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All Journal Jurnal Anestesiologi Indonesia Heart Science Journal
Radityo Prakoso
Faculty of Medicine, University of Indonesia/ Harapan Kita National Cardiovascular Center
Health Professions Immunology & microbiology Medicine & Pharmacology Public Health

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The Current Strategy in Managing Congenital and Structural Heart Disease: Find and Treat Them Appropriately Prakoso, Radityo
Heart Science Journal Vol. 5 No. 2 (2024): Challenges in the Management of Congenital Heart and Structural Heart Diseases
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub/hsj.2024.005.02.2

Abstract

Significant progress has been made in diagnosing and treating congenital heart defects (CHDs) over the past five decades. Notable advancements include pulse oximetry screening for critical CHDs in newborns and percutaneous, catheter-based procedures, improving outcomes even in developing nations. Recent studies demonstrate favorable outcomes with device closure of acyanotic CHDs, with non-fluoroscopy techniques adopted to minimize radiation risks. Positive results are observed with right ventricular outflow tract (RVOT) stent palliation for late-presenting cyanotic congenital heart diseases such as tetralogy of Fallot (TOF). Novel interventions like reverse Potts shunt anastomosis show promise in managing pediatric pulmonary arterial hypertension (PAH), while prophylactic treatments effectively reduce postoperative arrhythmias. Fontan procedure significantly enhances survival rates for individuals with single functional ventricles, although challenges arise with aging populations. In developed countries, fetal cardiac interventions utilizing advanced imaging techniques allow for early detection and preventive interventions, reducing secondary complications.
Successful High-Risk Pulseless-Balloon Aortic Valvuloplasty Procedure in Uncorrected Pulmonary Atresia with Severe Congenital Aortic Stenosis and Low Left Ventricular Function Sofia, Sefri Noventi; Bahrudin, Bahrudin; Riwanto, Ignatius; Susanto, Hardhono; Soetadji, Anindita; Baskoro, Adhi Gunawan; Prawara, Ananta Sidhi; Satyagraha, Muhammad Thifan; Kurniawati, Yovie; Prakoso, Radityo
JAI (Jurnal Anestesiologi Indonesia) Vol 17, No 3 (2025): JAI (Jurnal Anestesiologi Indonesia)
Publisher : Perhimpunan Dokter Spesialis Anestesiologi dan Terapi Intensif

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.14710/jai.v0i0.72347

Abstract

Background: Pulmonary atresia with ventricular septal defect (PA-VSD) and severe bicuspid aortic stenosis is an uncommon condition that presents significant surgical challenges. The dual obstruction leads to chronic pressure overload, resulting in ventricular hypertrophy and decreased systolic function. A low left ventricular ejection fraction (LVEF) increases the risk of mortality during surgical interventions. Percutaneous balloon aortic valvuloplasty (PBAV) poses additional risks due to the intentional induction of pulselessness during balloon inflation. This case report aims to detail the perioperative management strategies employed during PBAV in a patient with PA-VSD, severe aortic stenosis, and low LVEF.Case: We present a 19-year-old female patient weighing 45 kg with shortness of breath and fatigue. Her oxygen saturation was measured at 90% across all extremities. Electrocardiogram (ECG) findings indicated sinus rhythm with biventricular hypertrophy and incomplete left bundle branch block (LBBB). Chest X-ray revealed cardiomegaly and pulmonary artery dilation, while echocardiography confirmed PA-VSD, severe aortic stenosis with a mean pressure gradient (mPG) of 55 mmHg, and an LVEF of 41.3%. A percutaneous pulseless-BAV was performed using a Tyshak balloon via an antegrade transvenous femoral approach under fluoroscopy and transesophageal echocardiography guidance.Discussion: Anesthesia management focused on gradual medication titration, minimizing patient movement during the procedure, and ensuring comfort due to transesophageal echocardiogram (TEE) probe insertion. A temporary pacemaker was placed in the right ventricular apex for pacing at 220 beats per minute until cardiac arrest occurred post-balloon inflation, and defibrillation successfully restored spontaneous circulation.Conclusion: This case illustrates that PBAV in uncorrected PA-VSD with severe aortic stenosis and low LVEF is feasible despite its inherent risks when conducted by a skilled team utilizing careful judgment throughout the procedure.
Co-Authors Anindita Soetadji Bahrudin Bahrudin Baskoro, Adhi Gunawan Budi Nagawijaya Erika Maharani Hardhono Susanto Ignatius Riwanto, Ignatius Kurniawati, Yovie Muhammad Munawar Prawara, Ananta Sidhi Robert E. Saragih Satyagraha, Muhammad Thifan Sefri Noventi Sofia Yoga Yuniadi Yoga Yuniadi