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BAB I

PENDAHULUAN

A. Latar Belakang
Dewasa ini kita mengetahui mengenai penyakit jantung
bukan hanya dapat diderita oleh orang dewasa, namun dapat juga
did oleh anak-anak bahkan saat baru lahir. Biasanya penyakit
jantung anak memang tidak dapat langsung
diketahui, namun se bertambahnya usia, tanda-tanda dan
gejala dari penyakit jantung ini sangat mudah diketahui.
Salah satu penyakit jantung pada anak adalah TOP (Tetralo
fallot) kelainan jantung kongenital dengan gangguan sianosis
ditandai dengan kombinasi empat hal yang abnormal meliputi D
Septum Ventrikel, Stenosis Pulmonal, Overriding Aorta dan Hipe
Ventrikel Kanan.
Oleh karena itu di dalam makalah ini akaan dibahas men
penyakit TOF yang dapat mempermudah seorang perawat atau
kesehatan lain dalam mempelajari penyakit jantung pada anak khusu
TOF.

B. Tujuan
1. Mengetahui pengertia dari TOF.
2. Mengetahui etiologi TOF.
3. Mengetahui maifestasi klinik dari TOF.
4. Megetahui penatalaksanaan dari TOF.
5. Mengetahui diagnosa keperawatan yang dapat diangkat dari TOF.
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BAB II

PEMBAHASAN

A. Pengertian TOF
Tetralogi fallot (TF) adalah kelainan jantung bawaan de
gangguan sianosis yang ditandai dengan kombinasi 4 hal yang abno
meliputi defek septum ventrikel, stenosis pulmonal, overriding aorta
hipertrofi ventrikel kanan.
Tetralogi of Fallot (TOF) adalah kelainan jantung konge
dengan gangguan sianosis yang ditandai dengan kombinasi empa
yang abnormal meliputi Defek Septum Ventrikel, Stenosis Pulm
Overriding Aorta dan Hipertrofi Ventrikel Kanan. (Buku Ajar Kardi
Anak, 2002).
Komponen yang paling penting dalam menentukan d
beratnya penyakit adalah stenosis pulmonal dari sangat ringan sa
berat. Stenosis pulmonal bersifat progresif , makin lama makin b
Frekuensi TF lebih kurang 10 %. Derajat stenosis pulmonal s
menentukan gambaran kelainan; pada obstruksi ringan tidak ter
sianosis, sedangkan pada obstruksi berat sianosis terlihat sangat
nyata
Pada klien dengan TF, stenosis pulmonal menghalangi a
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Defek Septum Ventrikel (VSD) yaitu lubang pada sekat antara k rongga ventr
Stenosis pulmonal terjadi karena penyempitan klep pembuluh yang keluar dar
Aorta overriding dimana pembuluh darah utama yang keluar ventrikel kiri me
Hipertrofi ventrikel kanan atau penebalan otot di ventrikel k karena peningkat
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b. Anak yang lahir sebelumnya menderita penyakit jantung ba

misalnya VSD, pulmonary stenosis, and overriding aorta.
c. Adanya penyakit tertentu dalam keluarga seperti diabetes me
hipertensi, kolesterol tinggi, penyakit jantung atau kelainan bawa
2. Faktor eksogen
a. Riwayat kehamilan ibu : sebelumnya ikut program KB oral
suntik, minum obat-obatan tanpa resep dokter, (thalid
dextroamphetamine. aminopterin, amethopterin, jamu).
b. Ibu menderita penyakit infeksi : rubella.
c. Efek radiologi (paparan sinar X).
d. Ibu mengonsumsi alcohol dan merokok saat mengandung.
Para ahli berpendapat bahwa penyebab endogen dan eks
tersebut jarang terpisah menyebabkan penyakit jantung baw
Diperkirakan lebih dari 90% kasus penyebab adalah multifaktor.

C. Manifestasi klinis
1. Murmur mungkin merupakan tanda pertama yang biasa
ditem oleh dokter. Ia merupakan suara tambahan atau tidak
biasa dapat didengar pada denyut jantung si bayi.
Kebanyakan yang menderita tetaralogy of fallot
mempunyai suara mu
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7. Susah untuk diberi makan karena klien cepat lelah ketika d

makan
8. Clubbing finger’s.

