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Cracking the Case of the Cryptic Coronary: Novel Diagnostic Strategies for Anomalous RCA Originating from Mid-LAD Indrihapsari, Pratiwi; Satrijo, Budi
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.2024.005.02.15

Background:Coronary artery anomalies are typically congenital, though they may remain undetected until routine cardiac catheterization is performed. With a detection rate of only 1.3%, these anomalies often go unnoticed. In rare cases, the right coronary artery may originate from the left coronary system, but this anomaly is generally benign, provided the vessel does not traverse the aorta and pulmonary artery.Case Illustration: A 55-year-old male patient was diagnosed with NSTEMI and underwent coronary angiography. However, the medical team was unable to cannulate into the right coronary ostium despite multiple attempts. The left coronary ostium was located in the left sinus of Valsalva. Selective left coronary arteriography revealed normal courses of the left main and LAD but identified a critical stenosis in the LCx and a possible CTO at the RCA ostium. The patient received a stent in the LCx and returned the following month for another angiography, during which he received a stent in the proximal LAD. However, during cine angiography, it was found that the patient had an anomalous RCA that originated from the mid-portion of LAD, coursing anteriorly to the pulmonary artery, and down to the right atrioventricular groove. Subsequent CCTA confirmed the RCA's origin from the mid-LAD.Conclusion:The report uncovers a unique occurrence where the RCA originates from the mid of the LAD. Appreciation to the integration of coronary CTA, a non-invasive imaging method, it is now feasible to conduct a comprehensive examination of the heart and its intricate vascular network. This, in turn, enables the development of effective surgical and interventional cardiovascular therapies. In a medical environment, this cutting-edge technology is particularly valuable for detecting and assessing coronary abnormalities.

Reversible atrioventricular block during transcatheter ventricular septal defect closure – a serial case report Indrihapsari, Pratiwi; Putri, Valerinna Yogibuana Swastika
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.20

Background: The transcatheter ventricular septal defect procedure is a sophisticated intervention that carries potential complications, such as complete heart block. We report two cases of patients who experienced total AV block during transcatheter VSD closure and were successfully treated with steroids and atropine. Case Presentation: Perimembranous VSD was found in a 19-year-old military recruit. A baseline 12-lead EKG showed sinus rhythm and no conduction delays. Echocardiography revealed a 6-9 mm perimembranous VSD. Then the VSD was closed with a VSD Occluder No 10-8. ECG monitor and echocardiography showed a complete atrioventricular block during the procedure. Fortunately, 1mg atropine and 125mg methylprednisolone overcame this. Recurrent atrioventricular block and VSD were not found after the procedure. A 33-year-old male patient was diagnosed with a perimembranous VSD during routine screening. Initial 12-lead electrocardiography was unremarkable, while echocardiographic evaluation revealed a 3-5 mm perimembranous VSD. Transcatheter closure was performed using a VSD Occluder device (No. 10-8). Hemodynamic monitoring and echocardiography demonstrated a complete atrioventricular (AV) block intraoperatively. Pharmacological intervention with 1 mg atropine and 125 mg methylprednisolone resolved the conduction disturbance. Despite this transient complication, the procedure continued with successful device deployment. Post-procedural assessment confirmed complete VSD closure with no residual shunt or persistent AV conduction abnormalities. Conclusions: In the context of transcatheter closure of ventricular septal defects, there exists a risk of atrioventricular block, which can be precipitated by mechanical trauma or compression from the delivery system or device. Ensuring the appropriate sizing of the device is pivotal in minimizing this risk. Continuous heart rhythm monitoring is indispensable during both short-term and long-term follow-up periods.

Modalitas Pencitraan Non Invasif pada Sindroma Koroner Kronis Indrihapsari, Pratiwi; Widito, Sasmojo
Jurnal Klinik dan Riset Kesehatan Vol 4 No 2 (2025): Edisi Februari
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.2.7

Advancements in non-invasive cardiovascular imaging technology have introduced robust diagnostic modalities for managing cardiovascular diseases. Three prominent techniques in this domain are stress echocardiography, coronary computed tomography angiography (CCTA), cardiac magnetic resonance imaging (CMR), Single Photon Emission Computed Tomography (SPECT), and Positron Emission Tomography (PET). These modalities provide crucial information for accurate diagnosis and optimal therapeutic planning. Stress echocardiography occupies a strategic position in the diagnostic algorithm, particularly in suspected or confirmed cases of coronary artery disease. The strength of this modality lies in its ability to provide a comprehensive picture of myocardial functional status. Meanwhile, CCTA offers superiority in visualizing and characterizing atherosclerotic plaques in coronary vessels, enabling early detection and more precise risk stratification. This literature review aims to explore critical aspects of non-invasive cardiovascular imaging modalities in the context of diagnosing Chronic Coronary Syndrome.

Coronary plaque assessment by coronary computed tomography angiography Indrihapsari, Pratiwi; Handari, Saskia Dyah
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.2025.006.03.2

Coronary computed tomography angiography (CCTA) is a widely used non-invasive diagnostic technique in medical practice. It effectively detects, quantifies, and characterizes coronary artery plaques. With advancements in CCTA imaging, the quantity and quality of atherosclerotic plaques can now be accurately evaluated. This technique is commonly utilized to rule out the possibility of coronary artery disease and precisely assess how the condition impacts the coronary vessels. CCTA is a valuable diagnostic tool that can help identify high-risk plaque features and recommend appropriate treatment measures. By comparing morphological aspects of stable lesions with those of susceptible plaques, CCTA can help identify characteristics such as the napkin-ring sign, low CT attenuation, positive remodeling, significant plaque volume, and spotty calcification, which have been linked to an increased risk of acute coronary syndrome. To standardize the reporting of patients who undergo CCTA and guide probable following actions in patient care, the Coronary Artery Disease Reporting and Data System (CAD-RADS) was created. This system ensures that patient reports are consistent, accurate, and valuable for guiding appropriate treatment and care.

