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Infective Endocarditis with Multiple Valvar Vegetation in Uncorrected Tetralogy Fallot: A Case Report of Rare Condition Charlotte Johanna Cool; Eliza Techa Fattima; Mega Febrianora; Aninka Saboe
International Journal of Integrated Health Sciences Vol 9, No 2 (2021)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v9n2.2165

Objective: To describe a case of an adult patient with uncorrected Tetralogy of Fallot (TOF) who suffered from Infective Endocarditis (IE) that involved the tricuspid and aortic valves.Methods: On October 2019, a-twenty-year-old male with uncorrected TOF was admitted to the emergency department of Dr. Hasan Sadikin General Hospital with a chief complaint of fever. The echocardiography showed the presence of vegetation on the tricuspid valve and aortic valve. The patient was given empirical antibiotics therapy for IE treatment. The serial blood cultures did not yield any organism growth and the transthoracic echocardiography evaluation showed healed vegetation after 21 days of antibiotics treatment.Results: A high turbulence in small VSD and valvular stenosis, as found in TOF, can injure the endocardial surface. While bacterial adherence to the injured endocardial surface can cause IE, no specific criteria available for diagnosing IE in congenital heart disease (CHD) patients compared to other population. In CHD patients, it is necessary to consider the diagnosis of IE presenting with signs of infection or fever. Our patient was known to have uncorrected TOF and was admitted to the hospital with a chief complaint of fever. The uncorrected TOF was complicated by an unusual form of aggressive vegetation involving multiple valves.Conclusion: The incidence of IE in uncorrected TOF is around 4%. Patient is advised to receive a corrective surgery for the cardiac anomaly. Surgical repair of CHD with no residual lesion reduces the risk of IE.

Cardiac Cachexia dan Dampaknya terhadap Sintasan Penderita Gagal Jantung Aninka Saboe; Badai B. Tiksnadi; Augustine Purnomowati; Toni M. Aprami
Jurnal Kardiologi Indonesia Vol. 36, No. 2 April - Juni 2015
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v36i2.460

Background. Cardiac cachexia (CC) is one of indicator of poor prognosis in heart failure. Unfortunately, its existence is often overlooked by many cardiologists, this is further complicated by small number of study concerning CC, and the controversial issues they encompasses.Methods. The aim of this study is to analyze the survival in heart failure (HF) patients with cachexia complications. A retrospective cohort study was conducted on the data from Hasan Sadikin General Hospital HF registry from March 2013 – August 2014. The inclusion criteria was the data registry (registry’s inclusion criterias: HF patients above 18 years of age with left ventricle ejection fraction (LVEF) below 40%, time onset of HF more than 6 months and exclusion criterias were valvular diseases as primary etiology of HF). The exclusion criteria was if the patients have other chronic disease (COPD, CKD, cancer). Cardiac cachexia was diagnosed in patients fulfilling the criteria from international cachexia consensus.Results. There were 39 patients, most of them were female (61.5%), with mean LVEF 28.5% (+6.7). Cardiac cachexia was diagnosed in 6 (15.3%) patients. At 6 months of follow-up after initial enrollment, the cumulative rate of death from cardiovascular cause was 83% among cachectic as compared 37.5% among noncachectic patients p=0.001 Adjusted HR (95%CI) = 8.05 (2.40–27.04). There were no association between mortality with sex (p=0.268), etiology of HF (p=0.288), LVEF (p=0.061), comorbid condition (hypertension p=0.237, diabetes mellitus p=0.163).Conclusions. We conclude that patients with cardiac cachexia is independent predictor of death in HF and warrants a special consideration in the management of HF.

