No abstract

Latar belakang. Patent duktus arteriosus (PDA) merupakan salah satu penyakit jantung bawaan asianotik yang paling banyakdijumpai pada anak. PDA dapat memengaruhi pertumbuhan anak dan menyebabkan malnutrisi pada anak dan malnutrisi yangterjadi merupakan faktor risiko mortalitas dan morbiditas pada anak.Tujuan. Mengetahui pertambahan berat badan sebelum dan sesudah dilakukan tindakan penutupan duktus pada anak dengan PDAsecara transkateter dan untuk mengetahui faktor-faktor yang berpengaruh terhadap pertambahan berat badan setelah dilakukanpenutupan PDA secara transkateter.Metode. Penelitian observasional pre dan post test design dengan menggunakan data rekam medis. Anak dengan PDA yangdilakukan penutupan secara transkateter. Z-score berat badan menurut umur dinilai sebelum dan pada saat 1, 3, 6, dan 12 bulansetelah penutupan dan dilakukan analisis menggunakan repeated ANOVA test. Faktor-faktor yang memengaruhi pertambahanberat badan 3 bulan setelah penutupan dianalisis menggunakan chi square dan regressi logistik.Hasil. Terdapat 43 anak usia <5 tahun dengan PDA diikutkan dalam penelitian dari Januari 2005 sampai Juni 2011. Sebelumpenutupan 76,7% (33) anak dengan z-score berat badan/umur < -2 SD. Didapatkan perbaikan rerata z-score berat badan/umursebelum dan saat 1, 3, 6, dan 12 bulan setelah penutupan (-2,63 vs -2,41, -2,14, -1,92 and -1,56; p<0,05). Jenis kelamin, umur,z-score berat badan/umur sebelum penutupan, berat lahir, hipertensi pulmonal, gagal jantung, pekerjaan orang tua, pendidikanibu dan penghasilan orang tua tidak berhubungan dengan pertambahan berat badan 3 bulan setelah penutupan.Kesimpulan. Penutupan defek secara transkateter pada anak usia <5 tahun dengan PDA akan memberikan peningkatan z-scoreberat badan berdasarkan umur.

Background: In low-to-middle-income countries, repair of the left-to-right shunts congenital heart disease (CHD) are often done with existing pulmonary arterial hypertension (PAH). Long-term outcomes data of this condition in either low-to-middle or high-income countries are limited. We conducted a study to evaluate the outcomes of children with PAH related to left-to-right shunt CHD who underwent surgical or transcatheter repair. Methods: All cases of PAH related to left-to-right shunt CHD repairs from 2015–2018 were retrospectively reviewed with additional new patients who underwent repair within our study period (2019–2020). Cases with complex congenital heart disease and incomplete hemodynamic echocardiography or catheterization measurements were excluded. Kaplan-Meier curves, log-rank test, Cox regression with Firth’s correction and restricted mean survival time were used for survival analysis. Results: Of the 118 patients, 103 patients were enrolled and 15 patients were excluded due to complex congenital heart disease and missing hemodynamic measurements prior to repair. Overall, median age at intervention was 44 months, mPAP mean was 43.17 ± 16.05 mmHg and Pulmonary Vascular Resistance index (PVRi) mean was 2.84 ± 2.09 (WU.m 2 ). Nine patients died after repair. The survival rate for patients with PAH-CHD at 1 day, 30 days and 1400 days (4 years) was 96.1%, 92.1%, and 91.0% respectively. Patients with persisting PAH after correction had –476.1 days (95% confidence interval [CI]: –714.4, –237,8) shorter survival over 4 years of follow up compared to patients with reversed PAH. PVRi was found to be the influencing covariate of the difference of restricted mean survival time between these groups. Conclusion: In low-to-middle income settings, with accurate PAH reversibility assessment prior to intervention, repair of left-to-right shunt CHD with existing PAH in children has a favourable outcome. Inferior survival is found in patients with persistence of PAH. PVRi at baseline predicts between-group survival difference.

Background Brain abscess is a severe infection of brain parenchyma, which occurs in 25-46% of cases of uncorrected cyanotic congenital heart disease. Low arterial oxygen saturation is the main risk factor for brain abscess in children with cyanotic congenital heart disease, however, the arterial oxygen saturation test is invasive and not routinely done in our setting. Objective To evaluate low peripheral oxygen saturation as a risk factor for brain abscess in children with cyanotic congenital heart disease. Methods We conducted a matched, case-control study at Sardjito Hospital, Yogyakarta for children aged less than 18 years with cyanotic congenital heart disease, from 2010-2016. Case subjects were children with brain abscess complications. The control group had only cyanotic congenital heart disease, and were matched for age and sex to the case group. During hospitalization due to the brain abscess complication in the case group, data regarding peripheral oxygen saturation, polycythemia, pneumonia, sepsis, dental caries and restricted pulmonary blood flow were collected and compared between both groups. Results During the study period, 18 children with cyanotic congenital heart disease had brain abscesses. This group was compared to the control group of 36 children. Bivariate analysis revealed that the lowest level of peripheral oxygen saturation (OR 0.92; 95%CI 0.85 to 0.98; P=0.02) and dental caries (OR 3.3; 95%CI 1.01 to 11.18; P=0.04) were significant risk factors for brain abscess. However, in the multivariate analysis, the only statistically significant risk factor associated with brain abscess was the lowest level of peripheral oxygen saturation (OR 0.92; 95%CI 0.86 to 0.99; P=0.04). Conclusion Low peripheral oxygen saturation is a significant risk factor for brain abscess development in children with cyanotic congenital heart disease.  A decrease of 1% peripheral oxygen saturation may increase the risk of brain abscess by 8%.