bluuebunny/crossref_metadata_2025_split huggingface dataset:
C28. Chronic Limb Threatening Ischemia in Patient With Aortoiliac Occlusive Disease (Leriche Syndrome) and Pulmonary Hypertension
Authors: Permana E , Suwirya A P , Sutanegara B A 
Published: April 2022

Abstract

Background
Chronic limb-threatening ischemia (CLTI) is a manifestation of peripheral arterial disease (PAD) which is characterized by stenosis or occlusion of peripheral arteries causing impaired perfusion to the extremities, especially during rest and chronic progresses, which are associated with decreased quality of life and increased morbidity and mortality.

Case Description
A 51-year-old man complained of wound on both legs and pain during light activity. Risk factor is smoking for 30 years. History of primary pulmonary hypertension since 30 years. Physical examination revealed decreased pulsation from femoral artery to dorsalis pedis arteries in both leg. Echocardiography with RA and RV dilatation, D-shaped LV during systolic, mild TR and normal LV systolic function. Dupplex ultrasound and MSCT scan pulmonary-abdominal angiography shows thrombus in the abdominal aorta causing occlusion of blood flow distally. There is a comorbid pulmonary hypertension which causes right heart failure with symptoms of dyspnea. This patient is at high risk of undergoing revascularization surgery, so that in severe comorbid conditions an extraanatomical bypass with axillobifemoral bypass graft is considered.

Discussion
Atherosclerosis that occurs in the abdominal aorta, iliac artery, and femoropopliteal artery is called aortoiliac occlusive disease (AIOD). This condition when symptomatic is known as Leriche syndrome with a triad of symptoms of claudication, impotence, and reduced or no palpable pulsation of the femoral artery. Medical management include antiplatelet, statin, analgetic, and therapy according to risk factors. The main purpose is revascularization by surgery or endovascular which aims to improve blood flow to the distal artery.
C31. Closure of patent ductus arteriosus using intravenous paracetamol : a case series
Authors: Nursalim S , Setyawan D , Limbong M , Ahmad F 
Published: April 2022

Abstract

Background
Although patency of ductal arteriosus is essential for fetal circulation, postnatal ductal closure is critical for postnatal circulation adaptation in order to avoid pulmonary overcirculation with diminished circulation blood flow. Standard medical treatment for patent ductal arteriosus (PDA) consists of pharmacotheraphy and or surgical intervention.

Case Summary
We present 17 cases of PDA confirmed by echocardiography and was observed for ductal closure after 3 days of intravenous paracetamol intervention (10-15 mg/kg) given every 8 hours. The echocardiography evaluation of PDA status was conducted after those pharmacological intervention and divided based on the gestational age group. In the preterm groups (&lt;36 weeks), 3 cases remained open, 3 cases were closed, and 1 case with reduced flow. In the aterm groups (36-42 weeks), 5 out of 8 cases were closed, while the other 3 showed reduced flow. In the postterm groups (&gt;42 weeks), 1 case was closed and 1 case with reduced flow. Successful rate for PDA closure of each groups were 43%, 62,5% and 50%.

Discussion
Indomethacin and ibuprofen are standard treaments for PDA closure. However, they have some side effects such as acute renal failure and gastrointestinal complications. From this case series, paracetamol has a promising effect similar to indomethacin and ibuprofen in conducting PDA closure with less side effects. Paracetamol inhibits prostaglandin synthetase activity eventhough its precise mechanism of action remains controversial.
C34. Concomitant Finding of Hemorrhagic Cardiac Tamponade and Venous Thromboembolism as the First Manifestation of Occult Malignancy – A Case Report
Authors: Sitorus Sondang Jasmine , Alsagaff Mochamad Yusuf , Kusumastuti Etty 
Published: April 2022

Abstract

Background
Venous thromboembolism (VTE) encompasses pulmonary embolism (PE), and deep vein thrombosis (DVT) is a common complication of cancer. Cancer manifestation in cardiac often secondary from the metastatic process, mostly in the pericardium. These concomitant findings of PE, DVT, and hemorrhagic cardiac tamponade as the first signs of cancer in a young patient is rare.

Case Summary
A 39-years-old man was referred to the emergency department from secondary hospital with the main complaint of dyspnea that onset abruptly two days before admission and swollen of the entire right leg since one week before. We report concomitant finding of hemorrhagic cardiac tamponade, deep vein thrombosis, and acute pulmonary embolism as initial presentations of occult malignancy. Starting anticoagulant in the hemorrhagic state and finding the primary cancer were problematic and challenging.

