Articles
<![CDATA[Clinical Characteristics of Adult Uncorrected Secundum Atrial Septal Defect, A Pilot Study ]]>
<![CDATA[Lucia Krisdinarti]]>;
<![CDATA[Anggoro Budi Hartopo]]>;
<![CDATA[Dyah Wulan Anggrahini]]>;
<![CDATA[Ahmad Hamim Sadewa]]>;
<![CDATA[Abdus Samik Wahab]]>;
<![CDATA[Budi Yuli Setianto]]>
<![CDATA[ Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 48, No 2 (2016) ]]>
Publisher : <![CDATA[Journal of the Medical Sciences (Berkala Ilmu Kedokteran) ]]>
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DOI: 10.19106/JMedSci004802201603
<![CDATA[ABSTRACTAtrial septal defect (ASD) is the most frequent congenital heart disease in adulthood. Pulmonary hypertension (PH) complicating ASD compels patients seeking medical assistance because of its disabling symptom. Most adult ASD develop PH which render significant morbidity and mortality. The aim of the study is to characterize the clinical profiles of adult patients with ASD. The study design was cross sectional. The subjects were enrolled consecutively from outpatient clinics and inpatient wards. The demography, medical and imaging data were collected and recorded in case report form. Descriptive statistics was applied to characterize the subjects. Seventy-six subjects were enrolled. The majority were women (77.6 %) in the productive and child-bearing ages (63.2%). The most common symptoms were dyspneu on effort, fatigue, and palpitation. Most subjects had functional capacity of WHO class functional II (70.2 %). The mean oxygen saturation was 96.4 %. Based on the echocardiography examination, 77.6% of subjects had suffered from PH. The mean longest diameter of defects were 2.7 cm. The direction of blood flow was mostly left to right (77.6 %). Left and right ventricle function were within normal limit. Right heart catheterization showed mean left atrial pressure 11.5 mmHg, which confirmed the precapillary or arterial PH. Mean pulmonary artery pressure was 42.0 mmHg. The pulmonary artery resistance index mostly less than 4 Wood Unit/ m2 (63.7 %), indicating the feasibility to close the defect. Whereas 24.6 % of subjects were contraindicated for closing. Pulmonary artery hypertension (PAH) was diagnosed in 77.6 % subjects, meanwhile 13.2 % had borderline PAH. In conclusion, most adult ASD patients had developed PAH, mostly young women in productive ages, mainly visited hospital due to symptom of PH, the direction of flow predominantly left to right side and mostly had reduced functional capacity.]]>
<![CDATA[Association between serum soluble ST2 level and right ventricle systolic function on pulmonary hypertension due to atrial septal defect ]]>
<![CDATA[Firandi Saputra]]>;
<![CDATA[Anggoro Budi Hartopo]]>;
<![CDATA[Hariadi Hariawan]]>;
<![CDATA[Dyah Wulan Anggrahini]]>;
<![CDATA[Lucia Kris Dinarti]]>
<![CDATA[ Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 52, No 3 (2020) ]]>
Publisher : <![CDATA[Journal of the Medical Sciences (Berkala Ilmu Kedokteran) ]]>
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DOI: 10.19106/JMedSci005203202005
<![CDATA[Pulmonary hypertension (PH) due to atrial septal defect (ASD) may cause a decline in right ventricle (RV) function. Soluble ST2 isa prognostic biomarker for left ventricle dysfunction. However, its role in RV function has not been investigated. This study aimed to investigate the association between serumsoluble ST2 with RV systolic function in patients withASD–associatedPH. This was a cross sectional study. Subjects were patients participated in the COHARD-PH registry performed in Dr. Sardjito General Hospital, Yogyakarta Indonesia. The patients with ASD and PH confirmed by right heart catheterization (RHC) were enrolled in this study. The soluble ST2 level was measured in the serum collected from pulmonary artery during RHC. Right ventricle systolic function was determined by transthoracic echocardiography using peak systolic velocity of tricuspid annulus (S’) parameter. This study was performed in 32 adults with uncorrected ASD. They predominantly females [n=29 (90.6%)] with median age of 31(22.5-44.0) years old. Mean ASD diameter was 2.69±0.53 cm. Median mean pulmonary artery pressure (mPAP) 45.0 (36.25-70.0) mmHg. Median soluble ST2 level was 23.28 ng/mL. There were no significant correlations between soluble ST2 level with S’value (r=0.071; p=0.35), with mPAP (r=0.043; p=0.815), with pulmonary vasculer resistance (PVR) (r=0.025; p=0.893) and with right ventricle (RV) diameter (r=0.200; p=0.273). Soluble ST2 level was found higher in subject with RV dysfunctionbut not statistically significant. In conclusion, serum soluble ST2 level did not associate withRV systolic function, measured by S’, in adult ASD-associated PH.]]>
<![CDATA[Pulmonary artery hypertension patients and the coronavirus disease of 2019 (COVID-19): are they protected from severe disease? ]]>
