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All Journal Indonesian Journal of Cardiology Jurnal Sains dan Teknologi Jurnal Ilmu Kesehatan Indonesia (JIKSI) Journal of Health and Nutrition Research Sciences of Pharmacy Frontiers on Healthcare Research
Kino Kino
Department Of Cardiology And Vascular Medicine, Faculty Of Medicine, Universitas Andalas, West Sumatera, Indonesia
Aerospace Engineering Agriculture, Biological Sciences & Forestry Automotive Engineering Biochemistry, Genetics & Molecular Biology Chemical Engineering, Chemistry & Bioengineering Chemistry Computer Science & IT Control & Systems Engineering Dentistry Electrical & Electronics Engineering Energy Engineering Health Professions Immunology & microbiology Industrial & Manufacturing Engineering Mathematics Mechanical Engineering Medicine & Pharmacology Nursing Public Health Veterinary

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A Case Report : Patent Foramen Ovale Closure in Young Male Patient with Recurrent Cryptogenic Stroke Kino Kino; Wenny Widyastuti; Denada Florencia Leona
INSOLOGI: Jurnal Sains dan Teknologi Vol. 1 No. 6 (2022): Desember 2022
Publisher : Yayasan Literasi Sains Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.55123/insologi.v1i6.1143

Abstract

Patent foramen ovale is one of the most common congenital abnormalities in children. In PFO, there is a valve-like opening between the atrial septum secundum and primum at the fossa ovalis of the heart. A cryptogenic stroke is a stroke for which no clear cause can be identified. In some cases, the PFO can be wide open, allowing paradoxical embolism to pass from the vein into the arterial circulation, that cause cryptogenic stroke. The prevalence of PFO associated with cryptogenic stroke are relatively high, especially in young age. The thorough evaluation was needed to assure the causative relationship between the PFO and stroke or just a merely coincident, which can help to decide the best treatment strategy. Many studies recommend the closure of PFO in patient with cryptogenic stroke to prevent recurrent incident of stroke. This case report transcatheter PFO closure in a young male patient with history of recurrent stroke after serial examination to evaluate the likelihood of PFO as the cause of his stroke.
Coexistence of Infective Endocarditis and Recurrent Acute Rheumatic Fever: A Case Report Kino, Kino; Hariyanto, Didik; Fernando, Harben; Fahlevi, Indra
Frontiers on Healthcare Research Vol. 2 No. 2 (2025)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v2.n2.p29-34.2025

Abstract

Background: Infective endocarditis (IE) and recurrent acute rheumatic fever (ARF) are two serious cardiovascular conditions frequently associated with rheumatic heart disease (RHD). Their coexistence complicates diagnosis and management due to overlapping clinical features such as fever, migratory arthritis, and valvular dysfunction. This case report aims to elucidate the clinical presentation, diagnostic challenges, and treatment strategies in a pediatric patient with coexisting IE and recurrent ARF.   Methods: A detailed clinical case study was conducted involving a 10-year-old boy with a history of RHD presenting with joint pain and intermittent fever. Diagnostic evaluations included physical examination, laboratory investigations (including blood cultures and antistreptolysin O titers), and serial transthoracic echocardiography. Therapeutic interventions combined targeted intravenous antibiotics, corticosteroids, and secondary prophylaxis with benzathine penicillin G. Multidisciplinary consultations were employed to optimize management. Results: The patient exhibited echocardiographic evidence of mitral valve vegetations along with severe mitral regurgitation. Blood cultures remained negative, likely due to prior antibiotic exposure. Elevated antistreptolysin O titers confirmed recent streptococcal infection supporting recurrent ARF diagnosis. Clinical improvement was observed with symptom resolution and reduction in vegetation size on follow-up echocardiography. Multimodal therapy was well-tolerated, preventing further complications. Conclusion: This case highlights the diagnostic complexity and therapeutic balancing act required in managing coexisting IE and recurrent ARF in children with RHD. Early recognition through comprehensive evaluation and integrated treatment combining antimicrobial and immunomodulatory approaches can improve outcomes. Continued vigilance and multidisciplinary care are essential for preventing morbidity in this high-risk population.
Activin A and Heart Function in Severe Preeclampsia: Insights From Global Longitudinal Strain Sriyanti, Roza; Permatasari, Ressy; Kino, Kino
Journal of Health and Nutrition Research Vol. 4 No. 3 (2025)
Publisher : Media Publikasi Cendekia Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.56303/jhnresearch.v4i3.605

