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KORELASI BESAR SUDUT SUBCARINAL DENGAN PEMBESARAN ATRIUM SINISTRUM PADA PASIEN STENOSIS MITRAL

Yusni Waty Simbolon, dr. Henry Kusumo Husodoputro, Sp.Rad(K)

2014 | Tesis | S2 Ked.Klinik/MS-PPDS

Pendahuluan : Stenosis mitral terjadi karena adanya gangguan katup mitralis, yang ditandai dengan pembesaran atrium sinistrum.Pada foto sinar X thorax PA normal ruang atrium sinistrum sulit untuk divisualisasikan karena superposisi dengan ruang jantung lainnya. Pendorongan bronchus primarius sinistrum oleh atrium sinistrum yang membesar ke superior menyebabkan besar sudut subcarinal bertambah. Pemeriksaan sinar X thorax PA berdiri dapat memprediksi adanya stenosis mitral dengan melihat penambahan besar sudut subcarinal yang terjadi. Tujuan : Penelitian ini bertujuan untuk mengetahuikorelasi besar sudut subcarinal dengan pembesaran atrium sinistrum pada penderita stenosis mitral. Manfaat yang diharapkan dari penelitian ini, salah satunya adalah agar penambahan besar sudut subcarinal yang tampak pada pemeriksaan sinar X thorax PA berdiri dapat digunakan sebagai indikator adanya stenosis mitral terutama bagi Dokter Spesialis Radiologi. Bahan dan cara : Penelitian ini merupakan penelitian cross sectional. Subyek penelitian adalah pasien stenosis mitraldengan ukuran diameter atrium sinistrum diketahui melalui pemeriksaan ekhokardiografi serta memiliki data foto sinar X thorax PA berdiri yang memenuhi kriteria inklusi dan kriteria eksklusisebanyak minimal 54 orang pasien stenosis mitral. Pengumpulan sampel penelitian dilakukan dengan cara consecutive samplingdi Rumah Sakit Umum Pusat Dr. Sardjito Yogyakarta, waktu penelitian pada bulan Oktober 2013. Dilakukan pengukuran data dasar yaitu diameter atrium sinistrum, besar sudut subcarinaloleh dua orang Pengamat, Dokter Spesialis Radiologi. Hasil : Hasil uji korelasi Pearson yang dilakukan terhadap data utama penelitian, didapatkan nilai r = 0,29. Simpulan : Dari nilai koefisien korelasi yang didapatkan pada uji hipotesis, disimpulkan terdapat korelasi positif yang signifikan dengan kekuatan korelasi yang lemah antara besar sudut subcarinal pada foto sinar X thorax PA berdiri dengan pembesaran ukuran atrium sinistrum pada penderita stenosis mitral.

Mitral stenosis is one of cardiovascular disease related to problem in mitral valves. Thus in early stage often asymptomatic. Left atrial enlargement is the common sign of chronic mitral stenosis, which sometimes will continue as cardiac aritmias, therefore increase morbidity and mortality. Left atrium lies just inferior to the cartilage junction between left and right primary bronchi—the carina—and directly contacted with the inferior surface of left primary bronchus. In a normal PA projection chest X-ray, left atrial chamber is hardly visualized due to its superimposition with other cardiac chambers. Left atrial enlargement will be easily noticed when there is adjacent tissues deviation. Enlarged left atrial will push left primary bronchus in superoposteriorly direction, causes increasing of the subcarinal angle. Upright PA chest X-ray is able to predict the availability of mitral stenosis from its subcarinal angle size. The larger the left atrial the bigger the size of subcarinal angle. The aim of this study was to evaluate the correlation between the subcarinal angle size and left atrial enlargement in mitral stenosis. Radiologists in periferal clinics, that sometimes struggling with limitation of diagnostic modality such as echocardiography and human resource, can use the increasing of subcarinal angle size in upright PA chest X-ray as a predictor for mitral stenosis. This is a retrospective, analytic nor-experimental study with cross sectional design in Dr. Sardjito General Hospital, on October 2013. Subjects were mitral stenosis patients who had been diagnosed by cardiologists and also as internal control group, all compatible with the inclusion and exclusion criterias. Diameter of the left atrium had been measured by echocardiography. All subjects had upright PA chest X-ray. Subjects were selected with consecutive sampling method until minimum sample obtained. Left atrial diameter and the size of subcarinal angle were measured and statistically analized using correlation test (Pearson/Spearman). Linear regression test was used to evaluate the degree of correlation. The study was conducted with a cross sectional design. Subjects were 54 mitral stenosis patients whom had been examined with echocardiography for left atrial diameter. Left atrial measurements were conducted by cardiologist. Subjects also underwent an upright chest X-ray PA examination and those should meet the inclusion and exclusion criterias with an internal comparison group. Subjects were selected by consecutive sampling at Dr. Sardjito General Hospital, in October 2013. Baseline measurement is the size of subcarinal angle. Pearson correlation analysis test revealed that r = 0.298. It was concluded that there was a significant positive correlation despite weak correlation strength between the size of subcarinal angle on an upright chest X-ray PA and left atrial enlargement in patients with mitral stenosis.

Kata Kunci : stenosis mitral, diameter atrium sinistrum, besar sudut subcarinal, foto sinar X thorax PA berdiri


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