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Karakteristik Pasien Penyakit Jantung Bawaan Dewasa Pirau Kiri ke Kanan dan Hipertensi Paru di RSUD Saiful Anwar Malang Rahmawati, Novi; Yogibuana, Valerinna; Gultom, Yosafat; Triatmojo, Nicodemus
Jurnal Klinik dan Riset Kesehatan Vol 4 No 1 (2024): Edisi Oktober
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.1.3

Background: The worldwide incidence of congenital heart disease (CHD) is estimated at 1.2 million cases out of 135 million live births each year. Pulmonaryarterial hypertension (PAH) is a frequent complication of congenital heart disease (CHD), especially in patients with left-to-right shunt. Adult CHD (ACHD) and ACHD- PAH patients present to health facilities in late phase conditions, because the early- stage symptoms are very uncommon, as a result the treatmentbecomes more difficult with a poor prognosis. Until now, there’s no national registry of ACHD and ACHD- PAH in Indonesia. Aim: Describe the demographic characteristics, clinical presentation, supporting examination findings, management, complications, and outcomes of ACHD and ACHD-PAH populations in Malang. Methods: Left to Right Shunt and Pulmonary Hypertention Registry is an observational study of adult patients (aged ≥ 18 years) diagnosed with left to rightshunt CHD and PAH at Saiful Anwar Hospital Malang. This study evaluated patients from November 2022 - October 2023 consecutively. Patients underwent a series of examinations including clinical examination, ECG, chest X-ray, SMWT, laboratory examination, transthoracic echocardiography and right heart catheterization. Results: Total sample of this registry is 124 samples. The majority of sample is young adult woman and ASD is the most common ACHD defect. The majority of sample (83.0%) is with symptoms with NT pro BNP median is 548 (152.1 – 2550.5). The majority of sample was WHO functional class II Conclusion: LET SHINE Registry is the first ACHD and ACHD-PAH in East Java Province which depict demographic, clinical presentation, hemodynamicpresentation pf ACHD and ACHD-PAH patient.

Unveiling strategies in acute cardiac care for ventricular septal rupture following acute myocardial infarction: Lessons from cases Nurudinulloh, Akhmad Isna; Anjarwani, Setyasih; Prasetya, Indra; Yogibuana, Valerinna; Rahimah, Anna Fuji; Karolina, Wella
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.2025.006.02.17

Background: Ventricular septal rupture (VSR) following acute myocardial infarction (AMI) is drastically decreasing in the reperfusion era but mortality remains high. VSR correction is the definitive treatment and using mechanical support to delay closure is an attractive option despite data on success being limited. Case Illustration: A 60-year-old man presented with late presentation of anterior STEMI complicating hemodynamic deterioration. Echocardiography showed apical VSR 11-14 mm L-R shunt. Patient was given adequate fluids, multiple inotropic agents, and IABP insertion, then a successful PPCI procedure was performed immediately. IABP was maintained for hemodynamic stabilization and patient was scheduled for interventional closure. Unfortunately, the patient worsened due to cardiogenic shock and passed away on the 5th day of admission. In another case, a 61-year-old man came to our hospital also with a late presentation of anterior STEMI but stable in hemodynamics. Echocardiography showed apical VSR 9-11 mm L-R shunt. Coronary angiography showed CAD three vessel disease with critical stenosis at LAD. In hospital’s heart team discussion, patient was planned to be performed VSR closure percutaneously and continue with PCI procedure. Both procedures were performed successfully. Patient was improved and discharged on 20th day of admission. Conclusion: Rapid diagnosis and prompt treatment are the keys to optimal management of VSR complicating late presentation STEMI. Mechanical circulatory support and correction of VSR are required to optimize patient outcomes despite VSR is still a challenging case.

Valvular aspects from echocardiography in rheumatic heart disease Noverike, Nikhen; Anna Fuji Rahimah; Yogibuana, Valerinna; 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.2025.006.03.5

Rheumatic Heart Disease is a result of an autoimmune response to group A streptococcal infection and is globally impacted and prevalent in low- and middle-income countries, especially among children and young adults. It primarily affects the heart valves, leading to damage and dysfunction. The progression of RHD can vary, with some individuals experiencing mild symptoms while others may develop severe valve damage leading to heart failure. Echocardiography plays a crucial role in the diagnosis and monitoring of RHD, as it allows to visualize and assess the structural and functional abnormalities of the heart valves. Early detection through echocardiography screening is essential for timely intervention and management of RHD. It provides valuable information about the severity of valve damage and helps determine the most appropriate treatment approach, whether it involves medication or surgical intervention. The ability of echocardiography to provide information about volumes, flows, and pressures, and to acquire quantitative hemodynamic data, highlights its importance in the assessment of patients with RHD. In conclusion, echocardiography has revolutionized the way we diagnose, monitor, and manage rheumatic heart disease, and its importance in the medical field cannot be overstated. The continued integration of echocardiography into clinical practice will undoubtedly lead to improved outcomes for patients with RHD.

