Bayi VSD

Berbanding golongan dewasa yang lebih cenderung mengalami serangan koronari akibat salur darah tersumbat, kes jantung membabitkan kanak-kanak pula kebanyakannya berkait dengan kelainan jantung kongenital seperti jantung berlubang sejak lahir.

Antara masalah jantung berlubang yang berlaku pada bayi baru lahir ialah kecacatan septum atrium atau ASD (atrial septal defect) dan kecacatan septum ventrikel atau VSD (ventrical septal defect).

Baik di Malaysia mahupun dunia, VSD tersenarai sebagai masalah jantung berlubang paling banyak direkodkan dalam kalangan kanak-kanak dan kerap dirawat.

Asasnya, VSD merujuk kepada lubang atau kecacatan pada dinding (septum) di antara dua bilik pengepam jantung (ventrikel).

Dalam hal ini, darah akan mengalir melalui lubang terbabit dari bilik pengepam kiri jantung (ventrikel kiri) ke bilik pengepam kanan jantung (ventrikel kanan) sebelum keluar ke salur darah paru-paru.

VSD atau lubang yang kecil tidaklah begitu memberi kesan malah tidak membawa sebarang impak langsung. Cuma, ada deruan jantung yang akan mengeluarkan bunyi kuat.

Boleh jadi lubang yang kecil tidak memerlukan rawatan kerana lama-kelamaan mungkin akan tertutup dengan sendiri.

Tetapi, bagi VSD yang besar, ia menyebabkan darah dipam secara berlebihan ke dalam salur darah paru-paru lalu memaksa jantung dan paru-paru bekerja lebih kuat. Akibatnya, jantung kiri membengkak dan paru-paru menjadi sesak.

Bagi VSD besar, gejala dapat dilihat dengan jelas pada bayi beberapa minggu selepas dilahirkan antaranya sesak nafas, masalah penyusuan dan tumbesaran terbantut.

Semua tanda ini timbul disebabkan berlaku pengaliran darah berlebihan ke paru-paru dan jantung bekerja lebih laju.

Dalam hal ini, rawatan sangat digalakkan malah perlu disegerakan. Ini kerana, darah berlebihan yang mengalir ke jantung kiri terus ke paru-paru hingga memaksa jantung dan paru-paru bekerja lebih kuat memberi tekanan lebih tinggi kepada paru-paru.

Untuk jangka masa panjang, keadaan ini mengakibatkan kerosakan kekal pada salur darah paru-paru.

Bagi mencegah ia berlaku, lubang yang besar ditutup awal menerusi kaedah pembedahan supaya masalah serius dapat dielak.

Perlu diingat, ubat tidak akan memulihkan kecacatan sebaliknya sekadar membantu mengawal kegagalan sementara menunggu pembedahan penutupan VSD dilakukan nanti.

Dalam keadaan tertentu, meskipun VSD atau lubang yang kecil tidak menimbulkan sebarang kesan kepada anak, ia juga masih bergantung kepada kawasan lubang terbentuk.

Misalnya jika VSD berada berhampiran injap aorta, kemungkinan injap berkenaan termasuk ke dalam lubang boleh berlaku yang seterusnya menyebabkan ia bocor.

Oleh itu, penutupan VSD secara pembedahan diperlukan meskipun VSD adalah kecil berikutan kobocoran injap berkenaan selain keadaan injap yang berubah bentuk.

Ketua Jabatan Pusat Jantung Pediatrik Institut Jantung Negara (IJN), Dr Hasri Samion berkata, kebiasaannya penutupan VSD secara pembedahan dibuat menggunakan tampalan fabrik atau tampalan perikardium iaitu tisu yang melapisi jantung.

Bagaimanapun, kadangkala ia juga boleh dibuat dengan terus saja menjahit tanpa ditampal manakala muskular VSD yang tertentu boleh ditutup secara transkateter menggunakan alat penutup VSD.

“Kita juga menggunakan alat pacu jantung yang tahan lama mengikut kesesuaian jangkaan hayatnya. Kalau mahu dia hidup berpuluh-puluh tahun, mana mungkin kita gunakan alat pacu jantung yang cuma bertahan selama setahun.

