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All Journal Medical Journal of Indonesia Indonesian Journal of Cardiology Cermin Dunia Kedokteran
Doni Firman
Department Of Cardiology And Vascular Medicine, Faculty Of Medicine, University Of Indonesia National Cardiovascular Center Harapan Kita, Jakarta
Health Professions Medicine & Pharmacology Public Health

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Percutaneous transluminal septal myocardial ablation (PTSMA) of hypertrophic cardiomyopathy: Indonesian initial experience Yuniadi, Yoga; Koencoro, Ario S.; Hanafy, Dicky A.; Firman, Doni; Soesanto, Amiliana M.; Seggewiss, Hubert
Medical Journal of Indonesia Vol 19, No 3 (2010): August
Publisher : Faculty of Medicine Universitas Indonesia

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (2802.372 KB) | DOI: 10.13181/mji.v19i3.401

Abstract

Aim Percutaneous transluminal septal myocardial ablation (PTSMA), a non-surgical intervention to treat hypertrophic cardiomyopathy (HCM), has been a standard treatment in developed countries. However, this procedure not yet systematically performed in Indonesia. This case series aim to study feasibility, safety and efficacy of PTSMA in National Cardiovascular Center Harapan Kita, Jakarta.Methods Three HCM patients (2 male) with dynamic left ventricle outflow tract (LVOT) pressure gradient of higher than 30 mmHg underwent PTSMA. Left ventricle apex pressure was measured using multipurpose catheter and aortic pressure was measured by means of left coronary guiding catheter simultaneously. Target vessel is confirmed by myocardial echocardiography contrast. Two ml absolute alcohol delivered to the target vessel by means over the wire balloon. Immediate pressure gradient changed 10 minute after alcohol administration was recorded. Continuous ECG monitoring is attemted along the procedure.Results All subject demonstrated more than 50% LVOT pressure gradient reduction. One subject experienced transient total AV block and right bundle branch block which completely recovered 6 hours after procedure. In one patient, target vessel must be changed as it gives perfusion to extensive area of right ventricle.Conclusion PTSMA guided with myocardial echocardiography contrast is feasible, safe and effective to reduce LVOT pressure gradient in HCM patient. (Med J Indones 2009;19:164-71)Key words: percutaneous transluminal septal ablation, Indonesia
Pengalaman Awal Tindakan MitraClip di Pusat Jantung Nasional Harapan Kita, Jakarta Almazini, Prima; Hersunarti, Nani; Soerarso, Rarsari; Budi Siswanto, Bambang; Firman, Doni; M Soesanto, Amiliana
Cermin Dunia Kedokteran Vol 43, No 3 (2016): Kardiologi
Publisher : PT. Kalbe Farma Tbk.

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (594.129 KB) | DOI: 10.55175/cdk.v43i3.27

Abstract

Latar Belakang: MitraClip merupakan pilihan terapi untuk pasien regurgitasi katup mitral berat yang berisiko tinggi untuk operasi. Tujuan penelitian ini adalah melaporkan tindakan MitraClip di Pusat Jantung Nasional Harapan Kita Jakarta. Metode: Penelitian retrospektif di Pusat Jantung Nasional Harapan Kita, Jakarta. Data diperoleh dari database komputer dan rekam medis dari Februari 2014 sampai Januari 2015, kemudian dianalisis dengan SPSS. Hasil: Enam orang pasien berusia 51 – 75 tahun, menjalani tindakan MitraClip; 5 pasien regurgitasi katup mitral berat dan 1 pasien regurgitasi katup sedang. Satu pasien perempuan dan 5 pasien laki-laki. Dua pasien merupakan regurgitasi mitral degeneratif dan 4 pasien regurgitasi mitral fungsional. Dua pasien dipasangi satu buah MitraClip dan 4 pasien dipasangi dua buah MitraClip. Setelah tindakan, derajat regurgitasi berkurang menjadi ringan pada 2 pasien dan menjadi sedang pada 4 pasien. Dimensi diastolik akhirventrikel kiri berkurang dari 66 ± 6,5 mm saat awal menjadi 59 ± 7,3 mm (p=0,04) saat pulang. Dimensi sistolik akhir ventrikel kiri berkurang dari 50 ± 10,6 mm saat awal menjadi 48 ± 10,0 mm saat pulang (p=0,27). Satu bulan setelah tindakan MitraClip, 2 pasien dengan kelas fungsional I dan 4 pasien dengan kelas fungsional II. Tidak ada pasien yang meninggal dalam perawatan di rumah sakit. Satu pasien perawatan ulang di rumah sakit karena gagal jantung. Simpulan: MitraClip merupakan pilihan terapi yang efektif dan aman untuk pasien regurgitasi mitral degeneratif dan fungsional yang risiko tinggi untuk operasi. Dimensi ventrikel kiri, kelas fungsional NYHA, derajat keparahan regurgitasi katup, dan tingkat perawatan ulang mengalami perbaikan setelah dipasang MitraClip.
Perbandingan antara Intervensi Koroner Perkutan dengan Bedah Pintas Koroner pada Unprotected Left Main Coronary Artery Disease di Pusat Jantung Nasional Harapan Kita Jajang Sinardja; Yoga Yuniadi; Doni Firman
Jurnal Kardiologi Indonesia Vol. 32, No. 2 April - Juni 2011
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v32i2.105

