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Paediatric cardiac surgery in Indonesia
Asia Pacific
Royal
Heart J 1998;7( 1)
Children’s
Hospital
Paediatric
Cardiac
Symposium SUPPLEMENT
Paediatric Cardiac Surgery In Indonesia Toshihide Asou, Jusuf Rachmat Rumah Sakit Jantung Harapan Kita, National Cardiac Center, Jakarta, Indonesia Paediatric cardiac surgery in Indonesia first developed thanks to the cooperation of various cardiac centres abroad. The establishment of the Harapan Kita National Cardiac Center in 1985 was one of the most important initial steps in the development of paediatric cardiac surgery in Indonesia. Thereafter, paediatric cardiac surgery in Indonesia advanced remarkably in terms of the number of the operations performed and the variety of the diseases treated. As a result, the surgical outcomes were improved.
solved. Only 1% of the children with congenital heart disease are properly treated in Indonesia. Some of the underlying problems include a shortage of paediatric cardiac professionals, lack of information and education on the part of patients, as well as a shortage of funding, both privately and publicly. It would thus be welcome for paediatric cardiac surgeons, cardiologists and nurses in Indonesia to learn about congenital heart disease from doctors and nurses in advanced countries in order to improve the outlook for paediatric cardiac surgery and cardiology in Indonesia.
However, there are still numerous problems to be
Kawasaki Disease: Evolution Of Coronary Artery Aneurysms: An Angiographic Study Over 10 Years Yin Ming Ng, S.H. Lee, K.C. Chan, K.S. Lun, D. Wong Department of Paediatrics, Queen Elizabeth Hospital, Kowloon, Hong Kong Objectives: To study, utilising angiography, coronary artery abnormalities and to correlate the outcome of Kawasaki disease with coronary artery aneurysms (CAA) with the size of CAA at diagnosis, timing of IVGG administration, and other risk factors such as age of onset of disease. Method: Patients diagnosed as having Kawasaki disease between 1985 and 1995 were reviewed. With parents’ consent, 18 patients who had CAA were studied using angiography. All patients who had CAA were examined using 2-dimensional echocardiography (2DE) at diagnosis. Selective coronary angiograms were performed from 5 months to 10 years of age, 10 months after onset of the Kawasaki disease, with standard views using the Philips DCI-SX Diagnost C2 system. The sizes of the coronary arteries were measured and residual narrowing or aneurysmal dilatation were recorded. The angiographic results were also correlated with 2DE findings. Risk factors including age at diagnosis, size of CAA at diagnosis and timing of IVGG administration were analysed.
coronary artery stenosis could only be demonstrated by angiography and not by routine 2DE. Conclusions: 1. This series of patients who had angiograpy to detect CAA in Kawasaki disease showed a high incidence (7/18, 38.9%) of persistent residual coronary abnormalities, including CAA, stenosis and myocardial ischaemia. 2. Echocardiography cannot demonstrate in detail the coronary artery complications, for example, stenosis and multiple aneurysms. 3. Persistence of coronary abnormalities: one patient has persistent coronary abnormalities detected beyond 10 years; 2 patients beyond 8 years and 1 patient beyond 6 years. 4. The most significant risk factors are: giant CAA at diagnosis and most important of all, late or nontreatment of IVGG (6 of the 7 patients with coronary complications belong to this category, where 2 patients were not given IVGG and 4 were given IVGG later than 14 days after fever onset). Recommendation: All patients with initial CAA demonstrated by 2DE should have an angiographic study after the acute episode to detect abnormalities such as coronary artery stenosis and multiple aneurysms. Follow-up angiography is essential since the coronary abnormalities could be persistent.
