Page 123 - Abstract Book KONIKA 18

Cardiology

P-CAR-013
Medical Management in Acute Phase of Rheumatic Heart Disease: A Case Series

Yulia Evita Sari Sembiring, Astra Parahita, Anindita Soetadji
Department of Pediatrics, Faculty of Medicine Universitas Diponegoro/Dr. Kariadi General Hospital, Semarang,
Central Java, Indonesia
Abstract
Background Rheumatic heart disease (RHD) contribute to the cardiovascular morbidity and mortality in
developing countries. Proper management in acute phase may prevent valve damage and lead to better
prognosis. Objective To describe the outcome of medical management in acute phase toward progression
of valvular damage of patients with RHD. Cases Fourteen patients were diagnosed Rheumatic Fever
according to modified Jones criteria consist of 10 males and 4 females. Patient’s age was 9-17 years 1
month old. Nutritional status showed 12 patients were well-nourished and 2 patients were overweight. Major
signs were carditis found in all patients and polyarthritis in 3 patients. Minor signs were fever (7 cases),
arthralgia (5 cases). Blood examination showed leukocytosis, elevated ESR and CRP in 5 cases. Major valve
abnormalities with varied severity were mitral regurgitation (MR) 13/14 (93%) cases, aortic regurgitation
(AR) 5/14 (36%), tricuspid regurgitation (TR) 8/14 (57%) and 2/14 (14%) pulmonary regurgitation (PR).
Patients were treated with prednisone or aspirin as anti-inflammatory according to the severity of carditis.
To eradicate Streptococcus infection, 7/14 (50%) cases were given benzathine penicillin injection, while
others had erythromycin orally because of having penicillin allergy. Heart failure due to carditis and valvular
regurgitation was treated with heart failure therapy. After 6 months evaluation, 4 from 8 patients with severe
MR, 1 from 2 patients with severe AR, and 1 from 2 patient with severe TR improve to moderate while all
patients with mild PR resolved. Conclusion Valvular insufficiency were improved in 50% patients after 6
months therapy among patients with acute phase of RHD.
Keywords: rheumatic heart disease; carditis; mitral regurgitation; aortic regurgitation; heart failure

P-CAR-014
Hypoplastic Left Heart Syndrome: A Rare Case Report in Indonesia

1
Elcha Leonard , Sony Sutrisno 2
Department of Medicine and Department of Radiology , Faculty of Medicine,
2
1
Universitas Krida Wacana Christian, Jakarta, Indonesia
Abstract
Background Hypoplastic left heart syndrome (HLHS) is one of the congenital heart diseases (CHD) that has
morphologic variability and accounts for 7-9% of all infants born with CHD. HLHS refers to the abnormal
development of the left-sided cardiac structures, resulting in obstruction to blood flow from the left ventricular
outflow tract. Objective To demonstrate a rare case of HLHS in Indonesia. Case A 4 days old neonate born
in 37 weeks of gestation was admitted to the hospital, presented with shortness of breath, pale, and cyanotic.
There were signs of heavy work breathing showed by nasal flaring, intercostal and subcostal retraction. We
also found central cyanosis and pallor with cold peripheral pulses as well as cutis marmorata especially in the
periphery area of the body. Auscultation revealed loud S2. Additionally, thorax roentgen showed cardiomegaly
and the elevation of pulmonary vascularisation. Further detail echocardiography demonstrated hypoplastic left
ventricle, aorta and mitral valve atresia, patent ductus arteriosus with predominantly left to right shunt along
with large secundum ASD noted with the borderline ventricle function. During hospitalization, mechanical
ventilatory support, fluid resuscitation and vasoactive drugs were given. Patient died on the fifth day of life
due to cardiogenic shock. Conclusion HLHS is one of the most fatal CHD if left untreated. Despite the low
incidence rate, HLHS should still be accounted as one of the approaches to the diagnosis of CHD and thus
needed to be treated effectively in order to optimize patient’s recovery.
Keywords: hypoplastic left heart syndrome; congenital heart disease

KONIKA XVIII Abstract Book 75