D. Patofisiologi
Tetralogy of fallot biasanya berakibatkan oksigenasi yang re
berhubungan dengan tercampurnya darah yang deoksigenasi
oksigenasi pada ventricle kiri yang akan dipompakan ke aorta ka
obstruksi pada katup pulmonal. Ini dikenal dengan istilah right-t
shunt. Hal ini sering mengakibatkan kulit bayi menjadi pucat dan ter
biru. Apabila Tetralogy of fallot tidak ditangani pada jangka waktu
panjang, maka akan mengakibatkan hipertrofi ventricle kanan
progre dan dilatasi berhubung dengan resistensi yang meningkat
pada ven kanan. Hal ini dapat menyebabkan DC kanan yang bisa
berakhir de kematian.
Proses pembentukan jantung pada janin mulai terjadi pada
ke-18 usia kehamilan. Pada minggu ke-3 jantung hanya berbentuk
ta yang disebut fase tubing. Mulai akhir minggu ke-3 sampai
minggu usia kehamilan, terjadi fase looping dan septasi, yaitu fase
dimana te proses pembentukan dan penyekatan ruang-ruang
jantung
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Derajat hipertrofi ventrikel kanan yang timbul bergantung pada de

stenosis pulmonal. Pada 50% kasus stenosis pulmonal hanya infundib
pada 10%-25% kasus kombinasi infundibuler dan valvular, dan
kasus hanya stenosis valvular. Selebihnya adalah stenosis pulm
perifer.
Hubungan letak aorta dan arteri pulmonalis masih di tempat
normal, overriding aorta terjadi karena pangkal aorta berpindah ke
anterior mengarah ke septum. Klasifikasi overriding menurut Kjell
(1) tidak terdapat overriding aorta bila sumbu aorta desenden meng
ke belakang ventrikel kiri, (2) Pada overriding 25% sumbu aorta ase
ke arah ventrikel sehingga lebih kurang 25% orifisium aorta mengh
ke ventrikel kanan, (3) Pada overridng 50% sumbu aorta mengara
septum sehingga 50% orifisium aorta menghadap ventrikel kanan
Pada overriding 75% sumbu aorta asenden mengarah ke depan ven
kanan. Derajat overriding ini bersama dengan defek septum ventrike
derajat stenosis menentukan besarnya pirau kanan ke kiri.
(Ilmu Kesehatan anak, 2001).
Karena pada TOF terdapat empat macam kelainan jantung
bersamaan, maka :
1. Darah dari aorta sebagian berasal dari ventrikel kanan melalui lu
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4. Karena jantung bagian kanan harus memompa sejumlah besar d

ke dalam aorta yg bertekanan tinggi serta harus melawan tek
tinggi akibat stenosis pulmonal maka lama kelamaan otot-oto
akan mengalami pembesaran (hipertrofi ventrikel kanan).

Pengembalian darah dari vena sistemik ke atrium kanan

ventrikel kanan berlangsung normal. Ketika ventrikel kanan mengun
dan menghadapi stenosis pulmonalis, maka darah akan dipinta
melewati defek septum ventrikel tersebut ke dalam aorta. Akiba
darah yang dialirkan ke seluruh tubuh tidak teroksigenasi, hal inilah
menyebabkan terjadinya sianosis. (Ilmu Kesehatan anak, 2001).
Pada keadaan tertentu (dehidrasi, spasme infundibulum b
menangis lama, peningkatan suhu tubuh atau mengedan), pasien de
TOF mengalami hipoksia spell yang ditandai dengan : sianosis (p
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E. Pemeriksaan diagnostik
1. Laboratorium
Pemeriksaan laboratorium rutin penting pada setiap pen
jantung bawaan sianotik untuk menilai perkembangan pen
Hemoglobin dan hematokrit merupakan indikator yang cukup
untuk derajat hipoksemia. Peningkatan hemoglobin dan hemat
ini merupakan mekanisme kompensasi akibat saturasi oksigen
rendah. Pada umumnya hemoglobin dipertahankan antara 16-18
sedangkan hematokrit 50-65%. Bila kadar hemoglobin
hematokrit melampaui batas tersebut timbul bahaya terja
kelainan trombo emboli, sebaliknya bila kurang dari batas b
tersebut berarti terjadi anemia relatif yang harus diobati.
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3. Elektrokardiogram
Pada EKG sumbu QRS hampir selalu berdeviasi ke k
Tampak pula hipertrofi ventrikel kanan. Pada anak besar s
dijumpai P pulmonal.
4. Ekokardiogram
Ekokardiografi dapat memperlihatkan setiap kelainan
tetralogi fallot. Pelebaran dan posisi aorta berupa diskontin
septum ventrikel dan dinding depan aorta serta pelebaran vent
kanan mudah dilihat. Kelainan katup pulmonal seringkali
dinilai, demikian pula penentuan perbedaan tekanan antara vent
kanan dan a.pulmonalis tidak selalu mudah dilakukan.
5. Kateterisasi jantung
Diperlukan sebelum tindakan pembedahan untuk menge
defek septum ventrikel multiple, mendeteksi kelainan arteri kor
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menjadi tenang. Bila hal ini tidak terjadi dapat dilanjutkan de