Discussion
The challenge in management, posed by hemorrhagic versus thrombosis state in cancer, prompted us to cautiously deliver the treatment with consideration of benefit over the risk. Primary cancer is not always easy to identify. Comprehensive (re-)evaluation is mandatory.
C39. Ductus Arteriosus Stenting: A Promising and Life Saving Procedure for Ductal-Dependent Pulmonary Blood Flow
Authors: Permitasari D A , Priyatno A , Ayukusuma A R , Andini A R , Christina M , Susilawati M 
Published: April 2022

Abstract

Background
Duct-dependant congenital heart disease in newborn presents as a life-threatening emergency and the survival depends on patency of the ductus arteriosus. Stent implantation into ductus arteriosus has been proposed as non-surgical management for critical congenital heart disease with duct-dependent.

Case Summary
We present full-term newborn babies who had critical congenital heart disease with ductal-dependent pulmonary blood blow and successfully managed with ductal stenting. Patient A, a 13-days-old male had Tetralogy of Fallot-Pulmonary Atresia and restrictive Ventricular Septal Defect (VSD). Patient B, a 3-days-old male had Pulmonary Atresia-Intact Ventricular Septum (PA-IVS) with Patent Foramen Ovale (PFO). Patient C, a 5-days-old female had Tricuspid Atresia with restrictive VSD and multiple congenital anomaly. Patient D, a 2-days-old female had PA-IVS with PFO stretch. Prostaglandin-E1 infusion was started at first and stop 6 hours prior to the procedure. Ductus arteriosus stenting using drug-eluting stent and femoral artery approach was successful in all 4 patients. All patient had improvement of oxygen saturation and good post-procedure outcome.

Discussion
Ductal stenting in patient with duct-dependent pulmonary circulation appears to be an alternative to surgery. It provides a bridging palliation in cyanotic congenital heart disease until the time of definitive surgery. Stenting of ductus arteriosus is feasible and safe with good result, thus early recognition and timely management are important to save the life.
C42. Eisenmenger Syndrome, Could Its Pathophysiological Changes Serve as Protective Factors Against Severe COVID-19 Infection?
Authors: Gunawan R Y , Medishita H 
Published: April 2022

Abstract

Background
Congenital heart disease (CHD) and pulmonary artery hypertension (PAH) are comorbidities to severe COVID-19 infection. We reported a case of adult congenital heart disease (ACHD) with Eisenmenger Syndrome (ES) who survived COVID-19 without progression to severe infection.

Case Description
A 39 years old male with history of uncorrected ACHD complained of low-grade fever and cough for 3 days. Initial oxygen saturation was 85%, no tachypnoea, no tachycardia, and blood pressure was normal. SARS-CoV2 RT-PCR results was positive. Thorax CT showed lung fibrosis, minimal GGO, and prominent pulmonary notch. Notable laboratory result was haemoglobin: 20.4g/dL. Echocardiography showed a large secundum ASD with bidirectional shunt, dilated RA and RV, normal ventricular systolic functions, mild TR with increased tricuspid gradient (TR V max 4.27m/s) which concluded the diagnosis of ES. The patient was treated according to moderate COVID-19 guidelines and ES management. His response to treatment was favourable and was discharged in 3 weeks uneventfully.

Discussion
Studies have documented CHD and PAH as comorbid to severe COVID-19 infection, but our patient had moderate COVID-19 infection and recovered without progression to severe disease. We proposed several pathophysiological characteristics of ES which could serve as protective factors against severe COVID-19, which are: 1) Pre-existing PAH, where pulmonary vasculopathy and remodelling lessened endothelial response to inflammation, and reduced expression of ACE2 receptors, 2) Chronic hypoxia, which prepared cells and tissues against hypoxic environment, and 3) Polycythaemia, might be beneficial in haemoglobinopathy directly caused by SARS-CoV2.
C44. Electrocardiogram might failed identify acute coronary occlusion: When every minute counts
Authors: Habibi F N , Mangkoesoebroto A P , Pradityawati A , Ardhianto P 
Published: April 2022

Abstract

Backgrounds
Prompt diagnosis of acute coronary occlusion based on electrocardiogram (ECG) are essential to decide proper treatment. However, particular ECG such as Wellens syndrome have been higlighted without obvious ST-segmen elevation which is signifies critical stenosis or occlusion of the proximal left anterior descending (LAD) artery but unfortunately is often unrecognized by physicians.

Case Illustration
A 51-year old male patient referred from district hospital diagnosed as five day onset STEMI with recurrent chest pain. The first ECG in there emergency room was a deep inverted T wave in anterior and lateral lead that immediate intervention approach not choosen. The typical infarct evolution in anteroseptal lead appear one day after the onset. Troponin level was significantly increased. Urgent angiography was performed in our hospital, unfortunately it resulted critical stenosis in proximal LAD with triple vessels and left main coronary artery disease. Then we consider send to surgery due to high coronary complexity (Syntax score:62) and optimize antianginal agent.

