First In Indonesia, Cardiovascular Hospital Notes Mixed MICS Actions

Gambi Minimally Invasive Cardiac Surgery (MICS) with a combination of Mitral Valve Repair (MVr), Atrial Septal Protect (ASD) Closure, and Tricuspid Valve Repair (TVr) ( Zoom Screenshot)

JAKARTA - For the first time in the country, a team of doctors managed to carry out a Minimally Invasive Cardiac Surgery (MICS) with a combination of Mitral Valve Repair (MVr), Atrial Septal Protect (ASD) Closure, and Tricuspid Valve Repair (TVr) in one patient. This success was confirmed by Heartology Cardiovascular Hospital in the world of Indonesian heart medicine.

This success also places Heartology as the first hospital in Indonesia and the third in the world to successfully carry out these complex actions with optimal clinical results.

The patient named Mrs. Nurfitriyana, 38 years old from Purwakarta, came with complaints that she was easily tired, her heart was racing and her shortness of breath was getting heavier. The patient was then referred to do an examination with dr. Radityo Prakoso, Sp.JP(K) and it was found that there was an Atrial Septal Defect (ASD) or a hole in the heart barrier that caused abnormal blood flow between the right and left atriums.

During the follow-up echocardiography examination by dr. Ario Soeryo Kuncoro, Sp.JP(K) found that the holes in the bulk have been large and affect the function of two heart valves, namely partners and tricriticals. This condition indicates further complications due to long-term volume loading and requires surgery.

Saat kami melakukan pemeriksaan ekokardiography, terlihat bahwa kebogaan di sekat cardiac ternyata ternyata sudah berdampak pada kerja valung mitral dan triyuspid. Ini membutuhkan intervensi menyeluruh, bukan hanya menutup dugus di sekat. Diagnos yang akurat di tahap ini menjadi kunci keberhasilan seluruh tindakan, jelas dr. Ario Soeryo Kuncoro, Sp.JP(K), FIHA, Echocardiologist Heartology Cardiovascular Hospital.

Multidisciplinary Approach And Action Decision

With these results, the Heartology team decided to take comprehensive corrective action through a Minimally Invasive Cardiac Surgery (MICS) approach to surgical techniques with small incisions that minimize network trauma, accelerate recovery, and increase patient comfort.

The action was carried out by dr. Dicky A. Wartono, Sp.BTKV, together with dr. Akmal A. Sembiring, Sp.BTKV, and dr. Rynaldo P. Hutagalung, Sp.BTKV. This operation is classified as high-completexity MICS because it combines three major procedures as well as improvements to the partner valve, ASD closure, and repairs to the tricusepid valve in one minimal invasive action.

According to an international medical journal report, only two similar cases in the world have been previously reported:

Bazarov DV et al., Shanghai Chest (2023)-reported the success of ASD closure + partnerl annuloplasty + tricuspid annuloplisty through uniportal thiracoscopic MICS with fernal cannulation, operating time of 332 minutes, CPB 100 minutes, and patients returning on day-8. (Shanghai Chest Journal)

Eappen et al., Journal of Medical Science and Clinical Research (JMSCR, 2020) - reported ASD closure + Mitral Valve Replacement + Tricuspid Repair using a minimally invasive approach to Lutembacher syndrome patients. (JMSCR 2020)

Thus, Heartology Cardiovascular Hospital is the third center in the world to successfully document the concrete actions of ASD closure + partnerl valve repair + tricuspid valve repair via MICS, as well as the first in Indonesia.

This procedure belongs to the high-completexity MICS category. We made corrections to three vital areas of the heart through a very limited space, with very satisfactory results," said dr. Dicky A. Wartono, Sp.BTKV.

Quick Recovery And Optimal Clinical Results

Patients show excellent clinical recovery, where the heart function is stable again and complaints of shortness are drastically reduced in a matter of days. Just six days after the action, the patient has fully recovered and can return to light activities.

"This case is a concrete example of how the integration of precision diagnosis, advanced imaging, and modern surgical techniques can be implemented collaboratively in Indonesia," said dr. Radityo Prakoso, Sp.JP(K).

Meanwhile, dr. Ario Soeryo Kuncoro, Sp.JP(K) also emphasized the importance of early detection through comprehensive echocardiography, because in the case of large ASDs that have involved valves, the decision of timely surgical action determines long-term prognosis.