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All Journal Heart Science Journal
Vori, Ira
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Health Professions Immunology & microbiology Medicine & Pharmacology

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Carbon dioxide (CO2) as an alternative contrast agent in percutaneous transluminal angioplasty procedures for chronic limb-threatening ischemia patients with chronic kidney disease Vori, Ira; Kurnianingsih, Novi
Heart Science Journal Vol. 5 No. 4 (2024): The Current Perspective About Cardiometabolic Disease
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2024.005.04.16

Abstract

Background: Chronic limb-threatening ischemia (CLTI) is a very morbid illness that significantly reduces quality of life. The severity of this disease may necessitate revascularization or amputation.Arteriography is frequently performed for the planning of revascularization. Patients with compromised kidney function need alternative contrast agents.CO2 may be utilized in lower extremity vascular diagnostics and intervention, especially in patients at risk for contrast-induced nephropathy (CIN).Case Illustration: An 80-year-old female with bilateral leg pain and leg swelling had an ulcer on her toe for 2 weeks. She had a history of intermittent claudication for 1 year, hypertension for 5 years, kidney stones for 2 years, and chronic kidney disease for 1 year. She underwent an ECG, laboratory, USG, DUS, and CT-angiography examination. From her laboratory result, her initial creatinine was 5.02 mg/dL (eGFR 8 mL/m/1.73 m2). After good hydration, it became 1.28 mg/dL (eGFR 39 mL/m/1.73 m2). After a CT-angiography procedure, her creatinine level was increased (3.7 mg/dL; eGFR 10.9 mL/m/1.73 m2). She was diagnosed with CLTI Rutherford V Fontain 3 left lower extremity. She suggested doing an angioplasty procedure with a safer contrast agent. An angioplasty procedure was done at RSSA Malang with CO2 contrast. After the procedure, her leg pain improved, and her creatinine didn’t elevate.Conclusion: CO2 angiography might be used as a safe alternative contrast medium in patients with CLTI, which benefits the preservation of renal function and prevents limb amputations.
Diagnostic and therapeutic challenges in managing purulent pericardial effusion with concurrent pneumonia: A geriatric case report Vori, Ira; Anjarwani, Setyasih; Tjahjono, Cholid Tri
Heart Science Journal Vol. 6 No. 2 (2025): The Complexity in the Management of Heart Rhythm Disorder
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.02.22

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Introduction: Purulent pericarditis is defined as an infection in the pericardial space that produces macroscopically or microscopically purulent fluid. It was a rare but life-threatening condition. It may be primary or secondary to another infectious process. This condition, characterised by an infectious or inflammatory accumulation of fluid in the pericardial cavity, presents significant diagnostic and therapeutic challenges, particularly in the context of multiple comorbidities. The purpose of this case report is to provide descriptive information about rare clinical patient scenario of purulent massive pericardial effusion in elderly. Case Description: The patient's presentation, complicated by pneumonia and diabetes mellitus, underscores the complexities in diagnosing and managing an 85-year-old male patient with diverse medical backgrounds. Echocardiography confirmed the diagnosis of massive pericardial effusion and showed the purulent fluid from the pericardiocentesis procedure. Nevertheless, despite various efforts to find the origin of the infection and treat it with antibiotics according to the sensitivity test, the patient's outcome with many risk factors, immunocompromised condition, unclear source of infection, aside from septic shock that led to the patient's death during treatment. Conclusion: Clinicians need to be aware of immunocompromised elderly patients and act quickly to help them. They also need to deal with the diagnostic difficulties of identifying definitive infectious sources, the high risk of death even with modern treatments, and the important role that underlying comorbidities play in prognosis. Clinical evidence shows that purulent pericarditis is still a serious condition that can have adverse outcomes, especially in older patients who already have a lot of health problems.
Cardiac computed tomography beyond anatomical coronary artery disease assessment: A contemporary review Vori, Ira; 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.2025.006.03.9

Abstract

Cardiac computed tomography (CT) has undergone a remarkable transformation over the past two decades, evolving from a purely anatomical imaging modality to a comprehensive cardiac assessment tool. This review examines recent technological advancements and expanded clinical applications of cardiac CT. Contemporary systems, equipped with dual-energy imaging, wide-detector arrays, and sophisticated reconstruction algorithms, now enable functional assessment through myocardial perfusion imaging and CT-derived fractional flow reserve (CT-FFR), alongside advanced plaque characterization. Technical developments have improved temporal and spatial resolution while optimizing radiation exposure through refined dose management protocols. The integration of anatomical and functional data has proven particularly valuable in triple rule out at emergency department and also a guide for revascularization decisions, as physiological significance often supersedes anatomical severity in clinical decision-making. Additionally, cardiac CT has emerged as an essential tool in pre-procedural planning for structural heart interventions, including transcatheter aortic valve replacement, left atrial appendage (LAA) closure, and mitral valve (MV) interventions. The modality also demonstrates significant utility in electrophysiology applications, particularly in planning pulmonary vein isolation procedures. Recent guidelines from major cardiovascular societies have incorporated these advances, positioning cardiac CT as a first-line diagnostic tool for stable chest pain and a cost-effective gatekeeper for invasive procedures. Future directions include expanded applications in quantitative plaque assessment, artificial intelligence integration, and personalized risk stratification, promising to further enhance the role of cardiac CT in clinical practice.
Co-Authors Anjarwani, Setyasih Cholid Tri Tjahjono Kurnianingsih, Novi Saskia Dyah Handari