CURICULUM VITAE

Name : Mulyadi M. Djer, MD, SpA(K), PhDPlace / Date of Birth : Padang, 29 October 1964Adress : Jl. Taman Sari VIII/23, Jatinegara Baru, Buaran, Jakarta Timur 13940. Phone 021 48636322Current Position : Lecturer and Medical Staff, Department of Child Health FKUI-RSCM JakartaOrganization : Secretary of Indonesia Society of Pediatric Cardiology (Perkani)

Educational Qualifications:Year: 1989 Degree: Medical Doctor (MD)

Institution: FKUI 1997 Pediatric Specialist (SpA) FKUI

2003 Pediatric Cardiologist FKUI

2005 Consultant Pediatric Cardiologist [(SpA(K)] IDAI

2008 Doctor of Phylosophy (PhD) FKUI

Awards, Fellowship, Grants:2001-2002 Fellowship training in Pediatric Cardiology at Institut Jantung

Negara (National Heart Institute), Kuala Lumpur, Malaysia

2004 Live course in Pediatric Cardiac Intervention, Beijing, China2004 & 2006 Live course in Pediatric Catheter Intervention , Kuala Lumpur, Malaysia2004 Short course in Pediatric Cardiac Intensive Care, Miami, USA2005 & 2007 International Workshop on Interventional Pediatric Cardiology, Millan, Italy2005 Live course in Pediatric Interventional Cardiology and Emerging

New Technique in Cardiac Surgery, Buenos Aires, Argentina2006 Live course in Pediatric Interventional Cardiology and Adult

Congenital Heart Disease, Las Vegas, USA 2009 Live course in Pediatric and Adult Interventional Cardiac

Symposium, Cairns, Australia

Heart Disease in Infant and Children

Heart Disease in Infant and Children

Mulyadi M. Djer, MD, SpA(K), PhD

Mulyadi M. Djer, MD, SpA(K), PhD

Department of Child HealthMedical School University of Indonesia

Department of Child HealthMedical School University of Indonesia

Structures of the heart

Cardiac performanceCardiac performance

PreloadAfterloadContractilityRate

PreloadAfterloadContractilityRate

Normal Heart

Heart disease in childrenHeart disease in children Congenital heart disease

Acyanosis congenital heart disease Cyanosis congenital heart disease

Acquired heart disease Acute rheumatic fever Chronic rheumatic heart disease Kawasaki disease Cardiac involvement in systemic disease

Thalasemia Kidney disease etc

Congenital heart disease Acyanosis congenital heart disease Cyanosis congenital heart disease

Acquired heart disease Acute rheumatic fever Chronic rheumatic heart disease Kawasaki disease Cardiac involvement in systemic disease

Thalasemia Kidney disease etc

Heart disease in childrenHeart disease in children Congenital heart disease

Acyanosis congenital heart disease Cyanosis congenital heart disease

Acquired heart disease Acute rheumatic fever Chronic rheumatic heart disease Kawasaki disease Cardiac involvement in systemic disease

Thalasemia Kidney disease etc

Congenital heart disease Acyanosis congenital heart disease Cyanosis congenital heart disease

Acquired heart disease Acute rheumatic fever Chronic rheumatic heart disease Kawasaki disease Cardiac involvement in systemic disease

Thalasemia Kidney disease etc

Heart disease in childrenHeart disease in children Congenital heart disease

Acyanosis congenital heart disease Cyanosis congenital heart disease

Acquired heart disease Acute rheumatic fever Chronic rheumatic heart disease Kawasaki disease Cardiac involvement in systemic disease

Thalasemia Kidney disease etc

Congenital heart disease Acyanosis congenital heart disease Cyanosis congenital heart disease

Acquired heart disease Acute rheumatic fever Chronic rheumatic heart disease Kawasaki disease Cardiac involvement in systemic disease

Thalasemia Kidney disease etc

Congenital Heart DiseaseCongenital Heart Disease

Incidence of Congenital Heart DiseaseIncidence of Congenital Heart Disease The incidence: 8-10 in 1000 live birth

Indonesia: Total population : ± 235,000,000 Birth rate: 2.3 % Incidence CHD per year: 50,000

cases

The incidence: 8-10 in 1000 live birth Indonesia:

Total population : ± 235,000,000 Birth rate: 2.3 % Incidence CHD per year: 50,000

cases

Classification of CHDClassification of CHD Acyanosis

Normal pulmonary blood flow Pulmonary Stenosis (PS) Aortic Stenosis (AS) Coarctatio Aorta (CoA)

