Ruptur Sinus Valsava dfdffdffCTP (1).pptx

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1. dr. Caesario Tri Prasetyo Pembimbing : dr. Heroe Soebroto , SpB ., SpBTKV , Subsp.JPK (K) Ruptur Sinus Valsava

2. ANATOMY Charitos, E. I. and Sievers, H.-H. (2013) ‘Anatomy of the aortic root: implications for valve-sparing surgery.’, Annals of cardiothoracic surgery , 2(1), pp. 53–6. doi: 10.3978/j.issn.2225-319X.2012.11.18. Anderson, R. H., Spicer, D. E. and Mori, S. (2018) ‘The clinical anatomy of the aortic root’, Advances in Treatments for Aortic Valve and Root Diseases , pp. 3–23. doi: 10.1007/978-3-319-66483-5_1.

3. ANATOMY Tatsuishi , W . et al. (2015) ‘ Identification of coronary artery orifice to prevent coronary complications in bioprosthetic and transcatheter aortic valve replacement ’, Circulation Journal , 79(10), pp . 2157–2161. doi: 10.1253/circj.CJ-15-0415

4. PENDAHULUAN Zarayelyan, A. (2015) ‘Dynamic Anatomy of Aortic Root and Its Potential Role in TAVR Prostheses Further Development and Modification’, British Journal of Medicine and Medical Research , 5(12), pp. 1534–1546. doi: 10.9734/bjmmr/2015/14154

5. PENDAHULUAN ( Fungsi Sinus Valsava ) Toninato, R. et al. (2016) ‘Physiological vortices in the sinuses of Valsalva: An in vitro approach for bio-prosthetic valves’, Journal of Biomechanics , 49(13), pp. 2635–2643. doi: 10.1016/j.jbiomech.2016.05.027

6. History 1 st description by Hope in 1839 1 st important paper published by Thurman in 1840 Suggested ruptured as congenital by Abbott in 1919 Reviewed the subject of congenital and acquired lesion by Jones and Langley in 1949 1 st diagnosis of rupture during life by Venning in 1951 1 st. successful repair with CPB in 1956 at Mayo Clinic & University of Minnesota using CPB Luo, X. J. et al. (2013) ‘Modified Sakakibara classification system for ruptured sinus of Valsalva aneurysm’, Journal of Thoracic and Cardiovascular Surgery , 146(4), pp. 874–878. doi: 10.1016/j.jtcvs.2012.12.059. PENDAHULUAN

7. Jarang / sulit didiagnosa jika belum rupture Insidensi : 0,1-3,5% dari total kelainan jantung bawaan Laki : Perempuan : 2:1 Biasanya disertai kelainan jantung lainnya : VSD (60%) Bicuspid Aortic Valve Mitral and Tricuspid regurgitasi Doost, A., Craig, J. A. and Soh, S. Y. (2020) ‘Acute rupture of a sinus of Valsalva aneurysm into the right atrium: A case report and a narrative review’, BMC Cardiovascular Disorders , 20(1), pp. 1–6. doi: 10.1186/s12872-020-01383-7 PENDAHULUAN

8. ETIOLOGI Dapat dibagi menjadi 2 : Kongenital  Incomplete fusi aortopulmonary septum dengan interventricularis septum  Kelemahan pada junction pada aortic media dan annulus fibrosus. Didapat  Connective tissue disorder, TB, endocarditis, vaskulitis Arcario, M. J. et al. (2021) ‘Sinus of Valsalva Aneurysms: A Review with Perioperative Considerations’, Journal of Cardiothoracic and Vascular Anesthesia , 35(11), pp. 3340–3349. doi: 10.1053/j.jvca.2020.12.016.

