Comparison of Angiotensin-Converting Enzyme Inhibitor (ACEI) and Angiotensin Receptor Blocker (ARB) for Heart Failure Treatment in Congenital Heart Diseases with Left-to-Right Shunt

BACKGROUND: The angiotensin-converting enzyme inhibitors (ACEIs) have become the forefront of heart failure treatment for more than a decade. Currently, angiotensin receptor blockers (ARBs) are thought to have similar effectiveness. This study aimed to compare the impact of captopril, one of ACEI, and valsartan, one of ARB, on clinical presentation and echocardiographic, electrocardiographic, and chest x-ray improvement in patients with left-to-right shunt congenitalheart diseases.METHODS: This study used a double-blind randomized controlled trial of captopril and valsatran to children with left-to-right shunt congenital heart diseases who suffer from heart failure in the Dr. Soetomo General Hospital, Surabaya, Indonesia. Pediatric heart failure scores, echocardiography, electrocardiography (ECG), and chest photographs were examined at the beginning of the study and after 30 days of treatment.RESULTS: A decrease in pediatric heart failure scores were showed after the administration of ACEI (7.06±2.04 vs. 4.75±2.43; p<0.0001; 95% CI: −2.98 - 1.65); ARB (6.81±2.25 vs. 3.94±1.98; p<0.0001; 95% CI: −3.76 to 1.98). The echocardiography examination, an increase in left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), % fractional shortening (FS), and left ventricular (LV) dimension occurred after the administration of ACEI and ARB. The values also didn’t significantly differrent between the two groups. The ECG evaluation showed a decrease in heart rate frequency after the administration of ACEI (117.75±14.67 vs. 109.63±17.59; p=0.039; 95% CI: −15.78 to −0.46) and ARB (117.10±21.86 vs.108.6±20.66; p=0.006; 95% CI: −14.17 to −2.83).CONCLUSION: ARB showed better outcome in clinical condition, echocardiography, ECG, and chest radiographs.KEYWORDS: captopril, valsartan, heart failure, congenital heart disease, left to right shunt

Hubungan Status Gizi Anak Usia 2-5 Tahun dengan Kelainan Jantung Bawaan Biru di RSUD Dr Soetomo Surabaya

Latar belakang. Kelainan jantung bawaan biru adalah tipe umum dari kelainan jantung bawaan yang salah satunya disebabkan oleh faktor status gizi. Malnutrisi pada anak dengan kelainan jantung bawaan biru dapat meningkatkan mortalitas dan morbiditas. Tujuan. Untuk menganalisis hubungan status gizi dengan kelainan jantung bawaan biru. Metode. Penelitian ini menggunakan rancangan observatif cross-sectional. Berat badan, usia, dan jenis kelamin diambil sebagai variabel penelitian. Status gizi dihitung dengan menggunakan metode z-skor dan dibagi menjadi dua kelompok yaitu malnutrisi dan gizi baik. Hasil. Prevalensi kelainan jantung bawaan biru pada anak perempuan adalah 28 anak dan pada anak laki-laki adalah 16 anak. Angka kejadian terbanyak adalah pada anak usia 21-24 bulan. Tetralogi Fallot adalah tipe yang kelainan jantung bawaan biru terbanyak (68,2% dari total kelainan jantung bawaan biru). Pasien kelainan jantung bawaan biru dengan malnutrisi 63,6% dan gizi baik 36,4%. Dengan uji Chi-square diperoleh hubungan yang bermakna secara statistik (p=0,007) dan hubungan ini pada α=0,05 adalah lemah karena koefisien korelasinya sebesar 0,313. Kesimpulan. Terdapat hubungan yang lemah antara status gizi dengan kelainan jantung bawaan biru pada anak usia 2-5 tahun

PENGARUH TERAPI BEKAM BASAH DALAM MENURUNKAN APOLIPROTEIN-B PADA PENDERITA HIPERKOLESTEROLEMIA

ABSTRACTHypercholesterolemia is a high level of cholesterol in the blood. Patients must take anti-cholesterol drugs for a long time, so they are at risk of experiencing side effects from the drug. Apo-B and total cholesterol are indicators of cholesterol levels in the blood. Wet cupping therapy is a method of excreting metabolic waste in the blood through the surface of the skin. The study aims to prove the effect of wet cupping therapy as a complementary therapy to decrease Apolipoprotein-B. Method: This research is Quasy experimental research using humans as research subjects. The dependent variable is Apo-B, and total cholesterol gave wet cupping treatment. Cupping is done twice, 7 points, using a G21 needle. A large sample of 32 people with hypercholesterolemia divided into treatment groups and control groups. The research subjects were selected based on sample inclusion criteria. After 12 hours of fasting and still taking simvastatin, blood was taken through 5ml of the brachial vein. Put into a 2ml purple tube containing EDTA the rest inserted in a red tube. Apo-B measurement using ELISA sandwich method, elabscience reagent, BiopharmaELISA reader tool, in units of ng/ml. Total cholesterol uses the enzymatic colorimetry method, diasys reagent, Biolyzer100 spectrophotometry, in mg/dl units. Data analysis was carried out with the Wilcoxon Signed Ranks Test with a significance level of 5% (α = 0.05), the pre-datacompared with the post data. Results: A significant reduction in Apo-B measurements with p-value 0.000 (α &lt;0.05), SD 42. Conclusion: Intervention of wet cupping therapy can reduce Apo-B levels in the blood. Further research needs to be done to measure the potential for prevention of atherosclerosis.Keywords: wet cupping, Apo-B, cholesterol, bloo

