Effects of Pomegranate Extract Supplementation (Punica granatum L.) on Clinical Manifestations of Pulmonary Arterial Hypertension in Children with Acyanotic Congenital Heart Disease

Background: Pulmonary arterial hypertension (PAH) in congenital heart disease (CHD) mechanism includes vasoconstriction and vascular remodeling. In Indonesia, sildenafil as a vasodilator is the only standard treatment for PAH. Research on pomegranate extract showed its potential as an anti-inflammatory and anti-proliferative agent that could work synergically with sildenafil in reducing pulmonary arterial pressure (PAP) Objective: To investigate the effect of pomegranate supplementation in the clinical manifestation of PAH in children with acyanotic CHD. Methods: This study was a randomized controlled clinical trial that compared the clinical manifestation of PAH in children with acyanotic CHD who received standard therapy for PAH and pomegranate extract supplementation with the placebo group. Observations were carried out over three months, and pre-and post-test evaluations were conducted to assess changes in PAP, functional classification of PAH, body weight, systolic blood pressure, heart rate, respiratory rate, and oxygen saturation in both groups. Statistical analysis was undertaken using the Wilcoxon, Mann-Whitney, and Spearman correlation tests. Results: There was no significant difference in PAP reduction between the pomegranate and placebo groups (p = .44) and no significant difference in the functional classification of PAH in the placebo and pomegranate groups (p = .55). There was a considerable reduction in the respiratory rate in the pomegranate group (p = .017). Respiratory rate was positively correlated with the functional classification of PAH (p = .011). Conclusion: There was a significant reduction in the respiratory rate in the pomegranate group that correlated with the functional classification of PAH

Peranan ACE-Inhibitor pada penyakit jantung bawaan

Angiotensin-converting enzyme inhibitors have been shown to have the broadest impact of any drug in cardiovascular medicine. Dual role of ACE inhibitors, both preventing and treating cardiovascular disease. ACE inhibitors have an indirect effect on primary prevention by lessening hypertension and decreasing left ventricular hypertrophy, especially in patients with cardiac failure. In children, the causes of cardiac failure are significantly different and many cases are due to congenital malformations, such as left-to-right- shunts. In these patients, the function of both the right and the left ventricles will be affected and these children suffer from high-output cardiac failure. Therefore, in carefully selected patients with congenital heart disease, the response to systemic afterload reduction with ACE inhibitors appears favorable. Nevertheless, a more comprehensive controlled trial to assess the hemodynamic and functional effects of ACE inhibitors in such patients should be undertaken

Dimensions change and left ventricular function carvedilol post therapy due to heart failure cases in children with congenital heart disease left-to-right

Background: Congenital Heart Disease (CHD) is the most common congenital disorder in newborns with a prevalence of 9.1 per 1000 live births. In left-to-right PJB shunts occur excessive volume burden on the ventricles, resulting in heart failure. Purpose: Knowing the difference in changes in the dimensions and function of the left ventricle on echocardiography after standard therapy plus placebo with the standard therapy group plus carvedilol in children with heart failure due to left-to-right CHD. Method: Using a Randomized Controlled Trial (RCT) research design by giving a Double Blind Study treatment. Research data including comparison of initial data and final data of the two groups were analyzed by independent sample t test. Result: The results of measurement of left ventricular mass showed a significant decrease to 40.56 ± 23.63 g / m2 (p <0.001). There was a significant decrease in left ventricular volume to 42.23 ± 20.36 m3 (p = 0.05). There was a significant increase in the mean left ventricular ejection fraction to 74.16 ± 4.10% (p = 0.03). There was an increase in the left ventricular shortening fraction to 42.18 ± 3.66% (p = 0.04). Conclusion: There are differences in the dimensions of the left ventricular at the end of systolic (DVKI-AS), the left ventricle at the end of diastolic (VKI-AD), the thickness of the back wall of the left ventricle at the end of diastolic (DBVKI-AD), and the thickness of the interventricular septum at the end of diastolic (SIV-AD)

