Hemoglobin (g/i) -Tmdc mo
• S3utnjy§nh&HES
•24htniyenhetHES
118,67±17,62 123,98±17,00 103,51±19,50* 109,37+17,20*
114,87±19,16 119,53±15,52
• p < 0,05 so sanh vdi thdi didm trUde md vd 24 gid sau bii dieh HES
Nhan xet:
- Tai thdi diem trude PT ca 2 nhdm tp le hematocrit, hemoglobin nam trong gidi han binh thudng va trong gi6i han ci!ia thiet kd nghien eClU. Sii khae biet giCfa 2 nhom khdng ed p nghTa thd'ng ke.
- Sau khi tmyen het dung dieh HES hematocnt, hemoglobin cCia 2 nhdm ddu giam, Sii khac bidt giCfa 2 nhom khong cd p nghTa thdng ke.
- 24 gid sau khi tmyen het dung dich HES hematocrit, hemoglobin eOa 2 nhdm gdn nhu trd ve binh thudng so vdi thdi d i l m trude phdu thuat. Su khac biet Q\iSa 2 nhdm eijng khdng ed p nghTa thd'ng ke.
KET L U A N
Qua nghien edu trdn 60 bdnh nhan dugc truyin mdt tmng 2 loai dung dich tetmspan hodc voluven vdi liiu 30ml/kg tai bdnh vidn Bach Mai, budc diu chung (6/' riit ra mdt sd kit luan.
1. Mifc dp anh hudng len kiem toan, dien giai ci^a dung djch tetraspan it hdn dung djch voluven. pH, HC03#, BE d nhdm tmyen tetraspan thay ddi khdng dang ke trong khi d nhdm truyen voluven giam cd p nghTa thdng ke. SID 2 nhdm deu giam c6 p nghTa thdng ke va d nhdm tmyen tetraspan giam it hdn. AG d nhdm tmyen tetraspan giam eo p nghTa thd'ng ke cdn nhom tmyen voluven giam khdng cd p nghTa thd'ng ke. Cd
tinh trang tang Cl' mau d thdi didm sau khi tmydn hdt dung djch HES nhung vlin nam trong gidi han cho phep va d nhdm tmyen tetraspan tang it hdn. Cd tinh trang giam Ca^* mdu ca 2 nhdm cd p nghTa thdng ke va d nhom truyen tetraspan giam ft hdn.
TAI LIEU THAM K H A O
1. Nguyin Qudc Kinh (2002), "Rdi loan nudc dien giai trong ngoai khoa", Bdt giing gdy md hii sdc, tap 1. Nha xuat ban Yhoc, tr,162- 199
2. Nguyen Thd Khanh, Pham Til Duang (2005), "Xet nghiem sif dung trong lam sang". Nha xuat ban Y hoc Ha Ndi, fr. 297 - 353.
^3. Nguyin Ngpc Minh (2007), "Thay ddi sinh ly vd cac ehl sd ddng - cdm mau" Bai giing huyit hoc - truyin mdu. Nha xuat ban Y hoc, tr. 454 - 457.
4. Nguyen Thu (2002) "Sdc chan thUdng", Bdi giang gdy md hdi sifc. Nha xudt ban Y hoc, tap 1, tr. 270-294,
5. Chowdhury AH, Cox EF, Francis ST e/a/(2012), "A randomized, controlled, double - blind crossover study on the effects of 2-L infusions of 0.9% saline and plasma- lyte# 148 on renal blood flow velocity and renal cortical tissue perfusion in healthy volunteers.", Ann Surg , 256, pp 18-24.
6. Shaw AD, Bagshaw SM, Goldstein SL ef al (2012),
"Major complications, mortality, and resource utilization after open abdominal surgery: 0.9 saline compared to Plasma-Lyte.", Ann Surg; 255, pp 821-829.
7 Volta,CA (2012), "Effects of Different Strategy of Fluids Administration on Acid/Base Disorders and Inflammatory Mediators". Hdi nghj khoa hgc "Dung moi can bang - khuynh hudng mdi trong lieu phap djch tmyen". Ha Noi. pp 11-15.
