HIDAYAT SALAM
Cardiac MRI (magnetic resonance imaging) service at Harapan Kita Hospital, Jakarta, Thursday (15/12/2022).
The mitral valve is the valve that connects the left atrium and left ventricle of the heart. Leakage or regurgitation of the mitral valve causes the blood pump function of the left ventricle to not be optimal. In this condition, the workload of the heart muscle becomes heavier. The blood pump from the heart to the rest of the body becomes obstructed.
Mitral valve leak must be treated. If not done, the function of the heart chambers decreases so that the risk of heart failure. Previous treatment for mitral valve leaks was through mitral valve replacement surgery with a prosthetic valve. Along with the development of medical science, the action has changed from valve replacement to valve repair.
This valve repair is considered more useful with lower early and late death rates, as well as better improvement of left ventricular function. Valve repair surgery is also considered to reduce the risk of blood clots, complications related to anticoagulant drugs, and heart infections.
However, in pediatric mitral valve surgery, most of the mitral valve repair techniques cannot be applied optimally because the valve structure in children is difficult to modify. This is because the anatomy of the mitral valve in children is smaller, thinner, and difficult to replace with an artificial valve.
Leaks in the mitral valve must be treated immediately. If not, the function of the chambers of the heart can decrease so that you are at risk of experiencing heart failure and death.
Conventional mitral valve repair techniques in children are generally performed with anuloplasty. Unfortunately, this technique has the potential to cause residual leakage in the mitral valve. The incidence of residual postoperative mitral valve leakage or regurgitation was 62.3 percent.
Referring to data from the Pediatric Cardiac Surgery Unit at Harapan Kita Heart Hospital in the 2008-2017 period, out of 325 pediatric patients who received mitral valve repair surgery in the conventional way, 49 percent of them had residual postoperative leaks.
HIDAYAT SALAM
Cardiac catheterization service facility (cath lab) at Harapan Kita Hospital, Jakarta, Thursday (12/15/2022).
This residual leak can occur because the area between the two mitral valve leaves does not meet optimally. Mitral valve leaks are at risk of causing heart failure, damage to blood cells, and hindering the process of repairing heart muscle function after surgery.
Departing from this problem, thoracic and cardiovascular surgeon Budi Rahmat researched to find new, better techniques in mitral valve repair surgery in children. He also designed an operation to repair the mitral leak using the posterior annulus elevation technique. From the results of his research, the technique was proven to be effective in reducing residual postoperative mitral valve leakage.
Also read: Preventing Heart Disease from a Childhood Age
Budi explained the results of his research regarding the effectiveness of the posterior annulus elevation technique in an open session for his doctoral promotion at the Faculty of Medicine, University of Indonesia, Jakarta, Tuesday (11/7/2023). This research was used by Budi as material for his dissertation.
“The technique of raising the posterior annulus of the mitral valve is done by lifting the posterior annulus of the mitral so that the two valve leaflets (anterior and posterior valves) meet perfectly. This technique has never been done in a child’s mitral valve repair surgery before,” said Budi when defending his dissertation. Budi graduated as a doctor of medical science study program with graduation A GPA of 3.92.
Research process
The study conducted by Budi used a randomized controlled trial design or a randomized controlled trial conducted on patients at the Harapan Kita National Cardiovascular Hospital (RS), Jakarta. The research was conducted from July 2020 to June 2022.
FKUI
Budi Rahmat defending his dissertation regarding the effectiveness of the posterior annulus elevation technique in an open doctoral promotion session at the Faculty of Medicine, University of Indonesia, Jakarta, Tuesday (11/7/2023).
The subjects studied were children with mitral valve leak aged 1 day to 18 years who underwent mitral valve repair surgery. There were 64 patients who were research subjects.
Of that number, they were divided into two groups, namely the group that received treatment with the posterior annulus elevation technique after conventional valve repair was carried out, and the other group as a control group that only underwent conventional valve repair techniques.
Technically, the mitral valve posterior annulus elevation technique will be given after the conventional procedure of mitral valve repair is completed. Evaluation in the study was carried out periodically, namely on day 0, day 5, after two weeks, and three months after surgery.
Examination of the remaining mitral leak is done through echocardiography. In addition, other data from medical records were also measured, namely the length of time the patient was connected to a ventilator, length of ICU stay, length of stay, and the presence of Low cardiac output syndrome (LCOS), which is usually a post-cardiac surgery complication. Monitoring on the risk of heart failure is also carried out.
Also read: Child Heart Disease Services
From the results of the examination and evaluation it was found that the group that received intervention with the posterior annulus elevation technique showed a significant decrease in residual mitral leak compared to the control group.
After three months it was also seen that the posterior annulus elevation technique could be a protective factor that reduced the risk of residual leaks compared to the control group. This technique can also improve the area of coaptation of the mitral valve.
While from the clinical outcome, the group that received the new technical intervention with the control group did not show significant differences in the metabolic conditions of heart failure and markers of hemolysis (rupture of the red blood cell membrane).
“This new technique is expected to be a technique of choice that can be applied to mitral valve surgery thereby reducing morbidity due to residual mitral regurgitation. Consideration and evaluation from other cardiac surgeons is also needed from the application of this technique, including in the adult patient population,” said Budi.
AP PHOTO/NARIMAN EL MOFTY
Nadia kisses her 10-year-old granddaughter Zlata Moiseinko, who has a heart condition as she is undergoing treatment at a school building that has been converted into a makeshift hospital in Mostyska, Ukraine, Thursday, March 24, 2022.
Prof.
Through modifications made in surgery, namely with the posterior annulus elevation technique, patients can get great benefits in reducing the risk of postoperative mitral valve leakage.
He also hopes that more innovations will be produced in the field of medicine in Indonesia, particularly in the fields of thoracic and cardiovascular surgery. In addition to surgical techniques, innovation is needed to improve screening efforts for congenital heart disease in children in Indonesia.
Also read: Children with Congenital Heart Disease Are at More Risk of Experiencing Worsening
“The challenge faced by Indonesia as an archipelagic country with a large population is that many congenital heart diseases go undetected. We need more advanced techniques in congenital heart screening so that more babies born with congenital heart defects can be detected early,” he said.
2023-07-23 22:20:53
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