“Masalah jantung berlubang mempunyai potensi sangat besar untuk sembuh jika dirawat lebih awal. Realitinya, sejak tiga tahun kebelakangan ini, hampir 100 peratus kes jantung berlubang membabitkan kanak-kanak di IJN berjaya dirawat.

“Dalam tempoh lima tahun lalu, IJN menerima 1,800 hingga 2,000 kes setahun dengan suku berjaya dirawat tanpa memerlukan rawatan intervensi, menggunakan teknik yang tidak perlu dibedah,” katanya.

Beliau ditemui selepas Majlis Menandatangani Memorandum Persefahaman (MoU) Program MyHeart MyPrihatin dan Yayasan IJN di Kuala Lumpur, baru-baru ini, yang menyasar kerjasama untuk mengendali dan menampung kos rawatan serta pembedahan pesakit jantung kanak-kanak yang menghadapi masalah kewangan.

Jelas Dr Hasri, bayi VSD yang harus dirawat segera antaranya mengalami gejala teruk, terlalu kecil saiznya, mempunyai lebih daripada satu VSD serta mengalami VSD di bahagian yang tidak lazim.

Bagi keadaan seumpama ini kata beliau, bayi mungkin perlu menjalani pembedahan sementara untuk meringankan gejala serta mengurangkan tekanan tinggi di dalam paru-parunya.

“Prosedur ini berbentuk pengikatan salur darah paru-paru yang akan mengehadkan aliran darah. Apabila kanak-kanak terbabit lebih besar, pembedahan VSD akan dilakukan bagi mengeluarkan pengikat tadi dan menutupnya.

“Kesan jangka panjang kepada kanak-kanak yang menjalani pembedahan adalah sangat baik. Bagaimanapun, pemeriksaan susulan mungkin perlu diteruskan bagi mengesan masalah yang jarang-jarang berlaku, seperti injap aorta,” katanya.

Mengulas lanjut, ibu bapa seharusnya sedar kepentingan merujuk dan merawat anak yang bermasalah jantung berlubang lebih awal berikutan ia mampu dipulihkan.

Malah kebanyakan kes jantung berlubang dikendalikan pihaknya hanya memerlukan sekali rawatan malah ada yang tutup dengan sendiri menerusi teknik rawatan tanpa pembedahan.

“Pasangan muda khasnya, harus sedar kepentingan rujukan dan rawatan segera. Bayangkan, separuh daripada lebih 4,000 kes kongenital tidak memerlukan rawatan intervensi disebabkan mereka merujuk kepada hospital lebih awal.

“Bilangan pesakit jantung saban tahun terus meningkat dan kita tidak mahu kanak-kanak yang boleh dirawat lebih awal tergolong dalam kumpulan ini apabila dewasa nanti,” katanya.

Dr Hasri juga berkata, data menunjukkan 50 peratus kanak-kanak sindrom Down turut mengalami masalah jantung berlubang.

Menurutnya, dalam kes kongenital, kebiasaannya pembentukan jantung tidak berlaku dengan sempurna, namun ia boleh dikesan seawal ketika hamil lagi.

“Menggunakan gelombang bunyi untuk menggambarkan keadaan jantung janin, ubat akan diberi jika didapati ia berdenyut terlalu cepat atau perlahan.

“Bagaimanapun, jika tidak dapat dirawat sebelum dilahirkan, kita akan atur kaedah rawatan terbaik yang boleh diberi sejurus bayi lahir,” katanya.

Lubang pada dinding di antara dua bilik pengepam jantung.

Lubang kecil: Bunyi deruan jantung kuat.

Lubang besar: Sesak nafas, masalah penyusuan dan tumbesaran terbantut.

JIKA TAK DIRAWAT

Lubang kecil: Injap aorta boleh bocor jika lubang berada hampir dengannya.

Lubang besar: Tekanan paru-paru jadi tinggi dan salur darah paru-paru rosak kekal.

CARA RAWAT

Lubang kecil: Pembedahan hanya untuk keadaan membabitkan injap aorta.

Lubang besar: Pembedahan jantung dan penutupan VSD.

SELEPAS BEDAH

Pemeriksaan susulan mungkin perlu.

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