DOI: https://doi.org/10.14710/jai.v0i0.52497

Manajemen Anestesi Perioperatif Pasien Kardiomiopati Hipertrofi Obstruksi

SMF Anestesi dan Perawatan Intensif Pasca Bedah, Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita, Jakarta, Indonesia

Received: 15 Feb 2023; Published: 31 Mar 2023.

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Abstract

Latar Belakang: Kardiomiopati hipertrofi (HCM) adalah kondisi dominan autosomal. Penyebab penting kematian mendadak orang dewasa muda. Meskipun sering tanpa gejala, gejala yang muncul pada kardiomiopati hipertrofi adalah  gagal jantung seperti sesak napas, nyeri dada pada aktivitas, sinkop atau pra-sinkop, aritmia, dan kematian mendadak. Tanda-tanda yang bisa ditemukan seperti hipotensi, denyut nadi rendah, heave ventrikel kiri, murmur sistolik ejeksi, dan murmur regurgitasi mitral. Pasien dengan kondisi ini menjadi tantangan untuk ahli anestesi dalam operasi elektif dan gawat darurat.

Kasus: Pasien wanita 29 tahun, dengan diagnosa kardiomiopati hipertrofi obstruksi dan vegetasi yang akan dilakukan tindakan miektomi saluran keluar ventrikel kanan (RVOT), saluran keluar ventrikel kiri (LVOT), dan evakuasi vegetasi. Selama operasi hemodinamik dipertahankan untuk menjaga denyut jantung antara 60-90 denyut per menit, tekanan darah rata-rata 60-70 mmHg. End tidal carbon dioxide (EtCO2) dipertahankan antara 35-40 mmHg dan central venous pressure (CVP) dijaga tetap tinggi pada periode sebelum dan sesudah bypass. Periode weaning hingga pasca bypass, hemodinamik dipertahankan dengan milrinon (0,375 mcg/kgBB/menit) dan dilakukan pemasangan temporary pacemaker (TPM) karena didapatkan irama atrioventricular (AV) block. Pasien dilakukan miektomi septum, release LVOT, reseksi double chamber right ventricular (DCRV), dan evakuasi vegetasi. Pascaoperasi pasien dirawat di intensive care unit (ICU). Selama perawatan di ICU permasalahan yang dihadapi yaitu aritmia maligna.

Pembahasan: Teknik anestesi dan manajemen perioperatif pasien ini harus bertujuan untuk menjaga stabilitas hemodinamik, mempertahankan preload dan afterload yang memadai. Menghindari vasodilator dan menghindari agen yang meningkatkan kontraktilitas sangat penting dalam pengelolaan pasien ini. Tujuan intraoperatif termasuk mempertahankan irama sinus, meminimalkan rangsangan stres dan meminimalkan atau mencegah obstruksi saluran keluar ventrikel kiri.

Kesimpulan: Kardiomiopati hipertrofi menimbulkan banyak tantangan unik mengenai pelaksanaan anestesi. Preload yang memadai, kontrol stimulasi simpatik, denyut jantung dan peningkatan afterload diperlukan untuk mengurangi obstruksi saluran keluar ventrikel kiri.

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Perioperative Anesthesia Management of a Patient with Hypertrophic Obstructive Cardiomyopathy
Subject Perioperatif;Pasien;Kardiomiopati;Hipertrofi;Obstruksi;Laporan Kasus
Type Other
  Download (1MB)    Indexing metadata
Keywords: anestesi perioperatif; kardiomiopati hipertrofik obstruksi; miektomi; obstruksi saluran keluar ventrikel kiri; transesophageal echocardiography