Body Mass Index of Children with Tetralogy of Fallot

Background: Malnutrition is a common cause of morbidity and mortality amongst children with TOF. Objective: To analyze the BMI profile of children with TOF age 0 – 18 years old at Pediatric Department, Dr. Soetomo General Hospital, Surabaya. Material and method: A cross-sectional study of the BMI from the medical record of TOF patients age 0 – 18 years old at the Pediatric Department, Dr. Soetomo General Hospital, Surabaya since January 2016 to December 2017 was conducted. The data included gender, age group, demographic distribution, weight, and height. BMI was calculated by WHO formula reference; body weight (kg) divided by height squared body (m2), which was converted into z-score histogram size. BMI classification was guided by the Government’s Anthropometry Standards for Nutritional Status Assessment. Result: From 84 TOF patients, there were 43 males (51%) and 41 females (49%). The most dominant age group is 0 – 4 years old (n=47;56%). The majority of patients were from outside of Surabaya (n=64;76,2%). Based on their BMI, 36 patients (42.9%) have severe underweight, 10 patients (11.9%) were underweight, and 35 patients (41.7%) were normal, whilst the rests (3.6%) were overweight. Conclusion: In this study, the number of male patients was slightly higher than female patients. The majority of TOF patients were 0 – 4 years old and resided out town of Surabaya. The predominant BMI found was the underweight and severe underweight below of normal BMI

The effect of pomegranate extract against Endothelin-1 expression, inducible nitric oxide synthase, Dan thickness of smooth muscles in pulmonary artery media tunics

Background: Congenital Heart Disease which if not corrected on time can result in increased pulmonary artery pressure or what is referred to as Pulmonary Artery Hypertension (HAP). The pathogenesis of HAP involves remodeling of the pulmonary artery Pomegranate extract (EBD) can be developed as a therapy in cardiovascular disease as anti-proliferation and anti-inflammatory. Purpose: Analyzing the effect of pomegranate extract administration on the expression of Endothelin-1 (ET-1), Inducible Nitric Oxide Synthase (iNOS), and thickness of the tunica smooth muscle media of pulmonary arteries in rats modeled by pulmonary arterial hypertension. Method: This study was an observational analytic retrospective cohort study design. Analysis of the data used is a descriptive analysis of the number of cells expressing ET-1 and iNOS as well as the thickness of the tunica smooth muscle media of the pulmonary arteries for each group. Result: In the HAP model mouse group that was given EBD, the average number of cells expressing ET-1 decreased sharply from observation after 2 weeks to observation after 4 weeks. The mean number of cells expressing iNOS and the mean thickness of smooth muscle of the pulmonary artery also experienced a sharp decline from observation after 2 weeks to observation after 4 weeks. Conclusion: The administration of EBD can reduce the expression of ET-1, iNOS, and smooth muscle thickness in tunica pulmonary artery media in hypertensive mice

Caracteristics, Diagnosis, Management and Output of Persistent Pulmonary Hypertension of the Newborn at Dr. Soetomo Hospital.

Abstract Background Persistent pulmonary hypertension of the new-born (PPHN) is a failure of lung circulation in new-born. However the data related the characteristics of clinical profile, diagnostic, management and the outcome was still limited. Objective To investigated the characteristics, diagnostics, management and outcome from PPHN. Methods Retrospective observational study. Neonates with PPHN from January 2015 to December 2019 were identified from medical record. After the data was excluded, the characteristics, diagnostic, management and the outcome was collected. The statistical analysis to known the frequency and the chi-square test used to analyse the association between the treatment and the outcomes (P < 0.05). Results 37 medical records enrolled the study, with the characteristics; 62.2% babies was boy, 70.3% with term infant, 70.3% with normal birth weight, 24.3% with maternal history of eclampsia. 62.2% babies born by C-section, 21.9% with history of asphyxia and MAS. 78.4% with differences between pre-and post-ductal saturation. From echocardiography result, 13.5% diagnosed as mild PPHN, 54.1% as moderate PPHN and 32.4% severe PPHN. From the management consisted of 5.4% with O2 nasal, 32.4% O2 CPAP and 62.2% O2 ventilator, 24.3% with sildenafil, 5.4% with combination sildenafil and illoprost, 5.4% with combination sildenafil, illoprost, and surfactant, 2.7% with combination sildenafil, illoprost, surfactant, and inotropic, 24.3% with combination sildenafil, illoprost, and inotropic, and 37.8% with combination sildenafil and inotropic. The outcomes was obtained 35.1% babies was died and 64.9% babies was cured, with oxygenation supplementation had significantly affecting the outcomes (P=0.02) Conclusion The characteristics of PPHN was dominated by baby boy, term infant and good birth weight, history of asphyxia and MAS, maternal history of eclampsia, C-section delivery and the differences between pre-and post-ductal saturation. The diagnosis commonly with moderate PPHN. The management with O2 ventilator and combination sildenafil-inotropic. The outcome mostly the babies was cured