Hype or hope: The role of alcohol septal ablation in improving outcomes for young patients with obstructive hypertrophic cardiomyopathy: A case series Saputri, Vemmy Lian; Rizal, Ardian; Rahimah, Anna Fuji; Karolina, Wella; Yogibuana, Valerinna; Prasetya, Indra
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.2025.006.03.19

Background: Hypertrophic cardiomyopathy (HCM) is a disease that has a poor prognosis and a higher likelihood of death in young people. Alcohol septal ablation (ASA) is a minimally invasive procedure that involves the injection of ethanol through a septal perforator to lead to infarction of the hypertrophied septum. This case series aims to present data on the beneficial effects of ASA in promoting hope for enhanced outcomes in young patients with HCM. Case: Patient 1: A 32-year-old male with HCM has been suffering from chest discomfort and atrial fibrillation since 2020. Echocardiography detected an increased obstruction in the left ventricular outflow tract (LVOT), resulting in a gradient of 104 mmHg. The patient underwent ASA to decrease the gradient to 37 mmHg, reducing hospitalizations throughout a 12-month follow-up period. Patient 2: A 27-year-old female diagnosed with HCM has been frequently suffering episodes of near syncope and shortness of breath with light activity over the past 6 months. The echocardiography findings showed a significant increase in the resting gradient in the LVOT. Following ASA, the resting gradient decreased to 54 mmHg during a 3-month follow-up. The patient did not suffer further near syncope events, and her NYHA functional class improved throughout a 9-month follow-up period. Conclusion: The effectiveness of ASA as a treatment option is hope for young patients with obstructive HCM, which is demonstrated in this case series, leading to relieving symptoms, reduced repeated hospitalization, and improved functional capacity.

Approaches to closure of very large atrial septal defects in older adults: Challenges, complexities, and technical strategies Akbar, Akita Rukmana; Yogibuana, Valerinna
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.2025.006.03.21

BACKGROUND: In adults, atrial septal defects (ASDs) may reach very large sizes (>40 mm), creating significant procedural challenges requiring precise imaging, including the combined use of transesophageal echocardiography (TEE) and fluoroscopy for real-time guidance during device deployment, specialized closure techniques, and close post-procedure follow-up. Adult ASD patients face hemodynamic impacts that necessitate lesion and chamber pressure measurements before closure, techniques like push-and-pull. Post-closure, antiplatelet therapy is essential to prevent thromboembolic complications. CASE: A 53-year-old woman experienced recurrent palpitations and forceful heartbeats, especially during emotional stress. Initially dismissed as normal, she later sought medical attention due to worsening shortness of breath. A pulmonologist found no lung abnormalities and referred her to a cardiologist. Transthoracic echocardiography (TTE) identified a secundum ASD with a left-to-right shunt, prompting transesophageal echocardiography (TEE) for detailed evaluation. TEE revealed a very large ASD (28–40 mm) with deficient rims: no aortic rim, minimal posterior rim, mitral rim 11 mm, IVC rim 10 mm, and SVC rim 7 mm. Transcatheter closure was guided by both fluoroscopy and transesophageal echocardiography (TEE) via left upper pulmonary vein (LUPV) approach. Fluoroscopy played a crucial role in visualizing catheter and device trajectory, ensuring precise deployment despite deficient septal rims. Transcatheter closure was planned using a 44 mm Amplatzer Septal Occluder (ASO) without any complications. CONCLUSION: Transcatheter closure is preferred for most secundum ASDs, but large defects with deficient rims increase procedural complexity and complication risks. Adequate rim evaluation is vital for device anchoring. While ASDs >38 mm or with deficient rims carry higher risks and sometimes warrant surgery, advancements in device technology allow successful percutaneous closure with careful planning. The case highlighted the critical role of TEE and fluoroscopy in accurate sizing, rim assessment, and real-time guidance, ensuring proper device selection, positioning, and minimizing complications.

