangan intraoperatif oleh dokter bedah Toraks Kardio Vaskular.Metode : Penelitian eksperimental, consecutive sampling, 22 subjek, dilakukan torakotomi posterolateral elektif, di Rumah Sakit Umum Pusat Persahabatan Jakarta. Subjek dibagi menjadi kelompok 1 (PVB) dan kelompok 2 (epidural). Diberikan regimen anestesi blok yang sama di kedua kelompok. Skor nyeri VAS diukur saat pasien telah di ekstubasi, pada jam ke-24, 36, dan 48. Dilakukan pengukuran terhadap waktu mobilisasi duduk, komplikasi dan analgetik tambahan.Hasil : Blok Paravertebral memberikan hasil lebih baik pada penilaian VAS jam ke-24 (p=0,029). Pada penilaian VAS jam ke-36 dan 48, tidak ada perbedaan signifikan dikedua kelompok. Pada pengamatan waktu mobilisasi didapakan kelompok1 lebih cepat mobilisasi (p=0,038). Pada pengamatan terhadap komplikasi dan penambahan analgetik tidak didapatkan perbedaan bermakna.Kesimpulan : Teknik blok Paravertebral dengan kateter yang dipasang oleh dokter BTKV dapat digunakan dengan beberapa keuntungan untuk manajemen tatalaksana nyeri pada pasien pascatorakotomi.

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Background : Analgesia can effectively reduce morbidity, recovery, emprove condition and reduce hospital cost. Epidural block is often used for pain treatment post thoracotomy, however, some limitation posed on this technique. Paravertebral block (PVB) can be used as an alternative to the treatment of pain, instalation intraoperatively by Cardio Vascular Thoracic Surgeon.Method : Experimental research, consecutive sampling, 22 subjects, performed elective posterolateral thoracotomy, in General Hospital Persahabatan Jakarta. Subjects were divided into group 1 (PVB) and group 2 (epidural). Given same regimen block anesthesia in both groups. VAS pain scores measured when the patient has extubated, at 24 hr, 36, and 48. Do measures of mobilization time sitting, complication and additional analgeticsResults : PVB provides better result in VAS assessment 24 hr (p=0,029). On VAS assessment 36 hr and 48 h, there was no significant difference in both groups. Group 1 found faster mobilization (p=0,038). In observation of complications and additional analgetic not found significant differencesConclusion : PVB with catheter, placed by surgeon can be used with multiple advantages for pain management in post thoraotomy."

"[Latar Belakang: Iskemia dan cedera reperfusi pada tungkai dapat berdampak sistemik sampai kegagalan fungsi organ. Beberapa penelitian telah dilakukan untuk mencegah komplikasi jauh atau remote dari cedera reperfusi, namun hal ini masih banyak diperdebatkan. Penelitian ini dilakukan untuk melihat perbedaan kerusakan tubulus ginjal pada iskemia tungka bawahi akut yang tanpa perlakuan, perlakuan prekondisi iskemik dan perlakuan hipotermia Penelitian ini merupakan Metode: Penelitian eksperimental yang dilakukan pada 18 ekor kelinci New Zealand White, dengan ligasi arteri iliaka komunis kanan selama 4 jam dan reperfusi selama 8 jam, dibagi menjadi 3 kelompok: kelompok 1, tanpa perlakuan sebagai kontrol; kelompok 2, diberikan perlakuan prekondisi iskemik sebelum tindakan iskemik: dan kelompok 3; diberikan perlakuan hipotermia pada tungkai kanan selama iskemia. Setelah euthanasia, diambil sampel ginjal untuk pemeriksaan histopatologi.Hasil: Perbandingan kerusakan tubulus ginjal antara kelompok iskemia saja dengan kelompok perlakuan prekondisi iskemik tidak menunjukkan perbedaaan yang bermakna (p= 0.092), sedangkan perbandingan antara kelompok iskemia saja dengan kelompok perlakuan hipotermia menunjukkan hasil perbedaan yang bermakna (p = 0.033).Kesimpulan: Perlakuan hipotermia dapat mengurangi kerusakan tubulus ginjal akibat cedera remote reperfusi iskemia tungkai bawah akut., Background: Ischemia and reperfusion injury of the lower limb may cause a systemic effect to multi-organ failure. Several studies have been done to prevent distant or remote complication from reperfusion injury, but it is still in debate. This study was conducted to see the differences in renal tubular damage in acute limb ischemia without treatment, treatment of ischemic precondition and treatment of hypothermia.Methods: An experimental study in 18 New Zealand White rabbits, who performed right common iliac artery ligation for 4 hours and reperfusion during 8 hours, divided into 3 groups: group 1, no treatment as a control; group 2, given the treatment of ischemic precondition before ischemic action: and group 3; given the treatment of hypothermia on the right leg during ischemia. After euthanasia, kidney samples were taken for histopathological examination.Results: Comparison of renal tubular damage among any group of ischemia with ischemic preconditioning treatment group showed no significant difference (p = 0.092), whereas the comparison between groups ischemia alone with hypothermia treatment group showed a significant difference (p = 0.033).Conclusion: Treatment of hypothermia may reduce renal tubular damage due to remote reperfusion injury in acute limb ischemia.]"

