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Challenges in diagnosing pediatric pericarditis and the etiology in remote areas during the COVID-19 pandemic: a socio-clinical dilemma: A Socio-Clinical Dilemma Liwan, Armand Setiady; Yantie, Ni Putu Veny Kartika; Gunawijaya, Eka
Paediatrica Indonesiana Vol. 64 No. 2 (2024): March 2024
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi64.2.2024.184-92

Inflammation of the visceral and parietal surfaces of the pericardium is defined as pericarditis. It can evolve to excessive production of pericardial effusion if the speed of fluid accumulation is faster than the absorption. Acute pericarditis is rare in children but it can lead to circulatory collapse and death. It accounts for <0.2% of the emergency visits of children without prior heart diseases in tertiary pediatric emergency settings. The etiology of acute pericarditis varies depending on geography, and the most common etiology in children are bacterial infection, viral pericarditis, inflammatory or connective tissue diseases, malignancies, metabolic diseases, and post-cardiac surgery. Idiopathic pericarditis is presumed to have viral or post-viral etiology. It accounts for 37-68% of admissions in children with pericardial effusions or acute pericarditis.

The efficacy of audiovisual distraction as an anxiety-minimizing technique during echocardiography in preschool children Yantie, Ni Putu Veny Kartika; Gunawijaya, Eka; Windiani, I Gusti Ayu Trisna; Maharini, Kadek
Paediatrica Indonesiana Vol. 63 No. 5 (2023): September 2023
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14238/pi63.5.2023.328-34

Background Echocardiography procedures can cause fear and anxiety in children, especially at preschool age. Audiovisual distraction is a simple, harmless, and low-cost technique that does not interfere with the procedure. Objective To assess the effect of audiovisual distraction on the anxiety levels of children aged 2-5 years during echocardiography. Methods This quasi-experimental study included children aged 2-5 years who were admitted for echocardiography. Patients with hearing or visual impairment, Down syndrome, autism, or attention-deficit/hyperactivity disorder were excluded. We administered anxiety-reducing intervention in the form of cartoon audiovisual media shown on a ceiling-mounted television during the echocardiography procedure. Anxiety levels were assessed using the Visual Analogue Scale - Anxiety (VAS-A) before and after the intervention was given. We compared the subjects’ pre- and post-procedure VAS-A scores and heart rates. Results Of the 43 subjects who underwent echocardiography during the study period, the mean age was 3.2 (SD 0.9) years, with an equal sex distribution. Most subjects had a history of repeated echocardiography procedures and hospitalizations. Thirty-nine (90.6%) of subjects demonstrated anxiety during the echocardiography procedure. There was a significant mean difference of 11.9 (SD 13.2) bpm (95%CI 7.8 to 15.9 bpm, p<0.001) in heart rate pre- vs. post-intervention. Median pre- and post-intervention VAS-A scores were 5 (range 0-10) and 1 (range 0-4), respectively (P=0.001). Post-intervention, almost all (97.7%) subjects had no or mild anxiety. Conclusion Audiovisual content presented on television serves as an effective distraction method to reduce children's anxiety during echocardiography.

Challenging diagnostic of juvenile systemic sclerosis in limited sources: a case report Ronaldi, Melissa; Wati, Ketut Dewi Kumara; Gunawijaya, Eka; Yantie, Ni Putu Veny Kartika; Anandasari, Pande Putu Yuli
Pediatric Sciences Journal Vol. 5 No. 1 (2024): (Available online: 1 June 2024)
Publisher : Medical Faculty of Brawijaya University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/pedscij.v5i1.88

Background: Juvenile Systemic Sclerosis (JSSc) is a rare chronic-autoimmune rheumatic disease leading to potential delay in diagnosis, especially in limited sources due to lack of knowledge and facility. This case report aimed to present a rare case of JSSc in limited sources of medical facilities. Case presentation: A 15-year-old girl was earlier suspected of having congenital heart disease due to the presentation of bluish fingers without any detectable clinical heart disease manifestation, including normal electrocardiography as well as echocardiography. The patient experienced pain and difficulty executing wrist endorotation, representing limited joint movement action. Further physical examinations showed pale, cold fingers and toes, bluish color in the peripheral represented sclerodactyly and arthritis. Skin showed multiple erythema-hypopigmentation papuls, in accordance with gottorn papule, gottorn sign. The antinuclear antibody titer was 1:320. Chest CT-Scan result was a fibrotic line at the inferior lobe of the left lung with the left diaphragm tenting due to a chronic inflammatory process. Skin biopsy shows an acanthotic epidermis, dermafibrocollagenous tissue with extensive fibrosis, and sclerosis with vascular proliferation. These findings meet JSSc PRES, ACR, and EULAR standard classification criteria, including 1 major and 4 minors. The treatment regimen was started with methylprednisolone 2 mg/kg/day, then tapering off once clinical manifestation alleviated, methotrexate 10 mg/BSA, and folic acid 1 mg a day. Long-term monitoring plans are also scheduled. Conclusion: Recognizing early symptoms of JSSc would provide a better outcome.

