{"id":112,"date":"2008-05-17T15:43:10","date_gmt":"2008-05-17T07:43:10","guid":{"rendered":"http:\/\/naqib.net\/?page_id=112"},"modified":"2024-01-24T23:52:57","modified_gmt":"2024-01-24T15:52:57","slug":"3-laporan-2","status":"publish","type":"page","link":"https:\/\/naqib.net\/?page_id=112","title":{"rendered":"3. Laporan"},"content":{"rendered":"<p><strong>KISAH JANTUNG NAQIB :: TGA &#8211; Transposition Of Great Arteries<\/strong><\/p>\n<p>1. <a href=\"?page_id=107\">Kronologi Dari Kelahiran &#8211;&gt; Pembedahan<br \/>\n<\/a>2. <a href=\"?page_id=108\">Istilah Perubatan Berkaitan<br \/>\n<\/a>3. <a href=\"?page_id=112\">Laporan Pembedahan<br \/>\n<\/a>4. <a href=\"?page_id=123\">Next Checkup<\/a><\/p>\n<p><a href=\"http:\/\/kamilz.com\/kamilz\/images\/ijn_header.jpg\" target=\"_blank\" rel=\"noopener\"><img loading=\"lazy\" decoding=\"async\" style=\"border: 0;\" src=\"http:\/\/kamilz.com\/kamilz\/images\/ijn_header.jpg\" alt=\"\" width=\"423\" height=\"58\" \/><\/a><\/p>\n<p><span style=\"font-size: medium;\"><strong>DISCHARGE SUMMARY<\/strong><\/span><\/p>\n<p><strong>Name : <\/strong>Ahmad Naqib Naqiuddin Bin Ahmad Kamil<br \/>\n<strong>MRN : <\/strong>16XXXX<br \/>\n<strong>IC :<\/strong> 0409XXXXXXXX<br \/>\n<strong>Date of Birth : <\/strong>22\/09\/2004<br \/>\n<strong>Admission Date :<\/strong> 28\/11\/2004<br \/>\n<strong>Discharge Date: <\/strong>07\/01\/2005<br \/>\n<strong>Consultant : <\/strong>Dr. Haifa Abdul Latif \/ Mr. Hamdan Leman<br \/>\n&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<br \/>\n<strong>Principal Diagnosis : <\/strong>Simple transposition of great arteries with involuted right ventricle. Status post balloon atrial septostomy (23\/9\/2004).<br \/>\n&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<br \/>\n<strong>Secondary Diagnosis: <\/strong>Pre-existing conditions or complications that arose which required treatment during this hospitalisation:<br \/>\n&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<\/p>\n<p><strong> Principal Operation(s) and or Procedure(s) :<\/strong><\/p>\n<p>1). Right Blalock-Taussig Shunt and pulmonary artery banding for left ventricular retraining were done on 3rd December 2004 by Mr. Hamdan&#8217;s team. Findings: Left ventricle involuted.<\/p>\n<ul>\n<li>Left ventricle pressure 20\/16. Left ventricle \/ aorta &lt; 0.7.<\/li>\n<li>Right ventricle 80\/40..<\/li>\n<li>D-transposition of great arteries..<\/li>\n<li>Aorta anterior to the right of pulmonary artery.<\/li>\n<li>Pulmonary artery : aorta =2:1.<\/li>\n<li>Single coronary artery.<\/li>\n<li>Post pulmonary artery banding and right Blalock-Taussig Shunt:<\/li>\n<li>Oxygen saturation 67% on Fi02 100%.<\/li>\n<li>Left ventricle 60\/20. Aorta 80\/38.<\/li>\n<\/ul>\n<p>2). Arterial switch operation and pulmonary artery debanding were done on 17th December 2004 by Mr. Hamdan&#8217;s team.<br \/>\nFindings:<\/p>\n<ul>\n<li>D-transposition of great arteries. Aorta anterior to pulmonary artery (30% anterior to the right).<\/li>\n<li>Pericardial adhesion.<\/li>\n<li>Right Blalock-Taussig Shunt functioning. Pulmonary artery banding in-situ. Patent ductus arteriosus small and patent.<\/li>\n<li>Coronaries 1 &#8211; LR 2Cx.<\/li>\n<\/ul>\n<p>3). Delayed sternal closure was done on 18th December 2004 by Mr. Hamdan&#8217;s team.<br \/>\n&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<\/p>\n<p><strong>Brief Hospital Course:<\/strong><\/p>\n<p>A). Post pulmonary artery banding and Blalock-Taussig Shunt.<br \/>\n1). Blocked shunt.<br \/>\n&#8211; About 2 hours postop, he was noted to desaturated to 40%.<br \/>\n&#8211; Urgent echocardiography revealed :<\/p>\n<ul>\n<li>No pericardial effusion.<\/li>\n<li>Tachycardic heart.<\/li>\n<li>Poor left ventricular function LVEF = 32%.