The Ventricular Septal Defect (VSD) dengan Sindrom Eisenmenger pada Ibu Hamil: Serial Kasus
Abstract
Ventricular Septal Defect (VSD) adalah cacat lahir pada jantung di mana terdapat lubang di dinding (septum) yang memisahkan dua chamber bawah (ventrikel) jantung. Sindrom Eisenmenger mengacu pada cacat jantung yang terkait dengan resistensi pembuluh darah paru yang tinggi, aliran shunt reversal atau bi-directional pada pembuluh darah besar, ventrikel atau atrium, dan ditandai dengan munculnya sianosis. Kami melaporkan satu kasus wanita hamil dengan VSD disertai sindrom Eisenmenger yang akan dilakukan tindakan seksio sesarea. Kehamilan pada pasien dengan kondisi ini memerlukan perencanaan yang hati-hati dan pemantauan ketat karena risiko komplikasi yang tinggi baik bagi ibu maupun bayi. Teknik anestesi Combined Spinal Epidural (CSE) dipilih untuk prosedur seksio sesarea karena memberikan kombinasi antara onset anestesi spinal yang cepat dengan kemampuan epidural untuk pengendalian nyeri pascaoperasi yang lebih lama dan dapat diatur.Pasien dipantau di ruang Intensive Care Unit (ICU) dengan kondisi postoperatif baik.
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References
Hoffman JIE, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002; 39(12):1890-1900. Doi: 10.1016/s0735-1097(02)01886-7
Harris IS.. Management of pregnancy in patients with congenital heart disease. Prog Cardiovasc Dis. 2011;53(4):305-11. Doi: 10.1016/j.pcad.2010.08.001
Cauldwell M, Dos Santos F, Steer PJ, Swan L, Gatzoulis M, Johnson MR. Pregnancy in women with congenital heart disease. BMJ. 2018,360. Doi: 10.1136/bmj.k478
Hoffman JI, Kaplan S, Liberthson RR. Prevalence of congenital heart disease. Am Heart J. 2004; 147(3):425-39. Doi: 10.1016/j.ahj.2003.05.003
Cardiac disease in pregnancy. ACOG technical bulletin number 168–June 1992. Int J Gynaecol Obstet. 1993; 41(3):298-306.
Reller MD, Strickland MJ, Riehle-Colarusso T, Mahle WT, Correa A. Prevalence of congenital heart defects in metropolitan atlanta, 1998–2005. J Pediatr. 2008; 153(6):807–13. Doi: 10.1016/j.jpeds.2008.05.059
CDC. Congenital Heart Defects (CHDs). Centers for Disease Control and Prevention. 2022.
Yuan SM. Eisenmenger syndrome in pregnancy. Braz J Cardiovasc Surg. 2016;31(4): 325–29. Doi:10.5935/1678-9741.20160062.
Dakkak W, Oliver TI. Ventricular septal defect. [internet]. StatPearls. Tersedia pada: https://www.ncbi.nlm.nih.gov/. Diakses pada 15 Maret 2022.
Muthialu N, Balakrishnan S, Sundar R. Single patch closure of multiple VSDs through right atrial approach. Indian Heart J. 2018;70(4):578-79. Doi: 10.1016/j.ihj.2018.01.017
Durden RE, Turek JW, Reinking BE, Bansal M.. Acquired ventricular septal defect due to infective endocarditis. Ann Pediatr Cardiol, 2018;11(1):100-102. Doi: 10.4103/apc.APC_130_17
Maagaard M, Heiberg J, Eckerström F, Asschenfeldt B, Rex CE, Ringgaard S, Hjortdal VE. Biventricular morphology in adults born with a ventricular septal defect. Cardiol Young. 2018 ;28(12):1379-1385. Doi: 10.1017/S1047951118001361
Bazmi S, Malhotra S, Zaman F. A rare case of pregnancy with Eisenmenger syndrome. Int J Obstet Gynaecol Res (IJOGR). 2015;2(2):151-54.
Lopez BM, Malhamé I, Davies LK, Velez JMG, Marelli A, Rabai F. Eisenmenger syndrome in pregnancy: a management conundrum. J Cardiothorac Vasc Anesth. 2020;34(10): 2813-822.
Steer PJ. Pregnancy and contraception. Dalam: Adult congenital heart disease: a practical guide. Gatzoulis MA, Swan L, Therrien J and Pantley GA eds. Blackwell publishing. 2005, 16–35.
