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Rudiktyo E, Soesanto AM, Cramer MJ, Yonas E, Teske AJ, Siswanto BB, Doevendans PA. Global Left Ventricular Myocardial Work Efficiency in Patients With Severe Rheumatic Mitral Stenosis and Preserved Left Ventricular Ejection Fraction. J Cardiovasc Imaging 2023; 31:191-199. [PMID: 37901998 PMCID: PMC10622643 DOI: 10.4250/jcvi.2022.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 06/18/2023] [Accepted: 07/09/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Assessment of left ventricular (LV) function plays a pivotal role in the management of patients with valvular heart disease, including those caused by rheumatic heart disease. Noninvasive LV pressure-strain loop analysis is emerging as a new echocardiographic method to evaluate global LV systolic function, integrating longitudinal strain by speckle-tracking analysis and noninvasively measured blood pressure to estimate myocardial work. The aim of this study was to characterize global LV myocardial work efficiency in patients with severe rheumatic mitral stenosis (MS) with preserved ejection fraction (EF). METHODS We retrospectively included adult patients with severe rheumatic MS with preserved EF (> 50%) and sinus rhythm. Healthy individuals without structural heart disease were included as a control group. Global LV myocardial work efficiency was estimated with a proprietary algorithm from speckle-tracking strain analyses, as well as noninvasive blood pressure measurements. RESULTS A total of 45 individuals with isolated severe rheumatic MS with sinus rhythm and 45 healthy individuals were included. In healthy individuals without structural heart disease, the mean global LV myocardial work efficiency was 96% (standard deviation [SD], 2), Compared with healthy individuals, median global LV myocardial work efficiency was significantly worse in MS patients (89%; SD, 4; p < 0.001) although the LVEF was similar. CONCLUSIONS Individuals with isolated severe rheumatic MS and preserved EF, had global LV myocardial work efficiencies lower than normal controls.
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Affiliation(s)
- Estu Rudiktyo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
| | - Amiliana M Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Maarten J Cramer
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Emir Yonas
- Faculty of Medicine, Universitas YARSI, Jakarta, Indonesia
| | - Arco J Teske
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bambang B Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Pieter A Doevendans
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Central Military Hospital, Utrecht, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
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Raja Shariff RE, Soesanto AM, Scalia GM, Ewe SH, Izumo M, Liu L, Li WCW, Kam KKH, Fan Y, Hong GR, Kinsara AJ, Tucay ES, Oh JK, Lee APW. Echocardiographic Imaging in Transcatheter Structural Intervention: An AAE Review Paper. JACC Asia 2023; 3:556-579. [PMID: 37614546 PMCID: PMC10442887 DOI: 10.1016/j.jacasi.2023.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/24/2023] [Accepted: 05/27/2023] [Indexed: 08/25/2023]
Abstract
Transcatheter structural heart intervention (TSHI) has gained popularity over the past decade as a means of cardiac intervention in patients with prohibitive surgical risks. Following the exponential rise in cases and devices developed over the period, there has been increased focus on developing the role of "structural imagers" amongst cardiologists. This review, as part of a growing initiative to develop the field of interventional echocardiography, aims to highlight the role of echocardiography in myriad TSHIs available within Asia. We first discuss the various echocardiography-based imaging modalities, including 3-dimensional echocardiography, fusion imaging, and intracardiac echocardiography. We then highlight a selected list of structural interventions available in the region-a combination of established interventions alongside novel approaches-describing key anatomic and pathologic characteristics related to the relevant structural heart diseases, before delving into various aspects of echocardiography imaging for each TSHI.
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Affiliation(s)
| | - Amiliana M. Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | | | | | - Masaki Izumo
- Department of Cardiology, St Marianna University School of Medicine, Miyamae Ward, Kawasaki, Kanagawa, Japan
| | - Liwen Liu
- Department of Ultrasound, Xijing Hypertrophic Cardiomyopathy Center, Xijing Hospital, Fourth Military Medical University, Xi’an, Shaanxi, China
| | - Williams Ching-Wei Li
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Kevin Ka-Ho Kam
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong
| | - Yiting Fan
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Geu-Ru Hong
- Yonsei University College of Medicine, Sinchon-dong, Seodaemun-gu, Seoul, South Korea
| | - Abdulhalim Jamal Kinsara
- Ministry of National Guard—Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, COM-WR, King Abdullah International Medical Research Center, Jeddah, Saudi Arabia
| | - Edwin S. Tucay
- Philippine Heart Center, Diliman, Quezon City, Metro Manila, Philippines
| | - Jae K. Oh
- Mayo Clinic, Rochester, Minnesota, USA
| | - Alex Pui-Wai Lee
- Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong
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Hanafy DA, Soesanto AM, Setianto B, Immanuel S, Raharjo SB, Herqutanto, Amir M, Yuniadi Y. Identification of Pacemaker Lead Position Using Fluoroscopy to Avoid Significant Tricuspid Regurgitation. J Clin Med 2023; 12:4782. [PMID: 37510897 PMCID: PMC10381219 DOI: 10.3390/jcm12144782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 06/07/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
Permanent pacemaker implantation improves survival but can cause tricuspid valve dysfunction in the form of tricuspid regurgitation (TR). The dominant mechanism of pacemaker-mediated TR is lead impingement. This study evaluated the association between the location of the pacemaker leads crossing the tricuspid valve and the incidence of worsening TR and lead impingement using fluoroscopy. Lead positions were evaluated using perpendicular right anterior oblique (RAO) and parallel left anterior oblique (LAO) fluoroscopic angulation views of the tricuspid annulus. A two-dimensional transthoracic echocardiogram (TTE) was performed to evaluate the maximum TR jet area-to-right atrium ratio and define regurgitation severity. A three-dimensional TTE was performed to evaluate lead impingement. A worsening of TR was observed in 23 of 82 subjects. Most leads had an inferior position in the RAO view and a septal position in the LAO view. The mid position in the RAO view and septal position in the LAO view were risk factors for lead impingement. Mid and septal positions were associated with higher risks of significant TR and lead impingement. Lead impingement was associated with a high risk of significant TR. Pacemaker-mediated TR remains a significant problem after lead implantation.
