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"ASBTRACTPurpose: Splenic infarction may occur if the splenic branches are injured or ligated accidentally during gastrectomy. We used three-dimensional computed tomography (3D-CT) imaging to distinguish the vascular anatomy of the splenic hilum in individual patients, focusing on the splenic polar branches and the gastric branches.Methods: The subjects of this study were 104 patients who underwent computed tomography (CT) with intravenous contrast before gastrectomy. SYNAPSE 3D® (Fujifilm Medical, Tokyo, Japan) was used to generate the 3D-CT images. The total spleen volume and the area supplied by the superior polar artery (SPA) in each patient were estimated using the "liver analysis" function.Results: The SPA without the gastric branch (supplying only the spleen), the SPA with the gastric branch (supplying both the stomach and the spleen), and the posterior gastric artery (supplying only the stomach) were present in 14, 45, and 18% of the patients, respectively. The SPA supplied 12% of the total spleen volume on average; however, it supplied over 30% in two patients.Conclusion: We identified the vascular anatomy around the splenic hilum in over 100 patients. Based on our findings, we recommend preservation of the SPA when it is supplying a large area of the spleen. Preoperative 3D-CT analysis provides useful information to optimize safe gastrectomy."

"A reduction in lung capacity to oxygenize blood as well as in cardiovascular capacity to distribute blood may cause hypoxemia, which could then lead to tissue hypoxia and cellular death. The aim of oxygen treatment is to supply the minimum oxygen concentration needed to achieve adequate tissue oxygenation. There are various methods that can be used to supply oxygen, and the amount of oxygen requirement could also be calculated. Treatment methods are classified into STOT and LTOT. The benefit of oxygen treatment is increased survival, influence on the blood vessels, improved exercise capacity, and positive influence on the respiratory and neuropsychological systems. As with the case with pharmacological treatment, oxygen should be administered at certain doses to achieve greatest efficacy with the least toxicity."

"Penyakit jantung koroner merupakan salah satu penyebab kematian terbanyak, yang dapat dialami oleh baik laki-laki ataupun perempuan. Salah satu tata laksana yang dapat dilakukan untuk kondisi ini adalah Coronary Artery Bypass Graft (CABG). Tujuan dari penelitian ini adalah mengetahui hubungan antara lama rawat, jumlah pembuluh arteri koroner yang tersumbat, dan hipertensi terhadap kematian pasien CABG di Rumah Sakit Pusat Jantung dan Pembuluh Darah Harapan Kita. Desain penelitian yang dipilih adalah restrospective cohort. Data penelitian ini diperoleh dari rekam medik pasien yang tercatat di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita. Data pada penelitian ini melibatkan 66 subjek penelitian. Data yang dikumpulkan kemudian diuji dengan Chi-square dan Fisher untuk menentukan nilai probabilitas (p).Hasil penelitian ini menunjukkan bahwa tidak ada hubungan bermakna antara mortalitas dengan lama rawat (RR=1,57 IK95%=0,60-4,08 p=0,35), jumlah pembuluh arteri koroner yang tersumbat (RR=0,90 IK95%=0,25-3,27 p=1,00), dan riwayat hipertensi (RR=1,59 IK95%=0,41-6,21 p=0,72). Faktor lama rawat, jumlah pembuluh darah arteri koroner yang tersumbat, dan riwayat hipertensi tidak memiliki hubungan yang bermakna terhadap mortalitas subjek penelitian dalam waktu 6 tahun pasca tindakan coronary artery bypass graft.

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Coronary artery disease is one of the most common cause of death, that can be found both in men and women. This condition can be treated with some surgical intervention such as Coronary Artery Bypass Graft (CABG). The purpose of this study is to determine the association between length of stay, the number of diseased coronary artery vessel, and hypertension with mortality in post-CABG patients after 6 years in National Cardiovascular Center Harapan Kita. This study uses retrospective cohort as its design. Data used in this study involving 66 subjects. The data is then tested using Chi-square and Fisher to see the value of probability (p).Based on data analysis, it is found that there is no significant association between mortality with length of stay (RR=1.57 95%CI=0,60-4,08 p=0.346), the number of diseased coronary artery vessel (RR=0.90 95%CI=0.25- 3.27 p=1.000), and hypertension (RR=1.59 95%CI=0.41-6.21 p=0.716). Length of stay, the number of diseased coronary artery vessel, and hypertension are not associated with the mortality of post-coronary artery bypass graft patients after 6 years."

