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Kenapa Naqiuddin Perlu Di Bedah ? KLIK DISINI untuk lihat sejarah bagaimana masalah ini dikesan.

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Istilah Perubatan Yang Berkaitan ::
Selasa 18 Januari 2005


Hari ni.. ehh bukan hari ni.. dah lepas pukul 12. Semalam Naqiuddin tak berapa mau minum susu. Tak tau mengapa. Maybe sebab sebelum ni susu ada campur ubat. Tu yang tak nak makan. Bagi ubat direct pun susah nak makan.

Malam pergi shopping cari susu. Sebab stok susu dah habis. Sambil tu beli nestum sekali.. Ehh.. bukan Nestum.. Tapi Bijirin Dumex (Nestum lak dapat nama) untuk 4 bulan keatas. Maklumle.. staff gomen dapat gaji semalam.

Balik rumah try bagi Naqiuddin makan (walaupun ada 5 hari lagi nak umur 4 bulan). Habis le juga 2-3 sudu baby tu. Kira OK () la tu.. makan pun sambil gelak?. Esok lusa pandai le tu makan banyak.

Alhamdulillah.



Sabtu 15 Januari 2005
Jam 22:39:29 MYT GMT+8 Seminggu Di Rumah


Dah seminggu dah Naqiuddin balik rumah, baru kali ni nak menulis lagi kat ruangan ni.

Hari ni sepatutnya kenduri kahwin Pak Ngah kepada Naqiuddin kat Padang Serai Kedah. Tapi kami minta maaf tak dapat balik. Walaupun kenduri tu sambil buat aqiqah untuk Naqiuddin. InsyaALLAH () kalau Naqiuddin betul? sihat nanti kami balik. Raya haji ni pun raya di KL kot, walau cuti 4 hari.

Malam bawak Naqiuddin pergi buat suntikan DPT-Hib + Polio (untuk umur dua bulan sepatutnya, sekarang umur Naqiuddin 3 bulan 24 hari). Dr ()buat suntikan, dia senyum je . Agaknya dah lali dengan sakit? suntikan ni. Dia dah alami sakit yang lagi besar masa operation. Berat dah naik balik jadi 4.8 kg, setelah turun 0.5 kg dua minggu lepas.



Jumaat 07 Januari 2005
Jam 19:06:10 MYT GMT+8 Naqiuddin dah Ada kat rumah


Alhamdulillah. Terima Kasih atas semua.

Naqiuddin kini dah kembali ke rumah di Pandan indah setelah 1 bulan 10 hari di IJN.

Siapa yang faham bacala discharge summary kat bawah




DISCHARGE SUMMARY

Name : Ahmad Naqib Naqiuddin Bin Ahmad Kamil
MRN : 167747
IC : 040922140269
Date of Birth : 22/09/2004
Admission Date : 28/11/2004
Discharge Date: 07/01/2005
Consultant : Dr. Haifa Abdul Latif / Mr. Hamdan Leman
---------------------------------------------------------------------------
Principal Diagnosis : Simple Transposition Of Great Arteries with involuted right ventricle. Status post Baloon Arterial Septostomy (23/9/2004).
---------------------------------------------------------------------------
Secondary Diagnosis: Pre-existing conditions or complications that arose which required treatment during this hospitalisation:
---------------------------------------------------------------------------

Principal Operation(s) and or Procedure(s) :

1). Right Blalock-Taussig Shunt and pulmonary artery banding for left ventricular retraining were done on 3rd December 2004 by Mr. Hamdan's team. Findings: Left ventricle involuted.
  • Left ventricle pressure 20/16. Left ventricle / aorta < 0.7.

  • Right ventricle 80/40..

  • D-Transposition Of Great Arteries..

  • Aorta anterior to the right of pulmonary artery.

  • Pulmonary artery : aorta =2:1.

  • Single coronary artery.

  • Post pulmonary artery banding and right Blalock-Taussig Shunt:

  • Oxygen saturation 67% on Fi02 100%.

  • Left ventricle 60/20. Aorta 80/38.


2). Arterial switch operation and pulmonary artery debanding were done on 17th December 2004 by Mr. Hamdan's team.
Findings:

  • D-Transposition Of Great Arteries. Aorta anterior to pulmonary artery (30% anterior to the right).

  • Pericardial adhesion.

  • Right Blalock-Taussig Shunt functioning. Pulmonary artery banding in-situ. Patent ductus arteriosus small and patent.

  • Coronaries 1 - LR 2Cx.


3). Delayed sternal closure was done on 18th December 2004 by Mr. Hamdan's team.
---------------------------------------------------------------------------

Brief Hospital Course:

A). Post pulmonary artery banding and Blalock-Taussig Shunt.
1). Blocked shunt.
- About 2 hours postop, he was noted to desaturated to 40%.
- Urgent echocardiography revealed :
  • No pericardial effusion.

  • Tachycardic heart.

  • Poor left ventricular function LVEF = 32%.

  • Pulmonary artery band pressure gradient 39mm Hg.

  • Right Blalock-Taussig Shunt not seen.

- So heparin infusion lOunits/kg/hour was commenced immediately.
- Following that oxygen saturation gradually improved.
- About 7 hours later shunt murmur could be heard and his oxygen saturation maintain > 75%.
- Repeat echocardiography reveal Blalock-Taussig Shunt flow seen but minimal.

2). Pneumonia.
- Serial CXR done since post operative day 4 showed pneumonic changes.
- Initially he was treated with IV Rocephine and IV Amikacin.
- However as he still having low grade fever after 6 days of these antibiotics, he was started on IV Imipenam.
- All cultures were negative.

