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Introduction: The decision to close small ventricular septal defect is still controversial. Previous study showed that ventricular dysfunction in adulthood is correlated with small perimembranous ventricular septal defect. N terminal pro B-type natriuretic peptide (NT-proBNP) is a neurohormone secreted primarily from the ventricles in response to increased left and right ventricular pressure and volume load. The left ventricular end-diastolic pressure will reflect ventricular performance. This study aimed to evaluate the correlation between left ventricular end-diastolic pressure and the NT-proBNP in children with small perimembranous ventricular septal defect. Materials and Methods: Level of NT-proBNP in 41 patients with small perimembranous ventricular septal defect was measured before transcatheter closure procedure. We also measured the left ventricular end-diastolic pressure in each patients during catheterisation. We investigated the value of NT-proBNP in patients with small perimembranous ventricular septal defect and its correlation with the level of left ventricular end-diastolic pressure Result: We found positive correlation between NT-proBNP and left ventricular end-diastolic pressure (r = 0.278, p = 0.046). The median of NT-proBNP at left ventricular end-diastolic pressure < 10 was lower than at left ventricular end-diastolic pressure ≥ 10 (0.87 ng/ml versus 1.83 ng/ml, p = 0.023). The results of the NT-proBNP diagnostic test for predicting left ventricular end-diastolic pressure ≥ 10 using Receiver Operating Characteristic (ROC) analysis showed the area under the curve value of 0.715 (95% CI: 0.546–0.849). The cut-off value >0.99 ng/ml of NT-proBNP has 75.0% sensitivity and 72.2% specifity. Conclusion: Level of NT-proBNP higher than 0.99 ng/ml was correlated significantly with left ventricular end-diastolic pressure ≥10 in children with small perimembranous ventricular septal defect.

Background: Adolescents’ psychosocial and mental health is affected by body image. However, adolescent body image dissatisfaction (BID) is noted as an epidemic problem worldwide and limited studies in developing countries were performed. This study aimed to assess the association between psychosocial-mental health difficulties and BID among adolescents in Indonesia. Methods: We conducted a cross-sectional study in high schools in Jakarta selected by cluster random sampling. The randomly selected students aged 14-18 from each school were provided with online questionnaires, including Body Dissatisfaction Scale (BDS), Strength and Difficulties Questionnaire (SDQ), and Kessler Psychological Distress Scale (KPDS). Results: There were 327 subjects who filled out the questionnaire completely and were included in the analysis. The common psychosocial and mental health difficulties in adolescents in this study were hyperactivity-inattention, peer problems, and emotional problems (30%, 20.8%, and 20.2% consecutively). The overall psychosocial and mental health scores were not statistically higher in the BID group, but the emotional symptom scores were significantly higher in the BID group (p=0.023). The correlation between stress level and emotional symptom scores is also strong (pConclusion: Public health interventions are needed to assist adolescents to improve their body confidence and develop a resistant coping mechanism.

BACKGROUND: There is a lack of local data about recurrent acute respiratory infections in children with congenital heart disease (CHD). This study aims to investigate the incidence and recurrence of acute respiratory infection (ARI) in left-to-right shunt CHD. METHODS: This prospective cohort study investigated children with left-to-right shunt CHD, aged three months to five years, at Dr. Cipto Mangunkusumo Hospital between September 2012 and April 2013. Age and sex-matched participants without CHD were recruited as reference. The occurrence of ARI was observed for six months. Acyanotic CHD patients from 2015 to 2019 were also evaluated to determine the proportion of ARI among this population. RESULTS: A total of 100 subjects were enrolled in the study, 50 in the CHD group and 50 in the non-CHD group, six of whom were later excluded. The monthly incidence of ARI in the CHD group ranged between 40-60% ( p =0.027). Subjects with CHD had a cumulative increased risk of 10% for acquiring ARI (RR=1.1; 95% CI=1.02-1.2, p =0.027). The proportion of subjects with a high recurrence of ARI was also higher in the CHD compared to the non-CHD group (67% vs. 30 %, p

BACKGROUND Some ventricular septal defects (VSDs) require an interventional procedure for closure. Transcatheter and surgical closures of VSD have similar effectiveness, but transcatheter VSD closure is considered associated with less complication than surgical closure. This study aimed to compare mid-term or long-term complications of transcatheter and surgical VSD closures. METHODS This was a retrospective cohort study compared the complication rates of transcatheter and surgical VSD closures performed in Cipto Mangunkusumo Hospital from January 1, 2010, to April 30, 2017, with 34 subjects in each group. The inclusion criteria were as follows: single lesion outlet perimembranous or doubly committed subarterial VSD, age 2–18 years, body weight >8 kg, and no arrhythmia. Electrocardiography and echocardiography were done to collect primary data. Other data were collected from medical records. Mid-term complications occurred 1–24 months after interventional closure. Long-term complications occurred 24 months after interventional closure. Complications were arrhythmia, valve regurgitation, and residual shunt. Data were analyzed by chi-square test. RESULTS The rate of worsening valve regurgitation was higher in the transcatheter group than in the surgical group (16 versus 11, p = 0.322). The number of patients with residual shunts were similar between the transcatheter group and surgical group (5 versus 5; p = 1.000). Both complications were found in mid- and long-term. Arrhythmia as a long-term complication occurred in five and seven patients in the transcatheter and surgical groups, respectively (p = 0.752). CONCLUSIONS Transcatheter and surgical VSD closures have similar mid or long-term complications.

