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

*Dian Kesumarini  -  SMF Anestesiologi dan Terapi Pascabedah; Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita; Jakarta, Indonesia
Herdono Poernomo  -  SMF Anestesiologi dan Terapi Pascabedah; Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita; Jakarta, Indonesia
Published: 1 Jul 2020.
DOI: https://doi.org/10.14710/jai.v12i2.24657 View
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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

Article Metrics:

  1. Davies LK, Husain A, Weitzel NS. Anesthetic management for patient with congenital heart disease: The pediatric Population. In: Hensley, FA, Martin DE, Gravlee GP, editors. A Practical Approach to Cardiac Anesthesia. 5th Ed. Philadelphia: Lippincott Williams and Wilkins; 2013. Chapter 14; p.389-429
  2. Butts RJ, Ellis AR, Bradley SM, Hulsey TC, Atz AM. Effect of prostaglandin duration on outcomes in transposition of the great arteries with intact ventricular septum. Congenital Heart Disease. 2012 Sept 23;7(4): 387-91
  3. Gupta S, Saiyed A, Meena R, Dogra N. Anesthetic management during transposition of great arteries (TGA) correction: point to be focus. British Journal of Medicine &Medical Research. 2017; 19(8): 1-5
  4. Nield LE, Dragulescu A, MacColl C, Brun H, McCrindle BW, Kuiper B, et al. Coronary artery doppler patterns are associated with clinical outcomes post-arterial switch operation for transposition of the great arteries. European Heart Journal-Cardiovascular Imaging. 2017; 19(4): 461-68
  5. Villafane J, Hermoso RL, Bhatt AB, Tweddell JS, Geva T, Nathan M, et al. D-Transposition of the Great Arteries. The Current Era of the Arterial Switch Operation. Journal Of American College Of Cardiology. Elsevier. 2014; 64 (5):498-511
  6. Sconamiglio, G. Arterial switch operation for transposition of great arteries: late results in adult patients. International Cardiovascular Forum Journal. 2013;1: 8-15
  7. Rome J. Inpatient Pathway for Evaluation/Treatment of the Newborn with TGA. Children’s Hospital of Philadelphia. 2016; 1-3. Available from https://www.chop.edu/clinical-pathway/newborn-tga-clinical-pathway-immediate-post-operative-cicu-care-hand-or-team
  8. Sarris GE, Balmer C, Bonou P, Comas JV, Cruz ED, Chiara LD, et al. Clinical guideline for management of patients with transposition of the great arteries with intact ventricular septum. European Journal of Cardio-thoracic Surgery.2017;51:1-32
  9. Justice L, Buckley JR, Floh A, Horsley M, Alten J, Anand V, et al. Nutrition consideration in the pediatric cardiac intensive care unit patient. World Journal for Pediatric and Congenital Heart Surgery. 2018; 9(3): 333-43
  10. Gallagher JC, MacDougall C. Antibiotics Simplified. 4th ed. Philadelphia: Jones &Bartlett Inc: 2017:26-8
  11. Bronicki RA, Costello JM, Brown KL. Postoperative care of the pediatric cardiac surgical patient. In Shaffner DH, Nichols DG editors. Rogers’ Textbook of Pediatric Intensive Care. 5th ed. Philadelphia: Wolters Kluwer; 2015. Chapter 79, p. 1252-60
  12. Lu BY, Wu HD, Wang CC, Wu ET, Huang SC, Ko WJ, et al. The Impact of Postoperative Ventilator Support on Outcome of the Arterial Switch Operation-Report from a Single Institute. Acta Cardiol Sin. 2010;26:173-8
  13. Gocen U. Delayed sternal closure after arterial switch operations: a single center experience. 2017; Cukurova Med J.2017;42(3):540-5
  14. Mekkawy A, Ghoneim, El-Haddad O, & Elmishaway A. Predictors of early outcome of arterial switch operation on patient with D-TGA. Journal of the Egyptian Society of Cardio-Thoracic Surgery. 2017; 25(1), 52-7
  15. Burkhardt BEU, Rücker G, Stiller B. Prophylactic milrinone for the prevention of low cardiac output syndrome and mortality in children undergoing surgery for congenital heart disease. Cochrane Database of Systematic Reviews 2015, Issue 3. Art. No.: CD009515. DOI: 10.1002/14651858.CD009515.pub2

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Last update: 2021-02-24 11:34:41

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