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Affiliation(s)
- Dicky A Hanafy
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia
| | - Amiliana M Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia
| | - Budhi Setianto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia
| | - Suzanna Immanuel
- Department of Clinical Pathology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo National Central Public Hospital, Jakarta 10430, Indonesia
| | - Sunu B Raharjo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia
| | - Herqutanto
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta 12345, Indonesia
| | - Muzakkir Amir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Hasanuddin, Dr. Wahidin Sudirohusodo Cardiovascular Center, Makassar 90245, Indonesia
| | - Yoga Yuniadi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta 11420, Indonesia
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Rudiktyo E, Yonas E, Cramer MJ, Siswanto BB, Doevendans PA, Soesanto AM. Impact of Rheumatic Process in Left and Right Ventricular Function in Patients with Mitral Regurgitation. Glob Heart 2023; 18:15. [PMID: 36936249 PMCID: PMC10022539 DOI: 10.5334/gh.1192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 02/16/2023] [Indexed: 03/19/2023] Open
Abstract
Background Mitral regurgitation (MR) burdens the left and right ventricles with a volume or pressure overload that leads to a series of compensatory adaptations that eventually lead to ventricular dysfunction, and it is well known that in rheumatic heart disease (RHD) that the inflammatory process not only occurs in the valve but also involves the myocardial and pericardial layers. However, whether the inflammatory process in rheumatic MR is associated with ventricular function besides hemodynamic changes is not yet established. Purpose Evaluate whether rheumatic etiology is associated with ventricular dysfunction in patients with chronic MR. Methods The study population comprised patients aged 18 years or older included in the registry who had echocardiography performed at the National Cardiovascular Center Harapan Kita in Indonesia during the study period with isolated primary MR due to rheumatic etiology and degenerative process with at least moderate regurgitation. Results The current study included 1,130 patients with significant isolated degenerative MR and 276 patients with rheumatic MR. Patients with rheumatic MR were younger and had a higher prevalence of atrial fibrillation and pulmonary hypertension, worse left ventricle (LV) ejection fraction and tricuspid annular plane systolic excursion (TAPSE) value, and larger left atrium (LA) dimension compared to patients with degenerative mitral regurgitation (MR). Gender, age, LV end-systolic diameter, rheumatic etiology, and TAPSE were independently associated with more impaired LV ejection fraction. Whereas low LV ejection fraction, LV end-systolic diameter, and tricuspid peak velocity (TR) peak velocity >3.4 m/s were independently associated with more reduced right ventricle (RV) systolic function (Table 3). Conclusions Rheumatic etiology was independently associated with more impaired left ventricular function; however, rheumatic etiology was not associated with reduced right ventricular systolic function in a patient with significant chronic MR.
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Affiliation(s)
- Estu Rudiktyo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Emir Yonas
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Maarten J. Cramer
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bambang B. Siswanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Pieter A. Doevendans
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
- Central Military Hospital Utrecht, the Netherlands
- Netherlands Heart Institute Utrecht the Netherlands
| | - Amiliana M. Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia–National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Pandian NG, Kim JK, Arias-Godinez JA, Marx GR, Michelena HI, Chander Mohan J, Ogunyankin KO, Ronderos RE, Sade LE, Sadeghpour A, Sengupta SP, Siegel RJ, Shu X, Soesanto AM, Sugeng L, Venkateshvaran A, Campos Vieira ML, Little SH. Recommendations for the Use of Echocardiography in the Evaluation of Rheumatic Heart Disease: A Report from the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:3-28. [PMID: 36428195 DOI: 10.1016/j.echo.2022.10.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Acute rheumatic fever and its chronic sequela, rheumatic heart disease (RHD), pose major health problems globally, and remain the most common cardiovascular disease in children and young people worldwide. Echocardiography is the most important diagnostic tool in recognizing this preventable and treatable disease and plays an invaluable role in detecting the presence of subclinical disease needing prompt therapy or follow-up assessment. This document provides recommendations for the comprehensive use of echocardiography in the diagnosis and therapeutic intervention of RHD. Echocardiographic diagnosis of RHD is made when typical findings of valvular and subvalvular abnormalities are seen, including commissural fusion, leaflet thickening, and restricted leaflet mobility, with varying degrees of calcification. The mitral valve is predominantly affected, most often leading to mitral stenosis. Mixed valve disease and associated cardiopulmonary pathology are common. The severity of valvular lesions and hemodynamic effects on the cardiac chambers and pulmonary artery pressures should be rigorously examined. It is essential to take advantage of all available modalities of echocardiography to obtain accurate anatomic and hemodynamic details of the affected valve lesion(s) for diagnostic and strategic pre-treatment planning. Intraprocedural echocardiographic guidance is critical during catheter-based or surgical treatment of RHD, as is echocardiographic surveillance for post-intervention complications or disease progression. The role of echocardiography is indispensable in the entire spectrum of RHD management.
