Amiliana M. Soesanto

Modelling and simulation of blood circulation towards mitral valve replacement risk calculation

The operative mortality of a mitral valve replacement surgery in patients who suffer from a rheumatic heart disease and who have a concurrent pulmonary arterial hypertension accounts for 15 to 31 %. The complexity of the disease and of the cardiovascular system itself makes it difficult to find a specific reason for the high operative mortality. In a first approach to this problem we modelled and simulated the blood circulation under normal and diseased conditions. Herewith, the blood circulation can be analysed as a whole in spite of its complexity. For this purpose, we decided to model with the help of an electrical circuit analogy because it is not “spatially” dependant, fast and computational economic. The model includes the systemic and the pulmonary blood circulation with the main vessel-types. Hereby, we used the Multisim software to model and simulate. Simulation results show that our model matches the theoretical mitral flow patters from other resources. This model has positive signs to be used for a mitral valve replacement risk classification.

Fungsi Intrinsik Miokard Ventrikel Kiri pada Stenosis Katup Mitral: Evaluasi Sebelum dan Sesudah Balloon Mitral Valvotomy

One of the treatment options in mitral stenosis (MS) is balloon mitral valvulotomy (BMV) which may improve myocardial intrinsic function. This study was aimed to observe myocardial systolic function with intrinsic parameter by using STDS- focusing on global longitudinal strain (GLS) - in MS pre and post BMV. This descriptive analytic study which included MS patients who underwent BMV from 2009-2011, were examined by routine echocardiography examination, one day pre BMV and maximal 5 days post BMV. STDS of 4 Left ventricle chambers were taken. Exclusion criteria were: post BMV gradient more than 10 mmHg and post BMV significant mitral regurgitation. Paired t-test analysis was used to compare variables pre and post BMV procedure. There were 45 MS patients with mean age of 39 years old (± 10.7), pre BMV: mean MVA 0.68 cm2 (SD 0.57), mean MVG 14.02 mmHg (SD 5.06), mean EF 58.26% (SD 8.82) and mean GLS -11.81 (SD 3.50). Post BMV: mean MVA 1.4 cm2 (p : 0.000), mean MVG 5.82 (p<0.001), mean EF 61.28% (p=0.001) and GLS also significantly improved to 13.18 (p=0.02). Improvement of LVMIF after BMV procedure, may explain beneficial effect of BMV in regional myocardial deformation and systolic function in MS patients.

Towards Robot-Assisted Echocardiographic Monitoring in Catheterization Laboratories: Usability-Centered Manipulator for Transesophageal Echocardiography

This paper proposes a robotic Transesophageal Echocardiography (TOE) system concept for Catheterization Laboratories. Cardiovascular disease causes one third of all global mortality. TOE is utilized to assess cardiovascular structures and monitor cardiac function during diagnostic procedures and catheter-based structural interventions. However, the operation of TOE underlies various conditions that may cause a negative impact on performance, the health of the cardiac sonographer and patient safety. These factors have been conflated and evince the potential of robot-assisted TOE. Hence, a careful integration of clinical experience and Systems Engineering methods was used to develop a concept and physical model for TOE manipulation. The motion of different actuators of the fabricated motorized system has been tested. It is concluded that the developed medical system, counteracting conflated disadvantages, represents a progressive approach for cardiac healthcare.

Erratum to: Towards Robot-Assisted Echocardiographic Monitoring in Catheterization Laboratories

The online version of the original article can be found at https://doi.org/10.1007/s10916-017-0786-4

LBPS 02–19 CORRELATION BETWEEN URINARY PROTEIN AND VASCULAR DYSFUNCTION IN PREECLAMPTIC WOMEN BEFORE AND AFTER DELIVERY

Objective: To asses the correlation between urine protein-creatinine ratio and flow mediated dilation (FMD) before and after delivery in preeclamptic women. Design and Method: Women with a diagnosis of preeclampsia and planned for termination were enrolled for the study. History of hypertension before 20 weeks of gestation, diabetes mellitus, chronic kidney disease became exclusion criterias. The FMD was studied through the use of high resolution vascular ultrasound examination of brachial artery for 3 times; before delivery, 48–72 hours after delivery and 40–60 days after delivery. Urine protein-creatinine ratio (UPCR) was measured twice; prior to delivery and 40–60 days after delivery. Correlation between them was then evaluated. Results: Thirty patients were enrolled in this study. The mean ages was 29.5 ± 6,4 years old. FMD was improved after delivery, 5.46 ± 0.27 % (before delivery) & 8.14 ± 2.48 % (p < 0.001) 40–60 days after delivery. Bivariates analysis showed that after delivery, there was an inverse correlation between UPCR with FMD (r = -0,735 p < 0,0001). UPCR prior to delivery also has inverse correlation with FMD after delivery (r = -0.55.p = 0.002) and with the change of FMD before and after delivery (r = -0.45 with p = 0.01). Multivariate analysis showed that correlation between UPCR after delivery with FMD after delivery was independent. Conclusions: This study demonstrated there was a moderate-strong correlation between urinary protein prior and after delivery with flow mediated vasodilatation of brachial artery after delivery.

Early Experience of MitraClip Procedure at National Cardiovascular Center Harapan Kita, Jakarta

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.

Left Atrial Myxoma in Pregnancy: A Challenge in Diagnosis and Management

Primary tumors of the heart are rare where myxomas predominate as the most common type of primary cardiac tumors in all age groups. Even rarer, the incidence of myxomas during pregnancy is reported extremely low in the medical literature. The hemodynamic changes during pregnancy play an important role in influencing the clinical manifestation. The management is vary, depending on the week of gestation and risk assessment for both the mother and baby. We report a case of left atrial myxoma in 33-34 weeks of pregnancy. After judicious consideration, the patient was planned to have caesarian section at the full term pregnancy that will be followed one week after by tumor resection.