bluuebunny/crossref_metadata_2025_split huggingface dataset:
C43. Eisenmenger Syndrome The Challenge of Untreated Large Ventricular Septal Defect in Pregnant Women: A Case report
Authors: Kalista Yuliet , Djoen Herdianto , Rheza Giovanni 
Published: March 2023

Abstract

Background
Eisenmenger syndrome is a constellation of symptoms that arise from an uncorrected large congenital heart disease that have a reversed shunt to right to left. Eisenmenger syndrome in pregnancy is rare because pregnancy in this patient is not recommendeed due to high mortality for mother and baby. The objective of this case report is to highlight the argument of Eisenmenger syndrome in pregnancy.

Case Summary
A 38-years pregnant woman presented to the emergency room with dyspnea since the third trimester. Reported history of the untreated ventricular septal defect. Central cyanosis, systolic murmur and lower extremity oedema were found. ECG showed a right axis deviation with right ventricular hypertrophy. Cardiomegaly was found from a chest x-ray. Left ventricular diastolic dysfunction, large ventricular septal defect with Right-Left shunt, and pulmonary hypertension were found from echocardiography. Based on characteristic appearance, a diagnosis of Eisenmenger syndrome was made. Caesarean delivery was performed and the baby delivered safely, but the mother passed away.

Discussion
Eisenmenger syndrome in pregnancy comes with high mortality to mother and baby. A ventricular septal defect is a common cause of Eisenmenger syndrome. The choice for medical treatment from Eisenmenger syndrome in pregnancy is still controversial. Both caesarean section and vaginal delivery could be harmful to the patient due to vulnerability to hemodynamic change.
C45. Exercise-Induced Ventricular Tachycardia in Normal Coronary Artery Patient with Incidental Finding of COVID-19 : a case report
Authors: Taim A I , Saleh K , Muzakkir  
Published: March 2023

Abstract

Background
Exercised-induced ventricular tachycardia is associated with pre-existing ischemia or structural heart disease. However, exercise-induced ventricular tachycardia in asymptomatic patient without evident of coronary artery disease or structural heart disease needs further investigation.

Case Description
A 53-year-old woman with suspected coronary artery disease underwent an Exercise Stress Test. During recovery phase, the patient developed monomorphic ventricular tachycardia accompanied by drowsiness, which lasted eight minutes before resolving. The patient was tested positive on COVID-19 screening, a mandatory testing before hospital admission. Subsequent evaluation with transthoracic echocardiography and coronary angiography revealed absence of coronary artery stenosis and significant structural heart disease. Twenty-four hours Holter monitoring results were low-grade premature ventricular contractions.

Discussion
Exercise-induced ventricular tachycardia in normal coronary artery patient may be associated with an increased risk of sudden cardiac death, thus required careful examinations and establishment of underlying pathology. COVID-19 was reported to be associated with and might trigger episodes of ventricular tachycardia through sympathetic hyperactivity or re-entry in myocarditis. This case is noteworthy due to the absence of typical cause of exercise-induced ventricular tachycardia and the possible relation with COVID-19 infection. However electrocardiogram monitoring should be taken periodically to observe recurrences and to determine prognosis.
C47. Heparin Induced Thrombocytopenia (HIT) Associated with Multiple Deep Vein Thrombosis (DVT) and Intracardiac Thrombus Who Underwent Vena Cava Filter Prior to Surgical Thrombus Evacuation : a Case Report
Authors: Sihotang I M , Ryanti D , Haykal T B , Habib F , Ardini T W , Ketaren A P , Hasan H 
Published: March 2023

Abstract

Background
Heparin-induced thrombocytopenia (HIT) is a serious adverse drug reaction that increases patient’s risk of developing venous or arterial thromboembolism, which maybe life-threatening. The frequency varies from 0.5% to 5%, depending on population studies. This condition will worsen especially in patients with deep vein thrombosis.

Case
A 52 years old woman was reported swelling and decreased saturation of the lower extremities, with a history of Heparin therapy for 5 days before being referred to Haji Adam Malik Hospital Medan. Platelet count on admission day was 225.000/µl but dropped into 64.000/µl in the 7th post heparin treatment day. Doppler examination showed multiple thrombosis in deep femoral vein and and sign of stenosis peripheral artery. Echocardiography showed intracardiac thrombus without sign of acute pulmonary embolism. Two days after discontinuation of heparin, the platelet still tend to be low but in the next days, its count increases to within normal range. Due to the high risk of embolism, it was decided to place a vena cava filter prior to surgery for thrombus evacuation.

