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Modification of mandibular plates as an alternative for sternal fixation Pakubuana, Muhammad Alif; Nugraha, Aswin; Bermansyah; Satria, Gama; Umar, Ahmat; Tobing, Arie Hasiholan Lumban; Nasution, Indra Hakim
Journal of Indonesia Vascular Access Vol. 4 No. 2 (2024): Available online : 1 December 2024
Publisher : Indonesian Vascular Access Association (IVAA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/jinava.v4i2.52

Abstract

Introduction: The use of metallic wires for sternal closure after coronary artery bypass grafting (CABG) is standard practice, but it can lead to rare complications such as subsequent sternal wound dehiscence. These complications necessitate surgical revisions, prolong hospital stays, and increase the risk of morbidity and mortality. The following case report presents a patient who underwent modification of mandibular plates as an alternative for Sternal Fixation. Cases: A 55-year-old female patient with a history of severe coronary artery disease (CAD 3VD) underwent coronary artery bypass grafting (CABG). Postoperatively, she developed a sternal dehiscence, resulting in a sternal fracture. The patient underwent two revisions. The first revision concerns potential damage to the internal mammary artery with the Robicsek technique led to multiple fixations using PDS and large PGA 1 sutures. In the 2nd revision, consequently, the sternum was stabilized with three plates and screws on the ribs in the healthy rib area (sternochondral junction) combined with wire. Additionally, the patient had a history of hypertension, type 2 diabetes mellitus, refractory hypoalbuminemia, postmenopausal osteoporosis, and potential hormonal imbalances. In a recent presentation, a clinical examination revealed a fully conscious patient with stable vital signs and minimal drainage from the sternotomy wound. The treatment plan included close observation of the surgical wound, administration of Amikacin (antibiotic), and supportive therapies such as pain management, glycemic control, and inhalation therapy. She was scheduled for outpatient follow-up with a cardiologist for further cardiac monitoring. Conclusion: The case study highlights the complexities of managing sternal wound complications in cardiac surgery patients with additional health concerns. Innovative solutions like mandibular plates may be particularly beneficial for stabilizing the sternum and promoting recovery in post-CABG patients with crushed sternums and complicating factors such as hypertension, diabetes, and refractory hypoalbuminemia, along with postmenopausal osteoporosis and potential hormonal imbalances.
A case series of paediatric atrial myxoma: Clinical challenges and surgical management: Atrial Myxoma Septyandra, Ezi; Bermansyah; Nugraha, Aswin; Nova, Ria
Journal of Indonesia Vascular Access Vol. 4 No. 2 (2024): Available online : 1 December 2024
Publisher : Indonesian Vascular Access Association (IVAA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/jinava.v4i2.55

Abstract

Introduction : Cardiac myxomas are rare, benign tumors of the heart, most commonly found in the left atrium, though they can occur in any heart chamber. These tumors can embolize, causing organ infarction, and may present with symptoms such as dyspnea, orthopnea, cough, peripheral edema, palpitations, and fatigue. The clinical presentation varies widely and may mimic other diseases, making early detection and diagnosis critical. The reported incidence of cardiac myxoma at RS Mohammad Hoesin is 5 cases over 2023-2024, consisting of 3 pediatric cases and 2 adult cases. This report emphasizes the significance of thorough history taking, detailed physical examination, echocardiography, and surgical resection in managing atrial myxoma in two paediatric patients. Case Presentation : We reported three cases: a 16-year-old male, an 11-year-old female, and 12-year-old male, They were presenting with shortness of breath as the chief complaint. The male patient was diagnosed with decompensated heart failure due to a large left atrial myxoma, accompanied by tricuspid and pulmonary regurgitation, and underwent successful surgical removal of the myxoma. The female patient, with a history of contact with tuberculosis, was found to have a mass in the right atrium with a differential diagnosis of myxoma or tuberculoma. She was treated for clinical pulmonary tuberculosis and is currently under medical management. The last patient, male was diagnosed with a large left atrial myxoma, tricuspid regurgitation, and severe mitral regurgitation. The myxoma had removed from the left atrium in this patient. Conclusion : Paediatric atrial myxoma is a rare condition with a wide range of clinical manifestations, from asymptomatic cases to intracardiac obstruction, embolization, and constitutional symptoms. This often results in misdiagnosis as other more common heart diseases. Transthoracic echocardiography is useful as an initial diagnostic tool, as it effectively determines the tumor's location, size, shape, and connections, aiding in the selection of the optimal management strategy. Surgical excision is the primary treatment, with regular echocardiographic follow-up essential for the early detection of recurrence and long-term patient health.
Infective endocarditis: a case series Yazid, Keyshia Nur; Bermansyah; Satria, Gama; Umar, Ahmat; Nugraha, Aswin; Tobing, Arie Hasiholan Lumbang; Nasution, Indra Hakim
Journal of Indonesia Vascular Access Vol. 4 No. 2 (2024): Available online : 1 December 2024
Publisher : Indonesian Vascular Access Association (IVAA)

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.51559/jinava.v4i2.56

Abstract

Introduction: Infective endocarditis (IE) remains a critical cardiovascular condition with significant mortality rates, ranging from 20% during hospitalization to 25-30% within six months post-infection. Valve abnormalities have been strongly associated with IE and worsen patient symptoms and prognostic. This study presents a case series of IE in Dr. Mohammad Hoesin Palembang Hospital. Case presentations: This case series reports on the management and outcomes of four pediatric patients treated for IE between January and May 2024 in RSUP Mohammad Hoesin Palembang. Each patient presents with moderate to severe mitral regurgitation and valve vegetation. Diagnoses were based on clinical symptoms and echocardiographic findings, adhering to the Duke criteria. The management involved systemic antibiotics and valve replacement surgery, with a focus on individualized treatment plans based on the severity of regurgitation and the presence of vegetation. Notably, all four patients survived and demonstrated substantial improvement in quality of life after surgical management. Conclusions: Our findings emphasize the efficacy of a multidisciplinary approach combining antibiotic therapy with timely surgical intervention for successful treatment outcomes in IE. Early diagnosis and appropriate management, including valve replacement, when necessary, are crucial for improving patient survival and quality of life.