<![CDATA[Anggoro Budi Hartopo]]>;
<![CDATA[Dyah Wulan Anggrahini]]>;
<![CDATA[Bambang Budi Siswanto]]>;
<![CDATA[Lucia Kris Dinarti]]>
<![CDATA[ Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 52, No 3 (2020): Special Issue: COVID-19 ]]>
Publisher : <![CDATA[Journal of the Medical Sciences (Berkala Ilmu Kedokteran) ]]>
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DOI: 10.19106/JMedSciSI005203202008
<![CDATA[The coronavirus disease of 2019 (COVID-19) is a current pandemic of viral infection which mainly involves respiratory system and may progress into severe multiple organ dysfunction and mortality. Pulmonary artery hypertension (PAH) is a disease marked by increased mean pulmonary artery pressure and pulmonary vascular resistance due to pulmonary panvascular remodeling. Although rare, the prevalence of PAH is currently escalating in Indonesia due to increased diagnostic capacity and referral, treatment availability and improved survival. Despite chronic cardiac and pulmonary diseases are at increased risk to develop severe COVID-19, patients with PAH are considered to be not in higher risk to develop severe COVID-19. However, whether this population is protected from severe COVID-19 is unclear. There are protective and offensive factors need to be considered in PAH patients in respect to COVID-19.]]>
<![CDATA[Pulmonary arterial hypertension after atrial septal defect closure: a case report ]]>
<![CDATA[Lucia Kris Dinarti]]>;
<![CDATA[Dyah Wulan Anggrahini]]>;
<![CDATA[Muhammad Reyhan Hadwiono]]>;
<![CDATA[Abdul Majid Halim Wiradhika]]>;
<![CDATA[Vera Dewanto]]>;
<![CDATA[Anggoro Budi Hartopo]]>
<![CDATA[ Journal of the Medical Sciences (Berkala Ilmu Kedokteran) Vol 53, No 4 (2021) ]]>
Publisher : <![CDATA[Journal of the Medical Sciences (Berkala Ilmu Kedokteran) ]]>
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DOI: 10.19106/JMedSci005304202111
<![CDATA[Most patients with congenital heart disease (CHD) who underwent successful shunts defect repair can be remained asymptomatic for years. It leads to a high number of losses to follow-up after patients discharge. After closure, pulmonary hypertension (PH) prevalence seems to be high and associated with increased morbidity and mortality. We reported a 55 y.o. female diagnosed with pulmonary arterial hypertension (PAH) and atrial fibrillation (AF) 31 years after atrial septal defect (ASD) closure by surgery, who never had routine follow-up evaluation because she remained asymptomatic for years. Physical examination revealed heart enlargement with irregular rhythm and pan systolic murmur in the fourth left sternal border. Electrocardiogram showed AF normal ventricular response, right axis deviation and suggestive for right ventricular hypertrophy. Laboratory testing found the NT pro-BNP level was 2,476 pg/mL. The chest X-ray showed enlargement of the heart and was representative of PH. From echocardiography study, transthoracic and transoesophageal echocardiography, we found no sign of residual shunt. There were right atrial and right ventricular dilatation, severe tricuspid regurgitation (TR) and a high probability of PH with TR velocity of 4.46 m/s. Right heart catheterization concluded mean pulmonary arterial pressure 46 mmHg, flow ratio 1.1, and pulmonary artery resistance index 15.5 Woods unit.m-2. We highlight this case because of the high incidence of PH long after defect closure. The high number of lost to follow-up patients can lead to morbidity and mortality.]]>
<![CDATA[Significance of Six Minute Walking Distance in Predicting Functional Capacity Status of Patients with Pulmonary Hypertension Complicating an Atrial Septal Defect ]]>
<![CDATA[Anggia Endah Satuti]]>;
<![CDATA[Dyah Wulan Anggrahini]]>;
<![CDATA[Lucia Krisdinarti]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 1, No 1 (2015) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.17789
<![CDATA[Background: Six minute walk test (6 MWT) is a sub-maximal exercise test that measures an integrated response of all systems responsible during exercise. Pulmonary arterial hypertension (PAH) is a problem encountered by patients with atrial septal defect (ASD). Assessment of functional capacity in patients with PAH based on the WHO functional classifi cation remains a powerfulpredictor of survival in these patients. The World Health Organization functional classifi cation is a subjective tool because it is based on anamnesis of ordinary activity. On the contrary, 6 MWT is an objective tool to measure functional capacity of patients with pulmonary hypertension. Objective: To determine the walking distance obtained using 6 MWT as a measurement of functionalcapacity in ASD patients with PAH. Methods: A cross sectional study was used