Background While the number of cases of multisystem inflammatory syndrome in children (MIS-C) is increasing, reported cases in Asian countries are still low, particularly in Indonesia. This study aimed to describe the characteristics of patients with MIS-C in a tertiary referral hospital in Indonesia. Methods This is a cross-sectional study with collected data of patients with MIS-C admitted to Dr. Cipto Mangunkusumo from March 2020 to April 2021. Results The first case of MIS-C was detected 5 months after the first reported coronavirus disease 2019 case in Indonesia. Thirteen patients out of 158 positive admitted patients for COVID-19 were diagnosed with MIS-C during the study period. Of these 13 patients, 2 patients (15%) had a fatal outcome. Subjects were predominantly male, and the median age was 7.58 years (IQR 12.3) years. Most patients required mechanical ventilation (7 out of 13 patients) and intubation (8 out of 13 patients). Patients who needed intubation usually needed mechanical ventilation. All inflammatory markers, white blood cells, neutrophil counts, and all coagulation factor parameters (except for normal prothrombin time and activated partial prothrombin time) were elevated. The median time to MIS-C diagnosis was 2 days in the survivor group (n = 11) compared to 8.5 days in the non-survivor group (n = 2). Compared to the non-survivor group, those who survived spent more days in the hospital, received vasopressors earlier, and did not require mechanical ventilation as early as the non-survivors. Conclusions Our work highlights the differences in MIS-C clinical course, treatment, and clinical outcomes between the two groups.

Background: The alternative device to close perimembranous ventricular septal defect (pmVSD) has been searched for better result, less complications and applicable for infants. However, the ideal device is still unavailable. We aimed to evaluate the effectiveness and outcome of transcatheter pmVSD closure using the KONAR-multi functional occluder (MFO).Methods: Clinical, procedural, follow-up data of pmVSD patients with symptom of heart failure or evidence of significant left to right shunt, growth failure, recurrent respiratory tract infection, and history of endocarditis who underwent transcatheter closure using the MFO were prospectively evaluated.Results: Between January 2016 and December 2017, there were complete records of 132 pmVSD children closed using MFO from eleven centers in Indonesia. The median of age was 4.5 (0.3–17.4) years; weight 14.8 (3.5–57) kg, defect size at the smallest part 3.4 (1.0–8.1) mm, flow ratio 1.6 (1.3–4.9), mean pulmonary artery pressure 18 (7–79) mmHg, fluoroscopy time 18 (3.8–91) and procedural time 75 (26–290) minutes. A retrograde approach was done in 41 (31%) patients. Procedures succeeded in first attempt in 126 (95.4%), failed in three and migration in three patients. Six of eight infants with congestive heart failure were closed successfully. Of 126 patients with successful VSD closure, 12 months follow-up were completed in all patients. The rate of complete occlusion at 1 month, 3 months, 6 months and 12 months after intervention were 95.2%, 97.6%, 99.2%, and 99.2%, respectively. New-onset aortic regurgitation and moderate tricuspid regurgitation developed only in five and three patients. Neither complete atrioventricular block, nor other complications occurred.Conclusion: Transcatheter closure of pmVSD using the MFO is safe, effective, and feasible in infants and children.

Beta thalassemia major (TM) is a common hereditary disease in Indonesia. Iron overload due to regular transfusion may induce myocardial iron deposition leading to electrophysiological dysfunction and functional disorders of the heart. Ventricular arrhythmia is one of the most common causes of sudden cardiac death in thalassemia patients. This cross-sectional study of 62 TM patients aged 10–32 years in Cipto Mangunkusumo General Hospital was done to assess their electrophysiological properties and heart rate variability, including 24- hour Holter monitoring, signal averaged electrocardiogram (SAECG) for detection of ventricular late potential (VLP), and determination of heart rate variability (HRV). We also assessed their 12-lead ECG parameters, such as P wave, QRS complex, QT/ QTc interval, QRS dispersion, and QT/ QTc dispersion. Iron overload was defined by T2-star magnetic resonance (MR-T2*) values of less than 20 ms or ferritin level greater than 2500 ng/mL. Subjects were grouped accordingly. There were significant differences of QTc dispersion (p = 0.026) and deceleration capacity (p = 0.007) between MR-T2* groups. Multivariate analysis showed an inverse correlation between QTc dispersion and MR-T2* values. There was a proportional correlation between heart rate deceleration capacity in the low MR-T2* group (p = 0.058) and the high ferritin group (p = 0.007). No VLPs were detectable in any patients. In conclusion, prolonged QTc dispersion and decreased heart rate deceleration capacity were significantly correlated with greater odds of iron overload among patients with Thalassemia major.