"Latar Belakang: Beberapa penelitian telah membuktikan faktor-faktor yang berpengaruh pada maturasi fistula arteriovenosa, namun pengaruh profil lipid(LDL,HDL, Trigliserida, Kolesterol total) belum terlalu jelas.Tujuan: Untuk mengetahui pengaruh profil lipid pada maturasi fistula arteriovenosapada pasien penyakit ginjal tahap akhir dengan komorbid diabetes mellitus tipe 2.Metode: Desain yang digunakan adalah desain potong lintang. Penelitian inimengambil data sekunder dari penelitian dr. Dedy Pratama, SpBSubVE yangmelakukan penelitian di RSUPN Dr. Cipto Mangunkusumo, RS Hermina Bekasi Barat,dan RS Hermina Depok pada pasien penyakit gagal ginjal tahap akhir dengan diabetesmellitus tipe 2 dan dilakukan operasi fistula arteriovenosa brachiocefalica.Hasil: Total sampel 67, sampel terbanyak berjenis kelamin laki-laki 34 (50,7%)sedangkan perempuan sebanyak 33 (49,3%). Sebanyak 47 (70,1%) matur, sedangkanyang tidak matur 20 (29,9%). Didapatkan nilai rerata LDL pada sampel matur FAV110,13(32,786) dan tidak matur 135,6(39,317) P=0,008. Didapatkan diameter arteribrachialis pre operasi 4,25 mm(0,68) pada kelompok matur, 3,85(0,69) pada tidak maturP=0,029. Volume aliran pasca operasi 568,48(44,9-1451) pada kelompok matur,347,12(43,1-1295) pada kelompok tidak matur dengan P=0,031. Usia, hipertensi,merokok, gula darah sewaktu, indeks massa tubuh, trigliserida, HDL, kolesterol total,volume aliran pre operasi, IMT feeding artery, PSV feeding artery per dan pascaoperasi tidak berpengaruh pada maturasi.Simpulan: Nilai LDL lebih tinggi dari 119,5 mg/dL dapat menurunkan angka maturasiFAV pada pasien PGTA dengan DM tipe 2. Sedangkan kolesterol total, HDL, dantrigliserida pada penelitian ini tidak berpengaruh pada maturasi FAV.

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Background: Several studies have shown the factors that influence the maturation of

arteriovenous fistulas, but the effect of the lipid profile (LDL, HDL, triglycerides, total

cholesterol) is not clear.

Objective: To determine the effect of lipid profiles on the maturation of arteriovenous

fistulas in end-stage renal disease patients with comorbid type 2 diabetes mellitus.

Method: The design used is a cross-sectional design. This study took secondary data

from the research of dr. Dedy Pratama, SpBSubVE who conducted research at RSUPN

Dr. Cipto Mangunkusumo, West Bekasi Hermina Hospital, and Hermina Depok

Hospital in patients with end-stage renal failure with type 2 diabetes mellitus and

undergoing surgery for fistula arteriovenosa brachiocefalica.

Results: The total sample was 67, the largest sample was male 34 (50.7%), while the

female was 33 (49.3%). A total of 47 (70.1%) were mature, while 20 (29.9%) were not

mature. The average value of LDL in the mature FAV sample was 110.13 (32.786) and

the immature sample was 135.6 (39.317) P = 0.008. The preoperative brachial artery

diameter was 4.25 mm (0.68) in the mature group, 3.85 (0.69) in the immature P =

0.029. Postoperative flow volume was 568.48 (44.9-1451) in the mature group, 347.12

(43.1-1295) in the immature group with P = 0.031. Age, hypertension, smoking,

temporary blood sugar, body mass index, triglycerides, HDL, total cholesterol,

preoperative flow volume, BMI of artery feeding, PSV feeding arteries per and

postoperatively had no effect on maturation.

Conclusion: LDL values higher than 119.5 mg/dL can reduce the maturation rate of

AVF in ESRD patients with type 2 diabetes. Meanwhile, total cholesterol, HDL, and

triglycerides in this study had no effect on FAV maturation."

