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Mulyadi M. Djer
Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta
Health Professions Medicine & Pharmacology

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Outcomes of Tetralogy of Fallot repair performed after three years of age Ni Putu Veny Kartika Yantie; Mulyadi M. Djer; Najib Advan; Jusuf Rachmat
Paediatrica Indonesiana Vol 56 No 3 (2016): May 2016
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (301.964 KB) | DOI: 10.14238/pi56.3.2016.176-83

Abstract

subject of debate, however, in general repair before 3 years of age has resulted in good myocardial performance. Late repair has led to prolonged QRS duration, ventricular dysfunction in terms of myocardial performance index (MPI) and tricuspid annular plane systolic excursion (TAPSE), as well as longer intensive care unit (ICU) stays.Objective To evaluate QRS duration, right ventricular function as measured by TAPSE, and ICU length of stay (LoS) after repair of TOF performed after three years of age.Methods This retrospective cohort study was performed in children and adults who underwent ToF repair, with a minimum follow-up of 6 months. The TAPSE and QRS duration were evaluated during follow-up and compared between children who had the operation before vs. 3 years of age or older using Mann Whitney U and Chi-square tests.Results We enrolled 52 subjects who underwent ToF repair from January 2007 to June 2013 (18 in the ≤3 years-old group and 34 in the >3 years-old group). Subjects’ age at the time of repair ranged from 7 months to 25 years, with follow-up data at 24-30 months after discharge. Abnormalities of the right ventricle and left ventricle MPI were not significantly different between the two groups. However, we observed significant differences between the ≤3 years and >3 years groups in median ICU LoS [2 (range 1-9) days vs. 1.5 (range 1-46) days, respectively; (P=0.016)] and median QRS durations [118 (range 78-140) ms vs. 136 (range 80-190) ms, respectively; (P=0.039)]. The age at the time of repair did not increase the risk of having abnormal TAPSE (RR 0.85; 95%CI 0.26 to 2.79; P=0.798).Conclusion Tetralogy of Fallot repair after 3 years of age appears to not increase ICU LoS or is associated with lower TAPSE, but it is associated with longer QRS duration. [Paediatr Indones. 2016;56:176-83.].
Ventricular function and dimensions in children with human immunodeficiency virus infection Rahmat B. Kuswiyanto; Mulyadi M. Djer; Arwin A. P. Akib; Sudigdo Sastroasmoro
Paediatrica Indonesiana Vol 51 No 3 (2011): May 2011
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (131.735 KB) | DOI: 10.14238/pi51.3.2011.149-56

Abstract

Background Prevalence of cardiac complications in children 'With human immunodeficiency virus (HIV) infection have increased, in association 'With the availability of antiretroviral (ARV) therapy and the decrease of opportunistic infections. However, studies on cardiac complications in HIV patients in the various HIV clinical and immunologic categories have been limited. Furthermore, cardiac complications in Indonesian HIVinfected children have never been reported.Objectives To detennine the prevalence of cardiac complications in HIVinfected children and to compare ventricular function and dimensions based on HIV clinical and immunologic categories. Methods A cross􀁍sectional study was done in the Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta between October and December 2009 on 7 4 HIV􀁍infected children aged below 15 years. Children with severe chronic or acute systemic diseases were excluded. Investigations included physical examinations, 12􀁍lead electrocardiography and echocardiographyto assess left ventricular dimension and ventricular function. Cardiac findings among children in different clinical and immunological categories were compared.Results Five children showed left ventricular fractional shortening below 25% and 16 had right ventricular dysfunction. Mean cardiac function and dimension were in the normal range. No differences in cardiac function and dimension, among the clinical HIV category groups (p>0.05) or immunologic suppression status groups (p>0.05) were observed.Conclusion In children 'With HIV infection, the prevalence of left ventricular dysfunction and right ventricular dysfunction was 7% and 22%, respectively. No differences in cardiac function and dimension were found among the different HIV clinical and immunological categories.
Intravenous paracetamol and patent ductus arteriosus closure in preterm infants Rizky Adriansyah; Nikmah S. Idris; Mulyadi M. Djer; Sukman T. Putra; Rinawati Rohsiswatmo
Paediatrica Indonesiana Vol 57 No 4 (2017): July 2017
Publisher : Indonesian Pediatric Society

Show Abstract | Download Original | Original Source | Check in Google Scholar | Full PDF (238.428 KB) | DOI: 10.14238/pi57.4.2017.198-204

Abstract

Background Indomethacin and ibuprofen are the drugs of choice for closure of patent ductus arteriosus (PDA) in preterm infants. However, intravenous preparations are of limited availability in Indonesia. Circumstantial evidence has shown that intravenous paracetamol may be an alternative therapy for PDA closure in premature infants.Objective To evaluate the effect of intravenous paracetamol on PDA closure in preterm infants.Methods A before-and-after study was conducted between May and August 2014 in Cipto Mangunkusumo General Hospital, Jakarta in preterm infants with hemodynamically significant PDAs, as established by echocardiography using the following criteria: duct diameter >1.4 mm/kg, left atrium to aorta ratio >1.4, and mean velocity in the left pulmonary artery >0.42 m/s or mean diastolic velocity in the left pulmonary artery >0.2 m/s. Subjects, aged 2 and 7 days, received intravenous paracetamol (15 mg/kg every six hours) for 3 days. Paired T-test was used to compare pre-intervention PDA diameter to those assessed at 24 hours after the intervention and at 14 days of life.Results Twenty-nine subjects had a mean gestational age of 30.8 weeks and mean birth weight of 1,347 grams. Nineteen (65.5%) patients had closed PDAs at the day 14 evaluation, 1 experienced PDA reopening, and 9 had failed PDA closure. No liver toxicity was identified. Mean duct diameters before, 24 hours after the intervention, and at 14 days of life were 3.0, 0.9, and 0.6 mm, respectively (P<0.0001).Conclusion Intravenous paracetamol seems to be reasonably effective for PDA closure in preterm infants.
Co-Authors Arwin A. P. Akib Jusuf Rachmat Najib Advan Nikmah S. Idris NP Veny Kartika Yantie Rahmat B. Kuswiyanto Rinawati Rohsiswatmo Rizky Adriansyah Sudigdo Sastroasmoro Sukman T. Putra