DIEU TR! MOT SO ROI LOAN NHIP THAT KHOI PHAT TUf XOANG VALSALVA RANG NANG LUONG SONG CO TAN SO RADIO
PHAN DINH PHONG, N G U Y I N L A N V I $ T Vien Tim mach, Bdnh vien B^ch Mai PHAM TRAN LINH, PHAM QUOC KHANH So mon Tim mach, D^i hgc Y Hd Ngi TOM TAT
Tong quan: Rd'i loan nhip thit, bao gim ngoai tam thu thit (NTTT) va can tim nhanh thit (TNT) khdi phat tit vung xoang Valsalva ddng mach chd la mdt dang rdi loan nhip thit kha thifdng gap. Triet ddt cic roi loan nhip thit khdi phdt td xoang Valsalva bing ndng lugng song cd tin sd radio qua dudng dng thdng (dot dien) (?a dugc bdo cao trong mdt sd nghien citu nudc ngoai nhung trdn so lugng rit ban chi cdc bdnh nhan. Hien vdn thieu cae dd lidu vi tinh hieu qua vd an toin eda phuang phap. Cho din nay, tai Viet Nam, ehua cd nghien cdu nao di cap tdi van di nay.
Muc tieu nghidn cdu: Nhim danh gia budc diu hieu f?ua va tinh an toan cOa phuang phdp ddt didn diiu tn cac rii loan nhip that khdi phat td xoang Valsalva tai Wen Tim mach.
Phuang phap: Chdng toi tiin hanh nghien cdu tren 49 bdnh nhdn NTTT va/hodc TNT khdi phat td xoang Valsalva duge diiu tri bing phuang phdp ddt dien td
1/2010 din thang 4/2012. Cdc bdnh nhan dugc chup gdc dgng mach ehu bing thude cin quang dixde dmh cdc xoang Valsalva. Id eda cdc dong maeh vanh va vi tri dng thdng ddt (ablation catheter) Vi iri khdi phat rdi loan nhip duge xac dinh bang ky thuat tao nhip (pace mapping) va ghi dien the sdm (activation mapping).
Kit qui eung nhd cde bien chdng cQa ddt didn dugc danh gia ngay sau triet ddt va theo doi lam sang, dien tam dd mdi 3 thdng mdt lin. Td't ca cac bdnh nhan deu duac ghi dien tdm dd lien tuc 24 gid 3 thang sau thd thuit nham ddnh gia tai phit
Kit qua: 49 benh nfian duge nghien cdu bao gim 24 nam va 25 niJ, tuoi tmng binh 51,1 ± 13.7 (ndm).
NTTT-TNT khdi phat td xoang Valsalva la vanh trdi gdp d 36 ea (73,4%,); la vanh phai 5 (10,2%o), Id khong vdnh 2 (4,1 Yo) va chd ndi gida la vanh trai va phii 6 (12,3%,). Ghi dien the sdm la phuang phap chd yiu di xac dinh vi tri khdi phat NTTT-TNT vdi thdi gian hoat
V HOC THirc HANH (879) - S6 9/2013
hda didn sdm 30,3 ± 10,5 ms. Tl Id thdnh cdng ngay sau thd thuat Id 46/49 (93,9%). Sau thdi gian theo ddi trung binh 12.5 ± 6.6 thdng, 41/49(83,7%,) khdng edn eac rdi loan nhip tim. Khdng ed biin ehdng n0ng (nhii mdu ea tim. d<J( quy. tin thuang gdc vd van ding m^ch ChQ...) ndo duge ghi nh$n.
Kit ludn: Triit ddt bing ndng lugng sdng c6 tin sd mdio cd hiiu qui vd an todn trong diiu trj cdc rdi logn nhip thit khdi phdt td xoang Valsalva.