Background Respiratory distress is the most common cause of morbidity in premature babies in the delivery room. Nasal continuous positive airway pressure (nCPAP) is widely used as the preferred modality of treatment, although it may cause nasal trauma. Heated, humidified high-flow nasal (HHHFN) cannula is an alternative oxygen therapy, yet the safety and efficacy has not been widely studied. Objective To compare the safety and efficacy of HHHFN and nCPAP in premature babies with gestational age > 28 to < 35 weeks and moderate respiratory distress. Methods We conducted a randomized, non-inferiority, clinical trial using HHHFN vs. nCPAP as a treatment for moderate respiratory distress within 72 hours after they had been used. The efficacy endpoints were treatment failure, length of device use, length of Kangaroo Mother Care (KMC), and full enteral feeding time. Safety assessment included pain score, nasal trauma, and systemic complications. Results No differences were found in terms of incidence of endotracheal intubation within < 72 hours of HHHFN (20%) compared to nCPAP (18%) (P=0.799). However, there was a significant difference in moderate nasal trauma in nCPAP (14%) compared to HHHFN (0%)(P=0.006). There were no significant differences of blood gas analysis results, full enteral feeding time, length of KMC, length of device use, and rate of complications (bronchopulmonary dysplasia/BPD, intraventricular hemorrhage/IVH, patent ductus arteriosus/PDA, necrotizing enterocolitis/NEC and late onset neonatal sepsis/LONS) between the nCPAP and HHHFN groups. Conclusion The HHHFN is not inferior to nCPAP in terms of the safety and efficacy as primary non-invasive therapy in premature babies of gestational age > 28 to < 35 weeks with moderate respiratory distress . Compared to nCPAP, HHHFN induced lower nasal trauma.

The oral triiodothyronine for infants and children undergoing cardiopulmonary bypass (OTICC) trial showed that Triiodothyronine (T3) supplementation improved hemodynamic and clinical outcome parameters. We tested the validity of low cardiac output syndrome (LCOS), derived using clinical parameters and laboratory data, by comparing the LCOS diagnosis with objective parameters commonly measured in a cardiac intensive care unit (CCU) setting. OTICC, a randomized, placebo-controlled trial included children younger than 3 years with an Aristotle score between 6 and 9. We used the existing trial data set to compare the LCOS diagnosis with echocardiographic hemodynamic parameters. Additionally, we determined if LCOS, prospectively assigned during a clinical trial, served as an early predictor of clinical outcomes. All LCOS subjects at 6 and 12 h after cross-clamp release later showed significantly lower pulse pressure, stroke volume and cardiac output, and higher systemic vascular resistance. These LCOS patients also had significantly longer time to extubation (TTE) and higher mortality rate. LCOS incidence was significantly lower in the T3 treatment group [n = 86 vs. 66, respectively, p

Transmission of Group AWe aimed to investigate the prevalence and predictors of GAS carrier state and evaluate the antibiotic sensitivity pattern of GAS in Jakarta, Indonesia.We enrolled 201 asymptomatic schoolchildren (6-12 years) using stratified random sampling from a primary school in Jakarta. None of the children had a history of rheumatic fever or rheumatic heart disease. All participants underwent physical examination, and laboratory tests include complete blood count, erythrocyte sedimentation rate, C-reactive protein, antistreptolysin O titer, and throat swab culture.The prevalence of GAS carrier was 13.9% (95% confidence interval: 9.2%-18.6%) in our study. On multivariate analysis, tonsillar enlargement was found to be the only predicting factor of GAS carrier (The GAS carrier state is common among school-age children affecting approximately 13.9% children. Tonsillar enlargement is a significant finding predictive of GAS carrier state. All isolates are still sensitive to penicillin and mostly sensitive to erythromycin but are increasingly resistant to tetracycline.

Background:Severe pulmonary regurgitation may result in right ventricular volume overload and decreased right ventricular function. Severe pulmonary regurgitation can be predicted prior to repair of tetralogy of Fallot. The aim of this study was to determine the risk factors for severe pulmonary regurgitation in repaired tetralogy of Fallot with transannular patch.Methods:This was a cross-sectional study in 43 patients with repaired tetralogy of Fallot using transannular patch. This study was carried out in Dr. Cipto Mangunkusumo hospital during 2015 to 2018. Participants were followed up for routine examination using echocardiography. We used bivariate and multivariate logistic regression using STATA 12.1 to identify risk factors for severe pulmonary regurgitation in this population.Results:A total of 43 patients composed of 22 boys and 21 girls with repaired tetralogy of Fallot using transannular patch were enrolled in the study. Median age of participants was 6 years at admission (2.1–18.5 years) and 3.4 years (1–17 years) at repair. Median length of follow-up was 2.1(1–4.3) years. Risk factors associated with severe pulmonary regurgitation after tetralogy of Fallot repair were McGoon ratio > 1.8 (odds ratio = 6.9; 95% confidence interval = 1.6–30) and follow-up duration >1.9 years (odds ratio = 3.6; 95% confidence interval = 0.9–15.2).Conclusion:McGoon ratio > 1.8 and follow-up duration > 1.9 years are associated with severe pulmonary regurgitation after tetralogy of Fallot repair.