to determine the walking distance as a measurement of functional capacity in ASD patient with PAH. This study was a sub-study of an Atrial Septal DefectRegistry done in RSUP Dr. Sardijto, Yogyakarta, since 2012. Pulmonary arterial pressure was measured using Pulmonary Arterial Systolic Pressure (PASP) obtained from echocardiography. Pulmonary hypertension was divided into three categories based on PASP, mild with PASP of less than 45 mmHg, moderate with PASP of 45-59 mmHg and severe with PASP of more than 60 mmHg. All patients did 6 MWT to measure their functional capacity. The relationship between 6 MWT distance and severity of PAH was measured using Pearson correlation analysis. Results: Forty-three patients were included in this study with 32 female patients (74%) and 11 male patients (26%) with an age range of 17-70 years old. Forty-four patients (44%) with ASD had severe PAH. The mean of 6 MWT distance was 337 m. There were signifi cant differences between mild, moderate and severe PAH in correlation with the 6 MWT distance (p= 0.001). The patients with severe PAH had only 278 m walking distance compared to those with mild PAH who had 394 m walking distance. There was a significant relationship between the 6 MWT distance and severity of PAH (p=0.01). This study showed that 6 MWT correlates negatively with the severity of PAH. We found that the higher pulmonary arterial pressure, the shorter walking distance (p=0.01, r -0,506). Conclusion: ASD defect patients with severe PAH had shorter walking distance compared to those with mild PAH. The 6 MWT is a reliable and objective measurement of functional capacity for ASD patients with PAH.]]>
<![CDATA[The Incidence of Mitral Valve Prolapse and Mitral Valve Regurgitation in Patient with Secundum Atrial Septal Defect ]]>
<![CDATA[Ni Made Elva Mayasari]]>;
<![CDATA[Dyah Wulan Anggrahini]]>;
<![CDATA[Hasanah Mumpuni]]>;
<![CDATA[Lucia Krisdinarti]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 1, No 1 (2015) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.17790
<![CDATA[Background: Association between secundum atrial septal defect (ASD) and mitral valve disease has been recognized for many years. Noninvasive studies indicate a high incidence of mitral valve prolapse (37-70 percent) in these patients. Change of left ventricular geometry in atrial septal defect had been showed were associated with degree of mitral valve prolapse. This study delineates the incidence of mitral valve prolaps and mitral regurgitation in adult patients with secundum atrial septal defect and association with age at onset and size defect. Method: This study was a substudy from ASD registry in Dr. Sardjito General Hospital. The records of 103 adult patients ranged in age from 17 to 76 years old, with an average of 36 years old, and consisted of 16 men and 87 women who had secundum atrial septal defects demonstrated by crosssectional echocardiography between july 2012 until july 2013. Echocardiographic examinations were performed with the patient in the supine position. The echocardiograph was a Vivid 7. The mitral valve apparatus and mitral regurgitation was examined with long axis images, short axis image and apical four chamber view. Result: Mitral valve prolapse was observed in 76% patients with secundum atrial septal defect. Prolaps of anterior mitral leafl et (AML) in age group younger than 35 years and older than 36 years are 38,6% and 61,4% respectively. The incidence of mitral regurgitation was 43%. Severity varianceof mitral regurgitation were 31,7% mild, 7,7% moderate and 2,9% severe. Mitral regurgitation in patient with prolapse AML was 56.4%. None of the patients without mitral valve prolapse had mitral regurgitation.In patient with size defect more than 2 cm, the proportion of prolapse of AML and mitral regurgitation was higher as compared with patient with size defect less than 2 cm. Conclusion: Incidence of mitral valve prolaps and mitral regurgitation are high in patient with atrial septal defect and increase with onset of age. Patients with larger size defect had a greater likelihood of mitral prolapse and mitral regurgitation. Onset of age and size defect might be associated with magnitude of the shunt and abnormal ventricular geometry.Keywords: secundum atrial septal defect, mitral valve prolaps, mitral regurgitation]]>
<![CDATA[29-Years Old Woman Presenting with ST Elevation Myocardial Infarction ]]>
<![CDATA[Dyah Wulan Anggrahini]]>;
<![CDATA[Budi Yuli Setianto]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 1, No 1 (2015) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.17795
