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Peran Vital Ultrasonografi Dupleks pada Fistula Arteriovenosa sebagai Akses Hemodialisis Firdaus, Achmad Jauhar; Kurnianingsih, Novi
Jurnal Klinik dan Riset Kesehatan Vol 3 No 3 (2024): Edisi Juni
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.03.3.6

The global incidence of end-stage renal disease (ESRD) is rising, amounting to more than 800 million individuals are suffered, in line with the rise of the number of patients undergoing hemodialysis as treatment modalities. Hemodialysis requires vascular access, and the arteriovenous fistula (AVF) access is considered the most ideal vascular access option due to its long-term patency and low complication rate compared to other access options. However, up to one-third of hospital admissions for ESRD patients are caused by AVF dysfunction, which is also one of the main causes of morbidity and mortality in ESRD patients. AVF creation requires careful pre- and post-operative evaluation to ensure the vascular access maturation and patency. While the latest guidelines have not explicitly emphasized the role of vascular mapping and surveillance, routine duplex ultrasonography before and after AVF creation procedures holds great potential advantages to ensure the success of AV access for hemodialysis.

Successful unroofing of anomalous aortic origin of the left coronary artery with intramural course in patient with near syncope Firdaus, Achmad Jauhar; Handari, Saskia Dyah; Prasetya, Indra; Tjahjono, Cholid Tri
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.17

BACKGROUND: Left Anomalous Coronary Artery from the Opposite Sinus of Valsalva (L-ACAOS) refers to a congenital heart defect in which the left coronary artery originates from the right coronary sinus of Valsalva. This condition may increase the risk of sudden cardiac death (SCD), especially for those participating in intense physical exertion. This paper presents a case of a malignant type L-ACAOS in a young male who underwent successful surgical correction. CASE: A 35-year-old male without any known coronary artery disease risk factors presents with angina and near syncope while competing in a marathon run. He regularly participates in endurance sporting events without any complaints. However, in the last two years, he has begun to complain of angina during exertion. The ECG examination showed early repolarization in the inferior and lateral leads with no significant lab abnormalities. This led to coronary computed tomography angiography (CCTA), which revealed that the left coronary artery originates from the right coronary sinus and runs between the pulmonary trunk and ascending aorta, indicating a malignant-type anomalous coronary artery. He then undergoes a surgical correction with unroofing of the left main coronary artery and relocate the LMCA orifice to the left sinus. The procedure proceeded uneventfully with satisfactory results. CONCLUSION: Anomalous coronary arteries are concerning because they are associated with increased risks of SCD. The intramural course is associated with a higher risk of SCD due to stenosis caused by lateral compression that leads to ischemia and potentially fatal arrhythmias, making early detection and intervention critical.

Massive saddle embolism in chronic thromboembolic pulmonary hypertension: The unresolved tale Firdaus, Achmad Jauhar; Karolina, Wella
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.18

BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) represents a rare and severe variant of pulmonary hypertension (PH), leading to progressive damage to the cardiopulmonary system. The obstruction could happen anywhere from the small branches to the main pulmonary artery. A saddle-type emboli, a particularly severe type of pulmonary embolism that occurs in the main pulmonary artery and blocks both the right and left branches, has the highest potential to cause death. This article presents a case of progressive CTEPH with inoperable conditions that underwent catheter-directed thrombolysis (CDT) as a last resort given the limitations of other treatment modalities. CASE: A 53-year-old woman with worsening shortness of breath was diagnosed with CTEPH, but despite anticoagulant treatment, imaging evaluation showed a progressive saddle-type pulmonary embolism along with findings of interstitial lung disease (ILD). Multidisciplinary team discussions were conducted, and the decision to proceed with pulmonary endarterectomy (PEA) was influenced by various factors. CDT was then performed, however, there was no notable clinical improvement. The patient ultimately succumbed to the disease following 31 days of treatment. CONCLUSION: CTEPH is a rare type of pulmonary hypertension caused by pulmonary embolism. The treatment algorithm employs a multimodal strategy that addresses the different anatomical lesions. In proximal obstruction, surgical PEA remains the treatment of choice in operable patients. An experienced multidisciplinary team is mandatory. Without these requirements, other strategies can continue to be studied for their role in inoperable CTEPH.

