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Prakoso R, Kurniawati Y, Siagian SN, Sembiring AA, Sakti DDA, Mendel B, Pratiwi I, Lelya O, Lilyasari O. Right ventricular outflow tract stenting for late presenter unrepaired Fallot physiology: a single-center experience. Front Cardiovasc Med 2024; 11:1340570. [PMID: 38361582 PMCID: PMC10867157 DOI: 10.3389/fcvm.2024.1340570] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024] Open
Abstract
Objectives The purpose of this study was to assess the clinical outcome after right ventricular outflow tract (RVOT) stenting in late presenter patient with unrepaired Fallot physiology. Background In younger patients, RVOT stenting is an alternative to mBTT shunt; however, there have been few reports of this palliative technique in late presenter population, including adults. Methods This was a single-center, retrospective study of nonrandomized, palliated Fallot patients. Clinical outcomes such as left ventricular ejection fraction and saturation were measured in 32 individuals following RVOT stenting in adults (n = 10) and children (n = 22). The Statistical Package for Social Science (SPSS) 26.0 software was used to analyze the statistical data. Results During the procedure, the average stent diameter and length were 8.84 ± 1.64 mm and 35.46 ± 11.23 mm, respectively. Adult patients received slightly longer stents than pediatric patients (43.60 ± 11.64 mm vs. 31.77 ± 9.07 mm). Overall, patients' saturation increased from 58.56 ± 19.03% to 91.03 ± 8.98% (p < 0.001), as did their left ventricular ejection fraction (LVEF) from 64.00 ± 18.21% to 75.09 ± 12.98% (p = 0.001). Three patients improved their LVEF from 31 to 55%, 31 to 67%, and 26 to 50%. The median length of stay was 8 (2-35) days, with an ICU stay of 2 (0-30) days. The median time from RVOT stent palliation to total repair was 3 months (range: 1 month-12 months). Conclusions RVOT stenting is a safe and effective method for increasing saturation and ejection fraction not only in newborn infants but also in late presenters, including adults with unrepaired Fallot physiology.
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Affiliation(s)
- Radityo Prakoso
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center of Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Yovi Kurniawati
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center of Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Sisca Natalia Siagian
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center of Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Aditya Agita Sembiring
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center of Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Damba Dwisepto Aulia Sakti
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center of Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Brian Mendel
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center of Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Sultan Sulaiman Government Hospital, Serdang Bedagai, Indonesia
| | - Indah Pratiwi
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center of Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Olfi Lelya
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center of Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Oktavia Lilyasari
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center of Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
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Prakoso R, Ariani R, Mendel B, Lilyasari O. Transoesophageal echocardiography-guided balloon-assisted percutaneous closure of a large secundum atrial septal defect in a pregnant woman: a case report. Eur Heart J Case Rep 2024; 8:ytae014. [PMID: 38274706 PMCID: PMC10810588 DOI: 10.1093/ehjcr/ytae014] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/27/2024]
Abstract
Background According to the 2018 European Society of Cardiology guidelines, atrial septal defect (ASD) closure can be performed during pregnancy but is rarely indicated. In this case, we demonstrate the viability of percutaneous balloon-assisted ASD closure without fluoroscopy in a pregnant woman. Case summary A 23-year-old G3P2A0 woman who was 20 weeks pregnant had primary complaints of breathlessness [New York Heart Association functional class (NYHA fc) III and IV] for 1 week prior to admission. A transthoracic echocardiography showed a dilatation of the right atrium (RA), a dilated right ventricle, a dilated main pulmonary artery (28.1 mm), and an oval-shaped 22 × 33 mm-sized secundum ASD with a left-to-right shunt. Despite optimal pharmacological treatment, the NYHA fc persisted. Under transoesophageal echocardiography monitoring, we introduced a 40 mm Cera™ ASD Occluder (Lifetech, China) via the delivery sheath. The device was deployed in the usual position; however, despite numerous placement adjustments, the left atrium disc kept getting dislodged to the RA and could not engage correctly. Therefore, we decided to use a balloon-assisted approach using a sizing balloon of No. 34 mm. The device was successfully positioned, and a wiggle test was conducted to make sure that the device remained stable. The patient was able to give birth to the child normally several months later. Discussion Despite the fact that pregnant women with ASD receive a very low dose of radiation, it is nevertheless recommended to avoid radiation because this demographic is particularly vulnerable to it. It is possible to treat a large ASD in pregnant women with a successful balloon-assisted approach.