Transcatheter Closure for Ventricular Septal Defect (VSD): Unveiling Key Predictors in Pediatric Interventions Ria, Natal; Gunawijaya, Eka; Yantie, Ni Putu Veny Kartika
Jurnal Kardiologi Indonesia Vol 44 No 3 (2023): Indonesian Journal of Cardiology: July - September 2023
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1571

Background: Transcatheter closure of specific types of VSD has been widely performed, especially in developing countries, with encouraging follow-up results. Nevertheless, adverse outcomes and failure of closure may occur, which requires sufficient attention. Although transcatheter closure is still the preferable and safest procedure, the risk of failure can lead to the surgical VSD closure procedure. Methods: A retrospective cohort study was done in patients who underwent transcatheter VSD closure in the presence of AVP with or without AR at Integrated Cardiac Service Prof. Dr. I G N G Ngoerah General Hospital between July 2009 to June 2022. Failure to close was defined as a device failing to be implanted. Patient demographic and clinical data were collected. Results: Thirty-eight subjects were enrolled, 10 failed to close, where 8 out of 10 of the failure group were with aortic regurgitation, and 7 of the said group were SADC type. There were 16 males and 22 females. Among 38 subjects, 23 have perimembranous outlet VSD, and 15 have subarterial doubly committed VSD. Aortic regurgitation was found in 25 of 38 subjects. Transcatheter closure was done either by a retrograde technique using the Amplatzer Duct Occluder-II or an antegrade technique using the NIT occlude and MFO in 11, 3, and 24 subjects, respectively. The failure happened in 10 patients, 3 of them had minor complications, and 7 had no complications. There are 2 patients out of 10 with membranous septal aneurysms that failed to close. The final analysis identified VSD type SADC (RR 3.578; 95%CI 1.093 to 11.711; p = 0.030) as an independent factor associated with predictors of transcatheter closure failure in pediatric patients with VSD. Conclusion: Failure to close in transcatheter closure is higher in the SADC type compared to the PMO type. Transcatheter closure appears to be feasible but still challenging in our center.

Percutaneous Secundum Atrial Septal Defect Closure: Failure Rate and Procedural Predictors Yuwono, Elien; Gunawijaya, Eka; Yantie, Ni Putu Veny Kartika
Molecular and Cellular Biomedical Sciences Vol 8, No 1 (2024)
Publisher : Cell and BioPharmaceutical Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21705/mcbs.v8i1.442

Background: Percutaneous atrial septal defect (ASD) closure is one of therapeutic options for patients with a suitable ASD anatomy, however in developing countries, the exact figure and procedural characteristics remain unknown. Therefore, this study was conducted to identify the failure rate and procedural predictors of the percutaneous ASD closure.Materials and methods: A retrospective study using a database of all patients undergoing percutaneous ASD closure was conducted between March 2010 to November 2023. Patients who developed a pulmonary hypertensive crisis during the procedure were excluded. Procedural and echocardiographic parameter were measured and analyzed.Results: A total of 112 samples were included in this study, 74.1% were female and 55.36% were pediatric patients. The failure rate was 12.5% (n=14) with diameter index was higher in the failed group. Unpaired T-test revealed that ASD size was one of the predictor failure in pediatric patients (mean diameter: 24.7±6.46 mm vs. 16.36±5.94 mm, p=0.001). There were no statistically significant variations in rim diameters, while compared with all patients with appropriate rims (rim ≥7mm), the failure rate was higher in patients with two rims measuring between 5.9 and 6.9 mm and rims less than 5 mm. Two patients presented with device embolization and required surgical device removal.Conclusion: The failure rate of percutaneous ASD closure was 12.5%. A larger ASD increases the risk of failure of percutaneous closure in pediatric patients. Furthermore, patient with 5-6.9 mm on two or more rims as well as those with rim less than 5 mm, have a higher failure rate.Keywords: secundum atrial septal defect, percutaneous closure, failure rate