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Section: Case Reports
Language : ID
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  1. Davies MR, Cousins J. Cardiomyopathy and anaesthesia. Contin Educ Anaesthesia, Crit Care Pain. 2009;9(6):189–93
  2. Poliac LC, Barron ME, Maron BJ. Hypertrophic cardiomyopathy. Anesthesiology [Internet]. 2006 Jan [cited 2022 Sep 3];104(1):183–92. Available from: https://pubmed.ncbi.nlm.nih.gov/16394705/
  3. Lipshultz SE, Law YM, Asante-Korang A, Austin ED, Dipchand AI, Everitt MD, et al. Cardiomyopathy in Children: Classification and Diagnosis: A Scientific Statement From the American Heart Association. Vol. 140, Circulation. 2019. 9–68 p
  4. Maron BJ. Hypertrophic cardiomyopathy: a systematic review. JAMA. 2002 Mar;287(10):1308–20
  5. Maron BJ. Hypertrophic cardiomyopathy: an important global disease. Am J Med. 2004 Jan;116(1):63–5
  6. Maron BJ. The 2006 American Heart Association classification of cardiomyopathies is the gold standard. Circ Heart Fail. 2008;1(1):72–6
  7. Varma PK, Raman SP, Neema PK. Hypertrophic cardiomyopathy part II - Anesthetic and surgical considerations. Ann Card Anaesth. 2014;17(3):211–21
  8. Gajewski M, Hillel Z. Anesthesia management of patients with hypertrophic obstructive cardiomyopathy. Prog Cardiovasc Dis. 2012;54(6):503–11
  9. Gallagher JD. Perianesthetic management of hypertrophic cardiomyopathy. Vol. 105, Anesthesiology. United States; 2006. p. 631; author reply 632
  10. Rehfeldt KH. Anesthesia for Cardiac Surgery, 3rd Edition. Anesthesiology [Internet]. 2008 Nov 1;109(5):938–9. Available from: https://doi.org/10.1097/ALN.0b013e3181895dbb
  11. Habib G, Bucciarelli-Ducci C, Caforio ALP, Cardim N, Charron P, Cosyns B, et al. Multimodality Imaging in Restrictive Cardiomyopathies: An EACVI expert consensus document In collaboration with the “Working Group on myocardial and pericardial diseases” of the European Society of Cardiology Endorsed by The Indian Academy of Echocardiog. Eur Hear journal Cardiovasc Imaging. 2017 Oct;18(10):1090–121
  12. Cardim N, Galderisi M, Edvardsen T, Plein S, Popescu BA, D’Andrea A, et al. Role of multimodality cardiac imaging in the management of patients with hypertrophic cardiomyopathy: an expert consensus of the European Association of Cardiovascular Imaging Endorsed by the Saudi Heart Association. Eur Hear journal Cardiovasc Imaging. 2015 Mar;16(3):280
  13. Haugaa KH, Basso C, Badano LP, Bucciarelli-Ducci C, Cardim N, Gaemperli O, et al. Comprehensive multi-modality imaging approach in arrhythmogenic cardiomyopathy-an expert consensus document of the European Association of Cardiovascular Imaging. Eur Hear journal Cardiovasc Imaging. 2017 Mar;18(3):237–53
  14. Smiseth OA, Torp H, Opdahl A, Haugaa KH, Urheim S. Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J. 2016 Apr;37(15):1196–207
  15. Windram JD, Dragelescu A, Benson L, Forsey J, Shariat M, Yoo S-J, et al. Myocardial Dimensions in Children With Hypertrophic Cardiomyopathy: A Comparison Between Echocardiography and Cardiac Magnetic Resonance Imaging. Can J Cardiol. 2016 Dec;32(12):1507–12
  16. Buechel EV, Kaiser T, Jackson C, Schmitz A, Kellenberger CJ. Normal right- and left ventricular volumes and myocardial mass in children measured by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson Off J Soc Cardiovasc Magn Reson. 2009 Jun;11(1):19
  17. Ryan TD, Madueme PC, Jefferies JL, Michelfelder EC, Towbin JA, Woo JG, et al. Utility of Echocardiography in the Assessment of Left Ventricular Diastolic Function and Restrictive Physiology in Children and Young Adults with Restrictive Cardiomyopathy: A Comparative Echocardiography-Catheterization Study. Pediatr Cardiol. 2017 Feb;38(2):381–9
  18. M A, BJ M, JM G, WH J, JP S, AR P-A, et al. Glycogen storage diseases presenting as hypertrophic cardiomyopathy. N Engl J Med [Internet]. 2005 Jul 1 [cited 2022 Sep 3];352(4):631–6. Available from: https://pubmed.ncbi.nlm.nih.gov/15673802/
  19. Gallagher JD. Perianesthetic management of hypertrophic cardiomyopathy. Vol. 105, Anesthesiology. United States; 2006. p. 631; author reply 632
  20. Sahoo RK, Dash SK, Raut PS, Badole UR, Upasani CB. Perioperative anesthetic management of patients with hypertrophic cardiomyopathy for noncardiac surgery: A case series. Ann Card Anaesth. 2010;13(3):253–6

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