Background: Although there are studies on the growth of thoracic aorta in the general population, research based on serial computed tomography scan is rare. We investigated the influence of patient age and anthropometric variables on the size and growth rate of the thoracic aorta in the general hospital population. Methods: Data on 2,353 adults [2003][2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014] who underwent ≥2 serial computed tomography examinations with at least a 6-year interval were analyzed. There were 1,444 men (61%), and the mean age was 58±12 years (range, 17-92 years). Thoracic aortic diameters were measured at 5 levels (the sinus of Valsalva, ascending aorta, aortic arch, and proximal and distal descending thoracic aorta) in the first and last computed tomography scans taken at a median interval of 7.0 years (interquartile range: 6.4-8.0). Results: The mean aorta diameters were 34.9±4.7, 34.1±4.6, 28.0±3.8, 24.8±3.4, and 23.8±3.3 mm in the sinus of Valsalva, ascending aorta, arch, and proximal and distal descending thoracic aorta, respectively. The initial aorta diameter was larger in older subjects and in those with a larger body surface area (BSA). Female subjects had a significantly larger indexed diameter (diameter/BSA) than male subjects (P<0.001 at all five levels). In all thoracic aorta levels, the growth rate was the highest in subjects in their 40s, and the growth rate negatively correlated with the initial indexed diameter (P<0.001 at all five levels). In 40-50% of the subjects, thoracic aorta size remained stable during the interval. Conclusions: The thoracic aorta dilated with aging and was larger in subjects with a larger body size.Sex differences in the gross aortic diameter might be related to differences in body size. The growth of the thoracic aorta was faster in younger subjects with a smaller indexed diameter.
The purpose of this research was to describe the development of E-module based on flip book. This research and development used ADDIE (analysis, design, development, implementation, and evaluation) Model. However, the researcher stopped at the development stage. The result of this developmental research is producing an e-module using the Ncesoft flip book Maker application. According to the evaluation from the material and language experts, the developed e-module obtained an average score of 80% and from the media expert, it obtained 84%. Thus, the developed media was considered “Valid”. The development of e-module based on Ncesoft flip book Maker can help children to learn Plants and their functions.
Background Healthcare workers are still the front liners in health care services, and have major roles during the COVID-19 pandemic. In a resource-limited country like Indonesia, it is necessary to provide safe screening and management both for patients and healthcare workers to minimize the transmission. We report our experience in the cardiac surgery department on how to provide safe management during the COVID-19 pandemic. Methods A retrospective observational study was performed in a single-tertiary-center cardiac surgery department in Surabaya and included all patients who underwent cardiac surgery during the first year of the COVID-19 pandemic. We also collected the patients from a 1-year period before the pandemic as the comparison data. Analysis of the patient characteristics, operative data, and postoperative outcome, was performed. This study also provides our experience in changes of admission in the cardiac surgery preoperative system that can be utilized for others. Results A total of 179 patients were admitted to and had cardiac surgery. Of these, 3.80% ( n = 7) were COVID-19 confirmed by a real-time polymerase chain reaction. Five patients were delayed to have cardiac surgery with no mortality or morbidity reported in these patients. During the period after changes of admission procedural in cardiac surgery patients, there were no healthcare workers infected by COVID-19 by patient transmission in our center (0%). Conclusion Our study reported a systematic screening and that possible delay in cardiac surgery appears to be feasible and safe, both for patients and for healthcare workers during the COVID-19 pandemic.
Tetralogy of Fallot (ToF) is the most common form of cyanotic heart disease with a prevalence between 3,5 to 8%. Anomalous coronary artery is reported in 2-23% of ToF patient. Knowledge of the coronary anatomy prior to surgery was important to avoid injury to the vessel. In our case, ToF with the presence of coronary artery that crossing the right ventricle outflow (RVOT) tract altered our strategy of surgery using right ventricle-pulmonary artery bypass (Rastelli procedure) in order to avoid injury to the vessel. Case report: A 2-yearsold boy was presented with repeated respiratory complaint and delayed both in growth and development. Cyanosis and clubbing fingers were observed in this patient. Overriding aorta and infundibular-valvular pulmonary stenosis were found on transthoracic echocardiography exam and additional finding was right coronary artery crossing the RVOT. The patient underwent total correction of ToF with additional procedure of the right ventricle to pulmonary artery bypass (Rastelli Procedure). The surgery was successful and the length of stay of the patient was eight days. One month following the surgery, we evaluated the flow in the conduit was preferable. The case represented the possible alternative management for ToF with anomalous coronary artery.
Background: Temporary abdominal aortic cross-clamping is often applied as an adjunct procedure to control bleeding in patients with placenta accreta spectrum during cesarean hysterectomy. It is claimed to reduce the blood loss need for transfusion and improve visualization of the operating field. After the cross-clamp is removed, the tissue distal to the occlusion, which was initially in an ischemic state, gets a sudden blood flow causing ischemia-reperfusion injury due to the release of ROS. Transdermal administration of carbon dioxide is expected to reduce the release of ROS through the Bohr Effect to protect against ischemia-reperfusion injury, which can be seen from the level of malondialdehyde. Method: This experimental study recruited all patients with placenta accreta spectrum who underwent temporary abdominal aortic cross-clamping during cesarean hysterectomy from January to June 2022. Subjects were divided into control groups and treatment groups. The treatment group was given transdermal CO2 immediately after the aortic cross-clamp was removed. The plasma MDA levels were examined before and after aortic cross-clamping. Results: The number of subjects in each group was 7 subjects. There was an increase in MDA levels from 19.779+0.870nmol/ml to 21.104+1.053nmol/ml after cross-clamp in all groups, with an average increase of 1.325+0.801nmol/ml (p=0.00). The treatment group that received transdermal CO2 had a lower tendency to increase MDA levels, 1.063+0.803nmol/ml, compared to the control group at 1.586+0.766nmol/ml. Conclusion: There was an increase in MDA levels as a predictor of ischemia-reperfusion injury in patients undergoing temporary abdominal aortic cross-clamping. The administration of transdermal CO2 tends to suppress ischemia-reperfusion injury.
Background: Transposition of the great arteries (TGA) is a cyanotic heart disorder characterized by the aorta being positioned to the pulmonary artery's right-anterior. Arterial switch operation (ASO) is the main surgical procedure for TGA correction that has favorable outcomes. This case report aims to explain the findings of TGA cases that were performed successfully by ASO surgery at Dr. Soetomo Hospital in Surabaya.Case Presentation: We reported two cases of dextro-TGA, which were confirmed from anamnesis, physical examination and echocardiographic. Both cases have been successfully carried out with an arterial switch operation (ASO) procedure with a post-operative length of 14-15 days with stable hemodynamics.Conclusion: TGA is a congenital heart defect with a rapid worsening of clinical signs if not detected early. The early correction will improve post-correction outcomes in patients.
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