"Cedera iskemik reperfusi merupakan suatu kondisi yg sering dijumpai, dan dapat menyebabkan gangguan secara sitemik pada organ tubuh. Antara lain dapat menyebabkan kerusakan ke jaringan hepar secara remote.Tujuan: Mengetahui manfaat perlakuan prekondisi iskemik dan hipotermia pada cedera iskemik reperfusi tungkai bawah guna mencegah terjadinya kerusakan pada jaringan hepar.Metode. Dilakukan penelitian eksperimental pada kelinci New Zealand White (n=18) dengan satu kelompok kontrol (iskemia) dan dua kelompok perlakuan (hipotermia dan prekondisi iskemik). Dilakukan ligasi a. iliaca communis selama 4 jam, hipotermia (28oC), dan prekondisi iskemia pada masing-masing kelompok. Kemudian ligasi dilepas untuk reperfusi selama 8 jam. Lalu kelinci di euthanasia, jaringan hepar diambil untuk pemeriksaan histopatologi (Skoring penelitian).Hasil: Terdapat kerusakan jaringan hepar yang dinilai secara histopatologi sebagai efek cedera iskemik reperfusi jauh yang di akibatkan oleh iskemik tungkai akut pada hewan coba kelinci. Dengan melakukan skoring terhadap sel hepatosit, sitoplasma, sinusoid, batas interselular, mikrohemoragik, dan infiltrasi leukosit. Skor kelompok kontrol dengan median 89,50 min-max 75-91, Kelompok perlakuan IPC mean 49,17, SD 15,53. Kelompok perlakuan hipotermia mean 42,83 SD 22,02. Prekondisi iskemik dan hipotermia dapat mengurangi terjadi kerusakan jauh pada hepar secara bermakna dengan nilai p=0,002 dan p=0,004.Simpulan: Terbukti terjadinya kerusakan remote iskemik reperfusi pada hepar akibat cedera iskemik reperfusi tungkai akut, Hipotermia dan iskemik prekondisi secara signifikan dapat mengurangi terjadinya kerusakan itu.

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Background: ischemic reperfusion injury is a common condition that may disrupt systemic organs, especially causing liver damage remotely.

Objectives: to evaluate the benefit of ischemic preconditioning and hypothermia on ischemic reperfusion injury of the lower limbs from liver tissue damage.

Methods: this experimental study was performed using New Zealand White Rabbits (n=18) that were grouped into control group (ischemia) and treatment group (ischemic preconditioning and hypothermia). Iliaca communis artery was ligated for 4 hours and treated group had topical cooling until 28oC and performed ischmeic preconditioning. The ligation was released for reperfusion for 8 hours. The rabbits were then euthanized and liver tissue was taken for histopathologic examination.

Result: liver tissue damage was found histopathologically caused by remote ischemic reperfusion of rabbit limbs. By performing scoring of hepatocyte cells, cytoplasm, sinusioids, intercellular cells, microhemorrhage, and leucocyte infiltration. The median score for control group was 89.50 (ranged 75-91), and 49.17 for IPC group (SD 15.53).mean score for hypothermia group is 42.83 (SD 22.02). IPC and hypothermia showed to reduce liver damage significantly (p = 0.002 and p = 0.004)."

"Latar Belakang : Iskemia yang terjadi di suatu lokasi di tubuh mengakibatkan kerusakan pada lokasi yang berjauhan yang dikenal dengan sebutan cedera remote reperfusi. Paru merupakan salah satu organ target utama terjadinya kerusakan pada cedera remote reperfusi. Penelitian ini bertujuan melihat efek protektif hipotermia dan ischemic preconditioning (IPC) terhadap cedera remote reperfusi di paru.Metode : Dilakukan penelitian eksperimental pada kelinci New Zealand White (n=18) dengan satu kelompok kontrol (iskemia) dan dua kelompok perlakuan (preconditioning dan hipotermia). Dilakukan ligasi a. iliaca communis kanan selama 4 jam, hipotermia sedang (28oC), dan iskemia pre-conditioning pada masing-masing kelompok. Kemudian kelinci dibiarkan hidup selama 8 jam. Sampel jaringan paru di ambil untuk pemeriksaan derajat kerusakan paru secara histopatologi.Hasil : Terdapat perbedaan bermakna derajat perubahan histopatologik jaringan paru yang di berikan perlakuan IPC (p : 0,000) dan perlakuan Hipotermi (p : 0,015) terhadap kelompok kontrol.Kesimpulan : Ischemic preconditioning dan Hipotermi memberikan efek protektif pada paru dari akibat iskemik reperfusi tungkai bawah akut.

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Introduction. Acute lower limb ischemia may induced ischemia reperfusion injury to the lung and also initiate a systemic inflammatory response syndrome. The aim of this study was to proofed whether IPC and hypothermia of the limb before I/R injury would also attenuates the acute lung injury in rabbit model of hind limb I/R.

Method. This prospective, randomized, controlled, experimental animal study was performed in a university-based animal research facility with 18 New Zealand White Rabbit. The rabbits were randomized (n=6 per group) into three groups: I/R group (4 hours of hind limb ischemia and 8 hours of reperfusion), IPC group (three cycles of 5 minutes of ischemia/5 minutes of reperfusion immediately preceding I/R), and hypothermia ( 28oC) together with 4 hours of hind limb ischemia and 8 hours of reperfusion. Lung tissue were examined based for their histopathological changes. The changes were assessed based on the grading as normal, mild, moderate, and severe damage.

Result. Rabbit treated with IPC (p : 0,001) and hypothermia (p : 0,015) have demonstrated a significant decrease in histopathological features of acute lung reperfusion injury.

Conclusion. Ischemic preconditioning and hypothermia have shown protective effect for the lung from remote ischemic reperfusion injury induced by lower limb ischemia."