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Case Report: Role of Rotational Atherectomy in Complex PCI Seprian Widasmara; Mohammad Saifur Rohman; Heny Martini; Indra Prasetya
Heart Science Journal Vol 2, No 3 (2021): The Science and Art of Myocardial Revascularization
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.03.7

Background : One in three patients undergoing percutaneous coronary intervention (PCI) exhibits moderate or severe coronary artery calcification. Coronary calcification remains a major independent predictor of PCI failure and adverse outcomes. PCI of calcified coronary lesions remains challenging, despite significant improvements in the available tools and techniques. Rotational Atherectomy (RA) is a critical component to improve PCI success in these situations by producing lumen enlargement by physical removal of plaque and reduction in plaque rigidity, thus facilitating dilationCase Illustration: A 73-year-old man with exertional angina was referred to our hospital, with a history of hypertension, diabetes mellitus, ex-smoker and dyslipidemia. Physical exam, electrocardiogram, chest x-rays, and laboratory findings were unremarkable, but transthoracic echocardiogram revealed anterior wall hypokinesis. History of cardiac catheterization outside of our center with angiographic result of left anterior descending (LAD) lesion, highly calcified, non-dilatable on first several POBA attempts. Coronary angiography at our center, revealed diffuse calcification from proximal to distal of the LAD artery with about 90% maximum stenosis in mid LAD. RA (Rotablator, Boston) was then performed with A 1.50 mm burr gradually advanced at 150,000 rpm to passed the lesion. After deployments of stents, final angiogram showed well positioned stents with good distal run-off flow. The patient was uneventful during the procedure and was discharged following day. Discussion: In experienced hands, RA is as safe as standard PCI. RA is as a tool to make PCI possible in complex lesions with moderate or severe calcification when clinical variables make PCI appropriate. Rotablator is a catheter-based interventional cardiology procedure using a high-speed rotational device designed to ablate atherosclerotic plaque and restore luminal patency. This help to facilitate stent delivery, avoiding the barotrauma caused by repeated high-pressure balloon inflations that can lead to vessel dissection or perforation. Atherectomy can be performed safely with optimal burr selection and proper ablation techniques, and as a result, complication rates have been significantly minimized, with few changes in the acute complications reported in contemporary studies. Keywords: percutaneous coronary intervention, calcified lesion, rotational atherectomy.

The Added Value of Bioimpedance Analysis to NT-proBNP in Predicting Short-term outcome in Acute Heart Failure Patients Putri Annisa Kamila; Mohammad Saifur Rohman; Setyasih Anjarwani; Djanggan Sargowo; Anna Fuji Rahimah; Indra Prasetya; Muhammad Rizki Fadlan; Salvatore Di Somma
Heart Science Journal Vol 2, No 1 (2021): How to Diagnose Heart Failure and Deal with The Treatment Complexity
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.01.06

Background: Acute heart failure (AHF) is a significant clinical problem, which has a high prevalence, mortality, and rehospitalization. Congestion is critical in AHF's pathogenesis, which is also a predictor of mortality and rehospitalization in patients with AHF. Aim: Knowing the effect of adding a %Total body water (TBW) test detected by Bioimpedance Analysis to NT-proBNP as a short-term clinical outside predictor of patients with acute heart failure Method: This research is an analytical observational study using prospective cohort methods. The research was conducted at Dr. Saiful Anwar Malang Hospital in January 2018-July 2019, with research subjects taken consecutively against all AHF patients hospitalized at UD dr.UD dr. Saiful Anwar Malang. The data taken in the form of NT-proBNP value during mission and %TBW before the patient leaves the hospital detected with NICaS examination, then the outside seen is mortality rate and rehospitalization due to AHF within 90 days after exiting the hospital. Results: This study involved 65 subjects who were 61 years old and the majority male. Non-survivor patients had a higher NYHA class, NT-proBNP, and %TBW predischarge than the survivor group. Based on statistical analysis, we found that NT-proBNP is a good predictor of mortality (HI: AUC 0.74; 95%CI 0.59-0.90) and rehospitalization (HI: AUC 0.88; 95%CI 0.78-0.97). Similarly , %TBW pre-discharge shows good predictors of mortality (HI: AUC 0.72, 95%CI 0.56-0.87) and rehospitalization (HI: AUC 0.83, 95%CI 0.73-0.94). The addition of the %TBW predischarge parameter to NT-proBNP results in the best predictor numbers among the three for both mortality (HI: AUC 0.84; 95%CI 0.72-0.96) and rehospitalization (HI: AUC 0.92; 95%CI 0.85-1.00). Conclusion: The addition of predischarge %TBW examination detected by bioimpedance analysis tool against NT-proBNP increases the predicted value of short-term clinical outpatient in the form of mortality and rehospitalization of acute heart failure patients.Keywords: acute heart failure, NT-proBNP, bioimpedance analysis, total body water