Long term radial artery occlusion following distal or proximal transradial artery access in invasive cardiovascular procedures Saboe, Aninka; Ibrahim, Maulana; Pranata, Raymond; Dewi, Triwedya Indra; Yahya, Achmad Fauzi
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.10

Background: Radial artery occlusion (RAO) is one of the most common consequences of transradial artery access (TRA) in invasive cardiovascular procedures; therefore, alternative approaches, such as distal radial artery access (DRA), emerged. This study compares proximal and distal radial access for long-term RAO. Objectives: This study compares long-term RAO incidence with proximal and distal radial access following invasive cardiovascular procedures. Material and Methods: This is a retrospective cohort study. The subjects comprised patients with heart disease who underwent invasive cardiovascular procedures using radial access at Dr. Hasan Sadikin General Hospital Bandung between July 2017 and December 2020. The patients were categorized into two groups based on their access type: proximal and distal. The incidence of long-term RAO was evaluated through Doppler ultrasound at least one-year post-TRA. Results: The study included 107 patients (proximal = 72 patients; distal = 35 patients). The mean age was 58.2 ± 8.26 years, with a predominance of male patients (79.4%) and smokers (65.4%). The majority of procedures were interventional (58.2%). Baseline characteristics were comparable between the two groups, except for selecting the access side, which was more prevalent on the left side in the distal group. Long-term RAO occurred in 8 patients (7.48%), with 7 cases (9.72%) in the proximal group and 1 case (2.86%) in the distal group (p=0.269). Conclusion: The study findings reveal no significant difference in the incidence of long-term RAO between proximal and distal radial access in invasive cardiovascular procedures.

Unexpected Infective Endocarditis in Corrected Congenital Heart Disease: A Case Report Cool, Charlotte Johanna; Serulina, Rachmi; Saboe, Aninka
International Journal of Integrated Health Sciences Vol 10, No 1 (2022)
Publisher : Faculty of Medicine Universitas Padjadjaran

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.15850/ijihs.v10n1.2166

Objective: To describe patients with corrected Congenital Heart Disease (CHD) who experienced Infective Endocarditis (IE).Methods: Two cases of IE were observed in 2019. The first case involved a 36-year-old woman with previous percutaneous transcatheter perimembranous ventricular septal defect (VSD) closure four months before admission. Echocardiography showed vegetation at noncoronary cusps of the aortic valve. Patient received antibiotics for six weeks and underwent surgery for evacuation of vegetation and device, along with VSD closure with a cardiovascular patch (Gore-tex). The second case involved a 43-year-old woman with a history of surgical closure in secundum atrial septal defect (ASD) by pericardial patch two months before admission. Echocardiography showed vegetation at the tricuspid valve. Patient received antibiotics for four weeks and planned for surgery to evacuate vegetation. Results: IE is one of the major complications in CHD, whether uncorrected, treated, or corrected. The risk of IE increased with an invasive procedure. Post closure IE is rare. Poor dental hygiene and immunocompromised also increased patient's risk to be exposed to IE as shown in the first patient who had dental caries and the second patient who was on methylprednisolone for post-surgical pericardial effusion treatment. Conclusion: The risk of IE increases with invasive procedures in CHD patients. Although the incidence of IE is quite rare, its possibility should become of a serious concern among physicians.

HUBUNGAN ANTARA DIABETES MELITUS TIPE 2 DAN SKOR LESI KALSIFIKASI BERDASARKAN PEMERIKSAAN INTRAVASCULAR ULTRASOUND (IVUS) PADA PASIEN PENYAKIT ARTERI KORONER Aninka Saboe; Dendi Pudji Wahyudi; Eliza Techa Fattima; Achmad Fauzi Yahya
Jurnal Kardiologi Indonesia Vol 47 No 1 (2026): January - March, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.1449