Discussion
In current practice, ST-segment elevation at the J-point, ≥ 1 mm in ≥ 2 adjacent leads (other than leads V2 and V3, where elevation of ≥ 2 mm in men or ≥ 1.5 mm in women is considered significant) for STEMI diagnosis. However, these general ECG criteria fail to identify the STEMI equivalents. Wellens syndrome is one of them that suggesting severe stenosis of the proximal LAD artery, which will develop into an acute anterior wall MI within a few days to weeks in 75% of untreated patients.
C50. Obstructive hypertrophic cardiomyopathy in young adult man: a case report
Authors: Sinaga A , Ardini T W , Lubis A C , Hasan H 
Published: April 2022

Abstract

Background
Hypertrophic obstructive cardiomyopathy (obstructive HCM) is an autosomal dominant congenital disease characterized by obstruction of the left ventricular outflow tract with asymmetric septal hypertrophy. Obstructive HCM is predispose to the appearance of malignant ventricular arrhythmias, leading to syncope or sudden death.

Case Description
A 25-years-old male patient came to the hospital with chief complaint intolerance activity and previous syncope, without history of sudden cardiac death in his family member. ECG showed sinus rhytm with left axis deviation and left ventricular hypertrophy. Chest x ray showed cardiomegaly. The echocardiography showed asymmetric septal hypertrophy (septal/posterior wall thickness ratio 1.31), left atrium dilatation (LAVi 94.2 mL/m2), SAM and mild mitral regurgitation, mild aortic regurgitation, hyperdynamic ejection fraction (79%) with lower longitudinal strain values in basal and mid ventricular septal segment, grade I diastolic dysfunction, resting LVOT gradient 19.53 mmHg , provoked LVOT gradient 47.31 mmHg.

Discussion
Non-invasive treatment was given due to LVOT gradient below 50 mmHg. The patient prescribed diltiazem 100mg once daily and recommended clinical evaluation follow-up every year or any worsening of symptoms. The other family member suggested for familial screening echocardiography.
C51. Impending Rupture in Acute Type A Aortic Dissection : Case Report
Authors: Santoso Anita Surya , Sargowo Djanggan , Kurnianingsih Novi 
Published: April 2022

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.
C56. Isolated Right Ventricular Non-Compaction Cardiomyopathy (IRVNC) in Adolescence: A Case Report
Authors: Fernandes R , Lukito A A , Chandra S , Hutabarat H 
Published: April 2022

Abstract

Background
Non-compaction ventricular myocardium (NCVM) is a rare genetic cause of cardiomyopathy which mostly affects the left ventricle. A limited case of IRVNC was reported which render a limited knowledge for clinician.

Case Summary
A 16-y.o male presented to our emergency unit with recurrent syncope, chest discomfort, palpitation which exaggerated by strenuous exercise. There was no familial history of sudden death. On admission, BP of 102/64 mmHg and bradycardia of 49 bpm were remarkable. Electrocardiography revealed sinus arrhythmia, 49 bpm with early repolarization on precordial leads and LVH. Laboratory tests were in normal limits. Echocardiography revealed hyper-trabeculated RV with no LV-dysfunction. CMR was performed and showed normal LV dimension and function. Right atrium and RV were dilated with RV-dysfunction. RV trabeculae were indicative for IRVNC (NC/C ratio of 4.3). Holter ECG monitoring was done and remarkable for sinus arrhythmia without sinus pause nor ventricular arrhythmia.
Anticoagulant was given for embolic prevention in the non-compacted area. ACEi, β-blockers, and diuretic were not given due to hypotension, bradycardia and no signs of congestion. The patient showed clinical improvement and discharged after 5 days of hospitalization.

Discussions
Recently, there has been no specific criteria and cut off for IRNVC. Earlier studies mentioned that ILVNC criteria could be used for diagnosing IRNVC, as we used in our case. In the future, it’s necessary to determine new cut off points dedicated for IRVNC. Furthermore, close follow-up is needed as complications such as arrhythmia, embolic events and heart failure might occurred.
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: April 2022

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.
C65. Pace and Ablate as an Alternative Approach for Rate Control Strategy in Patient with Atrial Fibrillation
Authors: Hazzy Fandy , Rizal Ardian 
Published: April 2022

Abstract

Background
AF patient with refractory to optimal medical therapy for rate or rhythm control, atrioventricular (AV) nodal ablation with permanent pacemaker (PPM) implantation is an effective strategy for symptomatic relief. Maintenance of controlled ventricular rate helps to avoid frequent exacerbations of CHF and tachycardia-mediated cardiomyopathy, and is also associated with improved quality of life.