Discussion
This case demonstrates several interesting aspects of HIT, including thrombotic complication, limitation tools to support diagnosis of HIT, how to prepare this patient into surgical management, and the last is placing a IVCF prior to surgical thrombus evacuation and thrombectomy to reduce the risk of thromboemboli before surgical treatment. This is the first time procedure in Medan for placing a vena cava filter in a DVT patients who have contraindication to heparin administration.
C49. Hybrid Procedure in A Patient with Multiple Aortic Dissections and Marfan Syndrome: A Case Report
Authors: Taofan T , Gill R S D , Wartono D A , Adiarto S 
Published: March 2023

Abstract

Background
Aortic dissection is a tear in the inner layer of the aortic wall, which allows blood to enter into the wall of the aorta, creating a new passage for blood, known as the false lumen. The indications for surgical approach in aortic dissections Stanford A and DeBakey I and II are widely recognised and accepted, but little is known that in certain cases of Stanford A, DeBakey type I or type II aortic dissection patients who meet the eligibility criteria, endovascular repair can be performed.

Case Illustration
A 36-year-old woman came with a chief complaint of acute stabbed pain, she was known to have Concomitant DeBakey type II and IIIb aortic dissection, severe aortic regurgitation, and Marfan Syndrome. Because of her condition, we decided to conduct an open surgical repair with Bentall Procedure that was planned to be followed by an elective thoracic endovascular aortic repair (TEVAR). The Bentall procedure was a success and the patient’s clinical condition improved each day.

Conclusion
In concomitant DeBakey type II and IIIb aortic dissection cases, especially in those who have an underlying condition such as Marfan Syndrome, the Bentall procedure is the treatment of choice. In conditions when surgical procedure cannot be done, a hybrid approach of open surgery and TEVAR may provide a valuable alternative for patients.
C51. Impending Rupture in Acute Type A Aortic Dissection : Case Report
Authors: Santoso Anita Surya , Sargowo Djanggan , Kurnianingsih Novi 
Published: March 2023

Abstract

Background
Acute aortic dissection is a life threatening condition that remains a challenge to diagnose and treat. 67% patients was presented with Acute type A aortic dissection (ATAAD) and often accompanied with some complications.

Case Summary
A 40-year-old male with risk factor hypertension was presented with sudden sharp tearing-like chest pain and radiating to the back 3 hours before admission. He had transient decrease of consciousness and waken up spontaneously. He was compos mentis, with normal JVP, normal heart sound, no pulsus deficit, hypotension, cold acral and oliguria. He got fluid rehydration and the BP was stabilized. Haemoglobin was normal with increase D-Dimer. The ECG was normal and chest radiography revealed cardiomegaly and widening mediastinum. From eyeballing echocardiogram showed moderate pericardial effusion without right atrial and right ventricle collapse. A CT scan angiography was performed and revealed an Aortic Dissection Stanford A Debakey I.

Discussion
The development of an evidence-based strategy to rule out aortic dissection in patients presenting chest pain would be useful to diagnose patients with chest pain. Rapid diagnosis of dissection is most likely when CT is a part of the diagnostic testing. Hypotension and shock occurred in &gt; 25% of patients with type ATAAD and in this patient was associated transient loss of consciousness. This patient was in impending rupture condition. The definitive treatment for this patient was emergency aortic repair surgery. We was succeded to stabilize the patient then referred to a cardiothoracic surgeon in 24 hours later.
C52. Infected Femoral Artery Pseudoaneurysm with Klebsiella pneumoniae Bacteremia in Injected Drug Abuser: A Case Report
Authors: Khairunnisa H , Mardhiyah I , Mahavira A , Pasaribu F Z 
Published: March 2023

Abstract

Background
Injected drug abuse is a significant problem in modern societies today, with increases various vascular complications due to repeated punctures under septic conditions. One of the severe vascular complications is infected pseudoaneurysm. However, no study reported the involvement of Klebsiella pneumonia in infected pseudoaneurysm.