Results: Of the 18 patients who had angiograms, 7 patients showed persistent abnormalities; 2 have persistent stenosis of the RCA, one with LVC stenosis and multiple CAAs, and 4 others have persistent CAA which ranged from 4-1Omm. Two patients with residual stenosis had a thallium nuclear scan performed, showing myocardial ischaemia in one patient. The 3 patients with
55
Royal
Heart J 1998;7( 1)
Children’s
Hospital
Paediatric
Cardiac
Symposium SUPPLEMENT
Paediatric Cardiac Surgery In Indonesia Toshihide Asou, Jusuf Rachmat Rumah Sakit Jantung Harapan Kita, National Cardiac Center, Jakarta, Indonesia Paediatric cardiac surgery in Indonesia first developed thanks to the cooperation of various cardiac centres abroad. The establishment of the Harapan Kita National Cardiac Center in 1985 was one of the most important initial steps in the development of paediatric cardiac surgery in Indonesia. Thereafter, paediatric cardiac surgery in Indonesia advanced remarkably in terms of the number of the operations performed and the variety of the diseases treated. As a result, the surgical outcomes were improved.
solved. Only 1% of the children with congenital heart disease are properly treated in Indonesia. Some of the underlying problems include a shortage of paediatric cardiac professionals, lack of information and education on the part of patients, as well as a shortage of funding, both privately and publicly. It would thus be welcome for paediatric cardiac surgeons, cardiologists and nurses in Indonesia to learn about congenital heart disease from doctors and nurses in advanced countries in order to improve the outlook for paediatric cardiac surgery and cardiology in Indonesia.
However, there are still numerous problems to be
Kawasaki Disease: Evolution Of Coronary Artery Aneurysms: An Angiographic Study Over 10 Years Yin Ming Ng, S.H. Lee, K.C. Chan, K.S. Lun, D. Wong Department of Paediatrics, Queen Elizabeth Hospital, Kowloon, Hong Kong Objectives: To study, utilising angiography, coronary artery abnormalities and to correlate the outcome of Kawasaki disease with coronary artery aneurysms (CAA) with the size of CAA at diagnosis, timing of IVGG administration, and other risk factors such as age of onset of disease. Method: Patients diagnosed as having Kawasaki disease between 1985 and 1995 were reviewed. With parents’ consent, 18 patients who had CAA were studied using angiography. All patients who had CAA were examined using 2-dimensional echocardiography (2DE) at diagnosis. Selective coronary angiograms were performed from 5 months to 10 years of age, 10 months after onset of the Kawasaki disease, with standard views using the Philips DCI-SX Diagnost C2 system. The sizes of the coronary arteries were measured and residual narrowing or aneurysmal dilatation were recorded. The angiographic results were also correlated with 2DE findings. Risk factors including age at diagnosis, size of CAA at diagnosis and timing of IVGG administration were analysed.
coronary artery stenosis could only be demonstrated by angiography and not by routine 2DE. Conclusions: 1. This series of patients who had angiograpy to detect CAA in Kawasaki disease showed a high incidence (7/18, 38.9%) of persistent residual coronary abnormalities, including CAA, stenosis and myocardial ischaemia. 2. Echocardiography cannot demonstrate in detail the coronary artery complications, for example, stenosis and multiple aneurysms. 3. Persistence of coronary abnormalities: one patient has persistent coronary abnormalities detected beyond 10 years; 2 patients beyond 8 years and 1 patient beyond 6 years. 4. The most significant risk factors are: giant CAA at diagnosis and most important of all, late or nontreatment of IVGG (6 of the 7 patients with coronary complications belong to this category, where 2 patients were not given IVGG and 4 were given IVGG later than 14 days after fever onset). Recommendation: All patients with initial CAA demonstrated by 2DE should have an angiographic study after the acute episode to detect abnormalities such as coronary artery stenosis and multiple aneurysms. Follow-up angiography is essential since the coronary abnormalities could be persistent.
Results: Of the 18 patients who had angiograms, 7 patients showed persistent abnormalities; 2 have persistent stenosis of the RCA, one with LVC stenosis and multiple CAAs, and 4 others have persistent CAA which ranged from 4-1Omm. Two patients with residual stenosis had a thallium nuclear scan performed, showing myocardial ischaemia in one patient. The 3 patients with
55