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Affiliation(s)
- Radityo Prakoso
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Letjen S. Parman St No.Kav. 87, Slipi, Palmerah, West Jakarta City, 11420 Jakarta, Indonesia
| | - Rina Ariani
- Division of Non-invasive Diagnostic and Cardiovascular Imaging, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Letjen S. Parman St No.Kav. 87, Slipi, Palmerah, West Jakarta City, 11420 Jakarta, Indonesia
| | - Brian Mendel
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Letjen S. Parman St No.Kav. 87, Slipi, Palmerah, West Jakarta City, 11420 Jakarta, Indonesia
- Department of Cardiology and Vascular Medicine, Sultan Sulaiman Government Hospital, Serdang Bedagai, Negara 58 No. 315, Firdaus, Sei Rampah, Serdang Bedagai City, 20995 North Sumatera, Indonesia
| | - Oktavia Lilyasari
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Centre Harapan Kita, Universitas Indonesia, Letjen S. Parman St No.Kav. 87, Slipi, Palmerah, West Jakarta City, 11420 Jakarta, Indonesia
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Lilyasari O, Goo HW, Siripornpitak S, Abdul Latiff H, Ota H, Caro-Dominguez P. Multimodality diagnostic imaging for anomalous pulmonary venous connections: a pictorial essay. Pediatr Radiol 2023; 53:2120-2133. [PMID: 37202498 DOI: 10.1007/s00247-023-05660-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 05/20/2023]
Abstract
Anomalous pulmonary venous connections represent a heterogeneous group of congenital heart diseases in which a part or all pulmonary venous flow drains directly or indirectly into the right atrium. Clinically, anomalous pulmonary venous connections may be silent or have variable consequences, including neonatal cyanosis, volume overload and pulmonary arterial hypertension due to the left-to-right shunt. Anomalous pulmonary venous connections are frequently associated with other congenital cardiac defects and their accurate diagnosis is crucial for treatment planning. Therefore, multimodality diagnostic imaging, comprising a combination (but not all) of echocardiography, cardiac catheterization, cardiothoracic computed tomography and cardiac magnetic resonance imaging, helps identify potential blind spots relevant to each imaging modality before treatment and achieve optimal management and monitoring. For the same reasons, diagnostic imaging evaluation using a multimodality fashion should be used after treatment. Finally, those interpreting the images should be familiar with the various surgical approaches used to repair anomalous pulmonary venous connections and the common postoperative complications.
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Affiliation(s)
- Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Republic of Korea.
| | - Suvipaporn Siripornpitak
- Department of Diagnostic and Therapeutic Radiology, Mahidol University Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand
| | - Haifa Abdul Latiff
- Pediatric and Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Pablo Caro-Dominguez
- Unidad de Radiologia Pediatrica, Servicio de Radiologia, Hospital Universitario Virgen del Rocio, Seville, Spain
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Dewangga MSY, Prakoso R, Rahajoe AU, Lilyasari O. Efficacy and safety of transcarotid compared to transfemoral approach of patent ductus arteriosus stenting in duct-dependent cyanotic heart disease. Egypt Heart J 2023; 75:47. [PMID: 37306786 DOI: 10.1186/s43044-023-00371-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 05/20/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Minimally invasive transcatheter approaches were usually done for patent ductus arteriosus (PDA) with duct-dependent pulmonary circulation. There are two ways to establish vascular access, by using transfemoral either femoral vein (FV) or femoral artery (FA) and transcarotid artery (CA) with surgical cutdown approach to access the PDA and then provide good support for the balloon and the stent to be safely deployed. This study aims to compare the efficacy and safety of transcarotid with surgical cutdown compared to the transfemoral approach of patent ductus arteriosus stenting in duct-dependent cyanotic heart disease. RESULTS Overall procedural complication rates were higher in the FA/FV approach than in the CA approach (51% vs. 30%). The incidence of acute limb ischemia in the FA approach is significantly higher than in the CA approach (P < 0.05). No acute thrombosis/occlusion of the carotid artery was assessed by carotid vascular ultrasound in 2-day series. CONCLUSIONS The transcarotid approach with surgical cutdown may offer a secure and more efficient means of accessing the PDA, particularly for those emerging from the underside of the aortic arch.
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Affiliation(s)
- Made Satria Yudha Dewangga
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita Jakarta, University of Indonesia, Jakarta, Indonesia.
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Udayana-Prof. I.G.N.G Ngoerah Hospital, Bali, Indonesia.
| | - Radityo Prakoso
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita Jakarta, University of Indonesia, Jakarta, Indonesia
| | - Anna Ulfah Rahajoe
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita Jakarta, University of Indonesia, Jakarta, Indonesia
| | - Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita Jakarta, University of Indonesia, Jakarta, Indonesia
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Prakoso R, Sembiring AA, Hernisa L, Mendel B, Lelya O, Lilyasari O. Case report: Right atrial appendage hybrid access to bailout a stuck stent from the inferior vena cava of a small child. Front Cardiovasc Med 2023; 9:1084170. [PMID: 36776945 PMCID: PMC9912932 DOI: 10.3389/fcvm.2022.1084170] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/20/2022] [Indexed: 01/26/2023] Open
Abstract
A three-month-old baby boy (5. 4 Kg) with pulmonary atresia, subaortic ventricular septal defect (VSD), and patent ductus arteriosus (PDA) was sent for ductal stenting from the femoral vein. The route to the PDA was extremely tortuous and the procedure was complicated with a stent stuck in the abdominal inferior vena cava (IVC). Transfemoral stent recapture was technically laborious and the stent was successfully recaptured across a 10-Fr right atrial appendage (RAA) hybrid access avoiding a cardiopulmonary bypass (CBP). The PDA was subsequently stented for the femoral artery with satisfactory clinical outcomes.
