skip to main content

Tatalaksana Anestesi pada Ebstein’s Anomaly yang menjalani Cone Procedure

Staf Medik Anestesi Bedah Kardiovaskular, Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, Jakarta, Indonesia

Received: 21 Feb 2023; Published: 31 Mar 2023.
Open Access Copyright 2021 JAI (Jurnal Anestesiologi Indonesia)

Citation Format:
Abstract

Latar Belakang: Ebstein’s anomaly adalah kelainan kongenital yang ditandai dengan malformasi dan perpindahan apikal dari daun katup trikuspid. Pasien datang dengan rentang umur yang luas dari neonatus hingga dewasa dengan berbagai presentasi klinis mulai dari asimtomatik hingga gagal jantung, sianosis, dan aritmia paroksismal. Anomali ini kompleks dan bervariasi yang dapat dikelola dengan berbagai teknik koreksi bedah.

Kasus: Seorang wanita berusia 30 tahun datang ke rumah sakit dengan keluhan mudah lelah dan pingsan sejak kecil. Dari pemeriksaan ekokardiografi ditemukan trikuspid regurgitasi berat yang sesuai dengan Ebstein’s anomaly dan atrial septal defect (ASD). Pasien dinilai dengan status fisik ASA 4 dan dilakukan cone procedure.

Diskusi: Konsekuensi hemodinamik dan implikasi anestesi pada koreksi Ebstein’s anomaly sangat menantang. Manajemen anestesi yang komprehensif diperlukan untuk, mengatasi masalah yang disebabkan oleh trikuspid regurgitasi, atrialisasi ventrikel kanan, atrial septal defek, gangguan jalur konduksi, dan pada sebagian pasien disfungsi ventrikel kiri akibat geometri yang abnormal.

Kesimpulan: Ahli anestesiologi harus merencanakan strategi perioperatif yang tepat untuk mendapatkan hemodinamik yang optimal selama prosedur perbaikan Ebstein’s anomaly dan memfasilitasi pemulihan untuk mengurangi morbiditas dan mortalitas.

Note: This article has supplementary file(s).

Fulltext View|Download |  common.other
CTA
Subject
Type Other
  Download (6MB)    Indexing metadata
Keywords: anestesi kardiovaskular; bedah jantung; cone procedure; ebstein’s anomaly; penyakit jantung bawaan

Article Metrics:

  1. Lee CH, Lim JH, Rae Kim E, Kim YJ. Cone Repair in Adult Patients with Ebstein Anomaly. Korean J Thorac Cardiovasc Surg. 2020;53(5):243-249. doi: 10.5090/kjtcs.20.113
  2. Vegas A. Perioperative Two Dimensional Transesophageal Echocardiography. 2nd ed. Springer; 2018. doi: 10.1007/978-3-319-60902-7
  3. Schmitz ML, Ullah S, Dasgupta R, Thompson LL. Anestesia for Right-sided Obstructive Lesion. In: Andropoulos DB, Stayer SA, Mossad EB, Miller-Hance WC, eds. Anesthesia for Congenital Heart Disease. 3rd ed. Wiley-Blackwell; 2015:516-541
  4. Nasr VG, DiNardo JA. The Pediatric Cardiac Anesthesia Handbook. Wiley-Blackwell; 2017
  5. Lai W, Mertens LL, Cohen MS, Geva T. Ebstein’s Malformation and Tricuspid Valve Diseases. In: Echocardiography in Pediatric and Congenital Heart Disease: From Fetus to Adult. 2nd ed. Wiley-Blackwell; 2015
  6. Malhotra A, Agrawal V, Patel K, et al. Ebstein’s anomaly: “the one and a half ventricle heart.” Brazilian J Cardiovasc Surg. 2018;33(4):353-361. doi: 10.21470/1678-9741-2018-0100
  7. Perrino AC, Reeves ST. A Practical Approach to Transesophageal Echocardiography. 3rd ed. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2019. doi: 10.1097/ana.0b013e31819f1d14
  8. Baum VC, De Souza DG. Congenital Heart Disease in Adults. In: Kaplan JA, Augoustides JG., Manecke Jr GR, Maus T, Reich DL, eds. Kaplan’s Cardiac Anesthesia for Cardiac and Noncardiac Surgery. 7th ed. Elsevier; 2017:818-842
  9. Jost CHA, Connolly HM, Dearani JA, Edwards WD, Danielson GK. Ebstein’s anomaly. Circulation. 2007;115(2):277-285. doi: 10.1161/CIRCULATIONAHA.106.619338
  10. Sainathan S, Da Fonseca Da Silva L, Da Silva JP. Ebstein’s anomaly: Contemporary management strategies. J Thorac Dis. 2020;12(3):1161-1173. doi: 10.21037/jtd.2020.01.18
  11. Geerdink LM, van Everdingen WM, Kuipers IM, et al. Comprehensive Evaluation of Pediatric Patients with Ebstein Anomaly Requires Both Echocardiography and Cardiac Magnetic Resonance Imaging. Pediatr Cardiol. 2022;(0123456789). doi: 10.1007/s00246-022-02948-3
  12. Kumar SR, Kung G, Noh N, et al. Single-ventricle outcomes after neonatal palliation of severe ebstein anomaly with modified starnes procedure. Circulation. 2016;134(17):1257-1264. doi: 10.1161/CIRCULATIONAHA.115.021241
  13. Holst KA, Dearani JA, Said S, et al. Improving Results of Surgery for Ebstein Anomaly: Where Are We After 235 Cone Repairs? Ann Thorac Surg. 2018;105(1):160-168. doi: 10.1016/j.athoracsur.2017.09.058
  14. Brown ML, Dearani JA. Ebstein Anomaly. In: Mavroudis C, Backer C, eds. Pediatric Cardiac Surgery. 4th ed. Wiley-Blackwell; 2013:571-587
  15. Huang SC, Wu ET, Chen SJ, et al. Surgical Strategy Toward Biventricular Repair for Severe Ebstein Anomaly in Neonates and Infancy. Ann Thorac Surg. 2017;104(3):917-925. doi: 10.1016/j.athoracsur.2017.01.081
  16. Hetzer R, Hacke P, Javier M, et al. The long-term impact of various techniques for tricuspid repair in Ebstein’s anomaly. J Thorac Cardiovasc Surg. 2015;150(5):1212-1219. doi: 10.1016/j.jtcvs.2015.08.036
  17. Carpentier A, Chauvaud S, Mace L, et al. A new reconstructive operation for Ebstein’s anomaly of the tricuspid valve. J Thorac Cardiovasc Surg. 1988;96(1):92-101. doi: 10.1016/s0022-5223(19)35302-4
  18. Dearani JA, Said SM, Burkhart HM, Pike RB, O’Leary PW, Cetta F. Strategies for tricuspid re-repair in Ebstein malformation using the cone technique. Ann Thorac Surg. 2013;96(1):202-210. doi: 10.1016/j.athoracsur.2013.02.067
  19. Ross FJ, Latham GJ, Richards M, Geiduschek J, Thompson D, Joffe D. Perioperative and anesthetic considerations in Ebstein’s anomaly. Semin Cardiothorac Vasc Anesth. 2016;20(1):82-92. doi: 10.1177/1089253215605390
  20. Eftekhari H, Osman F. Wolff-Parkinson-White syndrome, pre-excited AF and Ebstein’s anomaly: A case study. Br J Card Nurs. 2011;6(9):444-449. doi: 10.12968/bjca.2011.6.9.444

Last update:

No citation recorded.

Last update: 2024-11-20 07:13:25

No citation recorded.