Quality of Life in Children with Acyanotic Congenital Heart Disease in dr. Soetomo General Hospital, Surabaya, Indonesia

Acyanotic congenital heart disease is a disease that affects the patient physically and psychologically result in the patient not being able to carry out his life normally. As a result, patients will feel lonely, rejected, and isolated from society which makes social integration more difficult. The picture of quality of life in acyanotic CHD patients can be used as a therapeutic evaluation material to improve quality of life. Material and Methods: This study used descriptive analytic method with total sampling. The variable studied was quality of life using Pedsql Inventory 3.0 Cardiac Module questionnaire to the patients aged 2-18 years who were treated at Dr. Soetomo General Hospital Surabaya in 2019—2020. Results: 74 Acyanotic CHD patients (left to right shunt) obtained an average quality of life of 73.89 ± 9.79 with low-value aspects, namely Heart Problems and Therapy I (72.92 ± 18.20), Cognitive (59.53 ± 18.40), and Communication (71.40 ± 24.21). There was a significant difference in the type of combination diagnosis compared with other types with a significance of 0.014 (p <0.05). Conclusion: Aspects that have a negative impact on the patient's quality of life are Heart Problems and Therapy I, Cognitive, and Communication. The Combination type is a diagnosis with the lowest quality of life compared to other types.


Material and Methods
This research uses descriptive analytic type with total sampling method, which is taking all data about acyanotic left to right shunt congenital heart  years) [4] .
Adolescent patients (13-18 years) and children (8-12 years) will receive a questionnaire containing reports from children and parents reports. this study only parental reports were used [4] . one answer [4] . The results of the assessment are taken from the sum of all points from each aspect and then divided by the number of questions answered. A higher value indicates a lower problem in the patient [4] .
General characteristics and distribution of patients based on gender, age category, type of diagnosis, duration of diagnosis, nutritional status, and comorbidities will be presented in the frequency distribution  increasing life expectancy, but also on improving the patient's quality of life [5] .
In children with chronic disease conditions, it was found that the influence on their growth and development was in the form of delays in physical development, communication, cognitive, adaptive, motor, and socialization compared to normal children. This impact depends on the child's view of the body, illness, therapy, and his view of death [6] . to deal with various stresses caused by his condition [7] .

Quality of Life in Patients
Quality of life can be measured in various ways, one of which is using a questionnaire. The Pediatric In the aspect of heart problems and therapy I, the specific problems that have a bad impact on the patient's quality of life are susceptibility to colds, fast heart rate, needing more rest than their friends. This is due to hemodynamic disorders such as enlargement of the pulmonary arteries due to pulmonary hypertension that occurs in children with congenital heart disease causing disruption of the pulmonary defense system, resulting in frequent patients experiencing respiratory infections [8] .
Tolerance to activity is a good indicator of the compensatory status of the heart or the degree of cardiac abnormality. The patient's fast heart rate indicates a compensation for the lack of oxygen intake throughout the body due to a left-to-right shunt. Patients who feel tired easily and need more rest than their friends can be caused by two conditions, namely reduced exercise / activity tolerance which can describe hemodynamic disorders in patients and intentional activity restrictions arising from anxiety about the worsening of symptoms that occur. might happen [5] .
On the cognitive aspect, specific problems that Personality type also has an impact on a person's ability to adapt to someone, especially if there are accompanying conditions and stressors obtained from the environment [10] . This hemodynamic disturbance causes impaired growth and decreased exercise tolerance in patients due to the body's inability to meet oxygen demands. In addition, increased blood flow to the lungs can also disrupt the defense system in the lungs which makes it easy for recurrent respiratory infections [5] . The disturbances found due to hemodynamic disorders certainly affect the patient's physical and psychological and have an impact on aspects of the patient's quality of life.

Differences in Quality of Life by Type of Diagnosis
In the combination type, there are certainly more holes than in the single type. This of course affects March 2022 | Vol 1 | Article 1 the amount of blood that moves from left to right.
Generally, the volume of displaced blood determines the severity of the symptoms [14] . Thus, the combination type obtained a higher level of symptom severity than the single type. This has an impact on the patient's overall life which results in a significantly reduced quality of life compared to patients with a single type of congenital heart disease.

Conclusion
Aspects that have a negative impact on the patient's quality of life are Heart Problems and