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Affiliation(s)
- Radityo Prakoso
- Department of Cardiology and Vascular Medicine, Division of Pediatric Cardiology and Congenital Heart Disease, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia,*Correspondence: Radityo Prakoso ✉
| | - Aditya Agita Sembiring
- Department of Cardiology and Vascular Medicine, Division of Pediatric Cardiology and Congenital Heart Disease, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Latifa Hernisa
- Division of Pediatric and Congenital Heart Surgery, National Cardiovascular Centre of Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Brian Mendel
- Department of Cardiology and Vascular Medicine, Division of Pediatric Cardiology and Congenital Heart Disease, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia,Department of Cardiology and Vascular Medicine, Sultan Sulaiman Government Hospital, Serdang Bedagai, Sei Rampah, Indonesia
| | - Olfi Lelya
- Department of Cardiology and Vascular Medicine, Division of Pediatric Cardiology and Congenital Heart Disease, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Division of Pediatric Cardiology and Congenital Heart Disease, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
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Lilyasari O, Istisakinah R, Ariani R, Rahmat B, Liastuti LD, Kurniawati Y, Muliawan HS, Sukmawan R. Operability of atrial septal defect with borderline pulmonary vascular resistance index: A study in developing country. Front Surg 2022; 9:1031451. [PMCID: PMC9630571 DOI: 10.3389/fsurg.2022.1031451] [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] [Received: 08/30/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundPulmonary arterial hypertension secondary to atrial septal defect (ASD) is an important determinant of morbidity and mortality in defect closure. We aimed to compare perioperative outcome between preoperative borderline and low pulmonary vascular resistance index (≥4 WU.m2 and <4 WU.m2, respectively) in surgical closure of secundum atrial septal defect with concomitant pulmonary arterial hypertension.Methods and resultsThis was a single-center retrospective cohort study between January 2015 and January 2020. We classified patients with low and borderline PVRI who underwent ASD closure and recorded the perioperative outcomes.ResultsWe analyzed a total of 183 patients with atrial septal defect and pulmonary arterial hypertension; 92 patients with borderline PVRI and 91 patients with low PVRI. Borderline pulmonary vascular resistance index was not associated with increased risk of postoperative mortality (p = 0.621; OR0.48, 95% CI 0.04–5.48), but associated with higher risk of overall morbidity in bivariate analysis (p = 0.002; OR3.28, 95% CI 1.5–6.72). Multivariate analysis showed positive association of borderline pulmonary vascular resistance index (p = 0.045; OR2.63, 95% CI 1.02–6.77) and preoperative tricuspid valve gradient ≥64 mmHg (p = 0.034; OR2.77, 95% CI 1.08–7.13) with overall morbidity.ConclusionThere is no difference in incidence of in-hospital mortality between preoperative borderline and low pulmonary vascular resistance index patients. However, preoperative borderline pulmonary vascular resistance index and tricuspid valve gradient ≥64 mmHg are associated with increased overall morbidity after surgical closure in secundum atrial septal defect patients with pulmonary arterial hypertension.
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Affiliation(s)
- Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
- Correspondence: Oktavia Lilyasari
| | - Rini Istisakinah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Rina Ariani
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Budi Rahmat
- Thoracic, Cardiac, and Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Universitas Indonesia - Pediatric and Congenital Heart Surgery Unit, Department of Surgery, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Lies Dina Liastuti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Yovi Kurniawati
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Hary Sakti 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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Prakoso R, Agita Sembiring A, Dwisepto Aulia Sakti D, Mendel B, Lilyasari O. Double Stenting in 19-Year-Old Patient With Tetralogy of Fallot With Prior Fractured Stent. JACC Case Rep 2022; 4:1375-1378. [PMID: 36299647 PMCID: PMC9588455 DOI: 10.1016/j.jaccas.2022.07.043] [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: 07/07/2022] [Accepted: 07/22/2022] [Indexed: 01/11/2023]
Abstract
A 19-year-old patient with tetralogy of Fallot was referred to the cath lab because of persistent desaturation and a fractured right ventricular outflow tract stent. Restenting was done because the infundibular stenosis was very tight. Total repair was completed 1 week after the procedure, and at that time, the patient's hemodynamics had greatly improved. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Radityo Prakoso
- Address for correspondence: Dr Radityo Prakoso, Letjen S. Parman Street, North Bambu City, Palmerah, West Jakarta City, Jakarta 11420, Indonesia.
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Aurora RG, Prakoso R, Fakhri D, Sakidjan I, Siagian SN, Almazini P, Lilyasari O. Impact of older age at Fontan completion on mid-term survival. Egypt Heart J 2022; 74:75. [PMID: 36242634 PMCID: PMC9569401 DOI: 10.1186/s43044-022-00314-5] [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: 06/21/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The optimum age of Fontan completion remains unknown. Currently, the majority of centers worldwide are performing Fontan completion at 2-4 years of age. In Indonesia, lack of awareness and limited resources probably explain why patients seek treatment at advanced stage. This study aimed to evaluate the impact of older age at Fontan completion on mid-term survival. RESULTS A single-center retrospective cohort study was performed on 261 patients who underwent Fontan completion between 2008 and 2019 and survived to discharge. The patients were followed up until April 2020, with a median follow-up period of 3 years (range 0-12 years). The median age was 5 years (range 2-24 years). The survival rates of patients with the age at operation ≤ 6 years and > 6 years were 92.1% and 82.8%, respectively. A subgroup analysis showed that the survival rates for age < 4 years, 4-6 years (reference age), 6-8 years, 8-10 years, 10-18 years, and > 18 years were 85.7%, 94.8%, 85.4%, 78.8%, 85.7%, and 66.7%, respectively. Age at Fontan completion of > 6 years (HR 3.84; p = 0.020) was associated with a lower 12-year survival rate. The age at operation of 8-10 years (HR 6.79; p = 0.022) and > 18 years (HR 15.30; p = 0.006) had the worst survival rates. CONCLUSIONS An older age at Fontan completion (> 6 years) significantly reduced mid-term survival rate. The age at Fontan of 8-10 years and > 18 years had higher risk of mid-term death than age of 4-6 years.