Navigating pulmonary hypertension: Echocardiography insight into right ventricular function and dynamics Rahmawati, Novi; Yogibuana, Valerinna
Heart Science Journal Vol. 6 No. 4 (2025): The Pursuit of Precision: Navigating Risks, Refining Diagnosis, and Securing Lo
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.04.4

Pulmonary hypertension (PH) is a pathophysiological disorder characterized by pulmonary vascular remodeling and dysfunction, which may arise in various clinical contexts, particularly in association with cardiovascular and respiratory diseases. PH is characterized by a mean pulmonary arterial pressure (mPAP) exceeding 20 mmHg at rest as determined by hemodynamic assessment via right heart catheterization (RHC), which remains the gold standard for diagnosis. Transthoracic echocardiography (TTE) is recommended as a non-invasive screening tool for the initial evaluation of individuals presenting with symptoms, risk factors, or clinical suspicion of PH. Echocardiography enables the identification of pulmonary hypertension by assessing right ventricular (RV) dysfunction and increased RV pressure overload. A comprehensive assessment of the RV’s dimensions and function is essential in all individuals with PH, given that mortality in PH is correlated with the severity of RV dysfunction. While RHC remains the definitive diagnostic modality for PH, echocardiography provides a valuable, widely available, and non-invasive alternative for estimating pulmonary artery pressures, assessing RV function, and stratifying disease severity, in alignment with current guidelines from the European Society of Cardiology (ESC) and the European Respiratory Society (ERS).

Impact of supervised physical activity as adjunctive therapy on functional capacity and NT-pro BNP in patients with negative-reactivity test pulmonary hypertension related to congenital heart disease patient in Saiful Anwar Hospital Malang : A preliminary study Setyowati, Danti Utami; Martini, Heny; Prasetya, Indra; Tjahjono, Cholid Tri; Yogibuana, Valerinna
Heart Science Journal Vol. 6 No. 4 (2025): The Pursuit of Precision: Navigating Risks, Refining Diagnosis, and Securing Lo
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2025.006.04.10

Background: Appropriate levels of physical activity (PhA) provide health benefits to patients with chronic diseases, including patients with pulmonary hypertension-related to congenital heart disease (CHD-PH), representing around 4-10% of all PH patients. Objective: The purpose of this analysis was to determine the benefits and effectiveness of PhA as an additional therapy to optimal medication vs. control group on the functional capacity and N-terminal prohormone of B-type natriuretic peptide (NT-pro BNP) in patients with inoperable CHD-PH. Methods: A clinical preliminary study was conducted with 26 consecutive patients in stable condition before the study. Each patient was educated about the benefits of PhA and efficacy parameters of the six-minute walking distance (6MWD) and NT-Pro BNP levels have been evaluated at baseline and after 12 weeks. Results: The study included participants aged 33 ± 11 years, 84% of whom were female. All patients tolerated PhA without severe adverse events. Patients significantly improved the mean 6MWD compared to baseline by 382.9 ± 64.7 (p=0,000) and 318.3 ± 74 (p=0,041) meters after 12 weeks (training vs. control group). Ln NT-pro BNP improved significantly in the training group (p=0,002). There were no differences at week 12 in the delta 6MWD and NT-pro BNP levels, with all P values >0,05. Likewise, there is no correlation between the two variables Conclusions: PhA as an add-on to medical therapy may enhance work capacity and other prognostic relevant parameters in patients with inoperable CHD-PH. However, further larger, multi-center randomized controlled trials, is warranted to validate these preliminary findings

Karakteristik Pasien Penyakit Jantung Bawaan Dewasa Pirau Kiri ke Kanan dan Hipertensi Paru di RSUD Saiful Anwar Malang Rahmawati, Novi; Yogibuana, Valerinna; Gultom, Yosafat; Triatmojo, Nicodemus
Jurnal Klinik dan Riset Kesehatan Vol 4 No 1 (2024): Edisi Oktober
Publisher : RSUD Dr. Saiful Anwar Province of East Java

