Tesis

Skor-Z Diameter Annulus Katup Pulmonal Praoperatif sebagai Prediktor Regurgitasi Pulmonal Pascareparasi Tetralogy of Fallot di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita = Preoperative Pulmonary Valve Annulus Diameter Z-Score as a Predictor of Pulmonary Regurgitation after Tetralogy of Fallot Repair in National Cardiovascular Center Harapan Kita.

Latar belakang : Tetralogy of Fallot (ToF) merupakan penyebab tersering penyakit jantung bawaan sianotik dan regurgitasi pulmonal (RP) masih menjadi komplikasi jangka panjang yang paling sering ditemukan setelah operasi reparasi ToF yang memengaruhi prognosis jangka panjang pasien. Penilaian ukuran annulus katup pulmonal (AKP) praoperatif penting dalam menentukan strategi pembedahan, dan skor-z AKP berhubungan dengan peningkatan risiko RP bermakna pascareparasi ToF, namun nilai cutoffoptimalnya masih bervariasi dan belum pernah diteliti pada populasi Indonesia. Tujuan : Diketahuinya keluaran skor-z diameter AKP praoperatif sebagai prediktor kejadian RP pascareparasi ToF. Metode : Dilakukan penelitian kohort retrospektif dengan data sekunder pasien anak yang menjalani operasi reparasi ToF di Rumah Sakit Jantung dan Pembuluh Darah Harapan Kita (RSJPDHK) pada Januari 2023-Desember 2024. Diameter AKP praoperatif diukur dari multislice computed tomography (MSCT) kardiak. Keluaran berupa regurgitasi pulmonal dinilai berdasarkan ekokardiografi dalam waktu 1 bulan pascaoperasi. Hasil : Total sebanyak 1 01 subjek yang dianalisis. Terdapat hubungan signifikan antara skor-z diameter maksimal (p = 0,001) dan minimal (p < 0,001) AKP dengan kejadian RP bermakna pada analisis bivariat. Analisis multivariat menunjukkan diameter minimal AKP menjadi prediktor independen kejadian RP bermakna (p < 0,001). Hasil analisis receiver operating curve (ROC) menunjukkan skor-z diameter minimal AKP (area under the curve [AUC] 0,701; cut-off -2,5) mempunyai kemampuan diskriminasi yang cukup baik dalam memprediksi terjadinya RP. Simpulan : Skor-z AKP dapat menjadi prediktor independen terhadap kejadian RP bermakna pascareparasi ToF. Skor-z diameter minimal AKP yang diukur dengan MSCT praoperatifdapat menjadi parameter penting dalam perencanaan strategi pembedahan dan menilai risiko RP pascaoperasi.
Kata kunci : Tetralogy of Fallot, annulus katup pulmonal, skor-z annulus pulmonal, regurgitasi pulmonal, operasi bedah jantung


Background : Tetralogy of Fallot (ToF) is the most common cause of cyanotic congenital heart disease and pulmonary regurgitation (PR) remains the most frequent long-term complication after ToF repair, affecting the patient’s long-term prognosis. Preoperative assessment of the pulmonary valve annulus (PVA) size is essential in determining the surgical strategy. The PVA z-score has been shown to be associated with an increased risk of significant PR after ToF repair; however, the optimal cutoff value varies among studies and has not been investigated in the Indonesian population. Objective : To determine the predictive value of the preoperative PVA z-score diameter for the occurrence of PR after ToF repair. Methods : A retrospective cohort study was conducted using secondary data from pediatric patients who underwent ToF repair at the National Cardiovascular Center Harapan Kita between January 2023 and December 2024. Preoperative PVA diameter was measured from cardiac multislice computed tomography (MSCT). The outcome, PR, was assessed using echocardiography within one month postoperatively. Results : A total of 101 subjects were analyzed. There was a significant association between maximal and minimal diameter of PVA z-scores (p = 0,001 and p < 0,001, respectively) with significant PR in the bivariate analysis. Multivariate analysis showed only minimal diameter of PVA z-score remained significant (p < 0,001). Receiver operating characteristic (ROC) analysis showed that the minimal diameter of PVA zscore (area under the curve [AUC] 0,701; cutoff -2,5) demonstrated acceptable discriminatory ability in predicting PR. Conclusion : The PVA diameter z-score was found to be an independent predictor of significant pulmonary regurgitation after ToF repair. The minimal diameter of PVA zscore, measured by preoperative MSCT, can be an important parameter in surgical strategy planning and for assessing the risk of postoperative PR.
Keywords : Tetralogy of Fallot, pulmonary valve annulus, pulmonary annulus z-score, pulmonary regurgitation, cardiac surgery