JOURNAL ANALYSIS

KEPERAWATAN ANAK II
SHORT-TERM OUTCOMES OF TRANSCATHETER CLOSURE OF ATRIAL
SEPTAL DEFECT IN CHILDREN AND ADOLESCENTS

Dosen Pengampu :
Eva Puspita Istiyana S.TR Kep

Disusun oleh :

Rana Nisrina Yahya 201813092

PROGRAM STUDI S1 KEPERAWATAN TK. III (B)

Jl. Ibrahim Adjie No.180, Sindangbarang, Bogor Barat 16117
Phone: 025.8327396 / 02518327399
E-mail: wijayahusada@gmail.com
Website: www.wijayahusada.com
 KRITISI JURNAL METODE PICO
"Short-term outcome of transcatheter closure of Atrial Septal Defect in children
and adolescents"

BAB I
ANALISI JURNAL

A. Judul Penelitian
"Short-term outcome of transcatheter closure of Atrial Septal Defect in children and
adolescents"
B. Peneliti
Safaa H. Ali An, Amal El Sisi, Duaa M. Raafat, Salah-Eldin Amry, Sharaf ED Mahamoud.
C. Ringkasan Jurnal
Atrial septal defects have been reported to be a 10% prevalence among congenital heart
defects and, if left untreated, even though they are recognized as benign, can contribute to
significant morbidity and mortality. very good. However, although surgical treatment is safe,
it is associated with morbidity and thoracotomy scarring. The first successful non-surgical
closure of ASD was described in 1974 by King and Mills. Numerous studies have shown that
individual devices provide a safe and effective alternative to surgical secundum closure of
ASD. In developing countries, Barriers to surgical procedures include the limited number of
intensive care unit beds, cardiac surgeons, intensive care professionals, and other resources.
Therefore, recent advances in the treatment of non-surgical ASD with devices have become
the treatment of choice in resource-limited countries. In this study, we evaluated the acute
and short-term outcomes of transcatheter closure of ASD in children and adolescents during
the first 4 years of experience in two institutional centers in Egypt. Sohag and Assiut
University Hospital.
D. Tujuan Penelitian
To evaluate the acute and short-term outcome of transcatheter closure of the secundum
atrial septal defect (ASD) in children and adolescents in the first 4 years of experience in two
institutional centers in Egypt
E. Kelebihan dan Kekurangan
1. Kelebihan
a. Researchers clearly explain the Atrial Septal Defeck
b. The researchers explained that the transcateter closure is safe for children
c. The researcher explains in detail the methods and procedures for ASD
2. Kekurangan
a. Researchers did not explain in detail about the data collection on patients completely
 BAB II
PEMBAHASAN

A. Problem
This study used a retrospective cohort study method that included 135 children and
adolescents currently undergoing ASD closure between April 2012 and May 2016. A review of
acute and short-term outcomes and side effects was conducted. Informed consent was obtained
from parents of children and adolescents. Inclusion criteria included children and adolescents
with a clinical diagnosis of single or multiple ASD with left-to-right shunt and excess right
ventricular volume on echocardiography.