<![CDATA[Myocardial infarction in young female is rare condition, but carries significant morbidity and mortality. The recognition management for MI in young female is challenging due to its unspecific clinical presentation and lack of guidance in the current guidelines. We reported a 29-years old woman presenting with infarction type chest pain, showing ST- elevation in the inferior leads with total AVblock as complication. The risk factors in this patient were smoking, family history, cardiomyopathy, and preeclampsia history. The cause for myocardial infarction in this patient was atherosclerotic plaque rupture, but we did not manage to performed coronary intervention due to her low ventricular function and unavailability data for myocardial viability at the time of hospitalization.]]>
<![CDATA[Clopidogrel Resistance in Patients with Coronary Stent Thrombosis ]]>
<![CDATA[Dyah Wulan Anggrahini]]>;
<![CDATA[Bambang Irawan]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 1, No 1 (2015) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.17796
<![CDATA[Antiplatelet drugs plays important role in the therapy of atherothrombosis. Dual antiplatelet therapy is recommended as a strategy for the prevention of stent thrombosis in patients who underwent Percutaneus Coronary Intervention (PCI). In combination with aspirin, tienoperidine is currently the drug of choice to prevent stent thrombosis. The issue of the high inter-individual variability ofresponse is clinically relevant, since poor responders are not adequately protected from major adverse cardiac events (MACE). We reported a 62-years old woman underwent primary PCI with implantation of BAS. She was later known to have in-stent thrombosis in the LAD after repeated angiography. The probable cause for the later cardiac event in this patient were overlapped stent, small vessel diameter, diabetes mellitus, and the patients also shown a persistent platelet reactivity despite clopidogrel therapy. We administered this patient with pasugrel as antiplatelet replacing clopidogrel and the patient was managed without ischemic symptoms afterwards.]]>
<![CDATA[Correlation Between Right Ventricular Function Using Myocardial Performance Index (Tei Index) with Pulmonary Arterial Hypertension Severity in Patient with Atrial Septal Defect ]]>
<![CDATA[Hendry Purnasidha Bagaswoto]]>;
<![CDATA[Dyah Wulan Anggrahini]]>;
<![CDATA[Hasanah Mumpuni]]>;
<![CDATA[Lucia Krisdinarti]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 2, No 1 (2016) ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.17818
<![CDATA[Background: Right ventricular (RV) volume overload that occurs in patients with atrial septal defect (ASD) could lead to the development of pulmonary arterial hypertension (PAH). RV function has been found depressed in some patients with PAH. Myocardial performance index (MPI) is one of methods to assess RV function. The aim of this study was to assess correlation between RVfunction using RV-MPI with PAH severity in patients with ASD. Methods: We conducted a cross sectional study between July 2012-July 2013. We enrolled 67patients with secundum type ASD. RV-MPI, defi ned as the sum of isovolumic relaxation time and isovolumic contraction time derived by ejection time, was measured from tricuspid infl ow and RV outflow. The normal range is 0.28-0.32. Pulmonary artery systolic pressure (PASP) was measured from echocardiography. Results: There were 67 patients (54 women) with mean age was 38.01±14.29 years (11.9% with no PAH, 11.9% mild PAH, 26.9% moderate PAH and 49.3% severe PAH). The mean PASP was 67.16±32.33 mmHg and mean MPI was 0.44±0.25. We found signifi cant correlation between PASP and MPI (r=0.73; p=0.000). In addition, we classifi ed the PAH severity based on PASP and there was signifi cant differences of MPI between groups (no PAH, MPI 0.25±0.07; mild PAH 0.24±0.05; moderate PAH 0.24±0.12; severe PAH 0.63±0.21; p=0.000). Furthermore, in severe PAH group, the correlation between PASP and MPI remain signifi cant (r=0.42; p<0.05). Conclusion: These result demonstrate a correlation between PAH severity and MPI in patientswith ASD. Specifi cally, RV function found decreased in ASD patients with severe PAH.Keyword: myocardial performance index (Tei index), pulmonary arterial hypertension, right ventricular function, atrial septal defect]]>
<![CDATA[Surgical and Non Surgical Interventions in Adult Congenital Heart Disease: Our Experience from COHARD registry ]]>
<![CDATA[Budi Yuli Setianto]]>;
<![CDATA[Dyah Wulan Anggrahini]]>
<![CDATA[ ACI (Acta Cardiologia Indonesiana) Vol 3, No 2(S) (2017): Supplement, Abstracts of Jogja INternational CARdiovascular TOpic Series (JIN ]]>
Publisher : <![CDATA[Faculty of Medicine, Public Health and Nursing Universitas Gadjah Mada ]]>
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DOI: 10.22146/aci.28012
<![CDATA[Surgical and Non Surgical Interventions in Adult Congenital Heart Disease:Our Experience from COHARD registry]]>
