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Perioperatif Transposition of The Great Arteries

*Dian Kesumarini  -  Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, Indonesia

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Abstract

ABSTRACT

Transposition of The Great Arteries (TGA) is one of the most complicated congenital heart defects. In TGA, there is atrioventricular discordance, where pulmonary artery rises from left ventricle (LV) and aorta rises from right ventricle (RV). This discordance causes changes in blood circulation, where oxygenized blood flows to the pulmonary circulation and deoxygenized blood flows to the systemic circulation.

TGA comprises of several types, each needs different approach and corrective surgery. Mainly, TGA is divided into two, congenitally-corrected TGA (cc-TGA) and dextro-TGA (d-TGA) which is further divided into two, TGA with intact ventricular septum (TGA-IVS) and TGA with ventricular septal defect (TGA-VSD). In cc-TGA, double switch procedure is needed. In d-TGA, arterial switch operation (ASO) is a procedure of choice. In TGA-IVS, the level of mixing is an important factor that needs to be maintained, while in TGA-VSD, pulmonary hypertension and heart failure happen more frequently. Anesthesia management is one of the most important factors to ensure the smoothness of corrective surgeries.

ABSTRAK

Transposition of the Great Arteries (TGA) merupakan salah satu kelainan jantung kongenital yang kompleks. Pada TGA, terjadi pertukaran sistem arterioventrikular di mana arteri pulmonalis keluar dari ventrikel kiri (LV) dan aorta keluar dari ventrikel kanan (RV). Pertukaran ini menyebabkan perubahan dalam sirkulasi darah, di mana darah yang teroksigenasi mengalir ke paru-paru dan darah yang tidak teroksigenasi mengalir ke sirkulasi sistemik.

TGA memiliki beberapa variasi yang memerlukan perhatian dan tindakan operatif yang berbeda. Secara garis besar, TGA dibagi menjadi congenitally-corrected TGA (cc-TGA) dan dextro-TGA (d-TGA) yang dibagi lagi menjadi dua, yaitu TGA dengan septum interventrikular intak (TGA-IVS) dan TGA dengan defek septum ventrikel (TGA-VSD). Pada cc-TGA, diperlukan tindakan double swtich. Pada d-TGA, Arterial Switch Operation (ASO) menjadi prosedur pilihan. Pada TGA-IVS, tingkat mixing menjadi faktor penting yang perlu dijaga. Sementara itu, pada TGA-VSD, hipertensi pulmonal dan gagal jantung lebih sering terjadi. Manajemen anestesi merupakan salah satu hal penting untuk memastikan kelancaran prosedur koreksi.

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Keywords: anestesia; ASO; kongenital; perioperatif; TGA

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