Tatalakasana Terkini Hipertensi Pulmoner pada Anak

Dyahris Koentartiwi; Ardhanis Ramadhanti; Ervan Aditya Putra Chafid

doi:10.20527/jps.v10i2.13407

Tatalakasana Terkini Hipertensi Pulmoner pada Anak

Dyahris Koentartiwi, Ardhanis Ramadhanti, Ervan Aditya Putra Chafid

Abstract

Hipertensi pulmoner (HP) merupakan suatu kondisi dimana terjadi peningkatan tekanan vaskular paru yang berkaitan dengan berbagai etiologi. Pada anak, sekitar 50% HP seringkali ditemukan pada pasien dengan penyakit jantung bawaan dengan left-to-right shunt, penyakit pulmonal, gangguan perkembangan paru serta idiopatik. Insiden HP pada anak secara umum dilaporkan sebesar 4-10 kasus per 1 juta anak per tahun. Terapi koreksi secara operatif atau kateterisasi masih menjadi pilihan utama untuk koreksi HP. Namun tingkat morbiditas dan mortalitas paska koreksi dilaporkan cukup tinggi. Oleh karena itu, beberapa studi terus mengkaji dan mengembangkan pilihan terapi untuk HP. Beberapa diantaranya adalah terapi vasodilator dengan PDE-5, CCB, analog prostasiklin dan inhalasi NO. Karena etiologi yang sangat komplek dan belum banyak bukti klinis atau konsensus tentang tatalaksana HP pada anak, maka pemilihan terapi HP yang sesuai masih cukup sulit. Pada prinsipnya tujuan utama dari terapi HP adalah meningkatkan angka harapan hidup dan memfasilitasi pasien agar dapat melakukan aktivitas secara mandiri tanpa limitasi. Tujuan dari penulisan tinjauan kepustakaan ini adalah untuk membahas tentang tatalaksana terkini HP pada anak sehingga diharapkan dapat menambah pengetahuan dan referensi sebagai dasar praktis klnis tentang tatalaksana HP pada anak.

Kata Kunci: Penyakit Jantung Bawaan, Hipertensi Pulmoner, Anak, Left-to-right Shunt, Vasodilator

Pulmonary hypertension (PH) is a condition in which pulmonary vascular pressure increases and associated with diverse diseases or etiology. In children, 50% of PAH cases are caused by CHD, especially due to large left-to-right shunts. Another causes were developmental lung diseases and idiopatic PH. The estimated incidence of sustained PH in all categories was reported at 4–10 cases per million children per year. Corrective procedures by surgery or catheterization are the therapies of choice for reversible PH. Since morbidity and mortality due to PAH after correction is high, many recent studies have been done on the evaluation in treatment option of PH. Several vasodilator therapy including sildenafil (Phosphodiesterase type 5 inhibitor), Calcium Channel Blocker, Prostacyclin Analogs and Nitric Oxide were recommendation therapy. Various etiologies and lack of consensus make it difficulty in management of PH. The ultimate goal of treatment should be improved survival and to facilitate normal activities of childhood without self-limitation. Therefore, this review was aimed to discuss about recent management of PH in children.

Keywords

Congenital Heart Disease, Pulmonary hypertension, Children, Left-to-right shunt, Vasodilator

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DOI: http://dx.doi.org/10.20527/jps.v10i2.13407