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Affiliation(s)
- Ruth Grace Aurora
- grid.9581.50000000120191471Department of Cardiology and Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jl. Letjen S. Parman Kav 87, Slipi, Jakarta, 11420 Indonesia
| | - Radityo Prakoso
- grid.9581.50000000120191471Department of Cardiology and Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jl. Letjen S. Parman Kav 87, Slipi, Jakarta, 11420 Indonesia
| | - Dicky Fakhri
- grid.490486.70000 0004 0470 8428Pediatric and Congenital Heart Surgery Unit, Department of Surgery, National Cardiovascular Center Harapan Kita, Jalan Let. Jend. S. Parman Kav 87, Jakarta Barat, 11420 Indonesia
| | - Indriwanto Sakidjan
- grid.9581.50000000120191471Department of Cardiology and Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jl. Letjen S. Parman Kav 87, Slipi, Jakarta, 11420 Indonesia
| | - Sisca Natalia Siagian
- grid.9581.50000000120191471Department of Cardiology and Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jl. Letjen S. Parman Kav 87, Slipi, Jakarta, 11420 Indonesia
| | - Prima Almazini
- grid.9581.50000000120191471Department of Cardiology and Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jl. Letjen S. Parman Kav 87, Slipi, Jakarta, 11420 Indonesia
| | - Oktavia Lilyasari
- grid.9581.50000000120191471Department of Cardiology and Vascular Medicine, Faculty of Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jl. Letjen S. Parman Kav 87, Slipi, Jakarta, 11420 Indonesia
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Siagian SN, Prakoso R, Putra BE, Kurniawati Y, Lelya O, Sembiring AA, Atmosudigdo IS, Roebiono PS, Rahajoe AU, Harimurti GM, Mendel B, Christianto C, Setiawan M, Lilyasari O. Echocardiography-Guided Percutaneous Patent Ductus Arteriosus Closure: 1-Year Single Center Experience in Indonesia. Front Cardiovasc Med 2022; 9:885140. [PMID: 35677684 PMCID: PMC9167953 DOI: 10.3389/fcvm.2022.885140] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Since the first successful percutaneous closure under transesophageal echocardiographic (TEE) guidance, many centers explored transcatheter procedures without fluoroscopy. This single-center study is aimed to show the feasibility and safety of percutaneous patent ductus arteriosus (PDA) closure under echocardiography-only guidance during our 1-year experience. Methods Patients with PDA were recruited for percutaneous PDA closure guided by either fluoroscopy or echocardiography-only in National Cardiovascular Center Harapan Kita (ClinicalTrials.gov Identifier: NCT05321849, clinicaltrials.gov/ct2/show/NCT05321849). Patients were evaluated clinically and radiologically using transthoracic echocardiography (TTE) at 6, 24, and 48 h after the procedure. The primary endpoint was the procedural success. Secondary endpoints were the procedural time and the rate of adverse events. Results A total of 60 patients underwent transcatheter PDA closure, 30 patients with fluoroscopy and 30 patients with echocardiography guidance. All patients had successful PDA closure. There were only residual shunts, which were disappeared after follow-up in both groups, but one patient with a fluoroscopy-guided procedure had moderate tricuspid regurgitation with suspected thrombus in the tricuspid valve. The procedural time was not significantly different between the fluoroscopy and echocardiography groups.
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Affiliation(s)
- Sisca Natalia Siagian
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
- *Correspondence: Sisca Natalia Siagian,
| | - Radityo Prakoso
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Bayushi Eka Putra
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Yovi Kurniawati
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Olfi Lelya
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Aditya Agita Sembiring
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Indriwanto Sakidjan Atmosudigdo
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Poppy Surwianti Roebiono
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Anna Ulfah Rahajoe
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Ganesja Moelia Harimurti
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | - Brian Mendel
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
| | | | - Moira Setiawan
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Oktavia Lilyasari
- Division of Pediatric Cardiology and Congenital Heart Disease, Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Universitas Indonesia, Jakarta, Indonesia
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Goo HW, Siripornpitak S, Chen SJ, Lilyasari O, Zhong YM, Latiff HA, Maeda E, Kim YJ, Tsai IC, Seo DM. Pediatric Cardiothoracic CT Guideline Provided by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group: Part 2. Contemporary Clinical Applications. Korean J Radiol 2021; 22:1397-1415. [PMID: 33987995 PMCID: PMC8316776 DOI: 10.3348/kjr.2020.1332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 12/14/2022] Open
Abstract
The use of pediatric cardiothoracic CT for congenital heart disease (CHD) was traditionally limited to the morphologic evaluation of the extracardiac thoracic vessels, lungs, and airways. Currently, the applications of CT have increased, owing to technological advancements in hardware and software as well as several dose-reduction measures. In the previously published part 1 of the guideline by the Asian Society of Cardiovascular Imaging Congenital Heart Disease Study Group, we reviewed the prerequisite technical knowledge for clinical applications in a user-friendly and vendor-specific manner. Herein, we present the second part of our guideline on contemporary clinical applications of pediatric cardiothoracic CT for CHD based on the consensus of experts from the Asian Society of Cardiovascular Imaging CHD Study Group. This guideline describes up-to-date clinical applications effectively in a systematic fashion.