Abstract

Background. Despite many studies had been done comparing the outcome of Percutaneous Coronary Intervention (PCI) versus Coronary Artery By-pass Grafting (CABG) in Unprotected Left Main Coronary Artery Disease (ULMCAD), there is none such study in Indonesia.Aim. To compare the outcome of PCI versus CABG in ULMCAD patients at National Cardiovascular Centre Harapan Kita (NCCHK) Jakarta.Methods. A retrospective cohort study was done including 137 ULMCAD NCCHK patients who underwent PCI (n = 67) or CABG (n = 70) from July 2008 until March 2010. One-year Major Adverse Cardio Cerebrovascular Event (MACCE) outcome as defined by death, myocardial infarction (MI), stroke, and target vessel revascularization (TVR), were evaluated using Chi-square analysis, while Kaplan-Meier and Cox regression analysis were used to examine the survival curve of the mentioned intervention.Results. One-year risk of composite MACCE (death, stroke, and TVR) (hazard ratio (HR): 1.267; 95% confidence interval (CI): 0.567 – 2.829, p = 0.564), and the risk of death (HR: 1.080; 95% CI: 0.405 – 2.878, p = 0.878) were not significantly different for patients undergoing PCI versus CABG. Proportion of stroke was significantly higher in the CABG group (8.6% vs 0.0%; p = 0.014), while proportion of TVR was significantly higher in the PCI group (13.4% vs 0.0%; p = 0.001). No MI event was documented in both groups. Conclusion. During one-year follow up, PCI showed similar rate of composite MACCE and death, but higher TVR as compared to CABG in ULMCAD patients. Meanwhile CABG showed higher stroke rate as compare to PCI.
Hubungan Waktu Pemberian Ebtifibatide dengan TIMI Flow Infarct Related Artery pada Intervensi Koroner Perkutan Primer Abdul Hakim Alkatiri; Yoga Yuniadi; Dicky A Hanafy; Doni Firman; Sunarya Soerianata
Jurnal Kardiologi Indonesia Vol. 32, No. 1 Januari - Maret 2011
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v32i1.118

Abstract

Background. Optimal administration timing of Glicoprotein IIb/IIIa inhibitor in STEMI patients undergoing Primary PCI is controversial. Several stud -ies have shown that early administration of eptifibatide, which is given to patients with pain awitan of < 90 minutes will improved TIMI grade flow of infarct related coronary artery (IRA). However, significant numbers of patient arrived in emergency room/PCI center with pain awitan of > 3 hours. This study was aimed to evaluated effect of eptifibatide administra-tion timing to TIMI grading flow in first angiographic IRA during primary PCI in patients with STEMI.Methods and result. Of 116 consecutive STEMI patients who underwent primary PCI, 79 patients received ebtifibatide < 90 minutes (Group 1) and 37 patients received eptifibatide > 90 minutes (Group 2) before first angiographic of IRA. There were no significant differences of TIMI 3 flow proportion after PCI between the groups (86.1% vs 83.8% for Group 1 and 2 respectively, p = 0.745). Group 2 showed more frequent TIMI 2 flow (18.9% vs 5.1%, p = 0.036) but tend to have less frequent TIMI 0 flow (56.8 % vs 67.1%, p = 0.281).Conclusion. Patients who received eptifibatide > 90 minutes before first angiographic IRA during primary PCI achieved more appropriate TIMI flow as compare to that received eptifibatide < 90 minutes.
Penghambat GPIIb/IIIa pada Intervensi Koroner Perkutan Primer: Kapan dan Dimana? Doni Firman
Jurnal Kardiologi Indonesia Vol. 32, No. 1 Januari - Maret 2011
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v32i1.119