"Profit lipid yang abnormal merupakan faktor risiko mayor untuk penyakit jantung koroner (PJK) dan beberapa penelitian sebelumnya menunjukkan adanya hubungan dengan gangguan pertumbuhan prenatal (BBLR) atau postnatal. Penelitian ini bertujuan untuk mengetahui besarnya risiko mempunyai profil lipid yang abnormal pada individu dengan gangguan pertumbuhan prenatal. Penelilian dilakukan pada populasi kohort di Kecamatan Tanjungsari Kabupaten Sumedang Sawa Barat yang lahir tahun 1988-1990. Kriteria BBLR berdasarkan pada bayi lahir > 37 minggu dengan berat badan lahir 2700 gram. Kriteria inklusi, BBLR dan non-BBLR dengan pertumbuhan postnatal sampai usia 36 bulan adekuat, mempunyai catatan lengkap BB lahir, TB lahir sampai usia 36 bulan dan catatan BB, TB pada usia 12-14 tahun, bersedia ikut dalam penelitian.Setelah dilakukan pemeriksaan profil lipid, validitas data dan stratifikasi, dari 871 orang subyek yang diteliti, hanya 229 yang memenuhi kriteria yang telah ditentukan. Ditentukan sebanyak 105 subyek penelitian melalui simple random yang mengalami dislipidemia dimasukkan kedalam kelompok kasus, untuk kelompok kontrol, diambil jumlah yang sama dengan matching. Untuk membandingkan data-data antara kedua kelompok dipakai uji student t-test, sedangkan menjawab masalah utama yaitu besarnya risiko mengalami dislipidemia digunakan perhitungan odds ratio dengan menggunakan table 2x2.Hasi penelitian karakteristek umum kedua kelompok (umur, jenis kelamin, berat badan dan tinggi bada) tidak ada perbedaan bermakna p<0,05. Tidak ada perbedaan yang bermakna kadar kolesterol total dan kolesterol LDL remaja dengan BBLR dibandingkan remaja yang non BBLR, p>0,05. Radar trigliserida lebih tingi bermakna pada remaja dengan BBLR dibandingkan dengan remaja non BBLR, p=0,00004, sedangkan kadar kolesterol HDL lebih rendah bermakna pads remaja dengan BBLR dibandingkan remaja non-BBLR, p=0,00004.. Pada remaja dengan BBLR mempunyai risiko lebih besar untuk teijadi dislipidemia dibandingkan remaja non BBLR dengan odds ratio 3,26 95%CI 1,77-6,02; p=0,00003.Kesimpulan : Remaja dengan gangguan pertumbuhan prenatal mempunyai risiko lebih besar untuk terjadi dislipidemia.

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Abnormal lipid profile is an independent risk factor for coronary artery disease. Some studies have shown that small for gestational age (SGA) was associated with abnormal plasma lipid profile in adolescent and adulthood. This study was conducted to asses whether SGA children are more prone to have abnormal plasma lipid profile.

This study was performed to cohort population in Kecamatan Tanjungsari Kabupaten Sumedang-West Java who was born between 1988-1990. The criteria of SGA are term infants, gestational age of > 37 weeks, birth weight : 2700 grams and birth length 45-50 centimeters. Appropriate gestational age (AGA) are term infants, gestational age > 37 weeks; birth weight > 2700 grams and birth length > 47 centimeters. Inclusion criteria were SGA and AGA with postnatal growth up to 36 months adequately, complete birth weight and birth length records up to 36 months as well and birth weight and birth length during 12-14 years of age, willing to accompany in this study.

After lipid profile examination was performed, validity and stratification data of 871 subjects, 229 subjects were complied with including criteria. With the simple random, I05 subjects of dislipidemia were decided as the case group and the same number of control group were included as matching. The significance of differences between two groups was examined using student t -test and Mann Whitney. A p level of 0.05 was considered statistically significant.

