Manajemen Perioperatif Pasien Atrial Septal Defect (ASD)   dengan Hipertensi Pulmonal yang Menjalani  Operasi Tutup Defek

Rifdhani Fakhrudin Nur; Juni Kurniawaty; Bhirowo Yudo Pratomo

doi:10.15851/jap.v12n2.3354

Manajemen Perioperatif Pasien Atrial Septal Defect (ASD) dengan Hipertensi Pulmonal yang Menjalani Operasi Tutup Defek

Rifdhani Fakhrudin Nur, Juni Kurniawaty, Bhirowo Yudo Pratomo

Abstract

Atrial septal defect (ASD) kompleks yang tidak didiagnosis dan dikoreksi hingga usia dewasa dapat menyebabkan hipertensi pulmonal. Manajemen perioperatif operasi penutupan defek pasien ASD dewasa dengan hipertensi pulmonal memberikan tantangan tersendiri karena dikaitkan dengan tingginya komplikasi perioperatif serta peningkatan morbiditas dan mortalitas. Kami melaporkan seorang wanita berusia 23 tahun dengan ASD dan hipertensi pulmonal yang menjalani operasi tutup defek. Pemeriksaan ekokardiografi praoperasi menunjukkan ASD sekundum right-to-left shunt dengan diameter 25–30 mm dan kateterisasi jantung kanan yang menunjukkan rerata tekanan arteri pulmonal 58 mmHg dan pulmonary vascular resistance 8,1 WU. Induksi anestesi dilakukan dengan balanced opioid, dosis kecil agen induksi, dan pelumpuh otot. Hemodinamik selama operasi stabil, dan periode penyapihan cardiopulmonary bypass berjalan lancar dengan topangan dobutamin dan norepinefrin. Pascaoperasi, pasien dirawat di Intensive Care Unit dengan keadaan umum baik, hemodinamik stabil, nyeri pascaoperasi terkontrol dan tanpa kejadian komplikasi. Penilaian praoperatif yang tepat, manajemen intraoperatif yang berhasil menjaga stabilitas hemodinamik, dan manajemen pascaoperatif yang dapat mencegah dan mengatasi komplikasi pascaoperasi dapat menghasilkan luaran yang baik pada pasien ini.

Keywords

Atrial Septal Defect; hipertensi pulmonal; manajemen perioperatif; operasi tutup defek

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