Clinical features and management of secundum atrial septal defect in infants and children

[no abstract available

Survival patterns of children with rheumatic heart disease

[no abstract available

Profile and prediction of severity of rheumatic mitral stenosis in children

[no abstract available

Anthropometric profiles of children with congenital heart disease

<p><strong>Background:</strong> Undernutrition is a common cause of morbidity in children with CHD. Previous data from developing country showed prevalence of preoperative undernutrition in children with CHD was up to 45%. The aim of this study are to determine the anthropometric profiles and prevalence of undernutrition in children with CHD by using the anthropometric measurement.</p><p><strong>Methods:</strong> A cross-sectional study was carried out in children aged 0-2 years old with CHD in Cipto Mangunkusumo hospital. All patients underwent an anthropometric evaluation (weight, length and head circumference) at presentation. Undernutrition, failure to thrive /FTT, short stature and microcephaly were determined according to WHO, weight-for-length, weight-for-age at 2 points, length-for-age, head circumference-for-age z-score &lt; -2SD accordingly.</p><p><strong>Results:</strong> We had total of 95 patients, 73 patients with acyanotic and 22 patients with cyanotic lesions. Prevalence of undernutrition in CHD was 51.1%, with 22.3% severe undernutrition. FTT was found in 64.9%, short stature in 49.5% and microcephaly in  37% patients. FTT was found higher in acyanotic (72.2%) compared to cyanotic lesions (42.9%). In acyanotic, weight was affected more than length (72.2% vs 49.3%). In cyanotic, weight and length affected equally (42.9% vs 54.5%). Diet counseling were done in patients with undernutrition. Medicines, transcatheter or surgery intervention were indicated in selected patients.</p><p><strong>Conclusions:</strong> Prevalence of FTT was higher than undernutrition in children with CHD. FTT was found higher in acyanotic lesions. In acyanotic, weight was affected more than length. In cyanotic, weight and length affected equally. <em><strong>(Med J Indones 2011; 20:40-5)</strong></em></p><p><strong>Keywords:</strong> <em>congenital heart disease, failure to thrive, short stature, undernutrition</em></p

Intravenous paracetamol and patent ductus arteriosus closure in preterm infants

Background Indomethacin and ibuprofen are the drugs of choice for closure of patent ductus arteriosus (PDA) in preterm infants. However, intravenous preparations are of limited availability in Indonesia. Circumstantial evidence has shown that intravenous paracetamol may be an alternative therapy for PDA closure in premature infants. Objective To evaluate the effect of intravenous paracetamol on PDA closure in preterm infants. Methods A before-and-after study was conducted between May and August 2014 in Cipto Mangunkusumo General Hospital, Jakarta in preterm infants with hemodynamically significant PDAs, as established by echocardiography using the following criteria: duct diameter >1.4 mm/kg, left atrium to aorta ratio >1.4, and mean velocity in the left pulmonary artery >0.42 m/s or mean diastolic velocity in the left pulmonary artery >0.2 m/s. Subjects, aged 2 and 7 days, received intravenous paracetamol (15 mg/kg every six hours) for 3 days. Paired T-test was used to compare pre-intervention PDA diameter to those assessed at 24 hours after the intervention and at 14 days of life. Results Twenty-nine subjects had a mean gestational age of 30.8 weeks and mean birth weight of 1,347 grams. Nineteen (65.5%) patients had closed PDAs at the day 14 evaluation, 1 experienced PDA reopening, and 9 had failed PDA closure. No liver toxicity was identified. Mean duct diameters before, 24 hours after the intervention, and at 14 days of life were 3.0, 0.9, and 0.6 mm, respectively (P<0.0001). Conclusion Intravenous paracetamol seems to be reasonably effective for PDA closure in preterm infants

Comparison of minimal inhibitory and bactericidal capacity of oral penicillin V with benzathine penicillin G to Streptococcus beta--hemolyticus group A in children with rheumatic heart disease

Background Injection ofbenzatine penicillin G (BPG) every 28 days is still the drug of choice for secondary prevention of rheu- matic heart disease (RHD). BPG sometimes poses problems due to pain at the injection site, possible anaphylaxis, and is not always available. Some centers choose oral penicillin over BPG. Objectives To compare minimal inhibitory capacity (MIC) and minimal bactericidal capacity (MBC) of oral penicillin V serum with those of BPG among SGA infected RHD. Methods This was a clinical trial with crossover design study to compare MIC of penicillin V and BPG. Outcome measures were MIC and MBC. Statistical analysis was performed using paired t-test and wilcoxon test. Result There were 32 subjects consisted of 17 males and 15 females. The mean value of MIC and MBC serum of penicillin V were 0.031 and 0.125. The mean value of MIC and MBC serum of BPG3 were 0.094 and 0.031. Respectively the MIC of penicillin V was similar to that of BPGy The mean value of MIC and MBC of BPG4 were 0.125 and 0.250. Respectively the MIC of penicillin V was significantly higher than that of BPG 4. The MBC of penicillin V was significantly higher than that of BPG 4. The MIC ofBPG 3 was similar to that ofBPG 4• The MBC of BPG 3 was similar to that of BPG 4. Conclusions The MIC of penicillin V was similar to that ofBPG 3, the MBC of oral penicillin V was higher than that ofBPG 3• The MIC and MBC of penicillin V was higher than those of BPG 4