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Affiliation(s)
| | - Jin Kyung Kim
- University of California, Irvine, Irvine, California
| | | | | | | | | | | | | | | | - Anita Sadeghpour
- MedStar Health Research Institute, Washington, District of Columbia
| | | | | | | | - Amiliana M Soesanto
- Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Lissa Sugeng
- North Shore University Hospital, Manhasset, New York
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6
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Soesanto AM. Editorial: New challenges with the management of rheumatic heart disease. Front Surg 2022; 9:1030172. [PMID: 36303846 PMCID: PMC9592842 DOI: 10.3389/fsurg.2022.1030172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 09/05/2022] [Indexed: 11/06/2022] Open
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Soesanto AM, Roeswita D, Atmosudigdo IS, Adiarto S, Sahara E. Clinical and Hemodynamic Factors Associated with Low Gradient Severe Rheumatic Mitral Stenosis. Int J Angiol 2022; 32:43-47. [PMID: 36727152 PMCID: PMC9886448 DOI: 10.1055/s-0042-1751231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Discrepancy between narrowed mitral valve area and transmitral gradient is not uncommon, suggesting the presence of low gradient (LG)-severe mitral stenosis (MS). Some clinical and hemodynamic factors are believed to associate with LG-severe MS. Transthoracic echocardiography reports were reviewed retrospectively to evaluate the association of all clinical and hemodynamic parameters with LG-severe MS. A 36% of total 322 patients was in the LG-severe MS group. In multivariate analysis, atrial fibrillation (95% confidence interval [CI] 4.60-16.71, odds ratio [OR] 8.77), net atrioventricular compliance > 4 mL/mm Hg (95% CI 3.96-14.25, OR 7.51), tricuspid regurgitation maximal velocity (TR Vmax) > 3.4 m/s (95% CI 0.13-0.48, OR 0.25), stroke volume index ≤ 35 mL/m 2 (95% CI 1.49-6.25, OR 3.05), female gender (95% CI 1.30-5.33, OR 2.63), and severe tricuspid regurgitation (95% CI 1.04-5.50, OR 2.39) were found to be associated with LG-severe MS. Atrial fibrillation, net atrioventricular compliance, TR Vmax, stroke volume index, female gender, and severe TR were associated with low transmitral gradient in patients with severe MS.
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Affiliation(s)
- Amiliana M. Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ National Cardiovascular Center Harapan Kita, Jakarta, Indonesia,Address for correspondence Amiliana Mardiani Soesanto, MD, PhD Department of Cardiology and Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, Universitas IndonesiaJl. Let. Jen. S. Parman, Kav 87, Jakarta 11420Indonesia
| | - Dina Roeswita
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Indriwanto S. Atmosudigdo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Suko Adiarto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Elen Sahara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/ National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Asmuni M, Soesanto AM, Kurniawati Y, Zahara R, Dwiputra B, Rossimarina V. OR79. Validation of EuroSCORE II, Ambler score and Harapan Kita Score as Predictor of In Hospital Mortality in Patients Underwent Heart Valve Surgery. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartjsupp/suab122.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
Preoperative risk prediction models have important role in heart valve surgery management. Changing in patient characteristics and surgical facilities over time, might affect the predicting value of those scoring system. This study aimed to compare the validation of EuroSCORE II, Ambler score and Harapan Kita score in predicting in hospital mortality at patients underwent heart valve surgery
Methods
Cohort restrospective study was performed at 416 patients who underwent heart valve surgery from November 2018 to December 2019. Data was taken from the medical records by consecutive sampling method. The calibration and discrimination value of EuroSCORE II, Ambler score and Harapan Kita score were obtained.
Results
Observed in hospital mortality was 6.7%. EuroSCORE II, Ambler score and Harapan Kita score have good calibration (Hosmer-Lemeshow test p = 0.065, p = 0.233 and p = 0.314). The discriminative value of these three scores predicting in hospital mortality for EuroScore II AUC 0.763 (95% CI; 0.660-0.867), Ambler score AUC 0.748 (95% CI; 0.655-0.841) and Harapan Kita score AUC 0.694 (95% CI; 0.584-0.804)
Conclusion
EuroSCORE II, Ambler score and Harapan Kita score have fairly good validation. Those scoring system have good calibration with Harapan Kita score calibration relatively better than EuroSCORE and Ambler score, meanwhile Harapan Kita score has less discrimination value than EuroScore II and Ambler score.