Case Summary
A 40-year-old homeless man, an injected drug abuser, presented to the emergency department with a severe pain lump in the right groin area since three weeks ago. The hemodynamic was unstable and the laboratory examination revealed severe infection. While ultrasonography was suggesting high suspicion of lymphadenitis in the right groin area, the Doppler ultrasonography was showing a pseudoaneurysm in the right common femoral artery. The blood cultures grew Klebsiella pneumonia ESBL. Patient was planned to be referred to vascular surgery center. Unfortunately, before patient got a referral, his condition worsened with a fall of hemoglobin suggesting rupture of pseudoaneurysm that didn’t improve with resuscitation.

Discussion
A tender swollen groin in an injected drug abuser should prompt a high index of suspicion for the presence of pseudoaneurysm. When faced with uncertain diagnosis, further investigation with appropriate imaging is warranted. In this case, diagnosis of infected pseudoaneurysm was confirmed due to the co-incidence of septic condition. Surgical management with controlled infection and resuscitation was required, however, it remained a challenge due to the unstable condition and pseudoaneurysm itself that was prone to rupture. In addition, Klebsiella pneumonia ESBL made bacteria resistant to cephalosporins and monobactams.
C63. Myocardial bridging on coronary angiography: an innocent bystander or a culprit in myocardial infarction?
Authors: Reeiner M , Aryadana W , Sutanegara B A P D , Artha I M J R 
Published: March 2023

Abstract
Myocardial bridging is one of the nonatherosclerotic causes of coronary artery disease and is characterized by muscles overlying the intramyocardial course of a major epicardial coronary artery segment, leading to systolic compression. This condition is usually benign but can be associated with unstable angina, myocardial infarction, and death. We report herein a myocardial infarction associated with a subtotal systolic narrowing of the LAD by a myocardial bridge. A 57-year-old-man with chronic heart failure caused by myocardial bridging post-non-ST elevation myocardial infarction and hypertensive heart disease. The electrocardiography showed sinus rhythm, echocardiography shows normal left and right ventricular function, regional wall motion abnormality, grade I diastolic dysfunction and “milking effect” was observed in the mid-segment of the left anterior descending coronary artery on the coronary angiogram. Schwarz type C is categorized in this case, β-blockers and calcium channel blockers remain the mainstay of treatment and relieve hemodynamic disorders caused by myocardial bridging by decreasing heart rate, increasing the period of diastolic coronary filling, and decreasing coronary artery contractility and compression. Other diagnostic modalities needed if symptoms persist despite optimal medical therapy and myotomy, coronary artery bypass graft, or stent implantation can be considered in these patients. At the six-month follow-up visit, the patient had no acute coronary syndrome event, but chest pain and heart failure were felt occasionally.
C66. Paraaortic abscess complicating an Aerococcus Viridans Endocarditis: A Case Report
Authors: Farissa I P , Goma M S , Permitasari D A , Nugroho M A 
Published: March 2023

Abstract

Background
Infective Endocarditis (IE) associated with high mortality and complication despite improvement in its management. Paravalvular abscess known as feared complication of IE because its association with increased mortality. We describe a case of man with paravalvular abscess complicating IE undergone Aortic Valve Replacement.

Case Summary
A 42 years old man presented with exertional dyspneu since 2 weeks prior to admission, exaggerated with mild activities, accompanied with nausea, vomiting, swollen legs, and subfebrile for weeks. He was conscious and moderately ill with pressure 100/50 mmHg, regular pulse of 70, respiratory rate 25 times/minute, temperature was 37˚C, oxygen saturation was 94% on room air with end diastolic murmur grade II/4 in right upper sternal border. The laboratory result was leucocytosis (12.900/cu mm). The echocardiography revealed calcified in RCC and NCC aortic valve, RCC prolapse, severe aortic insufficiency, hyperechoic in paravalvular area. MSCT Cardiac revealed fistula originating from aortic root to a sac led to left ventricle. Sensitivity cultured revealed Aerococcus viridans. We gave antibiotics for 3 weeks before he undergone Aortic Valve Replacement. 1 month follow up, he had no more symptoms, and the prosthetic valve was normal.