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Affiliation(s)
- Hyun Woo Goo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
| | - Suvipaporn Siripornpitak
- Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Shyh Jye Chen
- Department of Medical Imaging, National Taiwan University, Medical College and Hospital, Taipei, Taiwan
| | - Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Yu Min Zhong
- Diagnostic Imaging Center, Shanghai Children's Medical Center, Shanghai, China
| | - Haifa Abdul Latiff
- Pediatric and Congenital Heart Centre, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | - Eriko Maeda
- Department of Radiology, The University of Tokyo, Tokyo, Japan
| | - Young Jin Kim
- Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - I Chen Tsai
- Congenital Heart Disease Study Group Member of the Asian Society of Cardiovascular Imaging, Taichung, Taiwan
| | - Dong Man Seo
- Department of Cardiothoracic Surgery, Ewha Womans University Seoul Hospital, Seoul, Korea
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Rahmat B, Dwita NU, Arya Wardana PW, Lilyasari O. Preoperative Left Ventricle End Diastolic Volume Index as a Predictor for Low Cardiac Output Syndrome After Surgical Closure of Secundum Atrial Septal Defect With Small-Sized Left Ventricle. Front Pediatr 2021; 9:705257. [PMID: 35004531 PMCID: PMC8740283 DOI: 10.3389/fped.2021.705257] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Low cardiac output syndrome is one of the postoperative complications that are associated with significant morbidity and mortality after surgical closure of atrial septal defect (ASD) with small-sized left ventricle (LV). This study investigated whether preoperative left ventricular end-diastolic volume index (LVEDVi) could accurately predict low cardiac output syndrome (LCOS) after surgical closure of ASD with small-sized LV. Method: This retrospective cohort study involved adult ASD patients with small-sized LV from January 2018 to December 2019 in National Cardiovascular Center Harapan Kita. Preoperative MRI data to assess the left and right ventricle volume were collected. A bivariate analysis using independent Student's t-test was done. Diagnostic test using receiver operating characteristic (ROC) curve was also done to obtain the area under the curve (AUC) value. The best cutoff point was determined by Youden's index. Result: Fifty-seven subjects were involved in this study [age (mean ± SD) 32.56 ± 13.15 years; weight (mean ± SD) 48.82 ± 12.15 kg]. Subjects who had post-operative LCOS (n = 30) have significantly lower LVEDVi (45.0 ± 7.42 ml/m2 vs. 64.15 ± 13.37 ml/m2; p < 0.001), LVEDV (64.6 ± 16.0 ml vs. 85.9 ± 20.7 ml; p < 0.001), LVSV (38.97 ± 11.5 ml vs. 53.13 ± 7.5 ml; p < 0.001), and LVSVi (27.28 ± 8.55 ml/m2 vs. 37.42 ± 5.35 ml/m2; p < 0.001) compared to subjects who did not have post-operative LCOS (n = 27). ROC analysis showed that the best AUC was found on LVEDVi (AUC 95.3%; 95% confidence interval: 90.6-100%). The best cutoff value for LVEDVi to predict the occurrence of LCOS after surgical closure of ASD was 53.3 ml/m2 with a sensitivity of 86.7% and a specificity of 85.2%. Conclusion: This study showed that preoperative LVEDVi could predict LCOS after surgical closure of ASD with small-sized LV with a well-defined cutoff. The best cutoff value of LVEDVi to predict the occurrence of LCOS after surgical ASD closure was 53.5 ml/m2.
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Affiliation(s)
- Budi Rahmat
- Pediatric and Congenital Heart Surgery Unit, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.,Department of Thoracic, Cardiac and Vascular Surgery, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - Nurima Ulya Dwita
- Department of Thoracic, Cardiac and Vascular Surgery, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - Putu Wisnu Arya Wardana
- Department of Thoracic, Cardiac and Vascular Surgery, Faculty of Medicine, Cipto Mangunkusumo Hospital, University of Indonesia, Jakarta, Indonesia
| | - Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
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Lilyasari O, Prakoso R, Kurniawati Y, Roebiono PS, Rahajoe AU, Sakidjan I, Harimurti GM. Clinical Profile and Management of Rheumatic Heart Disease in Children and Young Adults at a Tertiary Cardiac Center in Indonesia. Front Surg 2020; 7:47. [PMID: 32903397 PMCID: PMC7434961 DOI: 10.3389/fsurg.2020.00047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 06/23/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction: Rheumatic heart disease (RHD) remains a major public health issue affecting children and young adults in developing countries. This study aimed to evaluate the clinical characteristics, management, and reactivation of RHD among children and young adults. Patients and Methods: This was a hospital-based retrospective study conducted at the National Cardiovascular Center Harapan Kita, Indonesia; we retrieved relevant data from patients diagnosed with RHD between 2012 and 2018. Results: Two hundred and seventy-nine patients were diagnosed with rheumatic heart disease, of whom 108 were children (mean age of 12.02 ± 3.36 years) and 171 were young adults (mean age was 24.9 ± 3.84). RHD was more common in female than in male young adults (1.5:1). Hospitalization due to RHD complications such as congestive heart failure was seen in 11.11% of cases in children, while pulmonary hypertension was present in 19.95% young adult cases. Reactivation of RHD occurred in 17.2% (48/279) cases, significantly in children (p < 0.001). Overall, the mitral valve (either isolated or combined) was the organ most affected in children (39.13%) and young adults (44.81%). Isolated mitral regurgitation was more common in children (13/21, 61.9%), while isolated mitral stenosis was more common in young adults (19/47, 40.42%). There was a high rate of rheumatic tricuspid valve disease in all populations (193/279, 69.17%) and reported involvement of pulmonary regurgitation (46/279, 16.48%). Multivalve lesions were more common than single lesions in both groups, with a combination of mitral and tricuspid regurgitation the predominant type in children (32/43, 74.41%) and mixed mitral lesion and tricuspid regurgitation in young adults (22/72, 30.56%). We observed a significant occurrence of quadrivalve lesions in children (p = 0.039). Valve repair was more common in children (49.07%) and replacement in young adults (32.16%), with low in-hospital mortality. Compliance with secondary prophylaxis was a significant challenge. Conclusion: Chronic RHD often presented with complications of the disease or reactivation of rheumatic fever (RF). Inadequate treatment of RF/RHD leads to extensive valvular damage and consequent disabilities. Efforts toward active early diagnosis and prompt treatment of RF/RHD and effective preventive measures are essential.