B. Intervention
In this study data collection was taken at two institutional centers in Egypt. Sohag
University. The ADS secundum closure transcatheter was tried in 135 patients. In the patient trial
procedure, all patients will receive an intravenous claforan injection 30 minutes before the
procedure. The procedure is performed under general anesthesia.
C. Comparation
1. Journal "Results period short of closure transcatetet Atrial Septal Defect in children
and adolescents "
Result:
The patients had an amedian age of 5 years (interquartile range: 3-9 years), 71% of the
patients were 5 years old, and a mean weight was 17 kg (interquartile range: 13-30 kg).
Single defect was observed in 113 patients (84%). The rest have some defects or are
multifenestrated which one device covers. The mean defect sizes of the single defect and the
mean length of the interatrial septum were 15.24 ± 5.16 mm and 38.13 ± 6.3 mm,
respectively. The ratio of instrument to measure TEE (Transoesophageal echocardiography)
of ASD was 1.19 ± 0.12. The device was successfully implanted in 98.5% of patients. Six
cases had appropriate PS (pulmonary stenosis), patent ductus arteriosus or perimembranous
ventricular septal defect and were treated with balloondilation, or closure. No file remains
were seen after device placement except in one patient with multiple fenestrations. There
were five side effects with high severity (3.7%) without death. Device erosion was confirmed
 in one of the two patients with massive hemopericardium; embolization of the device by
taking in one patient; and heart block was detected in two cases. No cardiac perforation,
device erosion, embolization, thrombus formation, or clinical evidence of bacterial
endocarditis were observed during follow-up.
2. Journal "The efficacy and safety of using amplatzer for transcatheter closure of atrial of
septal defect in small children with less than 10 kg "
Result:
The mean age of the patients at the transcatheter procedure was 12.06 ± 4.47 months (range:
6 to 14 months), the mean weight was 8.32 ± 0.72 kg (range: 7.5 to 9 , 8 kg). The mean
defect size was 10.00 ± 2.32 mm (range: 6-13 mm). The average device size used was 10.57
± 2.57 mm (range: 7.5 to 15 mm). The mean duration of follow-up was 16.66 ± 6.93 months
(range: 1-29 months). The ratio of respiratory rate, heart rate, pulmonary stenosis (PS), and
Qp to Qs had significant differences before and after the procedure during follow-up (P
<0.001). In addition, there was a left to right shunt in all patients. Based on the results,
closure of ASD was successful for all patients.
3. Journal of "Transcatheter device of atrial septal defects guided completely by
transthoracic echocardiogtaphy"
Result:
The successful closure of 150 patients and surgical repair was required in two patients. The
sizes of the applied ocluders range from 10 mm to 38 mm and the duration of the procedure
ranges from 30 to 90 minutes. No fatal complications were observed. Minor complications of
transient arrhythmias during the process of spreading the device. The follow-up period was 3
months to 2 months years, with no discharging occlusion, residual fistula, or thrombus-
related complications. In our comparative study, none were statistically significant.
Differences were observed in the success and complication rates.
4. Journal of "Transcatheter and intraoperative device closure and surgical repair for
Atrial Septal Defect"
Result:
Successful closure rates were similar in all three groups. There were significant differences in
aortic crss-clamping time, CPB duration and operative time between the bedan and device
groups. The length of stay in the intensive care unit, postoperative mechanical ventilation
 time and length of hospital stay were shorter in the two device groups than in the surgical
group. The longest incision in group surgery.
5. Journal "Conscious sedation using dexmedetomidine for percutaneous transcatheter
closure of atrial septal defects"
Result:
A total of 43 patients with a mean age of 12 to 56 years were analyzed. Under anesthesia
and requires recovery time. 16 women and 1 male patient required additional propofol. In
dexmedetomidine for ASD transcatheter it is a safe, effective closure and an appropriate
anesthetic.
6. Komparasi pada Jurnal
Atrial Septal Defect is a congenital heart disease in the form of a hole (defect) in the
interatrial septum that occurs due to failure of the interatrial septal fusion during the fetus.
Atrial Septal Defect (ASD) is a disease involving almost the entire atrial septum. Congenital
heart disease (CHD) is the most common and accounts for about 10% of CHD, which is
considered to be the third common CHD in the world. There are different types of this
malformation, which cause
blood flow between the systemic and respiratory bloodstream. The majority of these atrial
defects can be observed in the central area of the atrial septum and fossa ovalis, the size of
which can vary from a small opening to a very large defect.
Closure of transcatheter devices for atrial ostium secundum septal defects has been practiced
for over forty years. surgical closure of ASD can significantly improve right ventricular
function and morphology.
D. Outcome
From the results of this study it is proven secundum ASD transcatheter closure on
children and adolescents were viable and safe in the first 4 years of experience at our two
centers, with good medium-term outcomes. Balloon size is not required for secundum closure of
the ASD transcatheter. Multiple ASDs can be closed securely with one device.In this study,
successful closure was achieved in 98.5% of cases. There were 21 cases which had multiple or
multifenestrated defects which were closed with a single device; either a Cribriform Amplatzer
septal occluder or a larger device. This agrees with Hu et al. Who reported the safety and
efficacy of closing multiple defects with a single device, without distinction from multiple
occlusion, although the risk of residual shunting was greater with multiple occlusion. However, it
is possible that previous studies have recommended covering multiple defects> 7 mm apart with
two devices.
The most common serious complications reported in a recent analysis of the Food and
Drug Administration Manufacturer and User Facility Device Experience (MAUDE) database
were dislodged devices and cardiac perforation, erosion, or rupture.