Manajemen Anestesi pada Pasien Atrial Septal Defect dan Hipertensi Pulmonal yang Menjalani Prosedur Seksio Sesarea
Abstract
Penyakit jantung merupakan penyebab yang berperan penting dalam morbiditas dan mortalitas selama masa kehamilan, proses persalinan, dan pasca persalinan. Salah satunya adalah atrial septal defect yang dapat menyebabkan beberapa komplikasi yang lebih serius seperti hipertensi pulmonal. Penyakit jantung dalam kehamilan yang tidak terkontrol dapat meningkatkan risiko terjadinya perburukan kondisi pada maternal. Perempuan, 38 tahun, G4P3003Ab000 hamil 37-38 minggu dengan atrial septal defect sekundum besar L to R shunt 63%, hipertensi pulmonal, bekas seksio sesarea, dan risiko tinggi dari segi usia lebih dari 35 tahun. Pada pemeriksaan fisik terdapat tekanan darah sebesar 103/48 mmHg, SpO2 97% dengan room air, dan murmur. Pada pemeriksaan ekokardiografi didapatkan atrial septal defect secundum besar Left-Right Shunt (63%), Hipertensi pulmonal,regurgitasi mitral ringan, regurgitasi pulmonal ringan, regurgitasi trikuspid ringan dengan kemungkinan hipertensi pulmonal tinggi. Pasien mendapatkan terapi berupa revatiol, ranitidin, metokloperamid, dan paracetamol. Pasien dilakukan prosedur seksio sesarea dengan teknik anestesi combine spinal epidural dengan menggunakan bupivakain 0,5% 7,5 mg dan fentanyl 25 mcg. Pasien tidak mengalami komplikasi perioperatif. Managemen anestesi yang tepat dalam kehamilan dengan atrial septal defect dan hipertensi pulmonal untuk mencegah terjadinya sindrom Eisenmenger yang dapat meningkatkan risiko perburukan kondisi pada pasien
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References
Adam M. Physiological changes and cardiovascular investigations in pregnancy. Heart Lung Circ 2021; 30(1): 6–18.
Cederlöf ET, Lundgren M, Lindahl B, Christersson C. Pregnancy complications and risk of cardiovascular disease later in life: A nationwide cohort study. J Am Heart Assoc. 2022;11(2):e023079. Doi: 10.1161/JAHA.121.023079.
Chesnut DH, A. Wong C, C Tsen L, D Ngan Kee W, Beilin Y, Mhyre J. Chesnut’s Obstetric Anesthesia Principles and Practice. 5th Ed. Philadelphia: Elsevier Saunders. 2014
Butterworth JF, Mackey DC, Wasnick JD. Morgan & Mikhail’s Clinical Anesthesiology. 7th Ed. New York : McGraw Hill. 2018.
Shagana JA, Dhanraj M, Jain AR, Nirosa T. Physiological changes in pregnancy. Drug Invention Today. 2018; 10(8): 1-5.
Rao PS. Atrial septal defect – a review. Ed P Syamasundar Rao. InTech Open. April 2022 Chapter 1. Doi: 10.5772/38886.
Herlambang, Paryanto, Malau DEF, Hatta, Hendrik DSP. Secundum atrial septal defects complicated with severe pulmonary hypertension in pregnancy: management and outcome. JMJ 2018, 6(2): 97-104. DOI: https://doi.org/10.22437/jmj.v6i2.5948
Brida M, Chessa M, Celermajer D, Li W, Geva T, Khairy P. Atrial septal defect in adulthood: a new paradigm for congenital heart disease. Eur Heart J. 2022; 43(28): 2660-671.
American College of Obstetricians and Gynecologists' Presidential Task Force on Pregnancy and Heart Disease and Committee on Practice Bulletins—Obstetrics. ACOG Practice Bulletin No. 212: Pregnancy and heart disease. Obstet Gynecol. 2019, 133 (5): 320-56.
Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, Cífková R, De Bonis M. 2018 ESC Guidelines for the management of cardiovascular diseases during pregnancy : The Task Force for the Management of Cardiovascular Diseases during Pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2018; 39(34): 3165–241. Doi: https://doi.org/10.1093/eurheartj/ehy340.
Caroline D, Yogiarto M. Atrio-ventricular septal defect in pregnant women, how to deal with it: A case study. ACI. 2018; 3(2): 100-05. Doi: https://doi.org/10.22146/aci.33576
Alemayehu TY, Berhe YW, Getnet H, Molallign M. Hemodynamic changes after spinal anesthesia in preeclamptic patients undergoing cesarean section at a tertiary referral center in Ethiopia: a prospective cohort study. Patient Saf Surg. 2020;14(1):1–9.
Wima T, Haloho ABR. Anesthesia management in caesarean section with preeclampsia and partial HELLP syndrome. J Anesth Clin Res. 2020;1(1):8–14. Doi: https://doi.org/10.37275/jacr.v1i1.133
Meng ML, Arendt KW, Banayan JM, Bradley EA, Vaught AJ, Hameed AB, et al. Anesthetic care of the pregnant patient with cardiovascular disease: A scientific statement from the American Heart Association. Circulation 2023; 147(11): 657-73. Doi: https://doi.org/10.1161/CIR.0000000000001121
Kumar B, Soni S, Jafra A. Anesthetic management of double atrial septal defect with moderate pulmonary hypertension emergency caesarean section. J Anesth Clinical Res. 2019; 10(2): 876-77. Doi: https://doi.org/10.4172/2155-6148.1000876
Bolabandi R, Akash S, Bagalkotbar N. Anesthetic management of a parturient with large atrial septal defect and mild pulmonary hypertension. Medica Innovatica, 2019; 8(1): 37-40.
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