Increased pulmonary blood flow Patent Ductus Arteriosus (PDA) Atrial Septal Dfect (ASD) Ventricular Sseptal Defect (VSD)

Cyanosis Normal pulmonary blood flow

TGA without PS Increased pulmonary blood flow

TGA with VSD Truncus arteriosus Total anomaly pulmonary vein drainage

Decreased pulmonary blood flow ToF Pulmonary atresia Ticuspid atresia

Acyanosis Normal pulmonary blood flow

Pulmonary Stenosis (PS) Aortic Stenosis (AS) Coarctatio Aorta (CoA)

Increased pulmonary blood flow Patent Ductus Arteriosus (PDA) Atrial Septal Dfect (ASD) Ventricular Sseptal Defect (VSD)

Cyanosis Normal pulmonary blood flow

TGA without PS Increased pulmonary blood flow

TGA with VSD Truncus arteriosus Total anomaly pulmonary vein drainage

Decreased pulmonary blood flow ToF Pulmonary atresia Ticuspid atresia

Classification of CHDClassification of CHD Acyanosis

Normal pulmonary blood flow PS AS CoA

Increased pulmonary blood flow PDA ASD VSD

Cyanosis Normal pulmonary blood flow

Transposition of Great Artery (TGA) without PS Increased pulmonary blood flow

TGA with VSD Truncus arteriosus Total anomaly pulmonary vein drainage (TAPVD)

Decreased pulmonary blood flow Tetralogy of Fallot (ToF) Pulmonary atresia (PA) Ticuspid atresia

Acyanosis Normal pulmonary blood flow

PS AS CoA

Increased pulmonary blood flow PDA ASD VSD

Cyanosis Normal pulmonary blood flow

Transposition of Great Artery (TGA) without PS Increased pulmonary blood flow

TGA with VSD Truncus arteriosus Total anomaly pulmonary vein drainage (TAPVD)

Decreased pulmonary blood flow Tetralogy of Fallot (ToF) Pulmonary atresia (PA) Ticuspid atresia

Perbedaan Sirkulasi Janin dan Neonatus

Perbedaan Sirkulasi Janin dan Neonatus

Changes in Pulmonary Vascular Resistance 7 weeks preceding birth, at birth and 7 weeks after birth

Changes in Pulmonary Vascular Resistance 7 weeks preceding birth, at birth and 7 weeks after birth

Park MK. Pediatric cardiology for practitioner. 5th Ed. Philadelphia: Elsevier, 2008

Pathophysiology acyanotic and cyanotic Pathophysiology acyanotic and cyanotic

Hemodynamic acyanoticHemodynamic acyanotic Hemodynamic cyanoticHemodynamic cyanotic

Critically Congenital Heart DiseaseCritically Congenital Heart Disease Complex CHD in which circulation to

lungs /systemic depend on PDA Duct dependency pulmonary circulation

Pulmonary Atresia Duct deppendent systemic circulation

Hypoplastic left heart syndrom Duct deppendent systemic circulation

Transposition of great artery

Complex CHD in which circulation to lungs /systemic depend on PDA Duct dependency pulmonary circulation

Pulmonary Atresia Duct deppendent systemic circulation

Hypoplastic left heart syndrom Duct deppendent systemic circulation

Transposition of great artery

Critically CHDCritically CHD

Duct Dependent PulmonaryCirculation

Duct Dependent Systemic Circulation

Duct Dependent Mixing Circulation

PDA

Located between aorta and pulmonary arteryLocated between aorta and pulmonary artery

ASD

Defect between LA and RADefect between LA and RA

VSD VSD

Tetralogy Fallot

Syndrome consist of 4 items: VSD Pulmonary stenosis Aortic over-riding RVH

Syndrome consist of 4 items: VSD Pulmonary stenosis Aortic over-riding RVH

Transposition of Great arteryTransposition of Great artery

EtiologyEtiology

Genetic 10 % Chromosome 7 % Monogenic 3 %

Environment 3 % Multifactor 90 %

Genetic 10 % Chromosome 7 % Monogenic 3 %

Environment 3 % Multifactor 90 %

Sign and Symptom of CHDSign and Symptom of CHD Cyanosis Dyspneu Exercise intolerance

Infant Feeding problem Intermittent feeding Prolonged feeding

Big children Dyspneu on exertion Orthopneu Recurrent respiratory tract infection Poor weight gain Asymptomatic murmur