Unveiling associated factors related to congenital heart disease in children: A case-control study Wijaya, Lisa Amelia; Yantie , Ni Putu Veny Kartika; Gunawijaya, Eka
Pediatric Sciences Journal Vol. 6 No. 1 (2025): Available online : 1 June 2025
Publisher : Medical Faculty of Brawijaya University, Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/pedscij.v6i1.125

Background: Congenital heart diseases (CHDs) remain a significant global health burden and a leading cause of child mortality. However, limited evidence exists regarding the factors associated with CHDs, particularly in Indonesia. This study aims to identify factors associated with congenital heart defects (CHDs) in children. Methods: A case-control study was conducted using secondary data from pediatric cardiology patients at Ngoerah Hospital between 2021 and 2023, extracted from pedcardiobali.com. Patients aged 0–18 years who were diagnosed with CHD via echocardiography were included in the case group. Those with normal echocardiographic findings comprised the control group. Patients with incomplete medical records were excluded from the study. A total of 300 eligible subjects were selected, with 150 assigned to each group using a combination of purposive and random sampling methods. Multivariate logistic regression analysis was performed using SPSS version 29.0. Results: Among the 300 subjects, low birth weight (<2,500 grams) was significantly associated with CHDs (OR 3.365; 95% CI: 1.48–7.65; P = 0.004). Prematurity, maternal alcohol consumption, and congenital anomalies were identified as potential confounding factors (OR 1.19; 95% CI: 0.61–2.35; P = 0.61; OR 1.65; 95% CI: 0.45–6.06; P = 0.45; OR 1.98; 95% CI: 0.56–6.94; P = 0.29, respectively). No significant associations were found with maternal or paternal age, multiparity, multiple gestation, smoking, family history of CHDs, or maternal infection. Conclusion: Low birth weight is a dominant factor associated with CHDs. Early prenatal care and targeted interventions are crucial in reducing this risk. Further research is warranted to investigate the underlying mechanisms and genetic contributions to coronary heart disease (CHD).

Early Recognition of Anomalous Origin of Right Pulmonary Artery From The Ascending Aorta with Minimal Limited Resources Sukmapermata, Bunga; Yanti, Ni Putu Veny Kartika; Gunawijaya, Eka
Jurnal Indonesia Sosial Sains Vol. 6 No. 5 (2025): Jurnal Indonesia Sosial Sains
Publisher : CV. Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59141/jiss.v6i5.1713

The anomalous origin of the right pulmonary artery (AORPA) is a rare congenital heart defect with a poor prognosis if not surgically corrected. Atypical symptoms often lead to underdiagnosis and delayed treatment, necessitating timely and accurate examination. The utility of diagnostic tools, especially in resource-limited settings, remains a subject of debate. This research aims to assess the effectiveness of echocardiography and cardiac CT in detecting AORPA in children suspected of having congenital heart disease (CHD), compared to catheter angiography and/or surgery. A case report of a male term newborn presenting with respiratory distress and heart failure was presented. Initial diagnosis was made via echocardiography, which was later confirmed by computed tomography angiography (CTA). A literature search was conducted using PubMed, Google Scholar, and ScienceDirect with keywords such as "anomalous origin of right pulmonary artery," "ascending aorta," "children," "echocardiography," and "cardiac CT". Two relevant articles were critically appraised. The case demonstrated that transthoracic echocardiography (TTE) provided a timely diagnosis of AORPA at 11 days old, even when MDCT was delayed due to the patient's critical condition. While MDCT is superior for detailed anatomical features, TTE proved valuable as an initial diagnostic modality in a resource-limited area. Literature review showed TTE diagnostic accuracy at 88.9%, and MDCT with high sensitivity and specificity for pulmonary arterial anomalies. Despite diagnosis, the patient deteriorated and died without surgical repair. Early diagnosis and prompt surgical correction are essential for improved outcomes.