Background Right heart catheterisation remains the gold standard to diagnose pulmonary hypertension in CHD patients. Availability and cost of catheterisation are common problems in the developing world. Recent studies showed that echocardiography could be considered an alternative method to assess pulmonary hypertension because it is non-invasive, safe and accessible. Objectives This study aims to determine the diagnostic value of echocardiography in evaluating pulmonary hypertension in CHD patients. Method This study was a cross-sectional study with a total of 48 CHD patients aged under 18 suspected of pulmonary hypertension, with 22 males and 26 females. The investigation was conducted in Dr. Cipto Mangunkusumo Hospital from January until December 2020. All subjects were initially assessed with echocardiography and then underwent right cardiac catheterisation to confirm the diagnosis of pulmonary hypertension. The data were then recorded and analysed. We estimated the sensitivity, specificity and other diagnostic values while also performing Bland-Altman analysis to determine the agreement between echocardiography and catheterisation. Results The sensitivity and specificity of echocardiography in diagnosing pulmonary hypertension were 71.1% and 70%, respectively. Echocardiography showed a significant change in pre-test and post-test probability, which were 79.2% to 90%. There was a moderate correlation between the results of the two tests (rho: 0.38, p = 0.0077). The Bland-Altman analysis found -8.9 mmHg bias with 95% limits of agreement from -44.9 to 27.2 mmHg. Conclusion Echocardiography shows a considerable diagnostic capacity in determining pulmonary hypertension, although it remains inferior to cardiac catheterisation. Echocardiography should be considered as an alternative method in screening and diagnosing pulmonary hypertension.

During 11 years period from January 2005 to December 2015 there were 18 adolescent and adult patients who underwent transcatheter closure of PDA using PDA Amplatzer Duct Occluder (ADO). There were 9 cases with age of 14 to 18 years and 9 cases with age of more than 18 years where the oldest case was 46 years old. Two cases were male and 16 cases were female. Prior to procedures, clinical assessment, ECG, chest x-ray and transthoracic echocardiography (TTE) were performed to confirm the diagnosis of PDA. The procedures of device implantation was performed under conscious sedation in adults and using general anesthesia in adolescents.The size of PDA ranged from 1.6 mm to 11.1 mm. Based on Kritchenko classification, the type of PDA were 15 type A1 and 3type A2. Flow ratio between pulmonary to systemic circulation was between 1.1 and 5.9. The procedure time ranged from 60-189 minutes and the fluoroscopic time 7.1-77.3 minutes. The PA pressure ranged from 22 to 63 mmHg. Immediate results after procedures as seen in angiography showed complete closure in 14 cases and smoky residual shunt or minimal residual shunts in 4 cases, which probably due to the temporary leaking through the devices. In 24 hours, complete closure was achieved in all cases (100%) and continued until 1months. At 6 month follow up, there was no residual shunts detected and also there was no significant complications, such as device embolization or recanalization. This case series suggest that transcatheter closure of PDA in adolescents and adults using Amplatzer duct occluder (ADO) is effective and has excellent resultswithout significant complication. However, long-term follow up is required to assess long term efficacy and safety.

Latar belakang. Terapi baku emas dalam penutupan defek septum ventrikel (DSV) adalah pembedahan. Prosedur pembedahan mempunyai morbiditas yang terkait dengan torakotomi, pintasan jantung paru, komplikasi prosedur, jaringan parut bekas operasi, dan trauma psikologis. Oleh karena itu, timbul usaha pendekatan transkateter untuk menutup DSV yang bersifat relatif kurang invasif. Tujuan. Mengetahui perbandingan hasil penutupan DSV perimembran, komplikasi prosedur, lama rawat di rumah sakit, dan total biaya prosedur antara prosedur transkateter dengan prosedur pembedahan. Metode. Penelitian retrospektif analitik dengan data berupa rekam medis pasien anak dengan DSV perimembran yang datang ke Pelayanan Jantung Terpadu Rumah Sakit dr. Cipto Mangunkusumo dan dilakukan penutupan defek dengan salah satu prosedur dalam periode Januari 2010-Desember 2013. Hasil. Didapat 69 kasus anak dengan DSV perimembran, terdiri atas 39 kasus dengan prosedur pembedahan dan 30 kasus dengan prosedur transkateter. Prosedur pembedahan dan prosedur transkateter mempunyai tingkat keberhasilan yang serupa (89,7% vs 96,7%, p=0,271). Prosedur pembedahan mempunyai komplikasi yang lebih banyak dibandingkan prosedur transkateter (46,7% vs 7,7%, p