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Affiliation(s)
- M Asmuni
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita
| | - A M Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita
| | - Y Kurniawati
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita
| | - R Zahara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita
| | - B Dwiputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita
| | - V Rossimarina
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita
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Pravian D, Soesanto AM, Ambari AM, Kuncoro BRMAS, Dwiputra B, Muliawan HS, Sukmawan R. The effect of external counterpulsation on intrinsic myocardial function evaluated by speckle tracking echocardiography in refractory angina patients: a randomized controlled trial. Int J Cardiovasc Imaging 2021; 37:2483-2490. [PMID: 34037889 DOI: 10.1007/s10554-021-02289-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/15/2021] [Indexed: 01/12/2023]
Abstract
External Counterpulsation (ECP) is one of the therapeutic options in patients with refractory angina inadequately controlled by medical, interventional, or surgical therapy. The 2D Speckle Tracking Echocardiography (2D-STE) method is considered superior in assessing clinical improvement. We would like to evaluate any improvement of myocardial intrinsic function using 2D-STE in patients underwent standard ECP protocol (35 sessions). We conducted a double-blind randomized controlled trial. Patients with refractory angina who could not be revascularized conventionally were randomized into two groups: (1) the ECP group (300 mmHg) and (2) the Sham/control group (75 mmHg). ECP standard therapy was given for 35 sessions (1 h/day/session). The 2D-STE data, including longitudinal strain and post systolic index (PSI) were obtained before and after therapy. 43 subjects were analyzed, with 22 subjects in ECP group and 21 control subjects (Sham group). A homogenous baseline strain was found either globally (12.42 ± 4.55 vs 12.00 ± 4.92 [- %]; P = 0.774) or segmentally/regionally (12.63 (0.01-25.16) vs 12.43 (0.01-27.20) [- %]; P = 0.570). There was no statistically significant improvement between groups in the left ventricle longitudinal strain globally (P = 0.535) and segmentally/regionally (P = 0.434). PSI parameters showed improvement in the ECP group (P = 0.049), and segments with PSI ≥ 20% seemed to improve longitudinal strains in the ECP group after therapy (P = 0.042). In conclusion, 35 ECP therapy sessions did not improve either global or segmental/regional left ventricular mechanical function in patients with refractory angina. However, the mechanical function of myocardial segments with PSS tends to improve after ECP therapy.
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Affiliation(s)
- Dexanda Pravian
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Amiliana M Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
| | - Ade M Ambari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - B R M Ario S Kuncoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Bambang Dwiputra
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Hary S Muliawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Renan Sukmawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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10
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Putra BE, Sukmawan R, Ariani R, Soesanto AM, Kuncoro AS. Two Barricades in a Row Mixed Lesion of Dynamic Left Ventricular Outflow Tract Obstruction and Aortic Stenosis: Finding the Culprit for Decision Making. J Cardiovasc Echogr 2020; 30:104-109. [PMID: 33282649 PMCID: PMC7706381 DOI: 10.4103/jcecho.jcecho_58_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 11/28/2019] [Accepted: 03/19/2020] [Indexed: 11/25/2022] Open
Abstract
Concurrent lesions of dynamic left ventricular outflow tract obstruction (DLVOTO) with aortic stenosis pose a challenge in the measurement of the pressure gradient and severity of each lesion. Determining the true culprit lesion is difficult and challenging. The establishment of true culprit lesion is crucial in deciding the future course of action. We present two cases of concurrent DLVOTO and aortic stenosis. Although the composition of lesions is similar, the severity of each lesion was different and described a variety of technical problems. Finding the culprit through the shape of the stenotic jet from the continuous wave Doppler as well as other different technical approaches is the critical point of this case report. The first patient showed nonsignificant DLVOTO with severe aortic stenosis in which transthoracic echocardiography (TTE) alone was sufficient to find the culprit. Meanwhile, the second patient concluded to have significant DLVOTO with moderate aortic stenosis based on TTE and transesophageal echocardiography examination data. Jet morphology from Doppler examination is a crucial finding to differentiate DLVOTO with aortic stenosis, along with other parameters that might help find the dominant lesion. Multiple modalities with several tailor-made technical considerations might be needed to establish a culprit lesion.
