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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)

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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.

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Keywords: anestesi kardiovaskular; bedah jantung; cone procedure; ebstein’s anomaly; penyakit jantung bawaan

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