Deteksi Dini Penyakit Jantung Bawaan Melalui Pelatihan Webinar dan Screening Echocardiography di Kediri

Penyakit jantung bawaan (PJB) merupakan penyakit bawaan lahir yang paling banyak menimbulkan kematian. Kurangnya pengetahuan pada tenaga kesehatan menjadi hambatan dalam pencegahan dan deteksi dini PJB. Kegiatan edukasi yang bertujuan untuk meningkatkan pengetahuan tenaga kesehatan dalam melakukan deteksi dini dan penanganan PJB di Kediri perlu dilakukan. Kegiatan ini meliputi pelatihan webinar dan screening echocardiography dengan peserta tenaga kesehatan di Kediri. Tingkat pengetahuan peserta dinilai dengan pre-test dan post-test. Selanjutnya dilakukan screening echocardiography oleh Dokter Spesialis Anak Konsultan Jantung. Webinar diikuti oleh 451 peserta. Skor rata-rata pre-test adalah 5,80/15 dan skor rata-rata post-test adalah 12,84/15. Sebanyak 29 anak dilakukan pemeriksaan echocardiography. Terdapat 19 (65,52%) anak yang didiagnosis dengan PJB asianotik, 4 (13,79%) anak dengan PJB sianotik, dan 6 (20,68%) anak normal. Pelatihan webinar dapat meningkatkan pengetahuan tenaga kesehatan tentang deteksi dini PJB dan 79,31% anak yang telah dilakukan screening echocardiography didiagnosis dengan PJB di Kediri

The improvement chest x-ray after carvedilol therapy in heart failure due to left to right shunt, congenital heart disease

Background: Heart failure due to left to right shunt congenital heart defect will increase pulmonary blood flow and cause volume overload. This condition activated the sympathetic nervous system and the renin-angiotensin-aldosteron system. Conventional therapy has not blocked the sympathetic system yet. Carvedilol, a novel non selective β-blocker, reduced mortality and hospitalization in adults with heart failure. Limited information was available about its use in children. Objective: To evaluate the effect of carvedilol on chest x-ray in children with heart failure due to left to right shunt congenital heart defect. Methods: A randomized, double-blind, placebo-controlled study was done. In addition to conventional therapy, patients were assigned to receive placebo or carvedilol. Carvedilol was initiated at a dose of 0.05 mg/kg/day, with a target dose of 0.2 mg/kg/day. Chest x-ray was done before-after treatment and evaluated for cardio-thoracic ratio and pulmonary vascularity. The data was analyzed using independent sample t-test and Chi-square test, with confidence interval 95%. Results: Of 30 patients, 15 in each group. The mean age was 57.6(SD 43.57) months, 19(63.3%) were boys. There were 21(70%) children with VSD and 9(30%) children with PDA. Compared to control group, children in the carvedilol group had a significant decrease of cardio-thoracic ratio(-2.94?2.34% versus -0.48?3.19%, p=0.023, CI 95%:-4.556 to-0.360). However, there was no significant change of pulmonary vascularity(p=0.153). Conclusion: Carvedilol decreased the cardio-thoracic ratio on chest x-ray, but did not improve the pulmonary vascularity in children with heart failure due to left to right shunt Congenital heart defect