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.11594/jk-risk.04.1.3

Background: The worldwide incidence of congenital heart disease (CHD) is estimated at 1.2 million cases out of 135 million live births each year. Pulmonaryarterial hypertension (PAH) is a frequent complication of congenital heart disease (CHD), especially in patients with left-to-right shunt. Adult CHD (ACHD) and ACHD- PAH patients present to health facilities in late phase conditions, because the early- stage symptoms are very uncommon, as a result the treatmentbecomes more difficult with a poor prognosis. Until now, there’s no national registry of ACHD and ACHD- PAH in Indonesia. Aim: Describe the demographic characteristics, clinical presentation, supporting examination findings, management, complications, and outcomes of ACHD and ACHD-PAH populations in Malang. Methods: Left to Right Shunt and Pulmonary Hypertention Registry is an observational study of adult patients (aged ≥ 18 years) diagnosed with left to rightshunt CHD and PAH at Saiful Anwar Hospital Malang. This study evaluated patients from November 2022 - October 2023 consecutively. Patients underwent a series of examinations including clinical examination, ECG, chest X-ray, SMWT, laboratory examination, transthoracic echocardiography and right heart catheterization. Results: Total sample of this registry is 124 samples. The majority of sample is young adult woman and ASD is the most common ACHD defect. The majority of sample (83.0%) is with symptoms with NT pro BNP median is 548 (152.1 – 2550.5). The majority of sample was WHO functional class II Conclusion: LET SHINE Registry is the first ACHD and ACHD-PAH in East Java Province which depict demographic, clinical presentation, hemodynamicpresentation pf ACHD and ACHD-PAH patient.

Optimalisasi Hasil pada Ruptur Septal Ventrikel : Strategi Integratif dan Tantangan Modern Rosyidi, Muhammad Azhar; Anjarwani, Setyasih; Yogibuana, Valerinna
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.05.1.5

Acute Myocardial Infarction (AMI) requires immediate management to prevent serious complications, one of which is Ventricular Septal Rupture (VSR). This complication necessitates a multidisciplinary approach due to the complex interaction between ischemic injury, mechanical stress, and inflammatory processes within the heart. Post-AMI VSR leads to a left-to-right shunt, resulting in hemodynamic changes that affect both cardiac function and systemic circulation. Echocardiography serves as the primary modality for assessing the size and location of the rupture, although other imaging modalities are also employed for a more detailed evaluation of hemodynamic alterations. Initial management of post-AMI VSR focuses on hemodynamic stabilization through medical therapy. However, mechanical circulatory support, such as Intra-Aortic Balloon Pump (IABP) or Extracorporeal Membrane Oxygenation (ECMO), is often required in more severe cases. Surgical closure remains the gold standard of treatment, although the optimal timing for surgery is still debated among experts. As an alternative, transcatheter closure using occluder devices can be employed as acute, subacute, or definitive therapy, depending on the patient's condition. The management of post-AMI VSR involves hemodynamic stabilization and a decision between surgical or transcatheter closure, which must take into account the patient's clinical profile and the expertise of the medical team involved.

Idiopathic Pulmonary Arterial Hypertension Newly Diagnosed in Pregnancy with Anemia and Threatened Preterm Labor Harumsari, Stefani; Rahardjo, Bambang; Prasetyorini, Nugrahanti; Dwijayasa, Pande Made; Yogibuana, Valerinna; Rohman, Mohammad Saifur
Heart Science Journal Vol. 3 No. 4 (2022): Prevention, Screening dan Rehabilitation : The Back Bone of Quality Care Improv
Publisher : Universitas Brawijaya

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.21776/ub.hsj.2022.003.04.7

Background: Pulmonary hypertension (PH) is a rare cardiovascular disorder that leads to right heart failure (RHF). Although most PH occurs secondary to congenital heart disease (CHD), PH can occur primarily due to pulmonary arterial vasculature abnormalities, known as Idiopathic pulmonary arterial hypertension (IPAH). In addition, the physiologic changes during pregnancy can potentially lead to worsening PAH and confer a poor prognosis. Therefore, when the mother refuses termination, a multidisciplinary team should manage the pregnancy and delivery to improve maternal and fetal outcomes.Objectives: This case report aimed to describe the importance of early diagnosis and treatment in PAH.Case reports: We reported a case of a 24-year-old woman with idiopathic pulmonary arterial hypertension (IPAH) that was newly diagnosed at 25 weeks of pregnancy and previously misdiagnosed with patent ductus arteriosus (PDA). This pregnancy was complicated with anemia and threatened preterm labor. Sildenafil was used as a vasodilator to reduce the symptoms of PAH. Unfortunately, the pregnancy was terminated at 29 weeks because of PPROM after considering giving lung maturation and neuroprotectant to the fetus. The patient was discharged without complication, but the baby died after eight days of intensive care due to HMD II, which led to respiratory failure.Conclusion: PAH in pregnancy is a life-threatening condition if untreated. Continuous treatments can help control the symptoms and avoid further complications for both mother and baby.

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