Cyanosis Dyspneu Exercise intolerance

Infant Feeding problem Intermittent feeding Prolonged feeding

Big children Dyspneu on exertion Orthopneu Recurrent respiratory tract infection Poor weight gain Asymptomatic murmur

Cyanosis Central VS. PheripheralCyanosis Central VS. Pheripheral

Lefkowitz B, 2000

Central Mucous

membrane Mouth, tongue

Pheripheral Acral

Central Mucous

membrane Mouth, tongue

Pheripheral Acral

No murmur does not exclude CHD

The presence of murmur does not mean that there is CHD

No murmur does not exclude CHD

The presence of murmur does not mean that there is CHD

DiagnosisDiagnosis Clinical finding Supporting examination

Level 1 Periphery blood examination Arterial blood gas analysis Chest X ray Electrocardiography

Level 2 Echocardiography

Level 3 Cardiac catheterization

Diagnostic Therapeutic

Others CT Scan MRI

Clinical finding Supporting examination

Level 1 Periphery blood examination Arterial blood gas analysis Chest X ray Electrocardiography

Level 2 Echocardiography

Level 3 Cardiac catheterization

Diagnostic Therapeutic

Others CT Scan MRI

DiagnosisDiagnosis Clinical finding Supporting examination

Level 1 Periphery blood examination Arterial blood gas analysis Chest X ray Electrocardiography

Level 2 Echocardiography

Level 3 Cardiac catheterization

Diagnostic Therapeutic

Others CT Scan MRI

Clinical finding Supporting examination

Level 1 Periphery blood examination Arterial blood gas analysis Chest X ray Electrocardiography

Level 2 Echocardiography

Level 3 Cardiac catheterization

Diagnostic Therapeutic

Others CT Scan MRI

How to read chest X rayHow to read chest X ray

ElectrocardiographyElectrocardiography

Cardiac Potential Cardiac Potential action recording on action recording on ECC electrode placing ECC electrode placing on the surface of the on the surface of the bodybody

Reference value Reference value ageage

Cardiac Potential Cardiac Potential action recording on action recording on ECC electrode placing ECC electrode placing on the surface of the on the surface of the bodybody

Reference value Reference value ageage

DiagnosisDiagnosis Clinical finding Supporting examination

Level 1 Periphery blood examination Arterial blood gas analysis Chest X ray Electrocardiography

Level 2 Echocardiography

Level 3 Cardiac catheterization

Diagnostic Therapeutic

Others CT Scan MRI

Clinical finding Supporting examination

Level 1 Periphery blood examination Arterial blood gas analysis Chest X ray Electrocardiography

Level 2 Echocardiography

Level 3 Cardiac catheterization

Diagnostic Therapeutic

Others CT Scan MRI

EchocardiographyEchocardiography

DiagnosisDiagnosis Clinical finding Supporting examination

Level 1 Periphery blood examination Arterial blood gas analysis Chest X ray Electrocardiography

Level 2 Echocardiography

Level 3 Cardiac catheterization

Diagnostic Therapeutic

Others CT Scan MRI

Clinical finding Supporting examination

Level 1 Periphery blood examination Arterial blood gas analysis Chest X ray Electrocardiography

Level 2 Echocardiography

Level 3 Cardiac catheterization

Diagnostic Therapeutic

Others CT Scan MRI

Atrial septal defectAtrial septal defect

ASD ASD

DiagnosisDiagnosis Clinical finding Supporting examination

Level 1 Periphery blood examination Arterial blood gas analysis Chest X ray Electrocardiography

Level 2 Echocardiography

Level 3 Cardiac catheterization

Diagnostic Therapeutic

Others CT Scan MRI

Clinical finding Supporting examination

Level 1 Periphery blood examination Arterial blood gas analysis Chest X ray Electrocardiography

Level 2 Echocardiography

Level 3 Cardiac catheterization

Diagnostic Therapeutic

Others CT Scan MRI

MR-guided diagnostic and interventional proceduresMR-guided diagnostic and interventional procedures

Early diagnosis is important because: Management of disease and education to

parent depend on it Certain CHD has optimal age to undergo

definitive treatment TGA: 2 weeks Complete AVSD: 3-6 months Truncus arteriosus: < 6 months

Most CHD does not need intervention / surgery at time of diagnosis:

Intervention / surgery will be needed at any age in which the risk of intervention or surgery is low (usually above 1-2 year), but don’t late.

