Tesis

Hubungan fibrosis miokard ventrikel kiri dengan morbiditas pascaoperasi katup mitral pada stenosis mitral akibat penyakit jantung rematik = Relationship of left ventricular myocardial fibrosis with morbidity after mitral valve surgery in rheumatic mitral stenosis.

Latar belakang: Fibrosis miokard sering ditemukan pada kasus Stenosis Mitral (SM) akibat Penyakit Jantung Rematik (PJR). Keberadaan fibrosis miokard dapat mempengaruhi luaran klinis pascaoperasi jantung terutama pada populasi Penyakit Jantung Koroner (PJK) dan kelainan katup aorta. Namun hal ini belum diketahui pada kasus SM akibat PJR. Tujuan: Mengetahui hubungan luas fibrosis miokard ventrikel kiri terhadap morbiditas pascaoperasi katup mitral di Rumah Sakit (RS) pada pasien SM akibat PJR. Metode: Pasien dengan SM akibat PJR yang akan menjalani operasi katup mitral diperiksakan MRI jantung untuk mengevaluasi LGE. Morbiditas pascaoperasi di RS akan ditelaah melalui data rekam medik. Hasil: Terdapat 47 pasien yang menjadi subjek penelitian. Terdapat perbedaan rerata luas fibrosis miokard ventrikel kiri antara kelompok yang mengalami morbiditas pascaoperasi katup mitral dan yang tidak (5,97 ± 4,16% & 3,12 ± 2,62%, p=0,04). Hubungan bermakna tersebut diduga dipengaruhi oleh perubahan hemodinamik pascaoperasi antara kedua kelompok. Variabel lain yang memiliki hubungan dengan morbiditas pascaoperasi katup mitral adalah jenis kelamin dan mean MVG. Kesimpulan: Luas fibrosis miokard ventrikel kiri berhubungan dengan morbiditas pascaoperasi katup mitral di RS pada pasien SM akibat PJR.
Kata Kunci: fibrosis miokard, Late Gadolinium Enhancement (LGE), stenosis mitral, Penyakit Jantung Rematik (PJR).


Background: Myocardial fibrosis is a common finding in Mitral Stenosis (MS) caused by Rheumatic Heart Disease (RHD). Myocardial fibrosis may affect morbidity after cardiac surgery, especially among Coronary Heart Disease (CHD) and aortic valve abnormality cases. However, this is not yet known in MS caused by RHD. Objectives: To investigate the relationship of the extent of myocardial fibrosis in left ventricle with in-hospital morbidity after mitral valve surgery in patients with MS caused by RHD. Methods: Patients with rheumatic MS who were going to undergo mitral valve surgery were examined by cardiac MRI to evaluate LGE. Perioperative morbidity were extracted from medical record during hospitalization Results: Forty-seven patients were examined by LGE protocol from cardiac MRI before underwent mitral valve surgery. Significant mean difference of myocardial fibrosis was observed between patients with morbidity and patients without morbidity after mitral valve surgery (5,97 ± 4,16% & 3,12 ± 2,62%, p = 0,04). This significant association was allegedly influenced by postoperative hemodynamic changes between the two groups. Other variables associated with perioperative morbidity after mitral valve surgery were gender and mean MVG. Conclusion: The extent of left ventricular myocardial fibrosis is associated with in-hospital morbidity after mitral valve surgery in patients with rheumatic MS.
Keywords: Myocardial fibrosis, Late Gadolinium Enhancement (LGE), Mitral Stensosi, Rheumatic Heart Disease (RHD).