by: syarif hidayatullah
XI Excellent Program of Natural Science
MA Nurul Jadid
Paiton Probolinggo
If you try to grope your left chest,
so you will feel some pulsation. Where does it come from? It comes from the
working of heart. Heart is including one of the most important organs in our
body. Heart is located in mediastinum cavity from thoracic cavity, above our
lung. Heart has size as big as clamp every one. The function of heart is to
pump up blood unto all over body.
When the atrium(veranda) contracts,
the ventricle(chamber) relaxes and it occurs conversely. Atrium contraction is
generated by nerve stimulation accepted by Keith-Flack node and spread out to
Weinchebah nerves. Ventricular construction is caused by the stimulation
accepted by Tawara node and passed on to His bundle node.
The left and right atriums relax to
accept blood from vein at the same time. The right atrium receives from two
cava vena, while left atrium receives blood from pulmonary vein. Then the two
atriums contract thoroughly to push the blood into the relaxed ventricle. After
resting for a while, the two ventricles contract to push the blood into aorta
and pulmonary artery.
The reverse flow of blood into atrium
is prevented by the closing of tricuspid and bicuspid valves creating sound of
“lub”. After contracting full, the ventricle will relax. While relaxing, the
reserve flow of blood into ventricle within the artery is prevented by the
closing of semi lunar valve creating the sound of “dub”. Then, will appear a
big problem toward the system of circulatory, if the nerves in heart that have
big role in supporting of pumping up blood is getting weak because the
existence of grease in blood vessel. And this case is able to involve the
medical patient toward the most dangerous case, it is dead. People call it by
coronary heart disease.
In our common, grease congeries in
coronary blood vessel cannot be solved by consuming drugs only, and also a
doctor recommend to apply a ring or coronary artery surgical operation. The
goal is in order that coronary heart disease is controlled and to prevent a
heart attack suddenly.
A non invasive division lecturer,
Vascular Medical And Cardiology Department, Faculty Of Medicines, Indonesia
University (FKUI)-Blood Vessel And Heart Hospital (RSJPD) Harapan Kita, Doni
Firman said in Jakarta, on Thursday (4/4) “to choose to apply a stent
assemblies or coronary artery surgical operation (bypass) based on the doctor
depends on the mulberry and size of grease in coronary blood vessel.
If the grease congeries is small and
confined, usually the doctor will recommend to apply stent assemblies that
recognized in our surroundings as ring. This applying stent assemblies is
non-invasive surgical operation that just needs anaesthesia locally and done by
heart and blood vessel specialist doctor.
But unfortunately, if the grease is
big and much, also happening long enough vessel constriction the recommended
action is bypass operation that will be done by cardiovascular thorax surgical
specialist doctor. This action principled that transplanting a new blood vessel
taken from foot or wall of chest to coronary blood vessel till blood flow aim
to heart has new way.
Stent assemblies in coronary blood
vessel have a purpose to make blood vessel to be big and prevent constriction
anymore. Even through society mentions that it is a ring, the shape of
something that called a ring is to resemble with spring more than a ring, or
spring of pen, i. e. has shape as hollow tube with the wall of tube such as a
net.
During on this time, coronary blood
vessel ring that applied is made from metal, it is uncoated medicine metal ring
(bare metal stent/BMS) or coated medicine metal ring (drug eluting
stent/DES).
The coated medicine metal ring is
begun to publish in 2001. That ring changes metal ring uncoated medicine that
applied since 1988.
Medicine that coated at metal ring
has function to prevent grease accumulation that make blood vessel occur
constriction again and increase peril of occurring heart attack. Uncoated
medicine metal ring cannot dissolve grease, but it just stress or compress
grease till the grease move to another place.
“to implement coated medicine ring
decrease peril of occurring construction blood vessel again after operation.
But it is not free a hundred percent” doni said.
To choose applying uncoated or coated
medicine ring is to do depend on clinical condition each medical patient.
Non metal
Utilizing of metal ring even though
it has been coated medicine in the fact it still save problems because the ring
will be missed in medical patient’s body eternally. Now, a new variant appears
that is coronary blood vessel ring that made from non metal matter and able to
be reserved by body after lots of years shore up blood vessel.
According to Doni, when this non
metal ring that able to be reserved by body (bioresorbable vascular
scaffold/ BVS) that present in Asia and south east Asia brand name Absorb.
Amounts of brand name other non metal rings are applied in East Asia nations,
but those product are not supported by research and wide detailed examination.
Non metal ring that applied all at once in some of south East Asia nations
since September 2012 also applied in some of Europe and America nations.
Non metal ring that able to be
reserved by body is made from polylactic acid/PLLA, i.e. thermoplastic
aliphatic polyester that made from latest matter, such as corn essence, tapioca,
or sugar cane. These matters are able to be reserves by body, those are same
with ligature. Even though it is soluble, a research shows, blood vessel will
not constrict anymore after body reserve the ring.
Lots of researches show, coated
medicine non metal ring is also able to soluble grease in blood vessel. Research
to ensure the advantages of this ring, including the ability is to decrease
grease in blood vessel, still do continuously.
“even though convincing, this sophisticated
technology is still late. So there is nothing supporting data for long range,”
Doni said.
Till the beginning of 2013, there are
21 actions of applying non metal ring in RSJPD Harapan Kita. “RSJPD Harapan
Kita is the first hospital in Indonesia that apply this technology” the
managing director of RSJPD Harapan Kita, Hananto Andriantroo said.
After the ring used may still appear
again grease congeries in blood vessel.
The lecturer of division of vascular Medical and Cardiology Department,
Faculty of Medicines, Indonesia University (FKUI)-Blood Vessel And Heart
Hospital (RSJPD) Harapan Kita, Iwan Dakota, reminded us about the importance
changing toward a model of how life is done by medical patient after operation
of applying ring or bypass operation.
The appearing of plaque in blood
vessel is certainty together with the addition of age. Other of peril factor
appearing coronary heart disease that cannot elude is gender and descent.
Female before menopause has lower
susceptible than male in same age because has heterogeneous hormone that able
to head off figuration of grease in blood vessel. Those who have parent that
ever had heart disease potentially suffer the same case.
“cigarettes, hypertension, diabetes,
high cholesterol, overweight, and less in action physically are peril factor
appearing coronary heart disease. These are able to elude,” Iwan said
The ways of metal ring that able to
be reserved by body (BVS) work
1. The metal ring
that able to be reserved by body (bare metal stent/ BMS) is located in
the inside of artery through a balloon at the tip of tube where it is thin and
flexible.
2. Bare metal stent
is widened by manner pumping up the balloon, and it will push bare metal stent.
Plaque in the wall of artery will be pressed until that will give the
circulation of blood is getting larger.
3. The balloon will
be taken out, and leave bare metal stent that step by step let go medicine unto
the resumed blood vessel.
4. When the
circulation for blood is running well, bare metal stent begin to fade in the
artery together the blood.
5. Two years after,
bare metal stent will loss, but the blood vessel will not be getting narrow
anymore.
reference: kompas
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