WHO risk chart associated with the presence of coronary plaque on coronary computed tomographic angiography in asymptomatic indonesian population Indrihapsari, Pratiwi; Saskia Dyah Handari; Cholid Tri Tjahjono
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.2025.006.03.11

Background: Cardiovascular risk assessment tools, like the WHO Risk Chart, often categorize asymptomatic individuals as low risk, even when they have unmanaged cardiovascular risk factors. Among these patients, estimation of CAD is associated with significant differences in CACS; however, the relationship between WHO Risk Chart and CACS has not been studied. Objective: We studied WHO Risk Chart’s ability to detect for coronary plaque throughout CACS via CCTA. Methods: A total of 440 subjects aged 40 to 74 years old, who underwent CCTA for health checkup between January 2023 and December 2024 were enrolled. Clinical information was gathered from medical records, including risk factors, CACS, and CCTA results. Statistical analysis was performed using SPSS 24, applying univariate, bivariate, and multivariate regression analyses to identify correlations. Results: The WHO Risk Chart showed a significant correlation with CACS and the presence of coronary plaque (p <0.05). In total, 148 individuals were identified with normal coronary arteries, while 292 individuals presented with coronary plaque. Notable differences were found among genders, WHO Risk Chart, smoking status, hypertension, dyslipidemia, diabetes mellitus, and CACS levels between the two groups (p<0.05). The correlation coefficient suggests that an increase in the WHO Risk Chart is associated with a rise in CACS, indicating a bidirectional relationship between these two parameters. Conclusion: In an asymptomatic population from Indonesia, the WHO Risk Chart shows a strong positive correlation with CACS.

Modalitas Pencitraan Non Invasif pada Sindroma Koroner Kronis Indrihapsari, Pratiwi; Widito, Sasmojo
Jurnal Klinik dan Riset Kesehatan Vol 4 No 2 (2025): Edisi Februari
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.2.7

Advancements in non-invasive cardiovascular imaging technology have introduced robust diagnostic modalities for managing cardiovascular diseases. Three prominent techniques in this domain are stress echocardiography, coronary computed tomography angiography (CCTA), cardiac magnetic resonance imaging (CMR), Single Photon Emission Computed Tomography (SPECT), and Positron Emission Tomography (PET). These modalities provide crucial information for accurate diagnosis and optimal therapeutic planning. Stress echocardiography occupies a strategic position in the diagnostic algorithm, particularly in suspected or confirmed cases of coronary artery disease. The strength of this modality lies in its ability to provide a comprehensive picture of myocardial functional status. Meanwhile, CCTA offers superiority in visualizing and characterizing atherosclerotic plaques in coronary vessels, enabling early detection and more precise risk stratification. This literature review aims to explore critical aspects of non-invasive cardiovascular imaging modalities in the context of diagnosing Chronic Coronary Syndrome.

Reversible atrioventricular block during transcatheter ventricular septal defect closure – a serial case report Indrihapsari, Pratiwi; Putri, Valerinna Yogibuana Swastika
Heart Science Journal Vol. 6 No. 1 (2025): Challenges in Managing Acute Heart Failure
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.01.20

Background: The transcatheter ventricular septal defect procedure is a sophisticated intervention that carries potential complications, such as complete heart block. We report two cases of patients who experienced total AV block during transcatheter VSD closure and were successfully treated with steroids and atropine. Case Presentation: Perimembranous VSD was found in a 19-year-old military recruit. A baseline 12-lead EKG showed sinus rhythm and no conduction delays. Echocardiography revealed a 6-9 mm perimembranous VSD. Then the VSD was closed with a VSD Occluder No 10-8. ECG monitor and echocardiography showed a complete atrioventricular block during the procedure. Fortunately, 1mg atropine and 125mg methylprednisolone overcame this. Recurrent atrioventricular block and VSD were not found after the procedure. A 33-year-old male patient was diagnosed with a perimembranous VSD during routine screening. Initial 12-lead electrocardiography was unremarkable, while echocardiographic evaluation revealed a 3-5 mm perimembranous VSD. Transcatheter closure was performed using a VSD Occluder device (No. 10-8). Hemodynamic monitoring and echocardiography demonstrated a complete atrioventricular (AV) block intraoperatively. Pharmacological intervention with 1 mg atropine and 125 mg methylprednisolone resolved the conduction disturbance. Despite this transient complication, the procedure continued with successful device deployment. Post-procedural assessment confirmed complete VSD closure with no residual shunt or persistent AV conduction abnormalities. Conclusions: In the context of transcatheter closure of ventricular septal defects, there exists a risk of atrioventricular block, which can be precipitated by mechanical trauma or compression from the delivery system or device. Ensuring the appropriate sizing of the device is pivotal in minimizing this risk. Continuous heart rhythm monitoring is indispensable during both short-term and long-term follow-up periods.

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