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Affiliation(s)
- Bayushi Eka Putra
- Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Renan Sukmawan
- Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Rina Ariani
- Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Amiliana M Soesanto
- Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ario Soeryo Kuncoro
- Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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11
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Soesanto AM, Suastika LOS. Echocardiography Screening for Latent Rheumatic Heart Disease: What Can We Do in Indonesia? Front Surg 2020; 7:46. [PMID: 32974379 PMCID: PMC7466630 DOI: 10.3389/fsurg.2020.00046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 06/19/2020] [Indexed: 11/29/2022] Open
Abstract
Rheumatic heart disease (RHD), a sequela of acute rheumatic fever (ARF), is a preventable disease but remains a significant health problem, especially in developing countries. It causes disability, poor quality of life, early mortality, and national economic burden. The World Heart Federation (WHF) aimed to achieve a 25% reduction in premature deaths from ARF and RHD among individuals aged <25 years by 2025. Primordial and primary prophylaxis of RHD is aimed to prevent the occurrence of ARF, while the goal of secondary and tertiary prophylaxis is to limit the progression and reduce the consequences of RHD. Early recognition of RHD is important for early prophylaxis strategies to inhibit any progression to advanced stages. In 2012, WHF introduced the latest echocardiographic criteria to recognize the early stage of RHD. This includes the evaluation of pathological regurgitation jet and morphological features of RHD based on 2D, color, and spectral Doppler criteria. In remote areas, portable echocardiography is preferable for RHD screening. Previous portable devices were only capable of producing 2D and color images. Hence, a simplified echocardiographic criterion without spectral Doppler evaluation is needed in selected areas. Indonesia is a developing country, an archipelago with a population of over 250 million. Currently, there are no data on ARF incidence and RHD prevalence nationwide. The only data available are the number of patients in advanced stages who came to referral centers for further management. The screening program has to be introduced in Indonesia as part of national RHD prophylaxis.
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Affiliation(s)
- Amiliana M Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia/National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Luh Oliva Saraswati Suastika
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Udayana University, Udayana University Hospital, Denpasar, Indonesia
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Ariani R, Prakoso R, Kuncoro AS, Soesanto AM, Rudiktyo E, Kurniawati Y, Siagian SN. P336 Echocardiography guiding without floroscopy transcatheter ASD closure: Single center experience in indonesia. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Transcathether closure of Atrial Septal Defect (ASD) has become the first choice for most cases of secundum type of ASD worldwide with very good successful rate and low complication rate. However, the risk of radiation exposure to both patient and operator has gain increasing awareness due to its long term side effect. There is very limited data on transcathether ASD closure using only echocardiography without fluoroscopy.
Purpose
This study sought to evaluate feasibility, safety and effectiveness of transcatheter closure of atrial septal defects using echocardiography only without fluoroscopy in tertiary heart center in Jakarta Indonesia
Methods
We collected data from July 2018 to May 2019 of patients with secundum ASD underwent transcathether ASD closure using only echocardiography without fluoroscopy in tertiary heart center in Jakarta-Indonesia. All cooperative patient weighed > 25 kg has underwent pre-procedural 2D/3D TEE evaluation to evaluate suitability for device closure. Patient who do not fulfill above criteria will be evaluated at cath lab just before proceduel and will be excluded if TEE evaluation revealed not suitable for device closure. 2D TEE was used during transcathether closure guiding. In direct closure delivery sheath was guided into left upper pulmonary vein, right upper pulmonary vein, or in left atriumfor deployment. For patient suspected had coexsisting pulmonary hypertension, non flouoscopic right heart catheterization was done. Position of catheter was also confirmed by pressure waveform monitoring.
Results
There were 67 patients with attempted zero fluoroscopy technique, of which 97% (67 patients) were successful. In failed group, one patient had poor TEE window, and one patient had LA isomerism so transjugular approach was used and we had difficulty to guide interventionist to maneuver the cathether. To these groups, transcathether closure was switched to fluoroscopy methods and device susccesfully implanted in both cases. Of the success group, There were 12 male and 53 female, age ranging from 2-62 yo (median 29 yo). Median size of the defect was 20 mm (min-max : 9-33 mm), with median size device implanted was 26 (min-max: 12-42 mm). There were 14 patients underwent pre right heart catetherization before procedure with pulmonary resistance index dan PVR/SVR ratio acceptable for closure in all patients. There is difference in mean procedure duration in groups with direct closure vs pre-closure right heart cathetherization, though not reach statistically significant difference (38 + 17 min vs 55 + 29 min, p = 0.06). In majority of cases, delivery sheath was position in left upper pulmonary vein (69%, 45 patients). Residual shunt, occlusion device shedding or displacement, and pericardial effusion were not observed during or after the the procedure.
Conclusion
Percutaneous transcatheter ASD closure completely guided by TEE is a feasible and safe procedure.
