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All Journal Bioscientia Medicina : Journal of Biomedicine and Translational Research Cardiovascular and Cardiometabolic Journal (CCJ) Bioscientia Medicina : Journal of Biomedicine and Translational Research
I Kadek Herry Hermawan
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Biochemistry, Genetics & Molecular Biology Immunology & microbiology Medicine & Pharmacology Neuroscience

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Ventricular Septal Rupture (VSR) in Post-Acute Anterior Myocardial Infarction Patients : A Case Series Ken Christian Kawilarang; I Kadek Herry Hermawan; Febryanti Hartono
Cardiovascular and Cardiometabolic Journal Vol. 3 No. 2 (2022): Cardiovascular and Cardiometabolic Journal
Publisher : Universitas Airlangga

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.20473/ccj.v3i2.2022.100-111

Abstract

Case Summary: We present 2 cases of post-STEMI VSR. They had anterior AMI without reperfusion therapy because of patient delay and limited resources. Thereafter apical VSR occurs on 5th day. VSR was suspected because of sudden hemodynamic deterioration and new holosystolic murmur (Grade III/VI) at left parasternal line of fourth-fifth ICS. Then it was confirmed by echocardiography. Both patients underwent hemodynamic stabilization while waiting for surgical therapy. Unfortunately, they deceased because of cardiogenic shock accompanied by other comorbidities. Discussion: VSR causes shunt from left to the right ventricle, which overloads the RV, leading to cardiogenic shock. The peak incidence of VSR in the first 24 hours or 3-5 days post-AMI. This fits both of our cases. VSR occurs in total coronary occlusion, which then causes coagulation necrosis in the ischemic area, characterized by neutrophils that trigger apoptosis and lytic enzymes, so that septum becomes thin, brittle then ruptures. VSR is most common in anterior AMI and the defect is at apical septum, as in our patients. Definitive therapy for VSR is surgical closure, but the best timing is still under debate. This article is expected to make us more aware of post-AMI VSR, so we can quickly diagnose and promptly treat the patients with multidisciplinary approach. This is very important to optimize patient’s outcomes even in limited resources area.
Utility of Tc-99m DTPA Hybrid SPECT/CT Cisternography in the Detection of Occult Postoperative CSF Fistula in an Infant with Lipomeningomyelocele: A Diagnostic Challenge and Technical Considerations I Kadek Herry Hermawan; Achmad Hussein Sundawa Kartamihardja; Trias Nugrahadi; Reza Rinaldy Harahap
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1550

Abstract

Background: Lipomeningomyelocele represents a complex spectrum of closed spinal dysraphism where surgical repair is frequently complicated by cerebrospinal fluid leakage. While overt fistulas are clinically apparent, occult or intermittent leaks in the pediatric population pose a severe diagnostic challenge. Magnetic resonance imaging, despite being the anatomical gold standard, frequently fails to distinguish active extravasation from postoperative seroma or edema due to overlapping signal intensities. This study evaluates the diagnostic superiority of Tc-99m DTPA Hybrid SPECT/CT cisternography in resolving this dilemma. Case presentation: A 5-month-old female underwent resection of a large lumbosacral lipomeningomyelocele. Postoperatively, she developed persistent, clear fluid discharge from the incision, suggestive of a fistula, yet initial surgical re-exploration was inconclusive. The patient underwent radionuclide cisternography using 37 MBq of intrathecal Tc-99m DTPA. Standard planar scintigraphy at 1 hour and 3 hours was equivocal due to background renal activity. However, Hybrid SPECT/CT performed at 3 hours precisely localized an abnormal radiotracer tract extending from the thecal sac at L5 into the right multifidus muscle, a finding invisible on conventional imaging. Conclusion: The integration of physiological flow data from scintigraphy with the anatomical specificity of low-dose CT allows for the detection of slow-flow, occult leaks that evade MRI. In infants with distorted post-surgical anatomy, Hybrid SPECT/CT should be elevated from a problem-solving tool to a primary diagnostic modality when clinical suspicion persists. The technique facilitates targeted repair, minimizing morbidity in this vulnerable population.
Utility of Tc-99m DTPA Hybrid SPECT/CT Cisternography in the Detection of Occult Postoperative CSF Fistula in an Infant with Lipomeningomyelocele: A Diagnostic Challenge and Technical Considerations I Kadek Herry Hermawan; Achmad Hussein Sundawa Kartamihardja; Trias Nugrahadi; Reza Rinaldy Harahap
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 10 No. 4 (2026): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v10i4.1550

Abstract

Background: Lipomeningomyelocele represents a complex spectrum of closed spinal dysraphism where surgical repair is frequently complicated by cerebrospinal fluid leakage. While overt fistulas are clinically apparent, occult or intermittent leaks in the pediatric population pose a severe diagnostic challenge. Magnetic resonance imaging, despite being the anatomical gold standard, frequently fails to distinguish active extravasation from postoperative seroma or edema due to overlapping signal intensities. This study evaluates the diagnostic superiority of Tc-99m DTPA Hybrid SPECT/CT cisternography in resolving this dilemma. Case presentation: A 5-month-old female underwent resection of a large lumbosacral lipomeningomyelocele. Postoperatively, she developed persistent, clear fluid discharge from the incision, suggestive of a fistula, yet initial surgical re-exploration was inconclusive. The patient underwent radionuclide cisternography using 37 MBq of intrathecal Tc-99m DTPA. Standard planar scintigraphy at 1 hour and 3 hours was equivocal due to background renal activity. However, Hybrid SPECT/CT performed at 3 hours precisely localized an abnormal radiotracer tract extending from the thecal sac at L5 into the right multifidus muscle, a finding invisible on conventional imaging. Conclusion: The integration of physiological flow data from scintigraphy with the anatomical specificity of low-dose CT allows for the detection of slow-flow, occult leaks that evade MRI. In infants with distorted post-surgical anatomy, Hybrid SPECT/CT should be elevated from a problem-solving tool to a primary diagnostic modality when clinical suspicion persists. The technique facilitates targeted repair, minimizing morbidity in this vulnerable population.
Co-Authors Achmad Hussein Sundawa Kartamihardja Febryanti Hartono Ken Christian Kawilarang Reza Rinaldy Harahap Trias Nugrahadi