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Affiliation(s)
- Oktavia Lilyasari
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Radityo Prakoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Yovi Kurniawati
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Poppy S Roebiono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Anna Ulfah Rahajoe
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Indriwanto Sakidjan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
| | - Ganesja M Harimurti
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia, National Cardiovascular Centre Harapan Kita, Jakarta, Indonesia
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Prakoso R, Ariani R, Roebiono PS, Kurniawati Y, Lilyasari O, Sakidjan I, Rahajoe AU, Siagian SN, Lelya O, Harimurti GM. Percutaneous atrial septal defect closure in infant weighing <10 kg and having a bilateral superior vena cava: a case report. Med J Indones 2020. [DOI: 10.13181/mji.cr.192665] [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: 10/23/2022] Open
Abstract
Percutaneous closure has become a preferred treatment for secundum atrial septal defect (ASD). However, this approach remains challenging in treating small infant weighing <10 kg because of procedure-related complications. The closure of ASD in other congenital anomalies, such as a bilateral superior vena cava (SVC), should be cautiously conducted. A 15-month-old boy with a body weight of 8 kg was diagnosed with secundum ASD (911 mm in diameter), residual pulmonary stenosis, and bilateral SVC. Transcatheter closure of ASD was successfully performed by using a 12 mm CeraFlex occluder device (Lifetech Scientific Corporation). Post-procedural examination showed good results without any impingement to the adjacent structure. Therefore,the transcatheter closure of ASD in infant weighing <10 kg and having bilateral SVC is technically feasible and safe.
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Prakoso R, Ariani R, Lilyasari O, Kurniawati Y, Siagian SN, Sakidjan I, Roebiono PS, Rahajoe AU, Lelya O, Sembiring AA, Harimurti GM. Percutaneous atrial septal defect closure using transesophageal echocardiography without fluoroscopy in a pregnant woman: a case report. Med J Indones 2020. [DOI: 10.13181/mji.cr.193161] [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: 10/23/2022] Open
Abstract
Transcatheter closure is the treatment of choice for atrial septal defect (ASD); it has good efficacy and minimal complications. However, this approach in a pregnant woman is limited due to the risk of radiation exposure. A novel fluoroscopy-free technique has been introduced to reduce x-ray exposure. This case reported the experience of an ASD transcatheter closure in a pregnant woman without fluoroscopy guidance. To the best of our knowledge, this is the first successful fluoroscopy-free technique for transcatheter closure in Indonesia. The case is a 26-year-old primigravida at 26 weeks’ gestational age with secundum ASD and pulmonary hypertension. Transcatheter closure was successfully performed with a Cera ASD occluder (Lifetech Scientific Corporation) no. 28 mm guided by transesophageal echocardiography. During the procedure, transient supraventricular tachycardia was developed. There were no other major or minor periprocedural complications. ASD transcatheter closure in a pregnant woman without fluoroscopy is feasible, safe, and effective.
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Hoetama E, Prakoso R, Roebiono PS, Sakidjan I, Kurniawati Y, Siagian SN, Lelya O, Rahajoe AU, Harimurti GM, Lilyasari O. Balloon pulmonary valvuloplasty in neonates with critical pulmonary stenosis: Jugular or femoral. Ann Pediatr Cardiol 2019; 13:11-15. [PMID: 32030030 PMCID: PMC6979020 DOI: 10.4103/apc.apc_14_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/18/2019] [Accepted: 08/12/2019] [Indexed: 11/23/2022] Open
Abstract
Background: Critical pulmonary stenosis (PS) is one of the life-threatening congenital heart diseases which present during the neonatal period with cyanosis. Surgical valvotomy was once the procedure of choice for critical PS; however, balloon pulmonary valvuloplasty (BPV) has now become the standard treatment. Although the procedure is usually simple, crossing the pulmonary valve from the femoral vein can be difficult, especially when severe tricuspid regurgitation and right atrium dilatation are present. In such patients, the maneuver can be simplified by using the right internal jugular vein approach. However, many operators are reluctant to use this approach because of unfamiliarity with the technique, potential complications, and paucity of reports. Until now, there is no literature describing BPV using the transjugular approach in neonates, also none directly comparing the transfemoral and transjugular approaches. Objective: We compared transjugular with the transfemoral approach in terms of procedure time and complications. Materials and Methods: This was a retrospective cohort study. Participants were neonates with critical PS undergoing BPV in the National Cardiovascular Center Harapan Kita from 2013 to 2018. Results: Of 15 neonates undergoing BPV, eight were done using the transjugular approach and seven using the femoral approach. Mean age and weight in both groups was similar. In all eight patients using transjugular approach, crossing the pulmonary valve was consistently quick and easy. The total procedural time, pulmonary crossing time, and fluoro time was significantly shorter using the transjugular approach (65 ± 8 vs. 108 ± 17.8 min, P < 0.05; 22 ± 3.1 vs. 45 ± 14.8 min, P < 0.01; 29 ± 13 vs. 67 ± 35 min, P < 0.05). There were no complications relating to vascular access. Moreover, the BPV procedure itself demonstrated comparable results in both groups. Conclusion: BPV using the transjugular approach is safe and effective to relieve critical PS in neonates compared to the transfemoral approach.