Pediatric Rare Case of Supracardiac Total Anomalous Pulmonary Venous Anggreini, Faradilla Novita; Anandasari, Pande Putu Yuli; Margiani, Ni Nyoman; Gunawijaya, Eka
Indonesian Journal of Global Health Research Vol 6 No 6 (2024): Indonesian Journal of Global Health Research
Publisher : GLOBAL HEALTH SCIENCE GROUP

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37287/ijghr.v6i6.5921

Total anomalous pulmonary venous return (TAPVR) is a rare congenital heart defect, and patients are usually symptomatic at a very young age. Survival to adulthood without surgical correction is extremely rare. Objective: presented pediatric rare case of supracardiac total anomalous pulmonary venous. Methods: This study was a case report that describing detailed account of a patient's diagnosis, treatment, and follow-up a rare case. This study presents a single case. Results: we present a rare case of a 2-month-old infant diagnosed with Supracardiac TAPVR accompanied by an Atrial Septal Defect (ASD). The condition was identified through a combination of echocardiography and cardiac CT imaging. In these conditions, a right-to-left shunt is necessary for survival, along with the need for prompt corrective surgery. TAPVR is often associated with heterotaxy syndrome and other congenital heart defects. Various cross-sectional imaging modalities are valuable in detecting and evaluating pulmonary venous development anomalies. Conclution: These modalities provide both anatomical and functional information. Early detection and diagnosis lead to the best management strategies for patients with TAPVR. Multidetector Computed Tomography (MDCT) is a non-invasive imaging technique that plays an increasingly important role in evaluating these anomalies.

Early Recognition of Anomalous Origin of Right Pulmonary Artery From The Ascending Aorta with Minimal Limited Resources Sukmapermata, Bunga; Yanti, Ni Putu Veny Kartika; Gunawijaya, Eka
Jurnal Indonesia Sosial Sains Vol. 6 No. 5 (2025): Jurnal Indonesia Sosial Sains
Publisher : CV. Publikasi Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59141/jiss.v6i5.1713

The anomalous origin of the right pulmonary artery (AORPA) is a rare congenital heart defect with a poor prognosis if not surgically corrected. Atypical symptoms often lead to underdiagnosis and delayed treatment, necessitating timely and accurate examination. The utility of diagnostic tools, especially in resource-limited settings, remains a subject of debate. This research aims to assess the effectiveness of echocardiography and cardiac CT in detecting AORPA in children suspected of having congenital heart disease (CHD), compared to catheter angiography and/or surgery. A case report of a male term newborn presenting with respiratory distress and heart failure was presented. Initial diagnosis was made via echocardiography, which was later confirmed by computed tomography angiography (CTA). A literature search was conducted using PubMed, Google Scholar, and ScienceDirect with keywords such as "anomalous origin of right pulmonary artery," "ascending aorta," "children," "echocardiography," and "cardiac CT". Two relevant articles were critically appraised. The case demonstrated that transthoracic echocardiography (TTE) provided a timely diagnosis of AORPA at 11 days old, even when MDCT was delayed due to the patient's critical condition. While MDCT is superior for detailed anatomical features, TTE proved valuable as an initial diagnostic modality in a resource-limited area. Literature review showed TTE diagnostic accuracy at 88.9%, and MDCT with high sensitivity and specificity for pulmonary arterial anomalies. Despite diagnosis, the patient deteriorated and died without surgical repair. Early diagnosis and prompt surgical correction are essential for improved outcomes.

DILATED CARDIOMYOPATHY DENGAN INTRAKARDIAK TROMBUS BERKOMPLIKASI PADA STROKE NON HEMORAGIK: CASE REPORT Pande, Ni Nyoman Utami Wijayaswari; Gunawijaya, Eka; Yantie, Ni Putu Veny Kartika; Dewangga, Made Satria Yudha
Seroja Husada: Jurnal Kesehatan Masyarakat Vol. 1 No. 3 (2024): Seroja Husada: Jurnal Kesehatan Masyarakat
Publisher : Seroja Husada: Jurnal Kesehatan Masyarakat

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.572349/serojahusada.v1i3.2390

Patients with DCMP have been reported to have abnormalities in platelet function and reduced LVEF that contribute to hypercoagulability and stasis conditions that have been described as predisposing to intracardiac thrombus formation. Cases have been described of patients with DCMP who had an initial clinical presentation of thrombus at the LV apex and with thromboembolic events. The patient was treated in the pediatric intensive care unit with anticoagulant therapy and heart failure.

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