Discussion
The diagnostic of IE remains challenging. It may present as an acute, rapidly progressive infection, but also as a subacute or chronic disease. Its complications need to be monitored vigilantly because it worsens the outcome. Antibiotics use for microbial eradication contributed by removing infected material surgically, might improve successful treatment for IE.
C76. Primary Cardiac Tumors : Benign or Malignant ? The Importance of Clinicopathologic Confirmation : a case series
Authors: Andryan D P , Lestiadi I D , Siswanto B B 
Published: March 2023

Abstract

Background
Cardiac tumor is a rare condition of space-occupying lesion mass in cardiac chamber. The incidence of clinically diagnosed Primary Cardiac Tumors is approximately 1,380/100 million individuals. Majority of cases are benign, with nearly half of them are cardiac myxoma. Although early clinical symptom of benign and malignant cardiac tumor are similar, the management and prognosis are much different.

Objective
To present serial cases of benign and malignant primary cardiac tumor.

Case Description
Mrs. RH, a 60-year-old woman referred to heart failure clinic National Cardiovascular Center Harapan Kita with chief complaint of short of breath on exercise. Echocardiography confirmed a huge mass obstructed her left atrium. She was hospitalized urgently with giant Left Atrial Myxoma with normal coronary artery, then underwent surgery of LA myxoma extirpation, Mitral Valve repair and Tricuspid Valve repair. Histopathological analysis confirmed of LA myxoma.
Mr. RBM, a 42-years-old man came to emergency unit at National Cardiovascular Center Harapan Kita with chief complaint shortness of breath and palpitation in about 1 month. A history of a cardiac tumor extirpation and mitral valve replacement was done in Penang Adventist hospital 10 months before. Transthoracal and transesophageal echocardiography found solid mass obstructing mechanical valve. Histopathology analysis showed undifferentiated cardiac sarcoma and against LA myxoma.

Discussion
Clinical course and management of cardiac tumor depends on early detection and histopathologic analysis. Although surgery is the cornerstone for cardiac tumor management, but confirmation of histopathologic findings is important.
C78. Prosthetic valve thrombosis in uncontrolled internormalized ratio ended up with disaster on prosthetic valve surgary : a barrier of anticoagulant management in rural area
Authors: Hustiar M , Nadia  , Heriansyah T , Purnawarman A 
Published: March 2023

Abstract

Background
Mechanical prosthetic valve thrombosis (PVT) is a life-threatening complication that requires immediate intervention. With current prosthetic devices and aggressive prophylactic anticoagulation, the incidence of PVT remains low. It needs monitoring of international normalized ratio (INR), which is somewhat difficult to do in rural areas such as West Aceh due to geography. This report details the case of a woman with PVT who developed heart failure after a period of suboptimal anticoagulation.

Case Summary
We described a 51-year-old woman who had undergone coronary artery bypass graft and mitral valve replacement procedure in 2017. Her physical examination showed the decrease of the prosthetic click sound and lung congestion. From her blood examination, the INR was subtherapeutic. A thrombus was detected on the prosthetic mitral valve by transoesophageal echocardiography. She had history of uncontrolled INR because the patient do not routinely checked her blood to control the optimal dose of anticoagulant. The patient underwent reoperation for mechanical valve thrombosis but unfortunately in the end the patient died at the procedure.

Discussion
In patients undergoing mechanical heart valve replacement, time in therapeutic range of targeted INR should be ≥ 70 % otherwise it will increase in risk of thromboembolic events. However, in developing countries which have remote areas, repeated examination of the use of warfarin in obtaining the INR target is still a major challenge. Conversely, serious risks can occur if this is not achieved and might be ended up with disaster toward the patient.
C86. Secondary Prophylaxis For Rheumatic Heart Disease During The Pandemic Era: A Case Report
Authors: Ramadhan G F , Supriadi E 
Published: March 2023

Abstract

Background
Rheumatic heart disease (RHD) is heart diseases results from recurrent episodes of acute rheumatic fever (ARF). It often occurs in developing countries and its pathogenesis is not clearly understood. RHD can be controlled with prophylaxis that requires patients to visit healthcare facility regularly. However, the current pandemic condition is a challenge for patients to receive routine treatment and evaluation.