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Affiliation(s)
- Erick Hoetama
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Radityo Prakoso
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Poppy Surwianti Roebiono
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Indriwanto Sakidjan
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yovi Kurniawati
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Sisca Natalia Siagian
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Olfi Lelya
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anna Ulfah Rahajoe
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ganesja Moelia Harimurti
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Oktavia Lilyasari
- Pediatric Cardiology and Congenital Heart Disease Division, National Cardiovascular Center Harapan Kita, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Lilyasari O, Subekti Y, Atika N, Dinarti LK, Putri S, Opitasari C, Anggraini AB, Bussabawalai T, Teerawattananon Y. Economic evaluation of sildenafil for the treatment of pulmonary arterial hypertension in Indonesia. BMC Health Serv Res 2019; 19:573. [PMID: 31412857 PMCID: PMC6694473 DOI: 10.1186/s12913-019-4422-5] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 08/09/2019] [Indexed: 12/02/2022] Open
Abstract
Background This study aims to assess the cost-effectiveness and budget impact of adopting sildenafil to the benefits package for the indication of pulmonary arterial hypertension (PAH), compared to beraprost. Methods Based on a societal perspective, a model-based economic evaluation was performed using local and international data to quantify the potential costs and health-related outcomes in terms of life years (LYs) and quality-adjusted life years (QALYs). Results The economic model calculated the incremental cost-effectiveness ratio (ICER) per QALY gained for using sildenafil as first-line therapy compared to beraprost for the patient in functional class (FC) II and III, i.e. USD 3098 and USD 2827, respectively. The results indicated that in spite of sildenafil being more expensive than beraprost, generic sildenafil could potentially be a good value for money since ICER per QALY is below one times gross domestic product (GDP) per capita in Indonesia. Furthermore, budget impact analysis estimated that the incremental budget needed within 5 years for including sildenafil compared to beraprost for PAH patients starting in FC II and FC III was USD 436,775 and USD 3.6 million, respectively. Conclusions Compared to beraprost, sildenafil would be preferable for the treatment of PAH patients in FC II and FC III in Indonesia. The additional budget for adopting sildenafil compared to beraprost as the treatment of PAH in the benefits package was estimated at around USD 4.0 million. Electronic supplementary material The online version of this article (10.1186/s12913-019-4422-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Oktavia Lilyasari
- Department of Cardiology, Medical School, University of Indonesia - Harapan Kita National Hospital, Jakarta, Indonesia
| | - Yusuf Subekti
- Indonesian Health Technology Assessment Committee, Jakarta, Indonesia
| | - Nur Atika
- Indonesian Health Technology Assessment Committee, Jakarta, Indonesia
| | | | - Septiara Putri
- Faculty of Public Health, University of Indonesia, Jakarta, Indonesia
| | - Cicih Opitasari
- National Institute of Health Research, Ministry of Health, Jakarta, Indonesia
| | | | - Thanaporn Bussabawalai
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand.
| | - Yot Teerawattananon
- Health Intervention and Technology Assessment Program (HITAP), Ministry of Public Health, Nonthaburi, Thailand
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Abstract
BACKGROUND The Fontan procedure has been applied in many patients with single-ventricle physiology, with quite low mortality rates all over the world, and a 8.6%-9.1% rate in Indonesia. Structural and characteristic differences in the morphologically left and right ventricles influence the role of the systemic ventricle in the functionally univentricular heart and impact on postoperative outcomes. Mid- and long-term survival based on systemic ventricle morphology remains controversial. This study aimed to investigate the impact of systemic ventricle morphology on ten-year survival after the Fontan procedure. METHODS The 162 patients who underwent a Fontan operation at our institution between 2008 and February 2018 and survived to discharge were reviewed and followed up until March 2018. Data were extracted from the registry and pediatric surgical conferences, medical records, surgery reports, echocardiography and catheterization reports, and follow-up to the end of the study period. Median follow-up was 26.5 months (range 10.75-54 months). RESULTS The patients were divided into 2 groups based on systemic ventricle morphology. Seventy-four patients were included in the left morphology group and 88 in the right morphology group. There was no difference in 10-year survival rates between the two type of systemic ventricle morphology. Postoperative thromboembolic events influenced the 10-year survival rate after the Fontan procedure (hazard ratio 4.84, 95% confidence interval: 1.26-18.55, p = 0.021). CONCLUSION Systemic ventricle morphology was not associated with the 10-year survival rate after the Fontan procedure. Postoperative thromboembolic events accounted for a 4.84-times higher mortality risk after the Fontan procedure.