Background: Coronary artery calcification reflects the chronic burden of atherosclerosis and contributes to procedural complexity during Percutaneous Coronary Intervention (PCI). While coronary calcium has been extensively studied using Computed Tomography (CT), data on Intravascular Ultrasound (IVUS)-derived calcium characteristics in Southeast Asian populations remain limited. The Southeast Asian population, particularly Indonesians, may exhibit distinct patterns of atherosclerosis influenced by genetic, lifestyle, and metabolic factors. Therefore, we sought to investigate the association between cardiovascular risk factors and IVUS-derived total coronary calcium score in an Indonesian population. Methods: This single-center, retrospective observational study included consecutive patients who underwent IVUS-guided PCI between January 2020 and December 2021. Data on patient demographics and cardiovascular risk factors were obtained from medical records. The IVUS calcium scores recorded in the database were independently reanalyzed and validated by an experienced interventional cardiologist to ensure consistency and accuracy. Associations between cardiovascular risk factors and total IVUS calcium score were assessed using Spearman's rank correlation and the Kruskal–Wallis test.Results: A total of 111 patients were included in this study with a mean age of 61.3 ± 10.2 years; 72.1% were male. Hypertension was present in 60.4%, DM in 45.0%, dyslipidemia in 38.7%, and active smoking in 40.5%. The mean IVUS total calcium score was 1.93 ± 1.41. Among individual risk factors, dyslipidemia (ρ = 0.22, p = 0.021) and smoking (ρ = −0.24, p = 0.009) were significantly associated with calcium score. Patients with ≥2 risk factors had higher mean calcium scores (2.15 ± 1.35) compared with those with ≤1 risk factor (1.15 ± 1.33; p = 0.028). Conclusion: The total IVUS calcium score correlated significantly with the presence of dyslipidemia in this Indonesian population. A cumulative increase in cardiovascular risk factors was associated with greater coronary calcium burden, suggesting that multifactorial risk exposure plays an important role in coronary calcification in this population.

Coronary Vulnerable and High-Risk Plaque: Current Concepts, Selective Preventive PCI, and an ISIC Position Statement Muhammad Munawar; Aninka Saboe; Achmad Fauzi Yahya; Teguh Santoso; Abdul Hakim Alkatiri; Sunanto Ng; Sunarya Soerianata; Sodiqur Rifqi; Yudi Her Oktaviono; Nahar Taufiq; Janry Pangemanan; Sasmojo Widito; Muhammad Saifur Rohman; Muhammad Syukri; Doni Firman
Jurnal Kardiologi Indonesia Online First
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2316

The concept of coronary vulnerable plaque has evolved from a histopathological concept into a potential therapeutic target for precision cardiovascular prevention. Recent evidence has expanded this paradigm beyond the traditional vulnerable-plaque construct towards the broader concept of high-risk plaque, encompassing rupture-prone plaques, erosion-prone plaques, calcified nodules, plaque burden, inflammatory activity, healing capacity, and patient-level susceptibility to thrombosis.Advances in Coronary Computed Tomography Angiography (CCTA), Intravascular Ultrasound (IVUS), Optical Coherence Tomography (OCT), Near-Infrared Spectroscopy (NIRS), molecular imaging, and Artificial Intelligence (AI) have substantially improved the detection and characterization of high-risk plaque. Circulating lipid, inflammatory, metabolic, and renal biomarkers provide complementary information regarding patient vulnerability. Concurrently, contemporary pharmacological therapy has substantially improved the natural history of coronary atherosclerosis by promoting plaque stabilization, fibrous cap thickening, lipid core regression, and attenuation of vascular inflammation.The emergence of preventive Percutaneous Coronary Intervention (PCI) for non-flow-limiting vulnerable plaques, particularly following the PREVENT trial, has reignited interest in focal treatment before clinical destabilization. Nevertheless, important uncertainties remain regarding patient selection, diagnostic thresholds, imaging strategies, device selection, long-term durability, cost-effectiveness, and applicability in resource-limited healthcare systems. Drug-Eluting Stents (DES) remain the most established device platform, whereas next-generation bioresorbable scaffolds and Drug-Coated Balloons (DCB) may offer future approaches to local plaque treatment without permanent metallic implantation. Although Coronary Artery Bypass Grafting (CABG) does not directly treat vulnerable plaques, it may indirectly protect selected patients with diffuse multivessel disease by bypassing plaque-bearing coronary segments.For Indonesia and other resource-constrained healthcare systems, future implementation should emphasize pragmatic implementation rather than widespread adoption of advanced technologies. Emphasis should remain on aggressive Optimal Medical Therapy (OMT), selective use of advanced imaging, careful identification of patients at the highest absolute cardiovascular risk, structured operator training, national registries, and rigorous evaluation of cost-effectiveness. The ultimate objective is not simply to detect more vulnerable plaques but to prevent more myocardial infarctions and cardiovascular deaths through efficient use of healthcare resources.The Indonesian Society of Interventional Cardiology (ISIC) recommends that aggressive systemic prevention, centered on OMT, should remain the foundation of care. Advanced plaque imaging and preventive PCI should be reserved for carefully selected patients with converging high-risk plaque characteristics, high patient-level risk, and a favorable benefit–risk profile.