Abstract

Preeclampsia, a serious pregnancy complication affecting 2–5% of women globally, is a leading cause of maternal and fetal mortality. Its prevalence in Indonesia ranges from 0.8–7% depending on parity. Associated with long-term cardiovascular risks, recent research suggests that elevated maternal activin A levels may play a causal role in linking severe preeclampsia to subsequent cardiovascular complications, particularly through mechanisms involving cellular damage, including to the heart. The aim of this study was to assess the correlation between Activin A circulating level and cardiac ventricular function as assessed by cardiac global longitudinal strain (GLS) in severe preeclampsia. A cross-sectional study was conducted at M. Djamil Hospital, Padang, West Sumatera, Indonesia with a total of 31 patients with severe preeclampsia. The Enzyme-Linked Immunosorbent Assay (ELISA) as used to determine the level of Activin A in the blood serum. Ventricular function was assessed from the global longitudinal strain using echocardiographic evaluation. The mean level of Activin A was 2.97 ± 1.91 ng/mL. From the echocardiographic evaluation, the mean cardiac GLS value was 18.01 ± 3.27%.  The correlation between activin A levels and cardiac ventricular function was analyzed using Pearson's correlation test, which showed a strong negative correlation (r = -0.718, p < 0.001). This indicates that higher activin A levels are significantly associated with lower GLS values, demonstrating worse ventricular function.
Patofisiologi Patent Ductus Arteriosus Kino; Hariyanto, Didik; Perdana, Rully; Byant, Nadhila Annisa
Jurnal Ilmu Kesehatan Indonesia Vol. 6 No. 4 (2025): Desember 2025
Publisher : Fakultas Kedokteran, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jikesi.v6i4.1596

Abstract

Background: Patent ductus arteriosus (PDA) is a congenital heart defect resulting from the failure of the ductus arteriosus to close after birth. This condition leads to a left-to-right shunt between the aorta and the pulmonary artery, which may cause increased pulmonary blood flow, pulmonary hypertension, and heart failure if left untreated. Physiological closure of the ductus arteriosus after birth depends on postnatal circulatory changes and the regulation of molecular mediators, particularly prostaglandin E2 and nitric oxide, with additional contributions from genetic factors. Objective: To describe the role of molecular mechanisms and genetic factors in the pathophysiology of PDA and to highlight their implications for diagnostic and therapeutic approaches. Methods: This article is based on a narrative review of the scientific literature addressing the pathophysiology of PDA, with particular emphasis on the roles of prostaglandins, nitric oxide, and genetic factors such as the TBX1 gene and the Notch signaling pathway. Results: The literature indicates that persistent prostaglandin E2 levels and ongoing nitric oxide activity contribute to the maintenance of ductal patency after birth, especially in preterm neonates. Moreover, dysregulation of the TBX1 gene and alterations in the Notch signaling pathway are associated with impaired development and reduced contractility of ductus arteriosus smooth muscle, thereby hindering normal physiological closure. These findings provide a mechanistic basis for the use of prostaglandin-inhibiting pharmacological therapy in the management of PDA. Conclusion: Patent ductus arteriosus is a multifactorial condition driven by complex interactions between molecular mediators and genetic determinants. A comprehensive understanding of these mechanisms is essential for optimizing PDA management through more precise, pathophysiology-based therapeutic strategies.
Management of Iodine Contrast Media Related Anaphylactic Shock following Renal Arteriography: A Rare Case Report Kino, Kino; Karmia, Rofila Dita; Harun, Harnavi
Sciences of Pharmacy Volume 5 Issue 1
Publisher : ETFLIN