pemberian :
1) Propanolo l 0,01-0,25 mg/kg IV perlahan-lahan u
menurunkan denyut jantung sehingga seranga dapat di
Dosis total dilarutkan dengan 10 ml cairan dalam spuit,
awal/bolus diberikan separohnya, bila serangan belum ter
sisanya diberikan perlahan dalam 5-10 menit berikutnya.
2) Ketamin 1-3 mg/kg (rata-rata 2,2 mg/kg) IV perlahan. Ob
bekerja meningkatkan resistensi vaskuler sistemik dan
sedative
3) penambahan volume cairan tubuh dengan infus cairan
efektif dalam penganan serangan sianotik. Penambahan vo
darah juga dapat meningkatkan curah jantung, sehingga a
darah ke paru bertambah dan aliran darah sistemik mem
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Anak dengan serangan anoksia ditolong dengan knee-

position, dosis kecil morfin (1/8-1/4 mg) disertai dengan pemb
oksigen. Dengan tindakan ini serangan anoksia sering hilang de
cepat. Pada waktu ini diberikan pula obat-obat
pemblok (propanolol) untuk mengurangi
kontraktilitas miokard. Penceg terhadap anoksia
dilaksanakan pila dengan mencegah atau meng anemia
defisiensi besi relative, karena hal ini sering mena
frekuensi serangan. Asidosis metabolic harus diatasi secara
adekuat.
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9) Punggung kuku : pucat atau sianotik dengan peng

kapiler lambat.
10) Murmur stenosis valvular, distensi vena jugularis

c. Integritas :
1) Gejala : ansietas, takut
2) Tanda : berbagai manifestasi perilaku, misaln
ansietas, marah, ketakutan.
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1) Gejala : Dipsnea saat aktivitas, tidur sambil duduk

dengan beberapa bantal, penggunaan bantuan pernap
missal oksigen atau medikasi
2) Tanda : pernapasan : takipnea, napas dangkal,
3) Bunyi napas : mungkin tidak terdengar, dengan mengi
4) Fungsi mental : kegelisahan
5) Warna kulit : pucat atau sianosis
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3. Gangguan pertumbuhan dan perkembangan b/d oksigenasi

adekuat, kebutuhan nutrisis jaringan tubuh, isolasi social.
4. Resiko infeksi b/d keadaan umum tidak adekuat.
5. Gangguan pertukaran gas berhubungan dengan penurunan a
darah ke pulmonal
6. Penurunan cardiac output b.d sirkulasi yang tidak efektif de
adanya malformasi jantung
7. Gangguan perfusi jaringan b.d penurunan sirkulasi (anoksia kr
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psikolo
yang te
b. Intolerans Setelah diberikan asuhan keperawatan • Ikuti
aktivitas b/d selama 3 x 24 jam, diharapkan pasien,
ketidakseimba masalah intoleransi aktivitas dapat pember
ngan teratasi dengan kriteria hasil: pada sa
pemenuhan O2 No Indikator IR ER • Lakuka
terhadap 1. Aktifitas 2 5 dengan
kebutuhan 2. Istirahat 2 5 pengel
tubuh. 3. Kemudahan 3 5 berlebi
bernafas • Bantu
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c. Gangguan Setelah diberikan asuhan keperawatan • Sedia

pertumbuhan selama 3 x 24 jam, diharapkan nutris
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berulang b.d selama 3 x 24 jam, diharapkan tand

hipoksia serangan spell tidak terjadi dengan • Ken
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dan dalam, sianosis, gelisah/letargi, den

takikardi, mur-mur ber
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J. Evaluasi
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BAB III
PENUTUP
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