DOI: https://doi.org/10.14710/jai.v12i2.24657

Manajemen Perioperatif Operasi Arterial Switch pada Transposition of The Great Arteries with Intact Ventricular Septum

SMF Anestesiologi dan Terapi Pascabedah, Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, Jakarta, Indonesia

Published: 1 Jul 2020.
Open Access Copyright 2020 JAI (Jurnal Anestesiologi Indonesia)

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Abstract

Latar belakang: Penyakit jantung bawaan (PJB) berkontribusi terhadap hampir sepertiga dari kelainan kongenital secara keseluruhan. Transposition of the great arteries (d-TGA) adalah satu kelainan jantung bawaan (PJB) yang kompleks. Tindakan arterial switch operation (ASO) menjadi pilihan koreksi pada kasus TGA. Tindakan ini mempunyai risiko morbiditas dan mortalitas yang cukup tinggi.

Kasus: Bayi berusia 42 hari dengan berat badan 3100 gram dirujuk ke Rumah Sakit Jantung dan Pembuluh Darah (RSJPD) Harapan Kita karena kelainan jantung. Pasien dilakukan diagnosik ekokardiografi dan didapatkan TGA dengan septum ventrikular yang intak (TGA-IVS), atrium septal defect (ASD) sekundum L-R shunt, dan patent ductus arteriosus (PDA). Prosedur pembedahan meliputi ASO menggunakan manuver Le Compte, pemotongan PDA, ASD ditutup sebagian dan disisakan 3mm. Durasi cardiopulmonary bypass (CPB) 136 menit dengan cross clamp 85 menit, diberikan tranfusi PRC, FFP, dan TC, lalu dipindahkan ke intensive care unit (ICU) dengan support adrenalin 0.05 mcg/kg/menit dan milrinone 0.375 mcg/kg/menit. Ekstubasi dilakukan 72 jam pascaoperasi.

Pembahasan: Operasi arterial switch merupakan tindakan berisiko tinggi, dengan angka kematian dan morbiditas yang tinggi. Konsiderasi perianestesia pada pasien TGA ini di antaranya tatalaksana preanestesi, manajemen selama operasi, topangan hemodinamik, aritmia yang diakibatkan masalah pembuluh darah koroner, dan penilaian ekokardiografi epikardial pascaoperasi. Manajemen pascaoperasi penting untuk mengantisipasi efek dari CPB yang berpengaruh pada miokardium, sindroma curah jantung rendah, risiko infeksi, dan komplikasi lain yang sering terjadi pada infant setelah pembedahan ini.

Kesimpulan: Manajemen preoperatif dengan mengenali faktor risiko, tatalaksana anestesia intraoperatif, myocardial protection, serta perawatan komprehensif pascaoperasi di ICU sangat menentukan outcomepasien yang menjalani prosedur ini.

 

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Keywords: arterial switch operation; cardiopulmonary bypass; d-TGA; penyakit jantung bawaan; tatalaksana anestesi

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Section: Case Reports
Language : ID
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