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Affiliation(s)
- R Ariani
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine FMUI, Jakarta, Indonesia
| | - R Prakoso
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine FMUI, Jakarta, Indonesia
| | - A S Kuncoro
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine FMUI, Jakarta, Indonesia
| | - A M Soesanto
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine FMUI, Jakarta, Indonesia
| | - E Rudiktyo
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine FMUI, Jakarta, Indonesia
| | - Y Kurniawati
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine FMUI, Jakarta, Indonesia
| | - S N Siagian
- National Cardiovascular Center Harapan Kita, Department of Cardiology and Vascular Medicine FMUI, Jakarta, Indonesia
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Firmansyah DK, Soesanto AM, Hanafy DA, Bono A. Cox maze IV versus left atrial reduction for atrial contraction restoration. Asian Cardiovasc Thorac Ann 2019; 27:353-361. [DOI: 10.1177/0218492319841512] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The Cox maze procedure is the gold-standard concomitant surgical procedure to restore sinus rhythm in rheumatic mitral valve disease with atrial fibrillation. Left atrial reduction surgery was found to be beneficial for rhythm conversion, but no study has investigated its efficacy compared to the Cox maze procedure for atrial contractility restoration. We aimed to compare the early success rate of left atrial contractility restoration with the Cox maze procedure and left atrial reduction in rheumatic subjects. Methods Preoperative and within one-month postoperative electrocardiograms and echocardiograms of patients who underwent a Cox maze IV procedure or left atrial reduction with mitral valve surgery were compared. Effective atrial contraction was defined as A wave peak velocity ≥10 cm·s−1 or atrial filling fraction ≥20%. Results Ninety patients (mean age 40.6 ± 10.2 years, 66.7% female) were divided equally into group A (Cox maze IV) and group B (left atrial reduction). The early sinus rhythm conversion rate was 64.4% versus 24.4% ( p < 0.001) in groups A and B, respectively. In patients with restored sinus rhythm, contractility was restored in 41.4% and 36.4% ( p = 1.000). Postoperative left atrial volume index ≤76 mL·m−2 was an independent variable associated with early atrial contractility restoration in both groups (prevalence rate 0.97, p = 0.007). Conclusions In rheumatic subjects, the early sinus rhythm conversion rate was significantly higher after Cox maze IV compared to left atrial reduction, but for restoring left atrial contractility, left atrial reduction was not inferior to Cox maze IV.
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Affiliation(s)
- Dena K Firmansyah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Amiliana M Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Dicky A Hanafy
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Arinto Bono
- Department of Surgery, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Soesanto AM, Desandri DR, Haykal TM, Kasim M. Association between late gadolinium enhancement and global longitudinal strain in patients with rheumatic mitral stenosis. Int J Cardiovasc Imaging 2018; 35:781-789. [PMID: 30556113 DOI: 10.1007/s10554-018-1511-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 12/01/2018] [Indexed: 11/26/2022]
Abstract
The correlation between the extent of myocardial fibrosis and subclinical left ventricle (LV) systolic dysfunction in rheumatic mitral stenosis (MS) has not been widely studied. We sought to evaluate the correlation between the extent of LV myocardial fibrosis quantified by late gadolinium enhancement (LGE) using cardiac magnetic resonance (CMR) and global longitudinal strain (GLS) by speckle tracking echocardiography (STE) in patients with rheumatic MS. We prospectively evaluated 36 consecutive rheumatic MS patients who were planning to undergo mitral valve surgery. Then we evaluate the correlation between the extent of LV myocardial fibrosis quantified by LGE CMR and the systolic LV function by GLS using STE. Thirty-six patients with mean age of 45.7 ± 9.9 years old, showed mean LGE was 4.9 ± 2.7%. The mean LV ejection fraction (EF) measured by CMR was 50 ± 10.8%, and the mean LV GLS was 13.5 ± 3.9%. There was a moderate correlation between GLS and LGE (r - 0.432, p = 0.009). There were no correlations between GLS with mitral valve area (MVA) with r 0.149, p = 0.385, mean mitral valve gradient (MVG) with r -0.078, p = 0.653, and LVEF (r 0.299, p = 0.076). There was a moderate correlation between LGE and GLS in patients with rheumatic MS.
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Affiliation(s)
- Amiliana M Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia / National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
| | - Dwita Rian Desandri
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia / National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Teuku Muhammad Haykal
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia / National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Manoefris Kasim
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia / National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Raharjo SB, Ahmad F, Soesanto AM, Adji AB. 1005Effect of left atrial reduction on rhythm conversion in atrial fibrillation with rheumatic mitral valve disease. Europace 2018. [DOI: 10.1093/europace/euy015.554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S B Raharjo
- National Cardiovascular Center Harapan Kita, Cardiology & Vascular Medicine, University of Indonesia, Jakarta, Indonesia
| | - F Ahmad
- National Cardiovascular Center Harapan Kita, Cardiology & Vascular Medicine, University of Indonesia, Jakarta, Indonesia
| | - A M Soesanto
- National Cardiovascular Center Harapan Kita, Cardiology & Vascular Medicine, University of Indonesia, Jakarta, Indonesia
| | - A B Adji
- National Cardiovascular Center Harapan Kita, Cardiology & Vascular Medicine, University of Indonesia, Jakarta, Indonesia
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Yuniadi Y, Hanafy DA, Raharjo SB, Soeryo A, Yasmina II, Soesanto AM. Amplatzer Cardiac Plug for Stroke Prevention in Patients with Atrial Fibrillation and Bigger Left Atrial Appendix Size. Int J Angiol 2016; 25:241-246. [PMID: 27867289 DOI: 10.1055/s-0036-1582265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Left atrial appendage (LAA) dimensions have been shown as an independent predictor of higher risk for stroke in AF patients. Little data exist on the outcomes after LAA closure in patients with nonvalvular atrial fibrillation (NVAF) who have relatively bigger LAA size. This study aims to evaluate the results associated with LAA closure with the Amplatzer cardiac plug (ACP, AGA, St. Jude Medical, Minneapolis, MN) in bigger LAA size. A total of 25 patients with NVAF underwent LAA closure with the ACP device. All patients received short-term (up to 3 months) dual-antiplatelet therapy (clopidogrel and aspirin) after the procedure and aspirin only thereafter. A transesophageal echocardiography was performed in all patients at the 3- and 6-month follow-ups. No patient was lost to follow-up (≥ 12 months in all patients). The mean age, CHA2DS2-VASc score, and HAS-BLED score were 66.2 ± 8.79 years; 3.2 ± 1.46 and 2.4 ± 1.0, respectively. The average sizes of the LAA landing zone and ostium were 23.08 ± 5.0 and 24.9 ± 4.4 mm, respectively. The procedure was successful in 23 (92%) patients and was canceled in 2 (8%) patients due to huge LAA dimensions. In 56% of the patients "pull and release" technique is needed to appropriately implant the ACP. During a mean follow-up of 12 months, no cases of periprocedural stroke and no mortality were observed. In patients with NVAF at high risk of cardioembolic events and big LAA size, LAA closure using the ACP device is safe and effective.