European Society of Gynecology (ESG), Association for European Paediatric Cardiology (AEPC); German Society for Gender Medicine (DGesGM), Regitz-Zagrosek V, Blomstrom Lundqvist C, et al. ESC guidelines on the management of cardiovascular diseases during pregnancy: the Task Force on the management of cardiovascular diseases during pregnancy of the European Society of Cardiology (ESC). Eur Heart J. 2011; 32(24): 3147–197. Doi: 10.1093/eurheartj/ehr218
Robertson JE, Silversides CK, Mah ML, Kulikowski J, Maxwell C, Wald RM, et al. A contemporary approach to the obstetric management of women with heart disease. J Obstet Gynaecol Can 2012; 34(9): 812–19. Doi: 10.1016/S1701-2163(16)35378-6
Goldberg JF. Long-term follow-up of "simple" lesions--atrial septal defect, ventricular septal defect, and coarctation of the aorta. Congenit Heart Dis. 2015;10(5):466–74. Doi: 10.1111/chd.12298
Tamhane P, O’Sullivan G, Reynolds F. Oxytocin in parturients with cardiac disease. Int J Obstet Anesth 2006; 15(4): 332–33. Doi: 10.1016/j.ijoa.04.006
Arvanitaki A, Gatzoulis M A, Opotowsky AR, Khairy P, Dimopoulos K, Diller GP et al. Eisenmenger syndrome: JACC state-of-the-art review. J Am Coll Cardiol. 2022;79(12), 1183–198. Doi: 10.1016/j.jacc.2022.01.022
Yuan SM. Eisenmenger syndrome in Pregnancy. Brazilian Journal of Cardiovascular Surgery. 2016; 31(4): 325–29. Doi:10.5935/1678-9741.20160062.
Boukhris M, Hakim K, M’saad H, Ouarda F, Boussaada R. Successful pregnancy and delivery in a woman with a single ventricle and Eisenmenger syndrome. J Saudi Heart Assoc. 2013;25(4):261–64. Doi: 10.1016/j.jsha.2013.05.001
Cole PJ, Cross MH, Dresner M. Incremental spinal anaesthesia for elective Caesarean section in a patient with Eisenmenger’s syndrome. Br J Anaesth. 2001;86(5):723–6. Doi: 10.1093/bja/86.5.723
Siddiqui S, Latif N. PGE1 nebulisation during caesarean section for Eisenmenger’s syndrome: a case report. J Med Case Rep. 2008;2:149.
Mahli A, Coskun D. Anesthesia for pregnant patients with eisenmenger syndrome. obstetric anesthesia for co-morbid conditions. 2018,219–25.
Mishra L, Pani N, Samantaray R, Nayak K. Eisenmenger’s syndrome in pregnancy: use of epidural anesthesia and analgesia for elective Cesarean section. J Anaesthesiol Clin Pharmacol. 2014;30(3):425–26. Doi: 10.4103/0970-9185.137286
Mok T, Woods A, Small A, Tandel M, Kwan L, Lluri G, et al. Timing of delivery and associated outcomes in pregnancies complicated by maternal congenital heart disease. Am J Obstet Gynecol. 2021.
Katsurahgi S, Kamiya C, Yamanaka K, Neki R, Miyoshi T, Iwanaga N, et al. Maternal and fetal outcomes in pregnancy complicated with Eisenmenger syndrome. Taiwan J Obstet Gynecol. 2019;58(2), 183–87. Doi: 10.1016/j.tjog.2019.01.002
Liu Y, Li Y, Zhang J, Zhao Y, Liu K, Li J, et al. Pregnancy outcomes of women with Eisenmenger syndrome: A single-center study. Int J Cardiol. 2023; 374, 35–41. Doi: 10.1016/j.ijcard.2022.12.014
Arvanitaki A, Gatzoulis MA, Opotowsky AR, Khairy P, Dimopoulos K, Diller GP, et al. Eisenmenger syndrome: JACC state-of-the-art review. J Am Coll Cardiol. 2022;79(12):1183–198.
De Backer J, Regitz-Zagrosek V, Roos-Hesselink JW, Bauersachs J, Blomström-Lundqvist C, et al. 2025 ESC Guidelines for the management of cardiovascular disease and pregnancy: Developed by the task force on the management of cardiovascular disease and pregnancy of the European Society of Cardiology (ESC), endorsed by the European Society of Gynecology (ESG). Eur Heart J. 2025;46(43):4462–4568.
Liu Y, Li Y, Zhang J, Zhao Y, Liu K, Li J, et al. Pregnancy outcomes of women with Eisenmenger syndrome: A single-center study. Int J Cardiol. 2023;374:35–41.
Banerjee R, Opotowsky AR. Update on Eisenmenger syndrome: Review of pathophysiology and recent progress in risk assessment and management. Int J Cardiol Congenit Heart Dis. 2024;17:100520.
Arvanitaki A, Dimopoulos K, Opotowsky AR, Diller GP, Gatzoulis MA. Eisenmenger syndrome: diagnosis, prognosis and clinical management. Heart. 2020;106(21):1638–1645.
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