<\/li>\n<li>Pulmonary artery band pressure gradient 39mm Hg.<\/li>\n<li>Right Blalock-Taussig Shunt not seen.<\/li>\n<\/ul>\n<p>&#8211; So heparin infusion lOunits\/kg\/hour was commenced immediately.<br \/>\n&#8211; Following that oxygen saturation gradually improved.<br \/>\n&#8211; About 7 hours later shunt murmur could be heard and his oxygen saturation maintain &gt; 75%.<br \/>\n&#8211; Repeat echocardiography reveal Blalock-Taussig Shunt flow seen but minimal.<\/p>\n<p>2). Pneumonia.<br \/>\n&#8211; Serial CXR done since post operative day 4 showed pneumonic changes.<br \/>\n&#8211; Initially he was treated with IV Rocephine and IV Amikacin.<br \/>\n&#8211; However as he still having low grade fever after 6 days of these antibiotics, he was started on IV Imipenam.<br \/>\n&#8211; All cultures were negative.<\/p>\n<p>3). Ventilator dependent.<br \/>\n&#8211; On post operative day 5, he persistently had lowish oxygen saturation despite on high ventilatortings.<br \/>\n&#8211; So nitric oxide ventilation was commenced immediately.<br \/>\n&#8211; Following that his oxygen saturation improved.<br \/>\n&#8211; So his nitric oxide ventilation was gradually wean down and managed to off after 6 days.<br \/>\n&#8211; However he required quite high ventilatortings and had difficulty in weaning down histing.<br \/>\n&#8211; Discussion was done in the cardiothoracic &#8211; paediatric cardiology meeting and decided<br \/>\nto proceed with arterial switch and pulmonary artery debanding.<\/p>\n<p>B). Post arterial switch operation:<\/p>\n<p>1). Pulmonary hypertension.<br \/>\n&#8211; Immediately postop, he was noted to have high pulmonary artery pressure that is about 1\/2 systemic.<br \/>\n&#8211; So nitric oxide ventilation and primacor infusion were commenced immediately.<br \/>\n&#8211; Following that his pulmonary artery pressure gradually decreased to 1\/3 systemic.<br \/>\n&#8211; So his nitric oxide ventilation and primacor infusion were gradually wean down and was off by post operative day 3 and post operative day 6 respectively.<\/p>\n<p>2). Renal impairment.<br \/>\n&#8211; Few hours postop, he was noted to have decreased urine output and his body became oedematous.<br \/>\n&#8211; So peritoneal dialysis was inserted and lasix infusion were commenced immediately.<br \/>\n&#8211; Following that he had good urine output.<br \/>\n&#8211; His peritoneal dialysis and lasix infusion were discontinued by post operative day 3.<\/p>\n<p>3). Wound infection.<br \/>\n&#8211; On post operative day 6, his wound was noted to be infected.<br \/>\n&#8211; Wound swab C&amp;S : no growth.<br \/>\n&#8211; Treated with IV Vancomycin and IV Amikacin for 10 days.<\/p>\n<p>4). Presumed sepsis.<br \/>\n&#8211; On post operative day 12 he was noted to have thrombocytosis and leucocytosis.<br \/>\n&#8211; Treated with IV Imipenam for 1 week.<br \/>\n&#8211; Blood C&amp;S : no growth.<\/p>\n<p>5). Chronic lung disease.<br \/>\n&#8211; His serial CXR since post operative day 6 shows chronic lung changes.<br \/>\n&#8211; Had failed trial of extubation twice.<br \/>\n&#8211; Finally managed to extubate him by post operative day 10.<br \/>\n&#8211; He was given IV Dexamethasone according to BPD regime and was put on Budesonide MDI and combivent MDI.<\/p>\n<p><strong>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<\/strong><\/p>\n<p><strong> Condition of Patient upon Discharge :<\/strong><\/p>\n<p>Pink with oxygen saturation &gt; 95% on air.<br \/>\nMildly tachypnoeic.<br \/>\nAfebrile.<br \/>\nLungs : clear.<br \/>\nCardiovascular system: Ejection systolic murmur at left sternal edge 3\/6.<br \/>\nEcho:<br \/>\n&#8211; No pericardial effusion \/ pleural effusion.<br \/>\n&#8211; Both diaphragm moving well.<br \/>\n&#8211; Normal chambers size.<br \/>\n&#8211; Good left ventricular function ejection fraction 70%.