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"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."

"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."

"ABSTRAKTujuanPenelitian mengenai penggunaan analisis faktor risiko dan mortalitas pada operasijantung masih menjadi perdebatan dan merupakan area yang sedang berkembang.Analisis faktor risiko dalam penilaian suatu hasil pembedahan jantung merupakan halyang tidak dapat dihindari. Ahli bedah dan rumah sakit memerlukan suatu hasilpenilaian faktor risiko terhadap risiko kejadian mortalitas perioperasi agar dapatmenentukan keputusan klinis. Tujuan penelitian ini adalah untuk membandingkanParsonnet dan European System for Cardiac Operative Risk Evaluation (EuroSCORE)pada pasien yang menjalani perbaikan katup mitral dan memperkirakan faktor-faktorrisiko apa saja yang dapat mempengaruhi mortalitas perioperatif.Pasien dan MetodeDari bulan Januari 2010 sampai dengan bulan Desember 2012, 96 pasien terpilih yangtelah menjalani operasi perbaikan katup mitral menggunakan mesin jantung paru dantelah dilakukan analisis faktor risiko berdasarkan Parsonnet score and EuroSCORE .seluruh faktor risiko dianalisis dengan analisis deskriptif, tabulasi silang, Pearson ChiSquare, dan uji Anova, keduanya juga dianalisis dengan kurva ROCHasilAngka mortalitas riil sebesar 5,2 %. Berdasarkan Parsonnet score, nilai prediksimortalitas sebesar 18,26 % sementara pada EuroSCORE nilai prediksi mortalitassebesar 3,68 %. Hasil keduanya signifikan secara statistik. Nilai prediksi EuroSCORElebih mendekati angka kematian riil bila dibandingkan Parsonnet score .KesimpulanEuroSCORE lebih unggul dibandingkan dengan Parsonnet score .Nilai prediksiEuroSCORE lebih mendekati angka kematian riil . EuroSCORE merupakan alat ukuryang baik dalam analisis faktor risiko dan mortalitas pada operasi perbaikan katupmitral

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ABSTRACTObjectiveThe use of risk stratified mortality studies for analyzing surgical outcome in cardiacsurgery is obviously a developing area. Unfortunately, outcomes research in valverepair surgery has been relatively limited. The risk stratification in the assessment ofcardiac surgical results is inevitable. Surgeons and hospitals need availability of riskassessment result which may influence decision-making. Without risk stratification,surgeons and hospitals treating high-risk patients will appear to have worse resultsthan others. Our purpose was to compare the performance of risk stratification models,Parsonnet and European System for Cardiac Operative Risk Evaluation (EuroSCORE)in our patients undergoing mitral valve repair (MVr) and predict the risk factors thatinfluence inhospital mortality .Patient and methodsFrom January 2010 to December 2012, 96 consecutive patients have undergone MVrusing cardiopulmonary bypass and scored according to Parsonnet score andEuroSCORE algorithm. All risk factors were analyzed by descriptive analytic, crosstabulation, Pearson Chi Square, and Anova test, both scores analyzed by ROC curve.ResultsOverall hospital mortality was 5,2 %. In Parsonnet model, predicted mortality was18,26 % while in the EuroSCORE model, predicted mortality was 3,68 %. and it wasstatistically significant for the Parsonnet score and EURO score . Parsonnet Score hasa higher sensitivity compared to the EuroSCORE. From the ROC curve, AUC forParsonnet score (0,905) higher than AUC for EuroSCORE (0,892). Problems with theParsonnet score of subjectivity, inclusion of many items not associated with mortality,and the overprediction of mortality have been highlighted. Pre operative NYHA class,age, ejection fraction , complication, etiology, EuroSCORE, and Parsonnet scoreduring mitral valve repair were statistically significant for affecting inhospitalmortality risk.ConclusionsThe EuroSCORE is more reasonable overall predictor of hospital mortality in ourpatients undergoing MVr compared to Parsonnet score."