9. KLASIFIKASI Tomar, M. and Srivastava, R. (2022) ‘Percutaneous Closure of Ruptured Sinus of Valsalva Aneurysm: Role of Echocardiography’, Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging , 6(3), p. 222. doi: 10.4103/jiae.jiae_25_22

10. Tomar, M. and Srivastava, R. (2022) ‘Percutaneous Closure of Ruptured Sinus of Valsalva Aneurysm: Role of Echocardiography’, Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging , 6(3), p. 222. doi: 10.4103/jiae.jiae_25_22 Xu, B. et al. (2020) ‘Sinus of Valsalva Aneurysms: A State-of-the-Art Imaging Review’, Journal of the American Society of Echocardiography , 33(3), pp. 295–312. doi: 10.1016/j.echo.2019.11.008. KLASIFIKASI

11. GEJALA KLINIS Unruptured  Asymtomatik Aneurisma dapat menekan / menyebabkan gangguan pada struktur sekitar : Iskemia coroner Gangguan katup Ruptured  Gejala non spesifik yang tiba-tiba ( Tergantung lokasi dan ukuran rupture) - Palpitasi - Sesak napas - Nyeri dada - Gagal jantung Arcario, M. J. et al. (2021) ‘Sinus of Valsalva Aneurysms: A Review with Perioperative Considerations’, Journal of Cardiothoracic and Vascular Anesthesia , 35(11), pp. 3340–3349. doi: 10.1053/j.jvca.2020.12.016.

12. PEMERIKSAAN PENUNJANG Penegakan diagnose berdasarkan hasil pemeriksaan penunjang Dapat dilakukan menggunakan : Echocardiografi Transthoracic Echocardiography (TTE) Transoesophageal Echocardiography (TEE) Multidetector Cardiac CT (MDCT) Cardiac Magnetic Resonance Imaging (CMRI) Xu, B. et al. (2020) ‘Sinus of Valsalva Aneurysms: A State-of-the-Art Imaging Review’, Journal of the American Society of Echocardiography , 33(3), pp. 295–312. doi: 10.1016/j.echo.2019.11.008

13. Transthoracic Echocardiography (TTE) 1. Parasternal long-axis view (PLAX) 2. Parasternal short-axis view of the aortic root (PSAX) 3. apical-four-chamber and subcostal (A4C, A5C) 4. Modified, nonstandard views showing the aortic root 5. Suprasternal view : Need to rule out coarctation of the aorta. Color flow mapping across arch also showed diastolic flow reversal in the aorta due to aortic runof Tomar, M. and Srivastava, R. (2022) ‘Percutaneous Closure of Ruptured Sinus of Valsalva Aneurysm: Role of Echocardiography’, Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging , 6(3), p. 222. doi: 10.4103/jiae.jiae_25_22.

14. Transthoracic Echocardiography (TTE) Tomar, M. and Srivastava, R. (2022) ‘Percutaneous Closure of Ruptured Sinus of Valsalva Aneurysm: Role of Echocardiography’, Journal of The Indian Academy of Echocardiography & Cardiovascular Imaging , 6(3), p. 222. doi: 10.4103/jiae.jiae_25_22.

15. Transthoracic Echocardiography (TTE)

16. Transoesophageal Echocardiography (TEE) Primawati A, Krisdinarti L and Mumpuni H (2016) ‘Jurnal Kardiologi Indonesia Ruptured Aneurysm of Sinus of Valsalva Into the Right Ventricle: The Role of Echocardiography’, Jurnal Kardiologi Indonesia • , 37(1), pp. 33–40

17. Multidetector Cardiac CT (MDCT) Xu, B. et al. (2020) ‘Sinus of Valsalva Aneurysms: A State-of-the-Art Imaging Review’, Journal of the American Society of Echocardiography , 33(3), pp. 295–312. doi: 10.1016/j.echo.2019.11.008

18. Cardiac Magnetic Resonance Imaging (CMRI) Xu, B. et al. (2020) ‘Sinus of Valsalva Aneurysms: A State-of-the-Art Imaging Review’, Journal of the American Society of Echocardiography , 33(3), pp. 295–312. doi: 10.1016/j.echo.2019.11.008

19. TERAPI Pembedahan merupakan pilihan utama Approach ada 3: Aortotomi Ventrikulotomi Both of them Tergantung : Katub aorta Ukuran rupture Ada tidaknya anomaly jantung lainnya Weinreich , M., Yu, P. J. and Trost, B. (2015) ‘Sinus of Valsalva Aneurysms: Review of the Literature and an Update on Management’, Clinical Cardiology , 38(3), pp. 185–189. doi: 10.1002/clc.22359.

20. T h a n k Y o u !