Early surgery / intervention is needed if conservative treatment fail.

Early diagnosis is important because: Management of disease and education to

parent depend on it Certain CHD has optimal age to undergo

definitive treatment TGA: 2 weeks Complete AVSD: 3-6 months Truncus arteriosus: < 6 months

Most CHD does not need intervention / surgery at time of diagnosis:

Intervention / surgery will be needed at any age in which the risk of intervention or surgery is low (usually above 1-2 year), but don’t late.

Early surgery / intervention is needed if conservative treatment fail.

Early diagnosis is important because: Management of disease and education to

parent depend on it Certain CHD has optimal age to undergo

definitive treatment Severe CoA / Interrupted Ao arch: as soon

as possible TGA: 2 weeks Complete AVSD: 3-6 months Truncus arteriosus: < 6 months

Most CHD does not need intervention / surgery at time of diagnosis:

Intervention / surgery will be needed at any age in which the risk of intervention or surgery is low (usually above 1-2 year), but don’t late.

Early surgery / intervention is needed if conservative treatment fail.

Early diagnosis is important because: Management of disease and education to

parent depend on it Certain CHD has optimal age to undergo

definitive treatment Severe CoA / Interrupted Ao arch: as soon

as possible TGA: 2 weeks Complete AVSD: 3-6 months Truncus arteriosus: < 6 months

Most CHD does not need intervention / surgery at time of diagnosis:

Intervention / surgery will be needed at any age in which the risk of intervention or surgery is low (usually above 1-2 year), but don’t late.

Early surgery / intervention is needed if conservative treatment fail.

Early diagnosis is important because: Management of disease and education to

parent depend on it Certain CHD has optimal age to undergo

definitive treatment TGA: 2 weeks Complete AVSD: 3-6 months Truncus arteriosus: < 6 months

Most CHD does not need intervention / surgery at time of diagnosis:

Intervention / surgery will be needed at any age in which the risk of intervention or surgery is low (usually above 1-2 year), but don’t late.

Early surgery / intervention is needed if conservative treatment fail.

Early diagnosis is important because: Management of disease and education to

parent depend on it Certain CHD has optimal age to undergo

definitive treatment TGA: 2 weeks Complete AVSD: 3-6 months Truncus arteriosus: < 6 months

Most CHD does not need intervention / surgery at time of diagnosis:

Intervention / surgery will be needed at any age in which the risk of intervention or surgery is low (usually above 1-2 year), but don’t late.

Early surgery / intervention is needed if conservative treatment fail.

Management of CHD Management of CHD

Transcatheter Intervention

HybridIntervention

Surgery

Palliative Definitive

Medical Treatment

Management of Congenital Heart DiseaseManagement of Congenital Heart Disease

Do not required treatment or intervention, some of defect closed spontaneously

Treatment Medical treatment

Initial treatment (PGE1, indomethacin) Complication treatment (anti failure, anti spell) Conservative treatment (Eisenmenger)

Palliative Intervention non-surgery (BAS, PDA stenting) Surgery (BT shunt, PA banding)

Definitive Intervention non-surgery Non-complex CHD Surgery Complex CHD

Do not required treatment or intervention, some of defect closed spontaneously

Treatment Medical treatment

Initial treatment (PGE1, indomethacin) Complication treatment (anti failure, anti spell) Conservative treatment (Eisenmenger)

Palliative Intervention non-surgery (BAS, PDA stenting) Surgery (BT shunt, PA banding)

Definitive Intervention non-surgery Non-complex CHD Surgery Complex CHD

Treatment of Congenital Heart DiseaseTreatment of Congenital Heart Disease

Medical treatment Initial treatment (PGE1, indomethacin) Complication treatment (anti failure, anti spell) Conservative treatment (Eisenmenger)

Palliative Intervention non-surgery (BAS, PDA stenting) Surgery (BT shunt, PA banding)

Definitive Intervention non-surgery Non-complex CHD Surgery Complex CHD

Medical treatment Initial treatment (PGE1, indomethacin) Complication treatment (anti failure, anti spell) Conservative treatment (Eisenmenger)

Palliative Intervention non-surgery (BAS, PDA stenting) Surgery (BT shunt, PA banding)

Definitive Intervention non-surgery Non-complex CHD Surgery Complex CHD

Treatment of Congenital Heart DiseaseTreatment of Congenital Heart Disease

Medical treatment Initial treatment (PGE1, indomethacin) Complication treatment (anti failure, anti spell) Conservative treatment (Eisenmenger)

