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Anestesi spinal untuk seksio sesarean pada wanita hamil dengan defek septum atrium sekundum yang luas



Abstract

Atrial septal defect is one of the most common congenital heart diseases found in parturient. Most patients are asymptomatic before pregnancy, but chronic shunt form left to right atrium through the atrial septal defect can result in excess volume and right ventricular enlargement, which will be aggravated by volume retention in pregnancy. Furthermore, right atrial enlargement can predispose to atrial arrhythmias. Parturient with atrial septal defects also have a higher risk of preeclampsia, fetal death, and preterm birth than those without heart abnormalities. Management of anesthesia in pregnant women with congenital heart disease not only sees the effects of heart disease, but also the physiological changes caused by pregnancy. Finnally, we can decide the optimal anesthetic technique for the termination. The aim of management of anesthesia in patients with atrial septal defects is to avoid dysrhythmias, increase systemic vascular resistance, and decrease pulmonary vascular resistance which can worsen left-to-right shunt which can lead to right ventricular failure and pulmonary hypertension. We report a 23-year-old woman with a first pregnancy of a large atrial septal defect secundum who will undergo cesarean section surgery with a spinal anesthetic technique.

 

Defek septum atrium merupakan salah satu penyakit jantung bawaan yang sering didapatkan pada wanita hamil. Kebanyakan pasien tidak memiliki gejala sebelum kehamilan, namun aliran darah yang khronis dari atrium kiri ke atrium kanan melalui defek septum atrium dapat mengakibatkan kelebihan volume dan pembesaran ventrikel kanan, yang akan diperberat oleh retensi volume pada kehamilan. Selanjutnya, pembesaran atrium kanan dapat menjadi predisposisi dari aritmia atrial. Wanita hamil dengan defek septum atrium juga memiliki risiko preeklamsia, kematian janin, dan kelahiran prematur yang lebih tinggi dibandingkan mereka yang tidak memiliki kelainan jantung. Manajemen anestesi pada wanita hamil dengan penyakit jantung bawaan tidak hanya melihat efek dari penyakit jantung, tapi juga perubahan fisiologi yang diakibatkan oleh kehamilan. Sehingga kita dapat memutuskan teknik anestesi yang optimal sewaktu terminasi dilakukan. Tujuan dari manajemen anestesi pada pasien dengan defek septum atrium adalah menghindari disritmia, peningkatan resistensi vaskular sistemik, dan penurunan resistensi vaskular paru yang dapat memperburuk pirau kiri ke kanan yang dapat memicu kegagalan ventrikel kanan dan hipertensi pulmonal. Kami melaporkan seorang wanita 23 tahun dengan kehamilan pertama defek septum atrium sekundum luas yang akan menjalani operasi seksio sesarea dengan teknik anestesi spinal.

Keywords: Defek septum atrium kehamilan anestesi spinal

References

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How to Cite

Wibisana Kurniajaya, I. G. A. M., & Ketut Wibawa Nada. (2021). Anestesi spinal untuk seksio sesarean pada wanita hamil dengan defek septum atrium sekundum yang luas. Medicina, 52(2), 108–110. https://doi.org/10.15562/medicina.v52i2.649
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I Gusti Agung Made Wibisana Kurniajaya
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Ketut Wibawa Nada
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