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Affiliation(s)
- Yoga Yuniadi
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Indonesia; National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Dicky A Hanafy
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Indonesia; National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Sunu B Raharjo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Indonesia; National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Ario Soeryo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Indonesia; National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - IIf Yasmina
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Indonesia; National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Amiliana M Soesanto
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, Indonesia; National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Rangga Wibhuti IB, Soesanto AM, Shahab F. Diastolic function in patients with preeclampsia during pre- and post-partum period using tissue doppler imaging. Med J Indones 2016. [DOI: 10.13181/mji.v25i2.1410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Prior studies have compared the E/e’ elevation in preeclampsia patients to normal patients, however there are no data whether this elevation persists after birth. The aim of this study is to analyze diastolic function in preeclampsia patients during pre- and post-partum period using E/e’ parameter measurement.Methods: This is a prospective cohort study of pregnant women with preeclampsia who were hospitalized and planned for pregnancy termination. Basic clinical characteristics were obtained from all samples. Echocardiography was done prepartum, 48-72 hours after termination, and 40-60 days postpartum. Post hoc analysis using least significant difference method was used to compare the results between measurements.Results: 30 subjects were enrolled in the study. Analysis on E/e’ characteristics showed statistical difference between prepartum E/e’ and 40 days postpartum E/e’ (11.87±3.184 vs 9.43±2.529, p=0.001, CI=1.123-3.751), as well as between 48 hours post-partum and 40 days post-partum period (12.12±2.754 vs 9.43±2.529, p<0.001, CI=1.615-3.771). There were no statistical differences between pre-partum E/e’ and 48 hours post-partum E/e’ (11.87±3.184 vs 12.12±2.754, p=0.633, CI=-1.345-0.832).Conclusion: This study showed diastolic dysfunction in preeclampsia patients persists up until a few days after birth, but resolves in time (40 days after birth) as measured by tissue doppler imaging.
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Soesanto AM, Yuniadi Y, Mansyur M, Kusmana D. A novel echocardiography formula for calculating predicted pulmonary vascular resistance in patients with mitral stenosis. Med J Indones 2016. [DOI: 10.13181/mji.v25i2.1405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Background: Pulmonary vascular resistance (PVR) plays an important role in the natural history, prognosis, and outcome after valve intervention in patients with mitral stenosis (MS). The existing formula to estimate PVR by means of echocardiography is not readily applicable in the MS patient subset because it does not specifically calculate the risk of PVR in MS. The aim of this study was to find a new echocardiography formula to estimate PVR in MS.Methods: This diagnostic study was conducted in 2 stages. In the first stage, 58 consecutive subjects with MS were studied to find some model formulas for estimating PVR by multiple regression. Eight echo parameters were analyzed to seek their correlation with the invasive PVR value as a gold standard. The formula that had the best correlation and was easiest to use would be selected. In the second stage, those model formulas were validated by applying them to a further 34 consecutive MS subjects.Results: Four formulas which gave a discriminator coefficient of r2 0.62–0.68 were derived. The best model formula was proposed for further application. The new selected formula PVR=-7.465+3.566 TRvmax –(0.23 TVs’)+6.799 (RV-MPI) showed good correlation (r=0.71, p<0.001) to the invasive PVR value, with good reliability. TRvmax is maximal velocity of tricuspid regurgitation, TVs’ is systolic velocity of tricuspid annulus, and RV-MPI is right ventricle index myocardial performance. ROC curve showed that the cut off point 7.2 has good sensitivity and specificity (90% and 88%, respectively) to predict PVR 7 WU.Conclusion: This study has shown that a novel echocardiography formula can estimate PVR with good correlation and reliability in subjects with mitral stenosis.