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.58920/sciphar0501429

Abstract

Background, anaphylactic shock (AS) caused by iodinated contrast media (ICM) is a rare but potentially life-threatening immediate hypersensitivity reaction. Despite widespread use of ICM in diagnostic imaging, data on ICM-related AS are limited, particularly in Indonesia. Early recognition and timely intervention are crucial to reduce morbidity and mortality. Case presentation, a 28-year-old female underwent renal arteriography with iodixanol. Within 5 minutes of contrast administration, she developed a generalized pruritic rash, dyspnea, vomiting, hypotension, and unstable cardiac parameters. Clinical presentation confirmed iodixanol-induced anaphylactic shock. Management, initial management included intramuscular epinephrine, rapid intravenous fluids, intravenous antihistamines and corticosteroids, and norepinephrine infusion. The patient’s hemodynamic status stabilized, and she was monitored in the CVCU for 48 hours. Outcome and conclusion, the patient recovered fully without complications. This case emphasizes the importance of rapid recognition and prompt pharmacologic intervention in ICM-induced anaphylaxis, while highlighting the value of thorough allergy documentation and preventive counseling.
Recurrent Acute Rheumatic Fever with Severe Rheumatic Mitral Stenosis in 11-years-old Patient: A Case Report Kino, Kino; Hariyanto, Didik; Fernando, Harben; Risani, Puti
Frontiers on Healthcare Research Vol. 3 No. 1 (2026)
Publisher : Rumah Sakit Umum Pusat (RSUP) Dr. M. Djamil

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.63918/fhr.v3.n1.p33-38.2026

Abstract

Background: Acute Rheumatic Fever (ARF) was an immune-mediated complication of Group A Streptococcus (GAS) infection that could progress to Rheumatic Heart Disease (RHD) through repeated or untreated episodes. While RHD typically developed over years, yet some children in endemic settings can develop severe multivalvular disease rapidly, likely due to unrecognized/subclinical ARF and inadequate secondary prophylaxis. This case adds to the literature by illustrating severe rheumatic mitral stenosis at a young age with clinical features suggestive of recurrent ARF despite no documented prior ARF, emphasizing rapid progression could occur in endemic settings. Case report: An 11-year-old male presented with exertional dyspnea and intermittent joint pain without swelling or redness. There was no previously documented ARF episode. Serology showed positive anti-streptolysin O (ASO) supporting recent streptococcal exposure. Echocardiography demonstrated severe mitral stenosis, moderate mitral regurgitation, moderate aortic regurgitation, moderate aortic stenosis, and severe tricuspid regurgitation with high probability of pulmonary hypertension. Diagnosis of recurrent ARF with severe RHD was established using the modified Jones criteria, supported by echocardiographic evidence of multivalvular involvement. Initial management was adjusted for penicillin allergy and included azithromycin, corticosteroids, beta-blockers, diuretics, and nutritional rehabilitation, followed by erythromycin for secondary prophylaxis. Conclusion: This case highlighted the possibility of rapid progression to severe RHD in children due to subclinical ARF. Early diagnosis, routine echocardiography, strict adherence to secondary prophylaxis, and patient education were vital to prevent long-term complications, including heart failure and surgical interventions.
Soluble ST2 as a Marker of Subclinical Right Ventricular Dysfunction in Pulmonary Hypertension Associated With Congenital Heart Disease Fadhil Alfino Azmi; Mefri Yanni; Kino Kino; Hirowati Ali
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1930