Palliative Intervention non-surgery (BAS, PDA stenting) Surgery (BT shunt, PA banding)

Definitive Intervention non-surgery Non-complex CHD Surgery Complex CHD

Medical treatment Initial treatment (PGE1, indomethacin) Complication treatment (anti failure, anti spell) Conservative treatment (Eisenmenger)

Palliative Intervention non-surgery (BAS, PDA stenting) Surgery (BT shunt, PA banding)

Definitive Intervention non-surgery Non-complex CHD Surgery Complex CHD

Treatment of Congenital Heart DiseaseTreatment of Congenital Heart Disease

Medical treatment Initial treatment (PGE1, indomethacin) Complication treatment (anti failure, anti spell) Conservative treatment (Eisenmenger)

Palliative Intervention non-surgery (BAS, PDA stenting) Surgery (BT shunt, PA banding)

Definitive Intervention non-surgery Non-complex CHD Surgery Complex CHD

Medical treatment Initial treatment (PGE1, indomethacin) Complication treatment (anti failure, anti spell) Conservative treatment (Eisenmenger)

Palliative Intervention non-surgery (BAS, PDA stenting) Surgery (BT shunt, PA banding)

Definitive Intervention non-surgery Non-complex CHD Surgery Complex CHD

Medical TreatmentMedical Treatment1. Initial treatment: Prostaglandin E1

Critical CHD To open PDA Fast response Doses 10 nanogram/kg/minute Side effect:

Apneu Hypotension

1. Initial treatment: Prostaglandin E1

Critical CHD To open PDA Fast response Doses 10 nanogram/kg/minute Side effect:

Apneu Hypotension

...Medical treatment...Medical treatment

2. Complication treatmentCyanotic spella. Kneechest positionb. Acid-base correctionc. Sedation: Morphin sulphat 0,2 mg/kg

IM/SCd. Propranolol: 0,01-0,25 mg/kg

(average 0,05 mg/kg) IV slowly

2. Complication treatmentCyanotic spella. Kneechest positionb. Acid-base correctionc. Sedation: Morphin sulphat 0,2 mg/kg

IM/SCd. Propranolol: 0,01-0,25 mg/kg

(average 0,05 mg/kg) IV slowly

...Medical treatment...Medical treatmentHeart failure ↓ preload

Diuretic; Frusemide : 1-2mg/kg/day 2 X

Sprironolakton:

0-10 kg: 6,25mg/kg 2X; 11-20 kg: 12,5 mg/kg 2X; 21-40 kg: 25 mg/kg 2X; >40 kg: 25 mg/kg 3X

↓ afterload Vasodilator

Captopril: 0,3-6 mg/kg/day divided 2-3 dose

Heart failure ↓ preload

Diuretic; Frusemide : 1-2mg/kg/day 2 X

Sprironolakton:

0-10 kg: 6,25mg/kg 2X; 11-20 kg: 12,5 mg/kg 2X; 21-40 kg: 25 mg/kg 2X; >40 kg: 25 mg/kg 3X

↓ afterload Vasodilator

Captopril: 0,3-6 mg/kg/day divided 2-3 dose

...Medical treatment...Medical treatment ↑ Contractility

Dopamine : 5-10µg/kg/minute Dobutamine: 5-10 µg/kg/minute Digoxin (µg/kg/day)

Digitalization Maintenance

Premature 20 5 < 30 day 30 8 < 2 year 40-50 10-12 > 2 year 30-50 8-10

↑ Contractility Dopamine : 5-10µg/kg/minute Dobutamine: 5-10 µg/kg/minute Digoxin (µg/kg/day)

Digitalization Maintenance

Premature 20 5 < 30 day 30 8 < 2 year 40-50 10-12 > 2 year 30-50 8-10

↓ heart rate Adenosine: 0,1 mg/kg fastly Beta blocker: Propranolol: 0,01-0,25 mg/kg (average 0,05 mg/kg) IV slowly.

↓ heart rate Adenosine: 0,1 mg/kg fastly Beta blocker: Propranolol: 0,01-0,25 mg/kg (average 0,05 mg/kg) IV slowly.