There were no differences in general characteristic of both group (age, gender, birth length) p>0.05. No significant differences between total cholesterol and LDL cholesterol levels in subject with SGA compared with AGA, p>0 05. Triglyceride level was higher found significant in subject SGA compared with AGA, p=0.00004, however the HDL cholesterol level have a significant more less in subject SGA compared with AGA, p=0.00004. Subject with SGA have an increase risk to develop of dislipidaemia compare with subject AGA, odds ratio of 3.26, 95%CI 1.77-6.O2;p=0.00003.

Conclusion :

Subject with prenatal growth retardation have an increase risk for dislipidaemia in adult life."

"Tujuan : Menilai korelasi antara kelentutan atrioventrikular (Cn) dengan tekanan sistolik arteri pulmonal dan besarnya penurunan tekanan arteri pulmonal segera setelah dilakukan komisurotomi mitral transvena perkutan (KMTP). Latar Belakang : Pada pasien stenosis mitral (SM) terjadinya peningkatan tekanan arteri pulmonal dan beratnya gambaran klinis tidak selalu berkaitan dengan area efektif katup mitral (MVA) serta perbedaan tekanan transmitral (MVG) karena beberapa penelitian menunjukkan bahwa kelenturan atrioventrikular (Cn) juga mempengaruhi. Metode : Merupakan studi potong lintang yang dilakukan pada 30 pasien SM berat yang menjalani KMTP di PJNHK dari bulan Januari 2008 s/d oktober 2010. Pasien dibagi 2 kelompok, yakni kelompok I dengan Cn ::; 4 ml/mmHg dan kelompok II dengan Cn > 4 ml/mmHg. Pemeriksaan ekokardiografi dengan Vivid 7 dilakukan sebelum KMTP dan dalam 24 sampai 72 jam setelah KMTP. Cn ditentukan dengan persamaan : Cn = 1,270 (MV A I E-wave downslope), dan tekanan sistolik arteri pulmonal (sPAP) =Tricuspid valve gradient (TVG) + 10 mmHg. Hasil : Dari 194 subjek yang menjalani KMTP didapatkan sampel 30 orang yang memenuhi kriteria inklusi dan eksklusi. Proporsi kasus SM pada penelitian ini lebih banyak pada perempuan yaitu 70% dan usia rata- rata 36 tahun. Perbandingan sPAP pada kedua kelompok, baik sebelum ( 66,8 ± 21,7 mmHg V s 71,5 ± 31,5 mmHg, P = 0,64) maupun setelah KMTP ( 49,3 ± 10,8 mmHg Vs 56,4 ± 19,9 mmHg, P = 0,31) tidak berbeda bermakna, demikian pula besamya penurunan sPAP setelah KMTP pada kedua kelompok tidak berbeda bermakna ( 17,7 ± 15 mmHg Vs 15,7 ± 15,8 mmHg, P = 0,60). Kesimpulan : Kelenturan atrioventrikular (Cn) tidak mempengaruhi tekanan arteri pulmonal dan besamya perubahan tekanan arteri pulmonal segera setelah KMTP.

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Objectives : The purpose of this study is to evaluate the correlation beetwen Cn with systolic artery pulmonal and the magnitude of decreasing systolic pulmonary pressure after balloon mitral valvuloplasty. Background : In patients with mitral stenosis (MS), the increase in pulmonary arterial pressure and severity of the clinical symptom are not only related to the mitral valve area and mitral vave gradient, but also related to the atrioventricular compliance (Cn). Methods : This is a cross sectional study in Thirty patients with severe mitral stenosis underwent Balloon Mitral Valvuloplasthy (BMV) procedure in NCCHKfrom January 2008 until October 20 I I. The patients were divided into two group, group I with Cn ~ 4 ml/mmHg and group II with Cn > 4 ml/mmHg. Echocardiograpy was done before BMV and 24 unti/72 hours after BMVwith vivid 7. Cn was derivedfrom the equation that has been previously validated (ie, Cn = I270 x [MV area by PHT I mitral Ewave downslope] and systolic pulmonary artery pressure(sPAP) = Tricuspid valve gradient (TV G) + I 0 mmHg. Results : There were I94 patients underwent BMV, but only 30 patients meet the inclusion and exclusion criteria. The women proportion were 70% and average of ages were 36 years old. The systolic pulmonary artery pressure in both group were not difference before ( 66,8 ± 2I, 7 mmHg Vs 7I,5 ± 3I,5 mmHg, P = 0,64) and after BMV ( 49,3 ± I0,8 mmHg Vs 56,4 ± I9,9 mmHg, P = 0,3I) and also the magnitude of decreasing systolic pulmonary artery pressure after BMV not difference between the groups. Conclusion: In patients with severe mitral stenosis, atrioventricular compliance was not affected systolic pulmonary artery pressure before and after BMV nor the magnitude of systolic pulmonaty artery pressure after BMV."