Abstract

Background: Congenital Heart Disease with Pulmonary Hypertension (CHD-PH) increases Right Ventricular (RV) afterload, which may lead to subclinical myocardial impairment before overt systolic dysfunction becomes apparent. Early detection is crucial to prevent progression to right heart failure. Global Longitudinal Strain (GLS) by echocardiography is sensitive for identifying subclinical RV dysfunction despite preserved conventional systolic parameters, but the role of molecular biomarkers remains unclear. Soluble Suppression of Tumorigenicity 2 (sST2) has been proposed as a potential biomarker for subclinical RV dysfunction. This study aims to compare sST2 levels in CHD-PH patients with and without subclinical RV dysfunction as assessed by RV-Global Longitudinal Strain (RV-GLS). Methods: This cross-sectional study included adult CHD-PH patients (≥18 years) at the Integrated Heart Center, RSUP M. Djamil Padang, from January to June 2025. All participants underwent right heart catheterization and had preserved RV systolic function, as assessed by conventional echocardiography (Three-Dimensional Right Ventricular Ejection Fraction [3D RVEF] ≥45%). RV-GLS was assessed using Speckle-Tracking Echocardiography (STE), and serum sST2 levels were measured. Patients were categorized into subclinical RV dysfunction (GLS > –20%) and without subclinical RV dysfunction (GLS ≤ –20%) groups. Statistical analysis was performed to compare sST2 levels between groups. Results: Thirty-four patients were included (82% female, mean age 37.8 ± 15.6 years), with secundum Atrial Septal Defect (ASD) as the most common etiology (71%). Median sST2 levels in patients with CHD-PH without subclinical RV dysfunction were 15.65 (6.05–40.90) ng/mL, with a GLS of –20.50 (–27.20 to –20.00)%. In patients with CHD-PH with subclinical RV dysfunction, median sST2 was 15.15 (5.25–47.60) ng/mL, with a GLS of –11.80 (–19.90 to –6.20)%. No statistically significant difference in sST2 levels was observed between groups (p = 0.89). In contrast, patients with CHD-PH with subclinical RV dysfunction exhibited significantly higher indexed Pulmonary Arterial Resistance (PAR) and pulmonary-to-Systemic Vascular Resistance ratio (PAR/SVR ratio), indicating increased pulmonary vascular load despite preserved conventional RV systolic function. Conclusion: sST2 levels did not differ significantly between CHD-PH patients with subclinical RV dysfunction and those without. Subclinical RV dysfunction was associated with higher pulmonary vascular load, as reflected by increased indexed PAR and PAR/SVR ratio, despite preserved conventional RV systolic function. From this may conclude that subclinical RV myocardial impairment in CHD-PH is more closely related to hemodynamic afterload than to molecular stress biomarkers alone. These findings suggest that sST2 alone may have limited utility as a biomarker for detecting subclinical RV myocardial impairment in this population.
Pengaruh Mesenchymal Stem Cell (MSC) pada Penyakit Jantung Bawaan dengan Hipertensi Pulmonal Benny Afriansyah; Kino
Jurnal Ilmu Kesehatan Indonesia Vol. 7 No. 2 (2026): Juni 2026
Publisher : Fakultas Kedokteran, Universitas Andalas

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.25077/jikesi.v7i2.1866

Abstract

Background: Congenital heart disease (CHD) with pulmonary hypertension is a progressive condition characterized by vascular remodeling and pulmonary endothelial dysfunction, which leads to increased pulmonary vascular resistance and right ventricular failure. Mesenchymal stem cells (MSCs) represent a potential therapeutic approach for regenerating pulmonary endothelial and vascular cells in patients with pulmonary hypertension. MSCs have the capacity to differentiate into various cell types and secrete paracrine factors that promote tissue Repair. Objective: This study aims to critically review the available scientific evidence on the impact of Mesenchymal Stem Cell (MSC) therapy on pulmonary hypertension associated with congenital heart disease, focusing on therapeutic efficacy, underlying mechanisms of action, and safety profile as a potential clinical intervention. Methods: A narrative review of the literature published between 2007 and 2025 was performed. Relevant studies were identified through systematic searches of PubMed, Scopus, ScienceDirect, and Google Scholar using the following keywords: “congenital heart disease,” “pulmonary hypertension,” and “Mesenchymal Stem Cell.” Results: Studies have demonstrated that MSC therapy can improve right ventricular hemodynamics through adaptive anti-inflammatory and regenerative mechanisms. However, further research is necessary to establish the long-term safety, optimal dosage, and molecular mechanisms underlying the widespread application of MSC therapy, particularly in patients with CHD and pulmonary hypertension. Conclusion: Mesenchymal Stem Cells (MSCs) demonstrate promising therapeutic potential in pulmonary hypertension associated with congenital heart disease through mechanisms including homing capacity, anti-inflammatory effects, and vascular–cardiac regeneration. Therefore, MSCs may emerge as an effective adjuvant or alternative therapeutic option in the future, although further clinical validation is still required.
Co-Authors Benny Afriansyah Byant, Nadhila Annisa Denada Florencia Leona Didik Hariyanto Fadhil Alfino Azmi Fahlevi, Indra Fernando, Harben Harun Harnavi Hirowati Ali Karmia, Rofila Dita Perdana, Rully Permatasari, Ressy Risani, Puti Sriyanti, Roza Wenny Widyastuti Yanni, Mefri