WEBINAR TRAINING OF EARLY DETECTION OF CONGENITAL HEART DISEASE FOLLOWED BY ECHOCARDIOGRAPHY AND PULSE OXIMETRY SCREENING IN LUMAJANG, EAST JAVA, INDONESIA

Congenital heart disease (CHD) affects about 0.8% to 1.2% with the mortality rate being 81 cases per 100,000 live births. Generally, CHD is a structural abnormality of the heart and (or) large blood vessels that appear at birth. The purpose of this activity is to conduct webinar training on early detection of congenital heart disease followed by ecocardiography and oximetry pulse screening in lumajang east Java Indonesia the novelty in this service activity because it provides training on early detection of heart disease. The training method was carried out through webinars with health worker participants in Lumajang. The material provided includes early detection methods, diagnosis and therapy, as well as simulations of CHD cases. Pre and Post-test are used to evaluate the level of knowledge. A visit to the echocardiography and pulse oximetry examination by a pediatric cardiologist was carried out two weeks later in Lumajang. As a result of the activity, there were 140 participants who took part in the webinar training. The average score of the pre-test was 11.13/15 with only 5 participants getting a perfect score. At the end of the webinar, the average post-test score was 14.34/15 with 115 participants who finally got a perfect score. A total of 28 children were examined by echocardiography examination. 20 children were diagnosed with cyanotic CHD, 6 children were diagnosed with cyanotic CHD, and 2 were normal children. On pulse oximetry examination, all babies had an oxygen saturation of 95% or more and there was no difference of more than 3% between the pre and post duct sites. Conclusion Webinar training can increase health workers' knowledge about early detection of CHD.Keywords : Congenital Heart Disease; Filtering; Echocardiography; Pulse oximetry

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

Oxygen saturation among newborns in the first 10 hours of life to detect Critical Congenital Heart Disease - Ductus Dependent

ABSTRACT Delay diagnosis of Critical Congenital Heart Disease (CHD) can be associated with sudden clinical deterioration and dangerous cardiovascular conditions. The oxygen saturation screening among newborns in the first 10 hours of life is essential for early detection of critical CHD. This study aims to prove that measuring oxygen saturation among newborns in the first 10 hours of life can detect critical CHD. This study is a diagnostic experimental with consecutive sampling subjects in the infant care unit of Dr. Soetomo Hospital, including all newborns with birth weight ≥ 1500 grams and oxygen saturation at ≥ 1 hour of age below 90%. The measurement of oxygen saturation uses fingertip pulse oximetry in the right hand and foot at the age of 10 hours. A "positive oxygen saturation" is defined as oxygen saturation ≤ 85% or different oxygen saturation ≥ 3%, while a "negative oxygen saturation" is when the oxygen saturation is 85% to 90% or different oxygen saturation is 3%. Echocardiography is performed for the gold standard. From November 2019 to January 2020, 11 newborns underwent an oxygen saturation examination. Five subjects (45.46%) in the category of positive oxygen saturation, echocardiographic showed all Critical CHD (100%). Six subjects (54.54%) with negative oxygen saturation category, echocardiographic results showed two critical CHD (33.34%) and four non-critical CHD (66.66%). Fisher's exact test p < 0.005 (α). The diagnostic oxygen saturation test among newborns at 10 hours of life shows ≤85%, all subject’s echocardiography (100%) shows detection of critical CHD, while saturation 85% to 90% has of 33.3% for detection of critical CHD. The sensitivity and specificity of oxygen saturation for early diagnosis of critical CHD are 100% and 67%, respectively. Keywords: critical congenital heart disease, oxygen saturation, fingertip pulse oximetry, diagnostic tests*Corresponding Author: [email protected]

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

Factors Associated with the Occurrence of Cyanotic Spells in Tetralogy of Fallot Patients

A study was carried out on 114 tetralogy of Fallot patients attending the Department of Child Health, Medical School, University of Airlangga/Dr. Soetomo Hospital between 1 January 1988 to 31 December 1992. Only 81 patients fulfilled our study criteria where 52 (64.2'%) were cases with complications such as cyanotic spells, 4 (4 .93%) among them had brain abscesses. Twenty-nine individuals without complications acted as controls. Age, sex, nutritional status, hematocrit, MCHC and onset of symptoms between the two groups were analyzed using the multiple regression logistic. It has been shown that relative anemia, polycythemia and the age of 2-5 years contributed to the onset of cyanotic spells, respectively, R = 0.3171 and p = 0 .0004; R = 0.2220 and p = 0 .0073; R = 0.1363 and p = 0.00465. Therefore, in conventional treatment of tetralogy of Fallot patients it is essential to observe these risk factors in order to avoid complications and to improve the quality of life in these patients who are on the waiting list for surgery

Congenital heart disease in adults and its problems

There were 40 adult congenital heart disease (CHD) patients seen in the Cardiology Division during 1 year (February 1993 - February 1994). The most frequently seen defect was atrial septal defect; however there were also cases with patent ductus arteriosus, pulmonary stenosis, ventricular septal defect, and tetralogy of Fallot. Hemodynamic disorder, serious hindrance to education achievement, and occupational threat due to limited physical capabilities as well as malnutrition are some of prominent issues to be closely anticipated. In general the older the patients the more serious hemodynamic disorder they suffer due CHD. It is worth thinking how to improve the quality of life of CHD patients who succeed to live their adult lives and minimize any possible fatal complication risks