Background The technical aspects of ductal stenting have been reported, but little is known about the fate of the duct after stent implantation. Objectives To determine the effects of PDA stenting on the degree of cyanosis, blood oxygen saturation, long-term patency of PDA, and the growth of pulmonary artery and its branches, in patients with duct-dependent pulmonary circulation. Methods This was a case series study conducted at the Department of Pediatric Cardiology, Institut Jantung Negara (National Heart Institute), Kuala Lumpur, Malaysia from November 1996 to September 2001 on patients with duct-dependent pulmonary circulation who underwent stent implantation. All patients were followed-up until occlusion or block occurred or until the end of follow-up time. The evaluation consisted of clinical manifestations, electrocardiography, chest x-ray, echocardiography, and cardiac catheterization. Results Stent was successfully implanted in 60 patients (84%), failed in 7 patients (10%) and contra indicated in 4 patients (6%). There was significant improvement on the degree of cyanosis after stent implantation (p

Background The effectiveness of a single intramuscular benzathine penicillin G as a secondary prevention of acute rheu- matic fever after 28 days is still controversial. The latest study showed that serum penicillin concentration was below protective level in 4 weeks after a single intramuscular injection. Objective This study was a preliminary study to compare the in- hibiting ability of benzathine penicillin G towards group A Strepto- coccus β -hemolyticus in 21 and 28 days after a single IM injection by using Mueller-Hinton broth method. Methods The inhibiting ability was measured by the serum in- hibitory concentration and serum bactericidal concentration after a single intramuscular injection of benzathine penicillin G 1.2 mil- lion units. Results The subjects were 28 patients, with mean age of 15.5 years (SD 3.4). The numbers of male and female were equal. Mean serum inhibitory concentration in 21 days after a single injection was 926.4 (SD 3080.1) and after 28 days was 1540.9 (SD 4275.1), which was not significantly different (p=0.0662). Mean serum bac- tericidal concentration in 21 days after IM injection was 1579.6 (SD 4265.7) and in 28 days was 2417 (SD 6849.4) and it was not statistically different (p=0.2276). Conclusion This study concluded that there was no significant difference in the inhibiting ability of benzathine penicillin G to- wards group A Streptococcus β -hemolyticus between 21 and 28 days after a single intramuscular injection

Background Patent ductus arteriosus (PDA) is a congenital heart disease most commonly occurring in premature infants. Spontaneous ductus arteriosus (DA) closure in premature infants has been suggested to be associated with duct lumen maturity and the DA sensitivity to prostaglandin E2 (PGE2).Objective To assess for a possible correlation between serum PGE2 levels and PDA size in premature infants.Methods This observational study using repeated measurements on premature infants with PDA detected at days 2-3 of life was undertaken in Cipto Mangunkusumo Hospital and Fatmawati Hospital, Jakarta, from April to May 2014. The PDA was diagnosed using 2-D echocardiography and PGE2 levels were measured by immunoassay. Pearson’s correlation test was used to evaluate a possible correlation between PGE2 level and DA diameter.Results Thirty-three premature infants of median gestational age 31 (range 28-32) weeks and median birth weight 1,360 (range 1,000-1,500) grams were enrolled. Almost two-thirds of the subjects were male. Almost all (30/33) subjects had spontaneous DA closure before the age of 10 days. Subjects’ mean DA diameter was 2.9 (SD 0.5) mm with maximum flow velocity of 0.2 (SD 0.06) cm/sec, and left atrial-to-aortic root ratio (LA/Ao) of 1.5 (SD 0.2). Their mean PGE2 levels at the ages of 2-3, 5-7, and after 10 days were 5,238.6 (SD 1,225.2), 4,178.2 (SD 1,534.5), and 915.2 (SD 151.6) pg/mL, respectively. The PGE2 level at days 2-3 was significantly correlated with DA diameter (r = 0.667; P < 0.001), but not at days 5-7 (r = 0.292; P = 0.105) or at day 10 (r = 0.041; P = 0.941).Conclusion There is a strong, positive correlation between the PGE2 level and DA diameter in preterm infants at 2-3 days of age. However, there is no significant correlation between PGE2 level and persistence of PDA.

Introduction: Mortality in pediatric septic shock remains very high. Vasoactive-inotropic score (VIS) is widely used to predict prognosis in patients with heart disease. It is a simple method that was initially used as a predictor of morbidity and mortality in postoperative patients with congenital heart diseases. Previous reports showed that high VIS score was associated with high mortality in pediatric sepsis. However, its discriminative value remains unclear. We aim to explore the discriminative value of VIS in predicting mortality in pediatric septic shock patients. Methods: We conducted a retrospective cohort study on medical records of septic shock patients who received care in the pediatric intensive care unit (PICU). We screened medical records of pediatric patients which were diagnosed with septic shock and admitted to the PICU and received vasoactive/inotropic score for more than 8 h. Other supporting examination results were recorded, such as organ function evaluation for calculation of Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score. The outcome of patients was recorded. The receiver operating curve was constructed to calculate the area under the curve (AUC), sensitivity, and specificity of each cutoff point. Results: We obtained the optimum cutoff point of VIS > 11 with 78.87% sensitivity and 72.22% specificity. AUC positive was 0.779 (P < 0.001); predictive value and negative predictive value were 91.80% and 46.43%, respectively. Conclusion: VIS > 11 has a good ability to predict mortality in children with septic shock.