Case Summary
Female 66-year-old suffered from Heart Failure exacerbations caused by paroxysmal AF with rapid ventricular response (RVR) with underlying hypertensive cardiovascular disease. Rhythm control strategy with drip Amiodarone induce sinus bradycardia with unstable hemodynamic, when drugs was stopped then AF RVR reappeared, we tried to rate control strategy with Digoxin but, she experienced same condition as before. She underwent a pragmatical technique AV nodal ablation with cardiac pacing for rate control and she had drastic improvement of symptoms within the next 24 h. Complete AV block was achieved after application of 2 radiofrequency energies over the anatomic AV node. A permanent pacemaker (PPM) was programmed to VVIR at the rate of 70 bpm.

Discussion
Conventional medical therapies, including beta-blockers, non-dihydropyridine calcium channel blockers, digoxin, and anti-arrhythmic drugs, may fail to control the ventricular rate. Atrioventricular junction ablation and pacing (AVJAP) can be applied for patients whom medication is inadequate or associated with side effects (Recommendation IIA). According to our case, AVJAP is possible but an attractive choice for some elderly patients who are not compliant with treatment or associated with dangerous side effect for patients.
C69. Percutaneous Balloon Pulmonary Valvuloplasty for Critical Pulmonary Stenosis Baby as A Challenging Management in Resource-Limited Hospital: A Case Report
Authors: Sitio M , Santoso A S , Iskandar  , Widasmara S , Koentartiwi D , Yogibuana V , Martini H 
Published: April 2022

Abstract

Background
Severe or critical right ventricular outflow tract obstructions are life-threatening conditions. Percutaneous balloon pulmonary valvuloplasty is the preferred therapy for pulmonary valve stenosis.

Case Summary
A-50-day-old cyanotic baby girl, weighing 4.4 kg, was admitted to hospital with a bluish appearance insidiously progressing over the preceding 2 weeks. Transthoracic echocardiogram (TTE) revealed critical pulmonary valvular stenosis with pulmonary valve annulus diameter 7 mm, severe tricuspid regurgitation (TR), restrictive intraatrial mixing physiology, and an almost spontaneously closed Patent Ductus Arteriosus. The patient underwent percutaneous balloon pulmonary valvuloplasty (BPV). The available balloon, Tyshak mini balloon 9.0 mm x 20 mm, failed to across stenotic lession. It was replaced with coronary balloon 2 mm x 10 mm and inflated several times with a maximum pressure of 10 mmHg within 10 seconds. After the valve was adequately opened, the coronary balloon was replaced by previous Tyshak mini balloon. It was inflated once with pressure of 3 mmHg for 5 seconds. Successful dilatation is indicated by the disappearance of the waist around the balloon under cineangiography. RV-PA gradient decreased from 67 mmHg to 38 mmHg, a 43% reduction. After the procedure, the patient was no longer cyanotic. TTE after BPV demonstrated no pulmonary stenosis, TR TVG decreased from 100 mmHg to 20 mmHg, and no pulmonary regurgitation.

Discussion
Our successful results suggest that percutaneous balloon pulmonary valvuloplasty is a potential and safe intervention for babies with critical Pulmonal Stenosis that was conducted in resource-limited hospital.
C74. Post covid-19 cardiomyopathy in an adolescent patient: a case report
Authors: Pujowaskito P , Tartila T S , Tafriend N A , Jannah F D K 
Published: April 2022

Abstract

Background
Myocardial injury caused by viral myocarditis may occur during COVID-19 infections. This condition may lead to cardiomyopathy as the chronic sequela. We report a case of an adolescent COVID-19 survivor without underlying heart disease presented with dilated cardiomyopathy.

Case Summary
A 16-year-old male patient was referred to Cardiology Outpatient Clinic, Indonesian Army Central Hospital Gatot Soebroto. The patient presented with a chief complaint of fatigue and just recovered from mild to moderate COVID-19 one month before the visit. There was no prior history of heart disease. Physical examination was within normal limit, but laboratory findings showed highly elevated NT-proBNP (7705 pg/mL) and D-dimer (1850 ng/mL). ECG revealed normal sinus rhythm with poor R wave progression. Echocardiography detected all chamber dilatation, eccentric left ventricular hypertrophy, global hypokinetic, moderate mitral regurgitation, and reduced ejection fraction (22%). The patient was diagnosed with new-onset dilated cardiomyopathy as a COVID-19 sequela and we initiated treatment with ARB (candesartan), beta-blocker (bisoprolol), diuretics (furosemide and spironolactone), rivaroxaban, and trimetazidine. During a follow-up visit three months later, the patient’s recovery was stable.

Discussion
The occurrence of new-onset cardiomyopathy in our previously healthy young patient highlights the possible mechanism of COVID-19 as a single cause of myocardial injury without underlying heart disease. Comprehensive evaluation and optimal treatment should be taken during hospitalization and post-discharge period to prevent further complications. Additional examinations such as cardiac magnetic resonance and endomyocardial biopsy should be done to provide definitive confirmation.