3). Ventilator dependent.
- On post operative day 5, he persistently had lowish oxygen saturation despite on high ventilator settings.
- So nitric oxide ventilation was commenced immediately.
- Following that his oxygen saturation improved.
- So his nitric oxide ventilation was gradually wean down and managed to off after 6 days.
- However he required quite high ventilator settings and had difficulty in weaning down his setting.
- Discussion was done in the cardiothoracic - paediatric cardiology meeting and decided
to proceed with arterial switch and pulmonary artery debanding.

B). Post arterial switch operation:

1). Pulmonary hypertension.
- Immediately postop, he was noted to have high pulmonary artery pressure that is about 1/2 systemic.
- So nitric oxide ventilation and primacor infusion were commenced immediately.
- Following that his pulmonary artery pressure gradually decreased to 1/3 systemic.
- 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.

2). Renal impairment.
- Few hours postop, he was noted to have decreased urine output and his body became oedematous.
- So peritoneal dialysis was inserted and lasix infusion were commenced immediately.
- Following that he had good urine output.
- His peritoneal dialysis and lasix infusion were discontinued by post operative day 3.

3). Wound infection.
- On post operative day 6, his wound was noted to be infected.
- Wound swab C&S : no growth.
- Treated with IV Vancomycin and IV Amikacin for 10 days.

4). Presumed sepsis.
- On post operative day 12 he was noted to have thrombocytosis and leucocytosis.
- Treated with IV Imipenam for 1 week.
- Blood C&S : no growth.

5). Chronic lung disease.
- His serial CXR since post operative day 6 shows chronic lung changes.
- Had failed trial of extubation twice.
- Finally managed to extubate him by post operative day 10.
- He was given IV Dexamethasone according to BPD regime and was put on Budesonide MDI and combivent MDI.

---------------------------------------------------------------------------

Condition of Patient upon Discharge :


Pink with oxygen saturation > 95% on air.
Mildly tachypnoeic.
Afebrile.
Lungs : clear.
Cardiovascular system: Ejection systolic murmur at left sternal edge 3/6.
Echo:
- No pericardial effusion / pleural effusion.
- Both diaphragm moving well.
- Normal chambers size.
- Good left ventricular function ejection fraction 70%.
- No mitral regurgitation / tricuspid regurgitation.
- Mild pulmonary regurgitation pressure gradient 11mm Hg ( normal pulmonary artery pressure ).
- Proximal right pulmonary artery / left pulmonary artery well seen and no obstruction.
- Small patent foramen ovale with left to right shunt.
* Pleural and pericardia! effusion are common complications following cardiac surgery. They should be suspected if the patient presents with cardio-respiratory symptoms.

---------------------------------------------------------------------------

Medications :

Syr. Lasix - 5mg tds
Syr. Captopril - 3mg bd
Syr. Aldactone - 6.25mg bd
Syr. Viagra - 2mg 6 hourly
Budesonide MDI - 400mcg bd
Combivent MDI - 200mcg 6 hourly

---------------------------------------------------------------------------

Follow up care (Clinic Visit) :

To come again 6 weeks for review ( 22/2/2005 @ 11.00am) - Cardiothoracic doctor .
To come again 3 months for review (13/4/2005 @ 10.00am) - Paediatric cardiology doctor.

---------------------------------------------------------------------------

Referring Doctor :

Prof. Madya Dr. Bilkis Abd. Aziz
Pakar Perunding Kardiologi Kanak-Kanak Address :
Hospital Universiti Kebangsaan Malaysia
Jalan Yaacob Latif
Bandar Tun Razak
56000 Cheras
Kuala Lumpur.

---------------------------------------------------------------------------

Senior Registrar / Medical Officer :
Dr. Rozaina Hj Md Said, Senior Medical Officer
MBBS (UM)
Department of Pedriatic Cardiology,
Institut Jantung Negara Sdn Bhd,
Kuala Luimpur.
Date : 7th January 2005




Jumaat 07 Januari 2005
Jam 11:10:41 MYT GMT+8 Naqiuddin Dah Boleh Balik Rumah. Alhamdulillah.
Kategori: Jantung,IJN,Pembedahan,Naqib


Setelah 1 bulan 10 hari di IJN.... Akhirnya.. di hari Jumaat penghulu segala hari...

Ibu Naqiuddin baru bayar bil wad IJN. InsyaALLAH () tengahari ni abah Naqiuddin nak ambik bawak balik rumah.

Kena bayar bil RM 264.00 sebab guna Guarantee letter (GL) staff kerajaan. Kalau bayar sendiri kena RM 64, 989.19. Alhamdulillah, dapat kerja dengan kerajaan 2 minggu sebelum Naqiuddin lahir. Kalau tak.. tak tau kat mana nak korek duit.



Khamis 06 Januari 2005
Jam 21:08:37 MYT GMT+8 Esok Naqiuddin Balik Rumah
Kategori: Jantung,IJN,Pembedahan,Naqib


Hari ni buat Echo. Alhamdulillah, OK () tak ada masalah. Esok akan diberi ubat untuk kali terakhir, dan petang InsyaALLAH () boleh balik rumah. Alhamdulillah.

Malam esok juga Pak Ngah dan bakal Mak Ngah Naqiuddin akan bernikah kat Kg Manjoi, Ipoh. Minta maaflah sebab kami tak dapat join sekali majlis tu. Moga majlis berjalan lancar.



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