Abstract

Prosedur Intervensi Koroner Perkutan Primer (IKPP) merupakan prosedur pilihan pada pasien STEMI dengan awitan kurang dari 12 jam. Tetapi banyak hal yang masih belum terjawab di antaranya pada pasien dengan awitan dini (2 atau 3 jam) apakah pihannya langsung dirujuk ke RS dengan fasilitas IKPP tetapi dengan konsekuensi adanya keterlambatan atau langsung diberikan trombolitik. Masalah kedua adalah jenis terapi yang diberikan saat transportasi ke rumah sakit rujukan apakah antitrombin heparin, bivalirudin, penghambat GP IIb/IIIa atau trombolitik? Masalah ketiga adalah IKPP tidak selalu berhasil memberi reperfusi. Masalah lain adalah keberhasilan angiografis yang tidak disertai bukti reperfusi yang diharapkan pada pemeriksaan dengan modalitas imajing.
Trombolisis Intra-arterial Perkutan pada Stroke Iskemik Peri-angiografi Koroner: Pengalaman Awal di Pusat Jantung Nasional Harapan Kita Muhammad Fadil; Dicky Hanafy; I Irmalita; Doni Firman; Yoga Yuniadi
Jurnal Kardiologi Indonesia Vol. 31, No. 3 September - Desember 2010
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v31i3.133

Abstract

Background. Ischemic stroke is a rare but well-known complication of cardiac-catheter interventions attributable mostly to embolism. Peri-coronary angiography stroke, represents a unique opportunity for im-mediate stroke interventional therapy with intravenous, catheter based intra-arterial thrombolysis (IAT) or combined therapy using recombinant tissue plasminogen activator (rtPA). Intra-arterial thrombolysis is an option for treatment of selected patients who have major stroke of < 6 hours duration due to occlusion of the Media Cerebral artery(MCA) and who are not otherwise candidates for intravenous rtPA (Class I, Level of Evidence B, AHA guidelines). Objective.To review the first experience of percutaneous intra-arterial thrombolysis(PIAT) as a management of acute ischemic stroke due to complication of coronary angiography procedure. Summary. We present 3 cases of acute ischemic stroke which happened during coronary angiography procedures. All of them (NIHSS 30, 20 and 34) were treated immediately with intra-arterial thrombolysis (IAT) recom-binant tissue Plasminogen Activator (rtPA) and had a very good outcome with no residual of stroke (NIHSS 0). Although it has been stated clearly in the AHA guidelines for the early management of adult with ischemic stroke, up until now the procedure of IAT or (intra-venous thrombolysis) IVT upon acute ischemic stroke is not established yet in standard operational procedure of National Cardiovascular Center Harapan Kita (NCCHK) Jakarta, which perhaps makes the physicians hesitate on performing these procedures due to legal aspects, while in the other hand the risks of acute ischemic stroke remain the potential threats on every single coronary angiography or any intensive catheter based procedures.
Intervensi Koroner Perkutan Primer Doni Firman
Jurnal Kardiologi Indonesia Vol. 31, No. 2 Mei - Agustus 2010
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v31i2.144

