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All Journal Indonesian Journal of Cardiology Jurnal Kesehatan Tambusai
Mangkuanom, Arwin Saleh
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Dentistry Health Professions Medicine & Pharmacology Nursing Public Health

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Invasive Physiologic Study Across Various Spectrum of Coronary Artery Fistulas with Concomitant Coronary Artery Stenosis Sembiring, Theresia Sri Rezeki; Mangkuanom, Arwin Saleh; Firman, Doni; Alkatiri, Amir Aziz; Iryuza, Nanda
Jurnal Kardiologi Indonesia Vol 45 No 1 (2024): January - March, 2024
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1285

Abstract

Background: Most CAFs are asymptomatic but it might have serious hemodynamic consequences causing signs and symptoms of myocardial ischemia and heart failure prompting intervention, be it percutaneous or surgical, to manage the hemodynamic burden. Currently, there’s no widely accepted guidelines or consensus to manage patients with CAFs. The decision to undergo intervention is usually based on the presence of symptoms, size and also the anatomic features of the fistula. Case Illustration and Discussion: We presented 5 patients with CAFs undergoing FFR/iFR in our institution. Of all patients, only one showed significant iFR suggesting significant hemodynamic burden, probably due to stealing phenomenon. Number of fistulas varied from 1 – 3 with most fistula arose from left anterior descending and terminated in pulmonary artery. Only one patient underwent RHC showing relatively normal flow ratio supported by normal iFR reading across different coronary artery segments. One patient presented with patent stents in LAD and OM2 despite existing subtotal occlusion in proximal PDA, the other one presented with insignificant stenosis in RCA, and the other two presented with no concomitant stenosis. We underwent no further intervention for 4 patients with normal FFR/iFR reading but we underwent stent implantation for one patient with significant FFR/iFR reading. Upon 1-year-follow up, all patients are currently doing well with no significant complaints of chest pain or dyspnea. Conclusion: Due to limited literature covering the issue of CAFs and coronary artery stenosis, the decision which to intervene first between these two is currently still in the discretion of the attending physician. Whenever possible, further diagnostic work up should always be performed as an objective parameter of hemodynamic burden. FFR/iFR might be considered as one of many modalities to do so. Yet, further well-designed studies are needed to confirm the role of FFR/iFR hoping this modality might someday help in guiding decision-making in patients with CAFs. Keywords: coronary artery fistula; coronary artery stenosis; free fractional reserve (FFR); instantaneous wave free ratio (iFR)
TEKNIK PEMERIKSAAN FISIOLOGI INTRAKORONER PADA PASIEN PENYAKIT JANTUNG KORONER DENGAN LESI KORONER MULTIPEL Husein, Faiza; Nurhayati, Nurhayati; Mangkuanom, Arwin Saleh; Jamaluddin, Ahmad; Budiman, Muhamad Arif
Jurnal Kesehatan Tambusai Vol. 6 No. 3 (2025): SEPTEMBER 2025
Publisher : Universitas Pahlawan Tuanku Tambusai

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.31004/jkt.v6i3.49516

Abstract

Penyakit jantung koroner (PJK) merupakan penyebab utama kematian di dunia, terutama akibat komplikasi dari lesi koroner multiple, yaitu penyempitan pada dua atau lebih arteri koroner. PJK disebabkan oleh plak aterosklerosis yang menghambat aliran darah dan dapat menimbulkan nyeri dada, sesak napas, mual, dan pusing. Aterosklerosis sering menyumbat cabang-cabang utama arteri koroner, seperti left anterior descending (LAD), left circumflex (LCx), dan right coronary artery (RCA). Pemeriksaan fisiologi intrakoroner seperti Fractional Flow Reserve (FFR) dan Instantaneous Wave-Free Ratio (IFR) dapat digunakan untuk menilai signifikansi hemodinamik dari stenosis. FFR adalah pemeriksaan diagnostik yang digunakan untuk melihat signifikansi fisiologis stenosis arteri koroner secara spesifik. IFR merupakan pengukuran fisiologi intrakoroner lebih baru yang menggunakan prinsip serupa dengan FFR tetapi tidak memerlukan agen hiperemia. Namun, tidak terdapat perbedaan yang signifikan antara FFR dan IFR pada iskemia. Penelitian ini adalah studi kasus deskriptif pada pasien dengan diagnosa awal penyakit jantung koroner yang kemudian dilakukan pemeriksaan fisiologi intrakoroner berupa FFR dan IFR, dan didapatkan hasil lesi koroner multiple (lebih dari 2 koroner). Diperoleh nilai IFR pada LAD 0.92 dan FFR 0.75 (signifikan), IFR LCx 0.71 (signifikan), IFR RIM 0.95 (non signifikan), dan IFR RCA 0.92 serta FFR 0.72 (signifikan). IFR memiliki tingkat akurasi yang cukup baik, tapi FFR dinilai lebih akurat karena menggunakan agen hiperemi untuk menilai keparahan stenosis arteri koroner.
Co-Authors Agus Susanto Amir Aziz Alkatiri Budiman, Muhamad Arif Doni Firman Dwiyanti, Eka Husein, Faiza Iryuza, Nanda Jamaluddin Ahmad Nurhayati Nurhayati Sembiring, Theresia Sri Rezeki