Predicting lesion complexity in premature coronary artery disease: The utility of clinical risk scores Firdaus, Achmad Jauhar; Mohammad Saifur Rohman; Budi Satrijo; Cholid Tri Tjahjono; Anna Fuji Rahimah
Heart Science Journal Vol. 6 No. 3 (2025): Advancements in Cardiac Imaging : Unlocking New Perspectives on the Heart Visua
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.03.12

Background: Premature coronary artery disease (PCAD) has been recognized as a significant global health issue, with its prevalence increasing due to earlier exposure to various risk factors. Emerging evidence suggests that PCAD may be as aggressive, if not more so, than in older populations. The clinical implications and angiographic characteristics for more aggressive management strategies remain poorly explored. Objectives: This study aims to develop and validate a clinical scoring system in predicting lesion complexity in patients with PCAD. Methods: A retrospective cohort study was conducted on 645 patients who underwent invasive coronary angiography (ICA) from January 2023 to December 2024 in Dr. Saiful Anwar General Hospital, East Java, Indonesia. Patients were divided into developmental (n = 322) and validation (n = 323) groups. Clinical information was gathered from medical records, including risk factors and angiographic results. Predictors of complex CAD (SYNTAX ≥ 33) were identified by multiple logistic regression analysis. A clinical scoring system was developed and validated. Results: This study found complex CAD in 252 (39.1%) of all PCAD patients. Smoking (OR 2.3; p 0.006), dyslipidemia (OR 2.8; p < 0.001), diabetes mellitus (OR 3.9; p < 0.001), history of previous myocardial infarction (OR 6.5; p < 0.001), and family history of CAD (OR 5.7; p < 0.001) were independent predictors of complex CAD. A clinical scoring system was developed with a cut-off score ≥ 4 predicting complex CAD, with an area under the curve (AUC) value of 0.836 (95% CI 0.791-0.880), sensitivity of 71.3%, and specificity of 85.0%. Conclusion: The PCAD population continues to represent a high-risk group of concern. While the short-term prognosis is optimistic, the long-term outlook for this cohort is less promising due to the high recurrence rate and prolonged complications, especially in individuals with complicated CAD, leading to impaired quality of life

Peran Vital Ultrasonografi Dupleks pada Fistula Arteriovenosa sebagai Akses Hemodialisis Firdaus, Achmad Jauhar; Kurnianingsih, Novi
Jurnal Klinik dan Riset Kesehatan Vol 3 No 3 (2024): Edisi Juni
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.03.3.6

The global incidence of end-stage renal disease (ESRD) is rising, amounting to more than 800 million individuals are suffered, in line with the rise of the number of patients undergoing hemodialysis as treatment modalities. Hemodialysis requires vascular access, and the arteriovenous fistula (AVF) access is considered the most ideal vascular access option due to its long-term patency and low complication rate compared to other access options. However, up to one-third of hospital admissions for ESRD patients are caused by AVF dysfunction, which is also one of the main causes of morbidity and mortality in ESRD patients. AVF creation requires careful pre- and post-operative evaluation to ensure the vascular access maturation and patency. While the latest guidelines have not explicitly emphasized the role of vascular mapping and surveillance, routine duplex ultrasonography before and after AVF creation procedures holds great potential advantages to ensure the success of AV access for hemodialysis.

Pendekatan Terkini Dan Masa Depan Pada Penyakit Jantung Koroner Prematur Firdaus, Achmad Jauhar; Satrijo, Budi
Jurnal Klinik dan Riset Kesehatan Vol 5 No 1 (2025): Edisi Oktober 2025
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.05.1.6

Coronary artery disease is one of the most frequent cardiovascular diseases and has consistently ranked as the leading cause of death globally for the past three decades. During that period, trends regarding coronary artery disease in young adults have exhibited a complicated interaction of rising incidence and mortality rates in particular populations. Coronary artery disease encompasses a broad range of symptoms and is particularly concerning when it develops at a young age, typically before 55 years in men and 60 years in women. The disease spectrum varied from asymptomatic conditions to chronic symptoms known as chronic coronary syndrome and acute symptoms known as acute coronary syndrome. Multiple recommendations and consensus have been established concerning the approaches to these spectrums, although there is less discourse on precisely addressing the young population's specific requirements. This extensive analysis offers insights into premature coronary artery disease and the multidimensional approach based on the latest guidelines and the novel approach using the help of artificial intelligence and machine learning, emphasizing early detection and diagnosis across the whole clinical spectrum.

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