PalliativePalliative

Aim: to release sign or symptom Non-surgery:

BAS PDA stenting

Surgery: BT Shunt PA banding

Aim: to release sign or symptom Non-surgery:

BAS PDA stenting

Surgery: BT Shunt PA banding

Definitive TreatmentDefinitive Treatment

Non-surgery: Non-Complex CHD Surgery:

Bi-ventricular circulation Single-ventricular /univentricular

circulation One and half ventricle Heart transplantation

Non-surgery: Non-Complex CHD Surgery:

Bi-ventricular circulation Single-ventricular /univentricular

circulation One and half ventricle Heart transplantation

ComplicationsComplications Heart failure

preload afterload contractility heart rate

Cyanotic spell Endocarditis Eisenmenger syndrome etc

Heart failure preload afterload contractility heart rate

Cyanotic spell Endocarditis Eisenmenger syndrome etc

Ventricular Septal DefectVentricular Septal Defect

VSD VSD

RA

RV

RA LALA

RV LVLV

Ventricular septal defect

Ventricular septal defectVentricular septal defect Management:

Medical treatment Anti-failure

Digoxin Diuretic

Palliative PA banding

Definitive : VSD closure

Surgery Transcatheter closure

Management: Medical treatment

Anti-failure Digoxin Diuretic

Palliative PA banding

Definitive : VSD closure

Surgery Transcatheter closure

VSDVSD

Heart failure (+)Heart failure (+) Heart failure (-)Heart failure (-)

Anti failureAnti failure

FailFail SuccessSuccess

PABPAB

Evaluate in 6 mothsEvaluate in 6 moths

Surgical closure/Transcatheter closureSurgical closure/Transcatheter closure

Aortic valve prolaps

Aortic valve prolaps

Infundibular stenosis

Infundibular stenosis

PHPH SmallerSmallerSpontaneousclosure

Spontaneousclosure

CathCath

PVD(-)PVD(-) PVD(+)PVD(+) CathCath

CathCath

ReactiveReactive Non-reactive

Non-reactive

ConservativeConservative

FR>1.5FR>1.5FR<1.5FR<1.5

….VSD Occlusion Amplatzer Perimembranous VSD Occluder

….VSD Occlusion Amplatzer Perimembranous VSD Occluder

Amplatzer Perimembranous VSD OccluderAmplatzer Perimembranous VSD Occluder

Ventricular septal defectVentricular septal defect

VSD before occlusionVSD before occlusion

Ventricular septal defectVentricular septal defect

Snaring wire at PA and pull it out to FV

Snaring wire at PA and pull it out to FV

Ventricular septal defectVentricular septal defect

VSD during deploying the deviceVSD during deploying the device

VSD after occludedusing ASOVSD after occludedusing ASO

…VSD Surgery…VSD Surgery

Interventional Treatment of Congenital Heart disease

Interventional Treatment of Congenital Heart disease

Invasiveness

Effe

ctiv

enes

s

Good

Bad

State of ArtState of Art

Intervention

Minimal InvasiveSurgery

ConventionalSurgery

Transcatheter treatment of CHD offers a number of advantages over surgery

Transcatheter treatment of CHD offers a number of advantages over surgery

Less invasive Fast recovery Eliminates thoracotomy No surgical complication No post surgical pain No chest scar Shortened hospitalization Minimal hospital service

requirements

Less invasive Fast recovery Eliminates thoracotomy No surgical complication No post surgical pain No chest scar Shortened hospitalization Minimal hospital service

requirements

SurgerySurgery InterventionIntervention

Interventional treatment in CHDInterventional treatment in CHDPalliative

Balloon atrial septectomy (BAS)PDA stenting

DefinitivePercutaneous occlusion of cardiac defect

PDA, ASD,VSDCollateralArtery-venous malformation

Balloon angioplasty / valvuloplasty Balloon valvuloplasty: PS, AS or MSBalloon dilatation / stent branch of pulmonary artery stenosisBalloon angioplasty Coarctation of aortaRadio frequency assisted valvotomi in PA-IVS

PalliativeBalloon atrial septectomy (BAS)PDA stenting

DefinitivePercutaneous occlusion of cardiac defect

PDA, ASD,VSDCollateralArtery-venous malformation

Balloon angioplasty / valvuloplasty Balloon valvuloplasty: PS, AS or MSBalloon dilatation / stent branch of pulmonary artery stenosisBalloon angioplasty Coarctation of aortaRadio frequency assisted valvotomi in PA-IVS

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Interventional Pediatric Cardiology in IndonesiaInterventional Pediatric Cardiology in Indonesia