<br \/>\n&#8211; No mitral regurgitation \/ tricuspid regurgitation.<br \/>\n&#8211; Mild pulmonary regurgitation pressure gradient 11mm Hg ( normal pulmonary artery pressure ).<br \/>\n&#8211; Proximal right pulmonary artery \/ left pulmonary artery well seen and no obstruction.<br \/>\n&#8211; Small patent foramen ovale with left to right shunt.<br \/>\n* Pleural and pericardia! effusion are common complications following cardiac surgery. They should be suspected if the patient presents with cardio-respiratory symptoms.<\/p>\n<p><strong>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<\/strong><\/p>\n<p><strong> Medications :<\/strong><br \/>\nSyr. Lasix &#8211; 5mg tds<br \/>\nSyr. Captopril &#8211; 3mg bd<br \/>\nSyr. Aldactone &#8211; 6.25mg bd<br \/>\nSyr. Viagra &#8211; 2mg 6 hourly<br \/>\nBudesonide MDI &#8211; 400mcg bd<br \/>\nCombivent MDI &#8211; 200mcg 6 hourly<\/p>\n<p><strong>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<\/strong><\/p>\n<p><strong> Follow up care (Clinic Visit) :<\/strong><br \/>\nTo come again 6 weeks for review ( 22\/2\/2005 @ 11.00am) &#8211; Cardiothoracic doctor .<br \/>\nTo come again 3 months for review (13\/4\/2005 @ 10.00am) &#8211; Paediatric cardiology doctor.<\/p>\n<p><strong>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<\/strong><\/p>\n<p><strong>Referring Doctor :<\/strong><br \/>\nProf. Madya Dr. Bilkis Abd. Aziz<br \/>\nPakar Perunding Kardiologi Kanak-Kanak Address :<br \/>\nHospital Universiti Kebangsaan Malaysia<br \/>\nJalan Yaacob Latif<br \/>\nBandar Tun Razak<br \/>\n56000 Cheras<br \/>\nKuala Lumpur.<\/p>\n<p><strong>&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;&#8212;<\/strong><\/p>\n<p><strong> Senior Registrar \/ Medical Officer :<\/strong> Dr. Rozaina Hj Md Said, Senior Medical Officer<br \/>\nMBBS (UM)<br \/>\nDepartment of Pedriatic Cardiology,<br \/>\nInstitut Jantung Negara Sdn Bhd,<br \/>\nKuala Luimpur.<br \/>\n<strong>Date : <\/strong>7th January 2005<\/p>\n<p><strong>Topik Seterusnya<\/strong><\/p>\n<p>1. <a href=\"?page_id=107\">Kronologi Dari Kelahiran &#8211;&gt; Pembedahan<br \/>\n<\/a>2. <a href=\"?page_id=108\">Istilah Perubatan Berkaitan<br \/>\n<\/a>3. <a href=\"?page_id=112\">Laporan Pembedahan<br \/>\n<\/a>4. <a href=\"?page_id=123\">Next Checkup<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>KISAH JANTUNG NAQIB :: TGA &#8211; Transposition Of Great Arteries 1. Kronologi Dari Kelahiran &#8211;&gt; Pembedahan 2. Istilah Perubatan Berkaitan 3. Laporan Pembedahan 4. Next Checkup DISCHARGE SUMMARY Name : Ahmad Naqib Naqiuddin Bin Ahmad Kamil MRN : 16XXXX IC : 0409XXXXXXXX Date of Birth : 22\/09\/2004 Admission Date : 28\/11\/2004 Discharge Date: 07\/01\/2005 Consultant [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":106,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-112","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/naqib.net\/index.php?rest_route=\/wp\/v2\/pages\/112","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/naqib.net\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/naqib.net\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/naqib.net\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/naqib.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=112"}],"version-history":[{"count":1,"href":"https:\/\/naqib.net\/index.php?rest_route=\/wp\/v2\/pages\/112\/revisions"}],"predecessor-version":[{"id":1283,"href":"https:\/\/naqib.net\/index.php?rest_route=\/wp\/v2\/pages\/112\/revisions\/1283"}],"up":[{"embeddable":true,"href":"https:\/\/naqib.net\/index.php?rest_route=\/wp\/v2\/pages\/106"}],"wp:attachment":[{"href":"https:\/\/naqib.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=112"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}