Case Summary
A 17-years-old girl comes to emergency room with complaints of shortness of breath with mark limitation of physical activity 3 days prior to admission. The patient also complaint with joint pain and leg swelling. She was diagnosed Rheumatic Heart Disease and received prophylactic penicillin injections every month. However, since the pandemic, She do vice versa. In physical examination was found pansystolic murmur on aortic valve and bilateral lower extremity edema. Echocardiography showed moderate mitral regurgitation and mild aortic regurgitation. This patient was hospitalized and treated with benzathine penicillin G, prednisone, aspirin, furosemide and captopril.

Discussion
Management of ARF includes eradication cause of infection, treat complications, and secondary prevention. Administration of secondary prophylaxis is useful for reduce new bacterial strains that can cause recurrent acute or chronic attacks. First line of secondary prophylaxis for ARF is intramuscular benzathine penicillin G that given per month. In this current pandemic conditions, patients are expected to continue prophylaxis therapy and follow up the disease with using pandemic health protocols.
C89. Simultaneous Aortic Stenosis (AS) and Pulmonary Stenosis (PS) in A Middle-Aged Man: A Rare Case Report
Authors: Eliza B Suhuyanly , Sumantra I G 
Published: March 2023

Abstract

Background
Combined valvular lesions is very rare. Only 16 cases of combined valvular stenosis of the aortic and pulmonary valves have been reported. Failure to recognize and adequately correct both lesions may be catastrophic for the patient.

Case Illustration
A 38-year-old male came to the outpatient department with shortness of breath, fatigue, and swollen ankles. He had a short posture, broad forehead, bitemporal narrowing, broad nasal tip, long philtrum, wide mouth, and large earlobes. Cardiac examination revealed systolic murmurs over the pulmonary valve and at the aortic valve radiating to the apex (galliverdin phenomenon), rales in both lungs, and bilateral ankle edema. Electrocardiogram revealed sinus rhythm, extreme axis, RA enlargement, RBBB, and bifascicular block. Chest radiograph showed cardiomegaly, pulmonary edema, and left pleural effusion. Echocardiography demonstrated a dilated LA and concentric LVH with good LV function, HF/HG severe AS, a bicuspid aortic valve causing moderate aortic regurgitation, mild mitral regurgitation, mild tricuspid regurgitation, and severe valvular or supravalvular PS with RV hypertrophy. The patient was administered diuretics, a beta blocker, and an anti-platelet.

Discussion
Most patients with combined aortic and pulmonary obstruction at sub-valvular level have hypertrophic cardiomyopathy. Cases with both aortic and pulmonary valve stenoses are exceedingly rare. The age of presentation ranges from neonate to 55 years. It is more common in males. Most patients present with murmur since birth, dyspnea, and fatigue. Our patient is suspected to have Williams syndrome based on the physical appearance and cardiac examination findings.
C90. Successful Procedure of Ductus Arteriosus Stenting: Promising Choice for Pulmonary Atresia Survival
Authors: Andini R , Permitasari D A , Priyatno A 
Published: March 2023

Abstract

Background
Duct-dependant circulation in a baby presents as a life threatening emergency. Maintain the duct patency is crucial for patient survival before they have an cardiac surgery. We describe a case of a baby with pulmonary atresia who underwent succesful procedure of patent ductus arteriosus (PDA) stenting.

Case Summary
a female baby was born in peripheral hospital with birth weight of 3 kg by normal delivery, noticed to have cyanosis sixteen hours after birth. At our centre, the baby look cyanosed. Saturation by pulse oximetry was 84%. In physical examination appears, a continuous murmur was heard below clavicle at linea parasternal. Echocardiography confirmed the diagnosis of pulmonary atresia. Faint flow of PDA observed with duct size less than 1 mm. Prostaglandin E1 Infusion was start immediately at the rate of 1 µg/Kg/min. Within 6 hours of infusion the baby had an episode of apnoea. The baby then taken up for ductal stenting to keep the duct patent for few months before staged cardiac surgery.

Discussion
Pulmonary atresia is an critical case of congenital heart disease. The systemic or pulmonary circulation are mantained through flow in patent ductus arteriosus. Before cardiac surgical repair these patient can survive only if duct patency is reliably maintained. PDA stenting has been shown to be as an acceptable and less invasive approach to maintain ductal patency.