"Latar belakang: Defek septum ventrikel (DSV) merupakan salah satu PJB dengan jumlah kasus terbanyak. Hipertensi pulmonal merupakan salah satu komplikasi yang dapat terjadi dengan prevalensi antara 2-10% dari seluruh kasus DSV. Pasien yang datang ke Rumah Sakit Pusat Jantung Nasional Harapan Kita (RSPJNHK) sudah dengan kondisi hipertensi pulmonal dan usia dewasa. Adanya perubahan pedoman internasional AHA/ESC dalam menentukan kelayakan operasi pada pasien DSV. Perlu dilakukan penelitian mengenai hubungan nilai pulmonary artery resistance index (PARI) yang menjadi prediktor keluaran pada pasien yang dilakukan operasi penutupan DSV.Metode: Penelitian ini adalah studi kohort retrospektif berdasarkan data sekunder dari bagian rekam medis RSPJNHK Indonesia pada dewasa yang telah menjalani operasi tutup defek ventrikel pada periode 2015-2022. Variabel yang dinilai antara lain nilai pulmonary artery resistance index (PARI), lama penggunaan mesin jantung paru, lama penggunaan klem silang aorta, terhadap lama rawat, komplikasi pascaoperasi, dan kematian dini.Hasil: Terdapat 66 subjek pada penelitian ini. Usia rerata subjek studi ini 22,5 tahun. Pada penelitian ini terdapat peningkatan yang bermakna pada durasi ventilator (p = 0,012) dan lama rawat ICU (p = 0,031) pada kelompok nilai PARI >5 WU dibandingkan dengan kelompok PARI < 5 WU. Keluaran kelompok nilai PARI <5 WU lebih baik dibandingkan kelompok PARI >5 WU dengan mortalitas (0% vs 15,6%, p = 0,02), kejadian aritmia (14,7% vs 15,6 %; p = 0,59), dan krisis hipertensi pulmonal (0% vs 9,4%, p = 0,1)Simpulan: Terdapat hubungan antara nilai PARI dengan durasi ventilator mekanis dan lama rawat di ICU, namun tidak terdapat hubungan dengan aritmia dan kejadian krisis hipertensi pulmonal pascaoperasi. Terdapat hubungan yang bermakna antara nilai PARI dan mortalitas dini pascaoperasi penutupan defek septum ventrikel pada dewasa.

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Background: Ventricular septal defect (DSV) is one of the most common CHDs. Pulmonary hypertension is one of the complications that can occur with a prevalence of between 2-10% of all DSV cases. Patients who come to Harapan Kita National Heart Center Hospital (RSPJNHK) already have pulmonary hypertension and are adults. There are changes in AHA/ESC international guidelines in determining the feasibility of surgery in DSV patients. It is necessary to conduct research on the relationship between the value of the pulmonary artery resistance index (PARI) which is a predictor of outcome in patients undergoing DSV closure surgery.

Method: This study is a retrospective cohort study based on secondary data from the medical record section of the Harapan Kita National Cardiovascular Center Hospital in adult patients who had undergone ventricular septal defect closure surgery in the 2015-2022 period. The variable assessed included pulmonary artery resistance index (PARI), duration of cardiopulmonary bypass, duration of aortic cross clamp, on length of stay, postoperative complications, and mortality.

Result: There were 66 subjects in this study. The mean age of the subjects was 22.5 years. In this study, there was a significant increase in ventilator duration (p = 0,012) and ICU length of stay (p = 0,031) in the PARI value >5 WU group compared to the PARI <5 WU group. The outcome of the PARI <5 WU group was better than the PARI >5 WU group with mortality (0% vs 15,6%, p = 0,02), arrhythmic events (14,7% vs 15,6 %; p = 0,59), and pulmonary hyperetension crisis (0% vs 9,4%, p = 0,1).