Simple Clinical Predictors of Successful Fibrinolysis in Combined Assessment of ST-Segment Resolution, Myocardial Infraction Flow Grade, and Myocardial Perfusion Grade: Importance of Admission Blood Glucose and Ischemic Time Fahmy Rusnanta; Mohammad Saifur Rohman; Indra Prasetya; Ardian Rizal; Novi Kurnianingsih
Heart Science Journal Vol 2, No 3 (2021): The Science and Art of Myocardial Revascularization
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.03.3

Background : Fibrinolytic therapy (FT) is the alternative recommendation in patients with ST-segment elevation myocardial infarction (STEMI) if primary percutaneous coronary intervention (PCI) could not be perfomed timely at initial presentation. Successful revascularization of occluded infarct-related coronary arteries depends on complex mechanisms of hemodynamic, clinical, biochemical, and mechanical parameters. The aim of study was to find outpredictors of patient characteristics to achieve complete reperfusion based on Thrombolysis in Myocardial Infarction(TIMI) 3 flow, Myocardial Blush Grade (MBG) 3, and ST-segment resolution. Method : This retrospective study was held in Saiful Anwar, Malang Hospital during 2017-2021, including total of 142 patients. All patients received FT and coronary angiographic evaluation post-FT. Those were divided into 3 groups, which included R0,1 (0/1 highest measure of reperfusion), R2 (2 highest measures of reperfusion), and R3 (3 highest measures of reperfusion). Results : Ischemic time (OR 0,82 [95%CI -0,39;-0,01]; p=0,04] and admission blood glucose (ABG) (OR 0,99 [95%CI -0,01;0]; p=0,046] were negatively correlated to the complete restoration of reperfusion (R3). This study revealed that ischemic time <5 hours (AUC 0,742 [95%CI 0,645-0,839]; p=0,000) and ABG <140 mg/dL (AUC 0,701 [95%CI 0,612-0,790]; p=0,000) were significant predictor for R≥2. Coronary characteristic was not related to measure of reperfusion (p=0,25). Conclusion : Ischemic time <5 hours and ABG <140 mg/dL are important predictors of successful reperfusion post FT (R≥2). Early assessment of patients who are likely to have low parameter reperfusion (R<2) would help promptly preparing for primary PCI.

Common Femoral Artery Aneurysm: A Challenging Diagnostic and Treatment of a Rare Case Ayu Asri Devi Adityawati; Novi Kurnianingsih; Budi Satrijo; Indra Prasetya
Heart Science Journal Vol 2, No 2 (2021): Dealing with Vascular Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.02.7