Background: Evaluating outcome and identifying predictors of major complications among children undergoing cardiac surgery are essential to improve care. We evaluated short-term outcomes of postcardiac surgery and predictors of major complications in a national referral hospital in Indonesia. Methods: A prospective cohort study was conducted from April 2014 to March 2015 on all children undergoing cardiac surgery. Participants were followed up from the time of surgery until hospital discharge and 30-day mortality. We performed univariate and multivariate logistic regression using STATA 12-1 to identify predictors of postsurgical major complications. Results: A total of 257 patients (median age: 36 months) were recruited; 217 (84.1%) had complications, including low cardiac output syndrome (19.8%), arrhythmia (18.6%), sepsis (17.4%), and pleural effusion (14.8%). Forty-nine (19%) patients had major complications, including cardiac arrest (5%), need for emergency chest opening (3.9%), and multiple organ failure (7.4%). 12.8% died during hospital stay, and 30-day mortality was 13.6%. Predictors of major complications were cyanotic congenital heart disease (odds ratio [OR]: 4.6, 95% confidence interval [CI]: 1.5–14.2), longer duration of cardiopulmonary bypass (CPB, OR: 4.4, 95% CI: 1.5–13.4), high inotropes (OR: 13.1, 95% CI: 3.2–54.2), and increase in lactate >0.75 mmol/L/h or more in the first 24 h (OR: 37.1, 95% CI: 10.1–136.3). Conclusion: One-fifth of children undergoing cardiac surgery experienced major complications with around 13% mortality. Cyanotic congenital heart disease, longer duration of CPB, high inotropes on leaving operating theater, and increase in blood lactate are associated with major complications in children after cardiac surgery.

Background Digoxin has long been prescribed in children with heart failure, but its efficacy has not been evaluated. A previous study at the Department of Child Health, Dr. Cipto Mangunkusumo Hospital revealed that plasma digoxin levels, following a maintenance dose of 15 μg/kg/d, were sub-therapeutic. Regarding its narrow margin of safety, the trend is to use digoxin in even lower dose. Thus, the drug’s impact on cardiac performance need to be evaluated. Objective To evaluate whether a lower maintenance dose of digoxin (10 μg/kg/d) is sufficient to achieve a therapeutic level and to assess for possible correlations between plasma digoxin level and left ventricular ejection fraction (LVEF) as well as fractional shortening (LVFS). Methods A cross-sectional study was conducted on 20 pediatric heart failure patients at the Department of Child Health, Dr. Cipto Mangunkusumo Hospital, Jakarta, from January to May 2012. Plasma digoxin levels were measured by ELISA method after one month or more of treatment; LVEF and LVFS were measured by echocardiography. Correlations between plasma digoxin level and LVEF or LVFS were analyzed by Spearman’s correlation test. The LVEF before and after digoxin treatment were compared by paired T-test. Results Thirteen out of 20 patients had plasma digoxin levels within therapeutic range (0.5-1.5 ng/mL; 95%CI 0.599 to 0.898) and 7 had sub-therapeutic levels (

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

Transcatheter closure of patent ductus arteriosus (PDA) has been suggested to be the standard treatment of PDA. Although, in general, the procedure shows a high successful rate, outcomes may vary among pediatric cardiology centers. To evaluate the effectiveness of transcatheter closure of PDA in Cipto Mangunkusumo Hospital, Jakarta, Indonesia, this was a retrospective study on patients who underwent transcatheter closure of PDA in Cipto Mangunkusumo Hospital during the period of 2002–2013. Hospital registry was reviewed and data about patients’ characteristics, PDA severity, procedure, and outcomes were retrieved. There were 298 patients, of whom 90 were males, who underwent transcatheter closure of PDA during the study period. Median age was 3.4 years (1 months–18 years), and median body weight was 12 (3.6–59) kg. The diameter of PDA ranged from 1.1 to 15.4 mm with a median of 3.7 mm. Device could be deployed in all patients, in which most were the Amplatzer ductal occluder (69.8 %) and the remainders were coils. Median fluoroscopy time was 15.4 (1.5–87) min, and procedure time was 76 (30–200) min. Complete closure was achieved in most patients (97.3 %), whereas device migration occurred in a minority (0.3 %) of patients. No major complication occurred during or after the procedure. Transient anemia and bradycardia were found in 3.7 and 1.3 % patients, respectively. Most patients were discharged from the hospital at 1 day after the procedure. Transcatheter closure method is a safe and effective procedure to close PDA.