Ventricular function and high-sensitivity cardiac troponin T in preterm infants with neonatal sepsis

Background Hemodynamic instability in sepsis, especially in the neonatal population, is one of the leading causes of death in hospitalized infants. The major contribution for heart dysfunction in neonatal sepsis is the myocardial dysfunction that leads to decreasing of ventricular function. The combination of echocardiography and laboratory findings help us to understand the ventricular condition in preterm infants with sepsis. Objective To assess for a correlation between ventricular function and serum high-sensitivity cardiac troponin T (hs-cTnT) level in preterm infants with neonatal sepsis. Methods We prospectively studied 30 preterm infants with neonatal sepsis who were admitted to the neonatal intensive care unit (NICU) of Cipto Mangunkusumo Hospital from June 1 – August 31, 2013. The ventricular functions were measured using 2-dimensional echocardiography. The parameters of right ventricular (RV) function assessment were tricuspid annular plane systolic excursion (TAPSE) and RV myocardial performance index (MPI). For left ventricular (LV) performance, we assessed ejection fraction (EF), fractional shortening (FS), and LV-MPI. Serum hs-cTnT was measured and considered to be a marker of myocardial injury. Results Subjects had a mean gestational age of 31.5 (SD 2.18) weeks and mean birth weight of 1,525 (SD 437.5) g. The mean LV function measured by MPI was 0.281 (SD 0.075); mean EF was 72.5 (SD 5.09)%; and mean FS was 38.3 (SD 4.29)%. The RV function measured by TAPSE was mean 6.85 (SD 0.94) and that measured by MPI was median 0.255 (range 0.17-0.59). Serum hs-cTnT level was significantly higher in non-survivors than in survivors [282.08 (SD 77.81) pg/mL vs. 97.75 (24.2-142.2) pg/mL, respectively P =0.023]. There were moderate correlations between LV-MPI and hs-cTnT concentration (r=0.577; P=0.001), as well as between RV-MPI and hs-cTnT concentration (r=0.502; P=0.005). The positive correlation between LV and RV-MPI in neonatal sepsis was strong (r=0.77; P <0.001).Conclusion Left and right ventricular MPI show positive correlations with hs-cTnT levels. Serum hs-cTnT is significantly higher in non survivors. As such, this marker may have prognostic value for neonatal sepsis patients

Treadmill test in patients with rheumatic mitral regurgitation

[no abstract available

Profil Klinis dan Keluaran Penyakit Jantung Reumatik pada Anak yang Menjalani Bedah Katup

Latar belakang. Penyakit jantung reumatik merupakan kelainan jantung didapat penyebab kesakitan dan kematian terbanyak pada anak di Indonesia. Bedah katup pada anak dengan penyakit jantung reumatik jarang dilakukan. Tujuan. Untuk mengetahui profil klinis dan keluaran bedah katup pada anak dengan penyakit jantung reumatik. Metode. Penelitian secara retrospektif dilakukan pada 28 anak dengan penyakit jantung reumatik yang menjalani bedah katup di RSUPN Cipto Mangunkusumo selama tahun 2003 sampai 2009. Data dikumpulkan dan dicatat berdasarkan catatan medis berupa profil klinis sebelum operasi, umur saat operasi, jenis kelamin, status klinis, dan jenis operasi, serta data ekokardiografi berupa kelainan katup dan fungsi ventrikel. Sedangkan keluaran berupa komplikasi pascaoperasi, lesi residual dan fraksi ejeksi, fraksi pemendekan serta dimensi akhir diastolik ventrikel kiri seminggu pascaoperasi. Hasil. Umur rerata saat operasi 13,9 (SD 2,7) tahun; anak laki-laki dan perempuan sama banyak. Status klinis praoperatif fungsional kelas III dan kelas IV masing-masing terjadi pada 13 dan 9 anak. Regurgitasi mitral berat didapatkan pada 75% anak. Perbaikan katup mitral dilakukan pada 16, penggantian katup mitral pada 8, dan penggunaan katup ganda pada 4 anak. Tiga anak mengalami komplikasi berupa perdarahan, efusi pleura, dan sepsis, sedangkan satu orang meninggal. Lesi residual pascaoperasi didapatkan pada 11 anak, berupa regurgitasi dan stenosis mitral ringan, dan satu anak dengan paravalvular leak. Tidak didapatkan perbedaan yang bermakna dalam fraksi ejeksi, fraksi pemendekan dan dimensi akhir diastolik ventrikel kiri sebelum dan seminggu sesudah operasi. Kesimpulan. Bedah katup pada anak dengan penyakit jantung reumatik mempunyai keluaran yang baik, dengan angka kematian dan komplikasi yang rendah. Pemantauan lebih lanjut diperlukan untuk menilai keluaran jangka panjang