Abstract

Penyakit Kardiovaskular masih merupakan pembunuh nomor satu di Indonesia maupun di dunia. Dari data di Amerika setiap tahun 1,2 juta orang mengalami infark miokard dan kira-kira sepertiganya merupakan infark miokard dengan ST elevasi.Dari seluruh orang yang mengalami infark miokard di Amerika, 25-35% nya meninggal sebelum mendapat perawatan, sebagian besar karena Fibrilasi Ventrikel. Pada kelompok yang mendapat perawatan, angka kematian turun dari 11.2% di tahun 1990 menjadi 9.4% di tahun 1999. Hal tersebut dikarena-kan adanya tindakan reperfusi pada Infark dengan ST elevasi, baik dengan fibrinolitik maupun Intervensi Koroner Perkutan ( IKPP ). Dari analisa National Registry of Myocardia Infarction angka kematian di rumah sakit pada pasien yang mendapat reperfusi adalah sekitar 5.7%, jauh lebih rendah dibandingkan dengan pasien yang tidak mendapat reperfusi walau-pun sebenarnya kandidat yaitu 14.8%
Asosiasi Kadar Fibrinogen dengan Indeks Resistensi Mikrovaskular pada Penderita Infark Miokard Akut dengan Elevasi Segmen ST yang menjalani Intervensi Koroner Perkutan Primer Jusup Endang; Doni Firman; Iwan Dakota
Jurnal Kardiologi Indonesia Vol. 35, No. 3 Juli - September 2014
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v35i3.424

Abstract

Background: Primary percutaneus coronary intervention (PPCI) is a first of choice to return patient’s blood flow and perfusion with ST-segment elevation myocardial infarction (STEMI), however reperfusion in macrocirculation level is not always accompanied by a sufficient microcirculation reflow due to Microvascular Obstruction (MVO). Previous study demonstrated thathigh fibrinogen concentration may affect rheological parameters of the blood and play an important role in the pathomechanism of myocardial non-reperfusion phenomenon following successful mechanical recanalisation of the infarct-related coronary artery. Another study show eda more compact, lysis-resistant fibrin network in no reflow group, but without significant relation to fibrinogen level. However, there is a lack of data regarding fibrinogen and MVO. The aim of this study is to evaluate association between fibrinogen and MVO by index of microcirculatory resistance (IMR).Methods. 55 STEMI patients undergoing primary PCI were consecutively included. The fibrinogen was evaluated using clauss method and IMR was done right after PPCI to evaluate MVO.Results. From fifty-five patients included in the study, there were 87,3% men, with mean age 53,1±8.9 years old, and smoker show the biggest proportion compare with risk factor for coronary artery disease. All the patient undergo primary percutaneus coronary intervention with mean door-to-ballon time of 89.04+37.114 minute and ischemia time of 458,69+170,709 minute. Mean IMR was 55,2 + 47,454 and mean fibrinogen level was 350,8+103,19. From the scaterred plot fibrinogen prone to had a weak negative correlation with IMR and statistically non-significant(r = -0,137; p=0,319).Conclusion. There is no correlation between fibrinogen level and IMR value in STEMIpatients undergoing PPCI
Pengalaman Awal Tindakan MitraClip di Pusat Jantung Nasional Harapan Kita, Jakarta Prima Almazini; Nani Hersunarti; Rarsari Soerarso; Bambang Budi Siswanto; Doni Firman; Amiliana M Soesanto
Jurnal Kardiologi Indonesia Vol. 36, No. 2 April - Juni 2015
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v36i2.462

