No abstract

A total correction is a preferred treatment for Tetralogy of Fallot patients in every part of the world. However, the mortality in developing countries was as high as 6.9% to 15.3%. This was a retrospective analytic study that analyzed pre and post-operative risk factors that affected mortality on TOF patients that were performed total correction in Indonesia. A total of 47 TOF patients that were performed total correction from January 2016 to September 2019 were enrolled in this study based on the inclusion criteria. Preoperative and post-operative data were obtained from medical records. In this research, the majority of mortality was found in male patients (39.3%), while the female’s rate was lower (36.8%). Overall mortality was 38.3% and one operative death was found. The average age of patients was 84.12 months (12-210 months), whereas the average height (85.56 ± 36.17cm vs. 112.93 ± 21.73) and weight (17.22kg vs. 28.21kg) were lower for mortality patients. Some significant preoperative variables were identified as mortality risk factors such as: age below 60 months (p=0.047), smaller weight and height (p=0.008; p=0.002), abnormal hematocrit (p=0.002), and oxygen saturation below 75% (p=0.018). Significant post-operative risk factors included: temperature above 38.5⁰C (p=0.000), and ventilator time of more than 48 hours (p=0.033). In conclusion, the mortality of TOF patients undergoing a total correction in developing countries was quite high. It was associated with some risk factors, such as younger age, lower weight and height, low oxygen saturation, post-operative fever, and prolonged ventilator time.

No abstract

Introduction: Heart failure is one of cardiovascular diseases which becomes a global health problem, especially in Indonesia. It’s a clinical syndrome caused by variety of underlying diseases. Different causes that cause heart failure in patients will certainly lead to different manifestations and outcomes. Methods: This research was a descriptive study using secondary data taken from the patient's medical records. The number of samples in this study were 197 patients with heart failure in Camelia Hospitalization Room Dr. Soetomo General Hospital Surabaya. Sampling technique was total sampling. The variables were age, sex, stage, symptoms, physical examination, and pharmacological treatment. The data were analyzed descriptively. Results: Most heart failure causes in this hospital was coronary heart disease (40.6%). Patients aged 46-65 years old and male patients were more dominant although the difference was not really significant. Male patients were dominant in heart failure due to coronary heart disease and hypertension, meanwhile female patients were dominant in heart valve disease and other causes. Most patients in all causes of heart failure were diagnosed at advanced stage, such as stage III (35.5%) and stage IV (35.5%). Main symptom that was found more in the patients was dyspnea (70.1%), which could be found in coronary & heart valve disease. Physical examination results were based on the causes. Most pharmacological treatments that the patients had were Furosemide (88.3%) and Spironolactone (73.6%). Conclusion: Coronary heart disease still becomes the main cause of heart failure. Heart failure was more common in early and late elderly (46-65 years old), with male patients were more dominant. More patients were diagnosed at advanced stage. Symptom that was found more was dyspnea. Physical examination results were various based on its causes. Pharmacological treatments that the patients had gotten were Furosemide, kind of diuretics, and Spironolactone, kind of aldosterone antagonist.

Background Sternotomy is a standard approach performed in almost every surgical procedure on the heart and mediastinum. Effective hemostasis of the sternum is required to keep the operative field dry, avoid excessive blood transfusions during surgery, and prevent reoperation due to massive postoperative bleeding, which can further increase morbidity and mortality in patients. Bone wax is a mechanical hemostat commonly used after sternotomy and has been known to affect bone healing, trigger chronic inflammatory reactions, and increase the rate of infection. The application of chitosan, which has intrinsic hemostat ability, as hemostatic material is believed to improve bone healing following sternotomy. This study aimed to compare the effectiveness of bone wax and chitosan on bone healing after sternotomy. Methods Median sternotomies were performed on 2 groups of New Zealand White rabbits. Each group of 16 animals received either bone wax or chitosan powder as hemostatic material. The degree of bone healing, the number of foreign-body giant cells, and the number of osteoblasts were evaluated after 6 weeks. Results Radiographs showed that significantly more animals in the chitosan group had total sternal healing ( p = 0.033). Histopathology revealed that the number of foreign-body giant cells was significantly less ( p = 0.036) and the number of osteoblasts was significantly greater ( p < 0.0001) in the group of animals that received chitosan. Conclusion The use of chitosan as hemostatic material can promote better bone healing compared to bone wax.