Coronary Vulnerable and High-Risk Plaque: Current Concepts, Selective Preventive PCI, and an ISIC Position Statement Muhammad Munawar; Aninka Saboe; Achmad Fauzi Yahya; Teguh Santoso; Abdul Hakim Alkatiri; Sunanto Ng; Sunarya Soerianata; Sodiqur Rifqi; Yudi Her Oktaviono; Nahar Taufiq; Janry Pangemanan; Sasmojo Widito; Muhammad Saifur Rohman; Muhammad Syukri; Doni Firman
Jurnal Kardiologi Indonesia Vol 47 No 3 (2026): July - September, 2026
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.2316

The concept of coronary vulnerable plaque has evolved from a histopathological concept into a potential therapeutic target for precision cardiovascular prevention. Recent evidence has expanded this paradigm beyond the traditional vulnerable-plaque construct towards the broader concept of high-risk plaque, encompassing rupture-prone plaques, erosion-prone plaques, calcified nodules, plaque burden, inflammatory activity, healing capacity, and patient-level susceptibility to thrombosis.Advances in Coronary Computed Tomography Angiography (CCTA), Intravascular Ultrasound (IVUS), Optical Coherence Tomography (OCT), Near-Infrared Spectroscopy (NIRS), molecular imaging, and Artificial Intelligence (AI) have substantially improved the detection and characterization of high-risk plaque. Circulating lipid, inflammatory, metabolic, and renal biomarkers provide complementary information regarding patient vulnerability. Concurrently, contemporary pharmacological therapy has substantially improved the natural history of coronary atherosclerosis by promoting plaque stabilization, fibrous cap thickening, lipid core regression, and attenuation of vascular inflammation.The emergence of preventive Percutaneous Coronary Intervention (PCI) for non-flow-limiting vulnerable plaques, particularly following the PREVENT trial, has reignited interest in focal treatment before clinical destabilization. Nevertheless, important uncertainties remain regarding patient selection, diagnostic thresholds, imaging strategies, device selection, long-term durability, cost-effectiveness, and applicability in resource-limited healthcare systems. Drug-Eluting Stents (DES) remain the most established device platform, whereas next-generation bioresorbable scaffolds and Drug-Coated Balloons (DCB) may offer future approaches to local plaque treatment without permanent metallic implantation. Although Coronary Artery Bypass Grafting (CABG) does not directly treat vulnerable plaques, it may indirectly protect selected patients with diffuse multivessel disease by bypassing plaque-bearing coronary segments.For Indonesia and other resource-constrained healthcare systems, future implementation should emphasize pragmatic implementation rather than widespread adoption of advanced technologies. Emphasis should remain on aggressive Optimal Medical Therapy (OMT), selective use of advanced imaging, careful identification of patients at the highest absolute cardiovascular risk, structured operator training, national registries, and rigorous evaluation of cost-effectiveness. The ultimate objective is not simply to detect more vulnerable plaques but to prevent more myocardial infarctions and cardiovascular deaths through efficient use of healthcare resources.The Indonesian Society of Interventional Cardiology (ISIC) recommends that aggressive systemic prevention, centered on OMT, should remain the foundation of care. Advanced plaque imaging and preventive PCI should be reserved for carefully selected patients with converging high-risk plaque characteristics, high patient-level risk, and a favorable benefit–risk profile.

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