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Tay E, Muda N, Yap J, Muller DWM, Santoso T, Walters DL, Liu X, Yamen E, Jansz P, Yip J, Zambahari R, Passage J, Ding ZP, Wang J, Scalia G, Soesanto AM, Yeo KK. The MitraClip Asia-Pacific registry: Differences in outcomes between functional and degenerative mitral regurgitation. Catheter Cardiovasc Interv 2015; 87:E275-81. [PMID: 26508564 DOI: 10.1002/ccd.26289] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 09/24/2015] [Accepted: 10/03/2015] [Indexed: 11/06/2022]
Abstract
OBJECTIVES The objective of this study is to describe and compare the use of the MitraClip therapy in mitral regurgitation (MR) patients with degenerative MR (DMR) and functional MR (FMR). INTRODUCTION Percutaneous edge-to-edge repair of severe MR using the MitraClip device is approved for use in the USA for high risk DMR while European guidelines include its use in FMR patients as well. METHODS The MitraClip in the Asia-Pacific Registry (MARS) is a multicenter retrospective registry, involving eight sites in five Asia-Pacific countries. Clinical and echocardiographic characteristics, procedural outcomes and 1-month outcomes [death and major adverse events (MAE)] were compared between FMR and DMR patients treated with the MitraClip. RESULTS A total of 163 patients were included from 2011 to 2014. The acute procedural success rates for FMR (95.5%, n = 84) and DMR (92%, n = 69) were similar (P = 0.515). 45% of FMR had ≥2 clips inserted compared to 60% of those with DMR (P = 0.064).The 30-day mortality rate for FMR and DMR was similar at 4.5% and 6.7% respectively (P = 0.555). The 30-day MAE rate was 9.2% for FMR and 14.7% for DMR (P = 0.281). Both FMR and DMR patients had significant improvements in the severity of MR and NYHA class after 30 days. There was a significantly greater reduction in left ventricular end-diastolic diameter (P = 0.002) and end systolic diameter (P = 0.017) in DMR than in FMR. CONCLUSIONS The MitraClip therapy is a safe and efficacious treatment option for both FMR and DMR. Although, there is a significantly greater reduction in LV volumes in DMR, patients in both groups report clinical benefit with improvement in functional class. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Edgar Tay
- Department of Cardiology, National University Heart Centre, Singapore
| | - Nasir Muda
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Jonathan Yap
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - David W M Muller
- Department of Cardiology, St Vincent's Hospital, Sydney, Australia
| | | | - Darren L Walters
- Department of Cardiology, Prince Charles Hospital, Brisbane, Australia
| | - Xianbao Liu
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Province, People's Republic of China
| | - Eric Yamen
- Department of Cardiology, Sir Charles Gairdner Hospital, Perth, Australia
| | - Paul Jansz
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
| | - James Yip
- Department of Cardiology, National University Heart Centre, Singapore
| | - Robaayah Zambahari
- Department of Cardiology, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Jurgen Passage
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, Australia
| | - Zee Pin Ding
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Jian'an Wang
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Province, People's Republic of China
| | - Gregory Scalia
- Department of Cardiothoracic Surgery, Sir Charles Gairdner Hospital, Perth, Australia
| | - Amiliana M Soesanto
- Department of Cardiology, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore.,Duke-NUS Graduate Medical School, Singapore
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Yeo KK, Yap J, Yamen E, Muda N, Tay E, Walters DL, Santoso T, Liu X, Jansz P, Yip J, Zambahari R, Passage J, Koh TH, Wang J, Scalia G, Kuntjoro I, Soesanto AM, Muller D. Percutaneous mitral valve repair with the MitraClip: early results from the MitraClip Asia-Pacific Registry (MARS). EUROINTERVENTION 2014; 10:620-5. [DOI: 10.4244/eijv10i5a107] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Saragih WM, Sulistiowati S, Haryono N, Siswanto BB, Hersunarti N, Soesanto AM. Case report of secondary hypertension due to renal artery stenosis in young patient. Med J Indones 2014. [DOI: 10.13181/mji.v23i2.666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Secondary hypertension is rare to occur, but should become suspicion in young age. Secondary hypertension must be appropriately diagnosed and treated. Renal artery stenosis is one of many causes of secondary hypertension. The aim of this case report is to describe diagnosis, pathophysiology and management of secondary hypertension due to renal artery stenosis in young patient. A 17 year old man with symptom of shortness of breath was diagnosed with hypertension stage 3 on his medical examination at Pasar Rebo Hospital, Jakarta. Abdominal CT scan examination revealed bilateral renal artery stenosis. Percutaneous transluminal angiography (PTA) of left renal artery was performed at National Cardiovascular Centre Harapan Kita. Stent was placed succesfully and the blood pressure was normalized.
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Yuniadi Y, Koencoro AS, Hanafy DA, Firman D, Soesanto AM, Seggewiss H. Percutaneous transluminal septal myocardial ablation (PTSMA) of hypertrophic cardiomyopathy: Indonesian initial experience. Med J Indones 2010. [DOI: 10.13181/mji.v19i3.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Soesanto AM, Oemar H, Fauzi O. Left atrial myxoma with mitral regurgitation. Med J Indones 1997. [DOI: 10.13181/mji.v6i4.832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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