BACKGROUND: Aneurysm of peripheral artery is a rare vascular pathology, especially aneurysm in common femoral artery. Here, we presented a case report of right common femoral artery aneurysm caused by infectionCASE REPORT: a 76-year-old man referred to our hospital with pulsatile groin mass at his right thigh. He had no prior history of surgery or traumas, but he has been treated in private hospital due to septic condition, hypertension, and diabetes mellitus type II. Based on findings from physical examination and radiology examination, a diagnosis of common femoral artery aneurysm was made. The patient was referred to Cardiovascular and Thoracic Surgeon Department and scheduled for routine surgery, but on third day of admission patient became hemodynamically unstable and on re-examination it was found that the aneurysm had been ruptured. Emergency surgery was conducted on that day. During surgery patient was hemodynamically stable with PRC transfusion.DISCUSSION: Aneurysms can occur in almost any artery in the body. Femoral artery aneurysm was rare. Diagnostic procedure with various modalities were needed to establish a precise diagnosis for patient which come with swelling in his/her lower extremity. Doppler ultrasound was conducted in order to find a saccular mass with neck and a yin and yang phenomenon, which can narrow down the differential diagnosis to pseudoaneurysm or aneurysm. Subsequent CT angiography clearly confirmed the involvement of 3 layer arterial wall as a sign of an aneurysm. Femoral artery aneurysms (FAA) may be caused by weakening of the arterial wall due to atherosclerosis or mycotic aneurysm. Surgical repair of aneurysm is an option when symptomatic and that should also be considered when there is ongoing hemodynamic instability or limb ischemia.CONCLUSION: The common femoral artery aneurysm aren’t common. It is very rarely to be isolated aneurysm and usually don’t tend to be rupture. Whenever a femoral artery aneurysm is found, search and follow-up for other aneurysms should take place. Annual follow-up is recommended. Straightforward surgical management brings good results in this group of patient. Keywords: Femoral artery aneurysm, Common femoral artery aneurysm, Isolated aneurysm, Mycotic aneurysm

Current Anticoagulation Recommendation for COVID-19 Patients Indra Prasetya
Heart Science Journal Vol 2, No 4 (2021): Management of Thrombosis in Covid-19 Patient with Cardiovascular Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.04.1

Thromboembolic events in COVID-19 patients can be one of the factors that aggravate the disease and increase mortality. When severe hypoxemia and hypotension occur in COVID-19 patients, the possibility of embolism should be considered. As a result, anticoagulant therapy in COVID-19 patients has an essential role in lowering disease severity and mortality. Many studies report that giving anticoagulants to COVID-19 patients can reduce mortality. Therefore, it is important to understand the role and use of anticoagulant therapy in cases of COVID-19. Several guidelines that have been issued by several health organizations in the world and Indonesia can be used as guidelines for clinicians to start anticoagulant therapy in cases of COVID-19. Various anticoagulant drug regimens have also been recommended to be used both as prophylaxis and as therapy for thromboembolism that can occur after COVID-19 cases.

Coronavirus Infection Induced Coagulopathy As A Trigger Factor Of Arterial Thrombosis In Patient With Atherosclerotic Risk Factor: A Case Report Irma Kamelia; Heny Martini; Novi Kurnianingsih; Indra Prasetya
Heart Science Journal Vol 2, No 4 (2021): Management of Thrombosis in Covid-19 Patient with Cardiovascular Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2021.002.04.8

Background : A newly emerging pandemic of Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory coronavirus 2 is responsible for significant morbidity and mortality worldwide. As one of the effects is hematological changes related to the COVID-19 infection causing patient tend to thrombosis than hemorrhagic. Current review of evidence and statements on management of coagulopathy and thrombotic complications related to this novel disease is needs to be exploredCase : Male 53 years old referred from Private Hospital, due to Severe pneumonia due to COVID-19 and Acute Limb Ischemia. This patient was assessed as Pneumonia COVID-19 severe with acute limb ischemia bilateral grade IIB and performed bilateral surgical thrombectomy with antegrade approach using fogarty catheter with the result was thrombus 10cm along the left femoral artery and thrombus 2cm in the right femoral artery. Discussion : With consideration of atherosclerotic diseases in this patient, we decided to give rivaroxaban as an anticoagulant combined with aspilet and statin high dose. But due to lack of source in our hospital, and patient also denied for further management, treatment for the patient cannot be optimal, so the patient discharge with unresolved limb ischemia.Conclusion : This case showed that the increase risk of heparin resistance in SARS-CoV-2 patient, it is recommend- ed to monitor heparin activity of UFH treatment based on anti-Xa levels instead of aPTT alone

Trapping Technique for Successful Retrieval of a Ruptured Balloon Catheter Entrapped in Coronary Artery : A Case Report Putri Annisa Kamila; Budi Satrijo; Mohammad Saifur Rohman; Heny Martini; Indra Prasetya
Heart Science Journal Vol 1, No 2 (2020): The Assessment of Diagnostic and Treatment Modality in Heart Failure
Publisher : Universitas Brawijaya