Fungsi Sistolik dan Diastolik Ventrikel Kiri pada Anak dengan Leukemia Limfoblastik Akut Pasca Terapi Daunorubisin

Latar belakang. Pengobatan utama limfomia limfoblastik akut (LLA) adalah kemoterapi. Sitostatik yang paling sering memberikan efek samping pada sistem kardiovaskuler adalah golongan antrasiklin yaitu doksorubisin dan daunorubisin. Tanda awal kardiomiopati karena antrasiklin adalah gangguan fungsi diastolik. Adanya gangguan fungsi ventrikel dapat dibuktikan dengan metode radionuklid dan ekokardiografi Doppler. Tujuan penelitian. Memperoleh data fungsi diastolik dan sistolik ventrikel kiri, dimensi ventrikel kiri, dan status gizi pada anak dengan LLA pasca terapi daunorubisin. Metode. Penelitian cross sectional meneliti fungsi diastolik dan sistolik ventrikel kiri pada 19 anak LLA pasca terapi daunorubisin. Sebagai kontrol penelitian 21 anak LLA tanpa terapi daunorubisin dan 18 anak sehat. Pemeriksaan fungsi dan dimensi ventrikel kiri dilakukan dengan pemeriksaan ekokardiografi 2D, M mode dan Doppler. Analisis statistik hasil penelitian dilakukan dengan mempergunakan uji ANOVA dan Chi-square. Hasil. Terdapat 12 dari 19 anak pada kelompok studi dan 5 dari 21 anak pada kelompok kontrol LLA yang mengalami gangguan fungsi diastolik ventrikel kiri dengan pola penurunan relaksasi. Pola penurunan relaksasi terdapat pada kardiomiopati hipertrofi maupun kardiomiopati dilatasi, hipertrofi ventrikel kiri karena berbagai sebab, penyakit jantung iskemik, preload yang menurun, dan afterload yang meningkat. Pada kelompok kontrol LLA juga sudah terdapat gangguan fungsi diastolik ventrikel kiri. Disamping daunorubisin terdapat faktor lain yang mempengaruhi fungsi diastolik ventrikel kiri, penyakitnya sendiri dan obat-obat lain. Gangguan fungsi sistolik ventrikel kiri hanya didapatkan pada 1 anak kelompok studi. Hal ini disebabkan oleh dosis kumulatif daunorubisin yang masih relatif rendah dan follow up yang masih pendek. Tidak terdapat perubahan dimensi ventrikel kiri pada kelompok studi dibandingkan kelompok kontrol; belum terjadi kardiomiopati yang berhubungan dengan dosis kumulatif yang tinggi dan penggunaan yang lama untuk timbulnya manifestasi klinis. Pada kelompok studi tidak didapatkan perbedaan yang bermakna antara gizi dengan timbulnya gangguan fungsi diastolik. Kesimpulan. Pada anak dengan penyakit leukemia limfoblastik akut pasca terapi daunorubisin dosis kumulatif 120 mg/m2 telah mengalami gangguan fungsi diastolik ventrikel kiri, sedangkan fungsi sistolik tidak terganggu. Dimensi ventrikel kiri tidak mengalami perubahan. Tidak terdapat perbedaan status gizi pada anak dengan fungsi diastolik ventrikel kiri terganggu

Koarktasio Aorta

Koartasio Aorta adalah kelainan jantung kongenital yangmenyebabkan terjadinya obstruksi aliran darah yang melewati aorta, akibat adanya penyempitan pada arkusaorta distal atau pangkal aorta desendens torakalis, diatas duktus arteiosus (pre-ductal), didepan duktus arteriosus (juxta ductal) atau dibawah duktus arteriosus (post ductal). Pada neonatus sering disertai hipoplasi segmen isthmus atau arkus aorta bagian distal, akibat aliran yang kurang melalui arkus selama masa janin. Kelainan ini dapat berdiri sendiri, namun biasanya sangat berhubungan dengan adanya kelainan jantung yang lain seperti ventricular Septel Defect, Patent Ductus Arteriosus, Bicuspid Aortic Valve, dan kelainan jantung yang lain