Abstract

Background: Percutaneous mitral valve repair (PMVR) with MitraClip is considered as an optional treatment for patients with significant MR who are high risk for having surgery. This novel therapy is less invasive, safe, and effective for MR reduction, and hence improve symptoms of heart failure, as well as reverse left ventricle remodeling. The purpose of this study was to report the early experience of Mitraclip procedure for treating significant MR at the National Cardiovascular Center Harapan Kita.Methods: This retrospective study was conducted at National Cardiovascular Center Harapan Kita Hospital, Jakarta. The data was retrieved from computerized database and medical records from February 2014 to January 2015, and then analyzed with SPSS.Results: A total of 6 patients with age 51 - 75 years old, underwent MitraClip procedure. Of all patients, the MR were severe in 5 patients and moderate in 1 patient. One was female and 5 were male. Among these patients, 2 were degenerative MR and 6 were functional MR. Two patients were treated with single MitraClip and 4 patients required double MitraClip. Post proccedure, there was reduction of MR to mild was achieved in 2 patients and to moderate in 4 patients. The left ventricular end diastolic dimension decreased from 66 ± 6.5 mm at baseline to 59 ± 7.3 mm (p=0.04) and end systolic dimensions decreased from 50 ± 10.6 mm at baseline to 48 ± 10.0 mm before discharge (p=0.27) as evaluated from predischarge echocardiography. At one month after procedure, 2 patients were in New York Heart Association (NYHA) functional class I and 4 patients were in class II. In-hospital mortality was 0%. Only 1 patient was re-hospitalized after procedure due to heart failure.Conclusion: From our early experience, MitraClip was considered an effective and safe option for patients with functional and degenerative MR who are at high risk for open-heart surgery. Left ventricle dimension, NYHA functional class, MR reduction, and re-hospitalization rate were improved after procedure.
The Role of Ticagrelor in STEMI Fibrinolytic and Its Rationale to Utilize for Indonesian Patients Daniel Tobing; Dafsah Juzar; Achmad Fauzi Yahya; Antonia Anna Lukito; Doni Firman; Sodiqur Rifqi; Abdul Hakim Alkatiri; Rurus Suryawan
Jurnal Kardiologi Indonesia Vol 40 No 4 (2019): Indonesian Journal of Cardiology: October-December 2019
Publisher : The Indonesian Heart Association

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.30701/ijc.v40i4.915

Abstract

Worldwide, ischemic heart disease is the most common cause of death and its frequency is increasing. ST-segment elevation myocardial infarction or STEMIis as form of ischemic heart disease with the highest mortality rate. Based on ESC (European Society of Cardiology) guideline 2017 for STEMI management, reperfusion therapywhich is primary PCI strategy is recommended over fibrinolysis within induced timeframes, but if timely primary PCI cannot be performed after STEMI diagnosis, fibrinolytic therapy is recommended within 12 hours of symptom onset in patients without contraindications. In fibrinolytic therapy, oral aspirin should be given, and Clopidogrel is indicated as an addition to aspirin. Although Clopidogrel is a recommended P2Y12receptor inhibitorin fibrinolytic therapy,PERKI guideline 2018 in ACS management also mention thatswitching to Ticagrelor can be considered in patients whowillundergo PCI treatmentafter fibrinolytic. In PLATO study, patients who have acute coronary syndrome with or without ST-segment elevation, treatment with ticagrelor as compared with clopidogrel significantly reduced the rate of death from vascular causes, myocardial infarction, or stroke. However, patients who received fibrinolytic therapy within 24 hours before randomization were excluded. WhileinSET-FAST study, Ticagrelor provides more prompt and potent platelet inhibition compared with Clopidogrel in patients undergoing PCI within 24 hours of receiving fibrinolysis for STEMI. TREAT study was conducted to evaluate the safety of ticagrelor in STEMI patients receiving fibrinolytic therapy within 24 hours.TREAT study concluded, at 30 days observation, in patients younger than 75 years with STEMI, delayed administration of Ticagrelor after fibrinolytic therapy was noninferior to Clopidogrel for TIMI major bleeding. Based on the result from PLATO study and preliminary TREAT study result on 30 days, the use of Ticagrelor within 24 hours after fibrinolytic therapy can be considered with comparable safety profile to Clopidogrel. Keywords: STEMI, fibrinolysis, ticagrelor
Co-Authors Abdul Hakim Alkatiri Abdul Hakim Alkatiri Achmad Fauzi Yahya Amiliana M Soesanto Amiliana M Soesanto Amiliana M. Soesanto Antonia Anna Lukito Ario S. Koencoro Arwin Saleh Mangkuanom Bambang Budi Siswanto Bambang Budi Siswanto Budi Siswanto, Bambang Dafsah Juzar Daniel Tobing Dicky A Hanafy Dicky A. Hanafy Dicky Hanafy Hubert Seggewiss I Irmalita Iwan Dakota Jajang Sinardja Jusup Endang M Soesanto, Amiliana Muhammad Fadil Nani Hersunarti Nani Hersunarti Nani Hersunarti Prima Almazini Prima Almazini Prima Almazini Rarsari Soerarso Rarsari Soerarso Rarsari Soerarso Rurus Suryawan Sodiqur Rifqi Sunarya Soerianata Yoga Yuniadi Yoga Yuniadi