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All Journal Jurnal Anestesi Perioperatif Bali Journal of Anesthesiology Majalah Anestesia dan Critical Care Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education and Research Institute
Jefferson Hidayat
Cardiothoracic Anesthesia, Department Of Anesthesiology And Intensive Care, Faculty Of Medicine, Universitas Indonesia, Jakarta, Indonesia
Education Health Professions Medicine & Pharmacology Neuroscience Public Health Other

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Cone Procedure, A New Approach, A New Hope for Ebstein Anomaly Patient: A Case Report Hidayat, Jefferson; Kurnia, Andri
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 7 No. - (2023): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v7i-.196

Abstract

Ebstein anomaly is a rare congenital disease affecting the cardiac structure involving the tricuspid valve, leading to right ventricular dysfunction. Patients with Ebstein’s anomaly may have other structural abnormalities. Asymptomatic patients can be treated with conservative management, while symptomatic patients presenting with severe tricuspid regurgitation, NYHA class III-IV symptoms, and overwhelming tachyarrhythmias should undergo surgery. A 13-year-old girl presented with EA and ASD underwent a cone procedure with direct ASD closure and PFO creation. Cone procedure is a relatively new surgical approach in EA management and is preferred because it can be applied to various anatomical differences in EA. Managing the hemodynamic effects and anesthetic consideration during EA repair can be complex due to right ventricular dysfunction secondary to tricuspid regurgitation (TR). While opening the pericardium, the monitor showed VT, and the patient was given an internal defibrillation. Transesophageal echocardiography (TEE) was done intraoperatively to help evaluate ventricular function. The sternal closure was delayed due to cardiac edema. The procedure was done, but the patient’s hemodynamic was unstable, so it was decided to delay the sternal closure. Many studies showed that the Cone procedure is a long-lasting repair of TR and creates significant functional improvement, resulting in low in-hospital mortality. TEE during the cone procedure has a vital role in evaluating the tricuspid valve’s function after repair. Our patient's cone procedure was successfully done with reduced TR and good biventricular function, as shown in previous studies.
Anesthetic Management in Atrial Septal Defect with Small Left Ventricle and Pulmonary Hypertension Christina, Angela; Hidayat, Jefferson
Proceedings Book of International Conference and Exhibition on The Indonesian Medical Education Research Institute Vol. 8 No. - (2024): Proceedings Book of International Conference and Exhibition on The Indonesian M
Publisher : Writing Center IMERI FMUI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69951/proceedingsbookoficeonimeri.v8i-.250

Abstract

Atrial septal defect (ASD) can remain undiagnosed throughout adulthood and frequently develop complications. We report major challenges caused by late onset ASD including small left ventricle and pulmonary hypertension. We report the successful management of ASD closure in a 24-year-old man presented with a large secundum ASD with a diameter of 57 mm and bidirectional shunt, and a small left ventricle (LV). Moderate mitral regurgitation (MR) and tricuspid regurgitation (TR) were also found. Right heart catheterization showed high flow, low resistance pulmonary hypertension (PH). Despite surgery went well with short period of cardiopulmonary bypass (CPB) time. We found decreased function in both ventricles when weaning from cardiopulmonary bypass machine, which required epinephrine 0.2-0.4 mcg/kg/min, milrinone 0.375 mcg/kg/min, norepinephrine 0.05 mcg/kg/min, and dobutamine 5 mcg/kg/min to stabilize the hemodynamics. Post-operative transesophageal echocardiography (TEE) showed a left to right shunt small ASD with a diameter of 2 mm, trivial TR, moderate MR, no LV D-Shape, and small LV. The ejection fraction was 59%, with a high level of hemodynamic support, cardiac output of 3.6 l/m, and stroke volume of 41 mL. The patient was able to be weaned off hemodynamics supports and ventilator within five days. The patient was discharged 12 days after surgery. The management of ASD can be challenging in the presence of small LV, pulmonary hypertension, and arrhythmia.
Co-Authors Alatas, Anas Aldy Heriwardito Andi Ade Wijaya Andi Ade Wijaya Arif H. M. Marsaban Arif H. M. Marsaban Bona A. Fithrah Bona A. Fithrah Christina, Angela Dachlan, Muhammad Ruswan Daryono, Maria Veronica Tita Ekaputri Hadi Harijanto, Eddy Hendy Armanda Zaintama, Hendy Armanda Irmia Kusumadewi Kurnia, Andri Nainggolan, Gina Adriana Pratiwi, Astrid Ratna Farida Soenarto Rokyama, Hadli Sugiarto, Adhrie