Introduction: Device entrapment during PCI is an uncommon complication with incidence of less than 1%. Percutaneous retrieval should be favored as the treatment of choice for this condition.Case Illustration: A 61-year-old patient came for an elective percutaneous coronary intervention (PCI) procedure. She suffered from chest pain while doing moderate activities for 1 month. Angiography showed a diffuse lesion with maximum stenosis 90% in the proximal LAD, stenosis 75% in the proximal of Left Circumflex Artery (LCx), and diffuse lesions in the proximal and mid of the Right Coronary Artery (RCA). We decided to perform PCI in the LAD. A transfemoral coronary intervention was performed using a Judkins Left 3.5 (7F) guiding catheter to engage the LAD. A Guidewire ( Run-through NS Floppy) was advanced to the distal LAD. Balloon angioplasty was performed with a 2.75 x 15 mm Fluydo balloon in the proximal LAD at 16 bars, but the balloon was entrapped and while withdrawing the balloon, it accidentally ruptured in the LAD artery with the remaining segment inside the guiding catheter. A second Run-through NS Floppy Guidewire was inserted across the ruptured balloon and a 2.5 x 20 mm Fluydo Balloon was passed on the second wire and was inflated at 16 atm pressure, inside the guiding catheter, trapping the ruptured balloon. The ruptured balloon was successfully removed, by withdrawing the whole system, including the guiding catheter and the wire. Finally, we re-engaged the LAD with the same guiding catheter, passed the wire, and post dilated the stent on the LAD to achieve a good result.Conclusion: Percutaneous retrieval using trapping technique could represent a safe and effective technique for ruptured and entrapment of a balloon-catheter in a coronary artery.

The Role of Colchicine in Acute Coronary Syndrome Liemena Harold Adrian; Budi Satrijo; Djanggan Sargowo; Indra Prasetya
Heart Science Journal Vol 1, No 4 (2020): Acute Coronary Syndrome in Daily Practice : Diagnosis, Complication, and Managem
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2020.001.04.02

Background: Despite the advances of current optimal treatment of atherosclerotic disease, the incidence of events after acute coronary syndrome (ACS) remains high. Colchicine, with its well-established pleiotropic anti-inflam- matory effects, may inhibit NLRP3 inflammasome, a key mediator in atherosclerosis-associated inflammation (AAI) thus reducing systemic inflammation. NRLP3 inflammasome activation inside leukocytes (mainly monocytes and neutrophils) is precipitated by cholesterol crystals that are present in all atherosclerosis stages. ???????????????????????????????????????? ???????????????????????????????????????? ???????? ???????????????????????????????????????????????????????????????? ???????????????????????????????????? ???????????????? ???????? ???????????????????????????????????????????????????????? ???????????? ???????????????????????????????????????????????????????? ???????????????? ???????????????????????????? ???????????????????? cytokines are the crucial inflammatory pathway mediators that promote the formation of plaque and instability in the inflammatory cascade.Objective: This review will elaborate on the function of immune cells in atherosclerosis, explain the mechanisms of NLRP3 inflammasome activation in the context of AAI, and address the possible role of colchicine specifically targeting NLRP3 inflammasome and its concomitant downstream mediators in ACS, and provide an overview of current or ongoing studies produced in this area.Discussion : NRLP3 inflammasome activation inside leukocytes (mainly monocytes and neutrophils) is precipitat- ed by cholesterol crystals that are present in all atherosclerosis stages. Subsequent activation of pro-inflammatory ???????????????????????????????????? ???????????????? ???????? ???????????????????????????????????????????????????????? ???????????? ???????????????????????????????????????????????????????? ???????????????? ???????????????????????????? ???????????????????? ???????????????????????????????????? ???????????? ???????????? ???????????????????????????? ???????????????????????????????????????????????? pathway mediators that promote the formation of plaque and instability in the inflammatory cascade. A potential advantage of a medication acting through an inflammatory milieu found in atherosclerotic lesions has recently become the need for novel therapeutic options. Colchicine, with its well-established pleiotropic anti-inflammato- ry effects, may inhibit NLRP3 inflammasome, a key mediator in atherosclerosis-associated inflammation (AAI) thus reducing systemic inflammation.Conclusion: Colchicine is a safe and reliable medication for ACS patients, alongside reveal various benefit in reducing inflammation through inhibition of NLRP3 Inflammasome`

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