Background Patent ductus arterious (PDA) is a non-cyanotic congenital heart disease (CHD) caused by the patency of the arterial duct after birth. For the last three decades, management of PDA with transcatheter closure has been gaining popularity, including in developing countries. However its effectiveness in terms of clinical outcomes and cost may vary among center and has not been thoroughly evaluated yet in Indonesia. Objectives To compare the cost and clinical effectiveness of PDA closure using transcatheter approach compared to surgical ligation. Methods We performed a retrospective review on patients underwent either transcatheter or surgical closure of PDA between January 2000 and December 2006 in Cipto Mangunkusumo Hospital,Jakarta, Indonesia. Clinical outcomes as well as cost were compared using the student T-test and Chi-square for numerical and categorical variables, respectively Results During the study period, 89 patients underwent transcatheter closure using an Amplatzer® device occluder (ADO) device and 67 had surgical ligation. Successful PDA closure on first attempt was achieved in 87 (96%) and 63 (94%) children who underwent transcatheter and surgical closure, respectively (P = 1.000). Two children with unsuccessful transcatheter closure eventually had their PDA closed by surgery, whereas one child with residual PDA after surgical closure had his PDA closed by coil. No residual PDA was found in the transcatheter closure group at one-week follow up. Duration of hospitalization was significantly less for patients having transcatheter closure compared to surgery [2.7 (SD 1.5) vs. 6.6 (SD 1.5) days, P< 0.0001]. The cost for PDA closure with anAmplatzer® device was more expensive than surgical ligation [Rp. 29,930,000 (SD 57,200) vs. Rp. 12,205,000 (SD 89,300), P< 0.0001]. Conclusion Transcatheter closure is equally effective as surgical ligation in closing the PDA. Less hospitalization is required with transcatheter closure although the cost is higher than surgical ligation.

Background Patent ductus arteriosus (PDA) is a common congenital heart disease causing some blood in the aorta to flow into the pulmonary artery (PA), resulting in dilatation of the left atrium (IA) and left ventricle (LY), increased B-type natriuretic peptide (BNP) level, and the development of h eart failure. Objectives To evaluate the clinical course, changes in heart size and function, and BNP level after transcatheter closure of PDA using the Amplatzer® duct occluder (ADO). Methods This quasi-experimental study used a one-group, pretestposttest design, and was done on PDA patients who underwent transcatheter closure using ADO. The outcomes measurements were performed four times, namely, before the procedure and at one, three, and six months after the procedure. Results were compared using a serial time analysis. Outcomes measured were heart failure scores, chest x-ray (CXR) and echocardiography findings, and plasma BNP level. Results There were 23 PDA patients enrolled, of which 12 were females. Subjects' median bodyweight was 11 (range 6.6 to 55) kg. Prior to PDA closure, 12 subjects had mild heart fa ilure (class II) and 7 had moderate heart failure (class III). On follow-up at one month after the procedure, all subjects had improved heart failure scores (P

Background Thalassemia is a major public health problem in Indonesia. Cardiac diseases remain as the main cause of death in these patients due to iron overload. Although the T2* magnetic resonance imaging has been considered as the gold standard for assessing cardiac iron overload but it has limited availability. The tissue doppler imaging (TDI) echocardiography, a fairly new and easy method that is suggested, can detect early abnormal myocardial iron overload. Objective To assess myocardial systolic and diastolic function of thalassemic patients using TDI and examine their correlation with serum ferritin level. Methods A cross􀁌sectional study was conducted from January to March 2011 at the Harapan Kita Women and Children Hospital. We performed clinical examination, serum ferritin level, as well as conventional and tissue doppler echocardiography on all subjects. Results We included 34 regularly􀁌tranfused patients, of which 17 were boys. The mean age of the subjects was 11.6 (SD 4.7 years, range 2.6 􀁌 20 years). Mean pulse rate and blood pressure were within normal range. Hemoglobin level at inclusion ranged from 5.8 to 6 g/dL. Almost all patients did not receive regular chelation therapy. Median serum ferritin level was 6275 ng/mL (range 2151 - 17,646 ng/mL). Conventional echocardiography showed normal systolic function, but some diastolic dysfunctions were found including E wave abnormalites in 4 patients, A wave abnormalites in 3, and E/A ratio abnormalites found in 3. The TDI showed decreased systolic function (Sa wave abnormality) in 9 patients and diastolic dysfunctions (Ea wave abnormality in 11 patients and Aa wave abnormaly in 2). No abnormality was found in Ea/Aa and ElEa ratios. There was a weak negative correlation between ferritin level and Sa wave and Ea wave respectively and a moderately negative correlation between ferritin level and Ea/ Aa ratio. There was no correlation between serum ferritin and Aa wave or ElEa ratio. Conclusion TDI identifies a greater number of patients Mth systolic and diastolic myocardial dysfunction than was revealed by conventional echocardiography. There was a weak negative correlation between serum ferritin to Sa wave and Ea wave, and a moderately negative correlation between ferritin and Ea/Aa ratio. There was no correlation between serum ferritin and Aa wave or ElEa ratio. [paediatr Indones. 2012;52:187,93].