Conclusion: There is an association between PARI and duration of mechanical ventilation and length of ICU stay, but no association with arrhythmias and the incidence of postoperative pulmonary hypertensive crisis. There is a significant association between PARI and early mortality after ventricular septal defect closure surgery in adults."

"Pendahuluan: Saat ini, pengobatan antiplatelet tunggal menggunakan aspirin atau clopidogrel direkomendasikan untuk pasien penyakit arteri perifer (PAD) pasca-revaskularisasi. Namun, penelitian terbaru menyarankan bahwa kombinasi rivaroxaban dan aspirin lebih menguntungkan. Kami melakukan tinjauan sistematis untuk menentukan efikasi dan keamanan kombinasi rivaroxaban dan aspirin dibandingkan dengan aspirin saja. Metode: Kami melakukan tinjauan sistematis berdasarkan Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA). Pencarian dilakukan di Cochrane, PubMed, Scopus, EBSCOHost, dan Google Scholar menggunakan kata kunci. Kriteria inklusi dan eksklusi diterapkan. Studi yang dipilih dinilai menggunakan Cochrane risk of bias tool versi 2 untuk inklusi. Studi yang terpilih diekstraksi untuk karakteristik dan hasil. Hasil dianalisis secara kualitatif dan kuantitatif. Kami menggunakan model efek tetap atau acak untuk menentukan rasio tergabung yang sesuai. Interval kepercayaan 95% dan nilai p kurang dari 0,05 digunakan sebagai indikator signifikansi statistik. Hasil: Dua studi terkontrol acak multicenter dimasukkan setelah pencarian dan penilaian dengan risiko bias rendah. Kedua studi menunjukkan hasil efektivitas primer yang lebih baik dalam kelompok kombinasi dan perbaikan risiko perdarahan mayor. Analisis kuantitatif menemukan tingkat komplikasi PAD yang lebih rendah (OR=0,79; 95% CI=0,66–0,95) termasuk infark miokard, stroke, kematian kardiovaskular, dan iskemia tungkai akut. Kelompok kombinasi memberikan hasil keamanan primer (OR=1,32; 95% CI=1,06–1,67) dan sekunder (OR=1,47; 95% CI=1,19–1,84) yang lebih rendah. Kesimpulan: Kombinasi rivaroxaban dan aspirin memberikan hasil klinis yang lebih baik pada pasien PAD pasca-revaskularisasi. Namun, kombinasi ini harus digunakan dengan hati-hati karena dapat meningkatkan risiko perdarahan pada populasi tersebut.

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Introduction: Currently, single antiplatelet treatments using aspirin or clopidogrel were recommended for post-revascularization peripheral artery disease (PAD) patients. However, recent study suggested that combination of rivaroxaban and aspirin was more favorable. We conducted a systematic review to determine efficacy and safety of rivaroxaban and aspirin combination compared to aspirin alone. Method: We conducted a systematic review based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. Searching was conducted on Cochrane, PubMed, Scopus, EBSCOHost, and Google Scholar using keywords. Inclusion and exclusion criteria were applied. Selected studies were appraised using Cochrane risk of bias tool v.2 for inclusion. Included studies were extracted for characteristics and outcomes. Outcomes were analyzed qualitatively and quantitatively. We used fixed- or random-effect model to determine pooled ratio per appropriate. A 95% confidence interval and p-value of 0.05 and below were used as indicators of statistical significance. Results: Two multicentered, randomized controlled studies were included after searching and appraisal with low risk of bias. Both studies showed greater primary effectivity outcome in combination group and improvements of major bleeding risk. Quantitative analysis found lower PAD complications rate (OR=0.79; 95% CI=0.66–0.95) which including myocardial infarct, stroke, cardiovascular death, and acute limb ischemia. Combination group provided lesser primary (OR=1.32; 95% CI=1.06–1.67) and secondary (OR=1.47; 95% CI=1.19–1.84) safety outcome. Conclusion: Combination of rivaroxaban and aspirin provided better clinical outcome in postrevascularization PAD patients. However, this combination should be used carefully as this yield larger risk of bleeding in the population."