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Affiliation(s)
- Mira Fauziah
- 1 Department of Pediatric Cardiology and Congenital Heart Disease, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Oktavia Lilyasari
- 1 Department of Pediatric Cardiology and Congenital Heart Disease, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Lies Dina Liastuti
- 1 Department of Pediatric Cardiology and Congenital Heart Disease, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
| | - Budi Rahmat
- 2 Department of Pediatric and Congenital Heart Surgery, Faculty of Medicine, Universitas Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Fakhri D, Hernisa L, Prakoso R, Lilyasari O, Busro PW, Roebiono PS. Diagnosis Modalities and Repair Techniques of Anomalous Origin of The Left Coronary Artery From The Pulmonary Artery Without Mechanical-assisted Device: Single-centre Experience. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.04.032] [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: 11/17/2022]
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Hui PKT, Goo HW, Du J, Ip JJK, Kanzaki S, Kim YJ, Kritsaneepaiboon S, Lilyasari O, Siripornpitak S. Asian consortium on radiation dose of pediatric cardiac CT (ASCI-REDCARD). Pediatr Radiol 2017; 47:899-910. [PMID: 28435986 DOI: 10.1007/s00247-017-3847-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 08/18/2016] [Revised: 01/17/2017] [Accepted: 03/22/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND With incremental utilization of pediatric cardiac CT in congenital heart disease, it is imperative to define its current radiation dose levels in clinical practice in order to help imagers optimize CT protocols, particularly in Asia and other developing countries where CT physicists are not readily available. OBJECTIVE To evaluate current radiation dose levels and influencing factors in cardiac CT in children with congenital heart disease in Asia by conducting a retrospective multi-center, multi-vendor study. MATERIALS AND METHODS We included 1,043 pediatric cardiac CT examinations performed in 8 centers between January 2014 and December 2014 to evaluate congenital heart disease. In five weight groups, we calculated radiation dose metrics including volume CT dose index, size-specific dose estimate, dose-length product and effective dose. Age at CT exam, gender, tube voltage, scan mode, CT indication and image reconstruction algorithm were analyzed to learn whether they influenced CT radiation dose. RESULTS Volume CT dose index, size-specific dose estimate, dose-length product and effective dose of pediatric cardiac CT showed variations in the range of 4.3-23.8 mGy, 4.9-17.6 mGy, 55.8-501.3 mGy∙cm and 1.5-3.2 mSv, respectively, within five weight groups. Gender, tube voltage, scan mode and cardiac function assessment significantly influenced CT radiation dose. CONCLUSION This multi-center, multi-vendor study demonstrated variations in radiation dose metrics of pediatric cardiac CT reflecting current practice in Asia. Gender, tube voltage, scan mode and cardiac function assessment should be considered as essential radiation dose-influencing factors in developing optimal pediatric cardiac CT protocols.
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Affiliation(s)
- Peter K T Hui
- Department of Radiology, Hong Kong Baptist Hospital, Hong Kong, SAR, China
| | - Hyun Woo Goo
- Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea.
| | - Jing Du
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Janice J K Ip
- Department of Radiology, Queen Mary Hospital, Hong Kong, SAR, China
| | - Suzu Kanzaki
- Department of Radiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Young Jin Kim
- Department of Radiology, Yonsei University, Shinchon Severance Hospital, Seoul, South Korea
| | - Supika Kritsaneepaiboon
- Department of Radiology, Songklanagarind Hospital, Prince of Songkla University, Hat Yai, Thailand
| | - Oktavia Lilyasari
- Department of Cardiology, University of Indonesia, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Pratiwi KN, Putri AK, Akbarsyah P, Lilyasari O, Prakoso R. OP-059 Congenital Valvular Heart Disease in Pregnancy: Analyzing Risk Factors of Delivering Low Birth Weight Neonates. Am J Cardiol 2016. [DOI: 10.1016/j.amjcard.2016.04.099] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Satria A, Husink A, Artiko E, Aritonang F, Ramadhani H, Waliy L, Siswardana S, Perdan T, Rossimarina V, Rachmawan YP, Siwi K, Widya A, Vittryaturida, Ubaidillah N, Failasufi M, Ramadhan F, Wulandari H, Waranugraha Y, Putri D, Sargowo D, Soesanto AM, Lilyasari O, Adji AB, Romdoni R, Pikir B, Andrianto A, Sukmawan R, Supari S, Soesanto A, Muslim F, Soerianata S, Kasim M, Soesanto A, Soesanto A, Kuncoro A, Sukmawan R, Nadha K, Wita W, Santoso A, Adiarto S, Kasim M, Siswanto B, Soesanto A, Radi B, Hanafy D, Soesanto A, Uddin I, Fatah S, Herry Y, Rifqi S. Young Investigator AwardThe Efficacy of polysaccharide peptides ofGanoderma lucidumto reduce endothelial dysfunction and dyslipidemia in high risk and stable angina pectoris patientsHarapan Kita Score as predictor of in-hospital mortality and morbidity after heart valve surgeryCardiovascular Autonomic Neuropathy Profile in Controlled and Un-controlled Type 2 Diabetes Mellitus by Exercise Treadmill TestingThe difference of blood pressure and arterial stiffness after intake of arabica and robusta coffee in controlled hypertensionAsscociation of the biomarkers soluble ST2 andsubclinical left ventricularsystolicdysfunctionassessed by myocardialGlobal Longitudinal Strainin patients severe aortic stenosisRemote ischemic conditioning reduce final infarct size in ST-segment elevation myocardial infarction patient with succesful TIMI 3 flow primary percutaneous coronary interventionElevated plasma interleukin-6 associates with left ventricular diastolic dysfunction by tissue doppler imaging in chronic heart failureAssociation between serum ST2 levels and early myocardial fibrosis in disglycemic patientsEffect of respiratory training as adjuvant exercise training for improving pulmonary function and functional capacity among patients undergoing second phase cardiovascular rehabilitation after coronary artery bypass graft surgeryExpression of IL-10 on mitral valve and myocardium in patients with rheumatic mitral valve disease. Eur Heart J Suppl 2016. [DOI: 10.1093/eurheartj/suw026] [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: 11/13/2022]
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