Objective Fluid challenge is often used to predict fluid responsiveness in critically ill patients. Inappropriate fluid expansion can lead to some unwanted side effects; therefore, we need a noninvasive predictive parameter to assess fluid responsiveness. We want to assess the hemodynamic parameter changes after passive leg raising, which can mimic fluid expansion, to predict fluid responsiveness in pediatric intensive care unit patients and to get a cutoff value of cardiac index in predicting fluid responsiveness in pediatric patients. Design Nonrandomized experimental study. Setting Tertiary academic pediatric intensive care. Patients Children admitted to pediatric intensive care. Intervention Hemodynamic parameters were assessed at baseline, after passive leg raising, at second baseline, and after volume expansion (10 mL/kg normal saline infusion over 15 mins). Measurements and main results We measured the heart rate, systolic blood pressure, and stroke volume and cardiac index using Doppler echocardiography. The hemodynamic parameter changes induced by passive leg raising were monitored. Among 40 patients included in the study, 20 patients had a cardiac index increase of ≥10% after volume expansion (responders). Changes in heart rate, systolic blood pressure, and stroke volume after passive leg raising did not significantly relate to the response to volume expansion. There was significant relation between changes in cardiac index to predict fluid responsiveness (p = .012, r(2) = .22, 95% confidence interval 1.529 to 31.37). A cardiac index increase by ≥10% induced by passive leg raising predicted preload-dependent status with sensitivity of 55% and specificity of 85% (area under the curve 0.71 ± 0.084, 95% confidence interval 0.546-0.874). Conclusion The concomitant measurements in cardiac index changes after the passive leg raising maneuver can be helpful in predicting who might have an increase in cardiac index with subsequent fluid resuscitation.

Background: 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.Methods: 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 < -2SD accordingly.Results: 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.Conclusions: 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. (Med J Indones 2011; 20:40-5)Keywords: congenital heart disease, failure to thrive, short stature, undernutrition

Background Transcatheter closure using amplatzer duct occluder (ADO) is currently the treatment of choice for patent ductus arteriosus (PDA). The ADO device is constructed from a Nitinol wire mesh containing 55% nickel. Up to now, there is still a controversy about the effects of nickel contained in ADO. Objectives To determine blood nickel level at six months after transcatheter closure of PDA using ADO, toxic effects of nickel at six months after PDA closure using ADO, and the effects of nickel on complete blood count (CBC), blood glucose and renal function. Methods Subjects were patients with PDA at Integrated Cardiovascular Services, Dr. Cipto Mangunkusumo Hospital, Jakarta. Routine blood test and blood nickel levels were measured at the time of the procedure, and at the end of the first, third, and sixth months after intervention. Results There were 29 patients who underwent heart catheteri- zation and PDA closure using ADO. A time series analysis was conducted on 23 patients who completed six-month follow-up after the intervention. Median blood nickel level before procedure was 58 ng/mL while at one, three and six months afterwards were 60, 63 and 64 ng/mL respectively. The blood nickel levels did not differ significantly between pre- and post-ADO. After PDA closure, no toxic effects of nickel were found, both clinically and laboratorically. Conclusions PDA closure using ADO has no effects on the nickel levels, CBC, blood glucose and renal function

Background: Transcatheter closure of atrial septal defects (ASD) has been accepted world-wide as an alternative to surgical closure with excellent results. This interventional, non-surgical technique plays an important role in the treatment of ASD mostly in the developing world where resources are limited. Objectives: To report the outcomes and short term follow-up of transcatheter closure of ASD over a 12-year period at our institution with limited resources. Patients and Methods: This retrospective study included all patients with the diagnosis of secundum ASD and significant shunting (Qp/Qs > 1.5:1) as well as dilated right atrium and right ventricle who had transcatheter closure at Integrated Cardiovascular Center (PJT), Dr. Cipto Mangunkusumo Hospital between October 2002 and October 2014. One hundred fifty-two patients enrolled in this study were candidates for device closure. Right and left heart cardiac catheterization was performed before the procedure. All patients underwent physical examination, ECG, chest X-ray and transthoracal echocardiography (TTE) prior to device implantation. Results: A total of 152 patients with significant ASD underwent device implantation. Subjects’ age ranged from 0.63 to 69.6 years, with median 9.36 years and mean 16.30 years. They consisted of 33 (21.7%) males and 119 (78.3%) females, with mean body weight of 29.9 kg (range 8 to 75; SD 18.2). The device was successfully implanted in 150 patients where the majority of cases received the Amplatzer septal occluder (147/150; 98%) and the others received the Heart Lifetech ASD occluder (3/150, 2%), whereas two other cases were not suitable for device closure and we decided for surgical closure. The mean ASD size was 19.75 (range 14 - 25) mm. During the procedure, 5 (4.9%) patients had bradycardia and 3 (2.9%) patients had supraventricular tachycardia (SVT), all of which resolved. Conclusions: In our center with limited facilities and manpower, transcatheter closure of atrial septal defect was effective and safe as an alternative treatment to surgery. The outcome and short-term follow-up revealed excellent results, but long-term follow-up is needed.