Ectopia Cordis is a congenital anomaly in which the heart is located abnormally outside the thoracic cavity. Aetiology of this defect is still unclear with the incidence rate of 8:1,000,000 live births. Clinical manifestations usually present as severe sepsis respiratory distress due to heart failure as a result of an intrinsic abnormality of the heart which makes the management more challenging. Five days-old female newborn was referred to our hospital by a local doctor with "beating lump" outside her chest. The diagnosis of complete thoracic ectopia cordis was made by clinical examination, chest x-ray, and echocardiography. The Echo showed complete AV canal, ASD, mild pulmonary stenosis, and atrioventricular valve regurgitation. Palliative surgery was then undertaken with the initial goal to limit exposure and prevent further infection. The heart is covered with bovine pericardium sutured along the edge of the chest wall defect. Ectopia cordis is rare and has a poor prognosis especially thoracic and cervical types. Definitive surgery, to replace the heart to the thoracic cavity, is difficult to perform because of the hypoplastic thoracic cavity. Attempt to do palliative surgery, such as covering the heart with either skin flap or other material, becomes the choice of treatment in this case although there is no evidence reported of adulthood survivors.Ektopia Cordis adalah anomali kongenital di mana jantung terletak tidak normal di luar rongga toraks. Etiologi cacat ini masih belum jelas dengan tingkat kejadian 8: 1.000.000 kelahiran hidup. Manifestasi klinis biasanya timbul sebagai gangguan pernapasan sepsis berat akibat gagal jantung akibat kelainan intrinsik jantung yang membuat penatalaksanaan lebih menantang. Bayi perempuan yang baru berusia lima hari dirujuk ke rumah sakit kami oleh dokter setempat dengan "benjolan" di luar dadanya. Diagnosis dari ectopia cordis toraks lengkap dibuat dengan pemeriksaan klinis, rontgen dada, dan ekokardiografi. Echo menunjukkan saluran AV lengkap, ASD, stenosis paru ringan, dan regurgitasi katup atrioventrikular. Operasi paliatif kemudian dilakukan dengan tujuan awal untuk membatasi pajanan dan mencegah infeksi lebih lanjut. Jantung ditutup dengan pericardium bovine yang dijahit di sepanjang tepi dinding dada yang cacat. Cordic ectopia merupakan kasus yang jarang dan memiliki prognosis yang buruk terutama tipe toraks dan serviks. Pembedahan definitif, untuk menggantikan jantung ke rongga toraks, sulit dilakukan karena rongga toraks hipoplastik. Mencoba melakukan pembedahan paliatif, seperti menutupi jantung dengan lipatan kulit atau bahan lain, menjadi pilihan perawatan dalam kasus ini meskipun tidak ada bukti yang dilaporkan tentang orang dewasa yang selamat.

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.

Latar belakang: Setiap operasi ulang pada pasien yang telah menjalani prosedur operasi jantung terbuka maka risiko operasi menjadi lebih berat. Hal ini paling disebabkan oleh proses adhesi yang terjadi di rongga mediastinum. Tujuan penelitian ini membuktikan asam hialuronat dapat mengurangi terjadinya adhesi eperikardium paska perikardiotomi. Metode: Penelitian ini merupakan studi eksperimental dengan pendekatan Posttest-Only Control Group Design. Sampel terbagi menjadi dua kelompok. Sebanyak 8 ekor kelinci mendapat perlakuan pemberian asam hialuronat pada jaringan epicardium setelah dilakukan sternotomi, sedangkan delapan ekor tidak mendapat perlakuan. Dilakukan pengamatan selama 8 minggu kemudian jaringan epicardium dari kelinci diperiksa secara makroskopis (skor adhesi) dan secara histopatologi pada setiap masing-masing kelompok. Hasil: Rerata Adhesion Tenacity Score pada kelompok kontrol (2,25±0,77) lebih besar dibanding dengan kelompok perlakuan (1,25±0,46) dan perbedaan secara statistik bermakna (p<0,05). Pada uji rerata Adhesion Tissue Thickness pada kelompok perlakuan lebih rendah dibandingkan dengan kelompok kontrol yaitu 88,98 ± 30,64 µm dibandingkan dengan 40,24 ± 17,5 µm dan perbedaan secara statistik bermakna (p<0,05). Kesimpulan: Pemberian anti adhesi berupa asam hialuronat dapat dipertimbangkan pada kasus operasi Pericardiotomy sebagai terapi utama akan memberikan efek anti adhesi sehingga dapat menurunkan morbiditas dan mortalitas pada saat dilakukan reoperasi. Katakunci pericardialadhesion,AdhesionTenacityScore,AdhesionTissueThickness,Pericardiotomy,Hyaluronic Acid, anti-adhesion substance