SUMMARY
Ablation within the aoriic sinus of Valsalva for the tmatment of ventricular arrhythmias: the pmliminary msult
Backgmund: Ablation within the aoriic sinus of Valsalva for ventricular tachycardia (VT)/ pmmatum ventricular complexes (PVCs) has been reported in only small patient cohorts. Limited data exists concerning the outcome and safety of aortic ablation.
Aims: The aim was to study the pmliminary msult and safety of catheter ablation for VT/PVCs originating fmm the aortic cusps at the Vietnam Heart Institute.
Methods: The study consisted of 49 consecutive patients with symptomatic VT/PVCs who underwent mdiofmquency catheter ablation within aortic sinus cusps fmm January 2010 to Apnl 2012. Aortic root angiogmphy were used to define comnary cusp and catheter position, the ablation target sites wem defined by pace mapping and eariy activation mapping techniques. Ablation parameters including tissue tempemture and tissue impedance wem also measumd. Ablation success and mcurrence was defined by ECG and clinical follow up and 24-hour Holler monitonng after 3 months. All the pmcedure- mlated complications were documented.
Results: Of the 49 patients (24 men and 25 women, mean age 51.1 ± 13.7 yearn), the site of origin was the leR comnary cusp (LOC) in 36 (73.4%o), the right coronary cusp (RCC) in 5 (10.2%o). the noneomnary cusp (NCC) in 2 (4.1%), and at the junction between the LCC and RCC (L-RCC) in 6 (12.3%) eases Pace mapping with pulse amplitude/width up to 10 V/0.4 ms failed to captum in all eases. The mean eariy activation time (EAT) measumd at the successful ablation target sites was 30.3 ± 10 5 milliseconds. The mean procedure time was 80.9 ± 25.1 mins and the mean fluoroscopic time was 15.2 ± 7.7 mins. The initial success mte was 93.9%, (46/49). After 3 months of follow up, 41/49 (83.7%,) were fme of VT/PVCs without anti-arrhythmic dmgs pmven by 24-hour Holler monitoring. No severe complications (Ml. strokes, aortic valve pedoration...) have been documented.
Conclusion: Ablation within the aoriic sinus of Valsalva is safe and effective for the tmatment of ventricular arrhythmias.
OAT VAN D ^
Rdi loan nhip that thudng gdp trong thuc hanh ldm sang va Id mot trong nhiing van de phifc tap nhat ciia benh hpc tim maeh [1, 4].
Triet ddt bang ndng lUdng sdng tan sd radio (RF) qua dudng dng thdng da trd thanh lUa chpn hang dau trong dieu tri nhieu rdi loan nhjp that, giiip giam nhe trieu chifng va trong mot sd tmdng hdp, van hoi di/dc chifc ndng tim bj suy giam do cac rdi loan nhjp gdy ra (tachycardia-induced cardiomyopathy). Phudng phap
ddt dien c6 Uu diem vuot bdc so vdi thudc chdng loan nhjp d eh5: didu tri mang tfnh tridt de vdi ti le thanh edng cao vd bien ehifng th^p [1,4].
ThO thudt ddt didn thudng quy hidn nay dua tren cac ky thudt ldp ban do hoat ddng didn hpc d ndi mac cac budng tdni thdt (endocardial mapping). Mde du ti le thdnh cdng nhin ehung la eao (tren 90%^[1]) nhung vin edn tdn tai nhieu tmtfng hdp khdng the tridt ddt dope bSng phuong phap tiep can ndi mac.
Nhidu nghidn cifu gan day da dd cap den rdi loan nhjp thit cd ngudn gdc t i ; cae bd ed tim d xoang Valsalva ddng mach chCi. Mot sd tac gia nhu Kanagaratnam [2] coi day Id mdt ^bien the" cfla rdi loan nhjp d dudng ra tdm that vd ehiem mdt ti Id dang kd, khoang 18% tdng sd ea. Cdn theo tac gia khac la Rillig, "bidn thd" ndy gdp vdi ti Id cao hdn, tdi 31,2%
tdng sd eae tmdng hop rdi loan nhip thdt duac dieu tri ddt didn [2].
Tif ddu ndm 2010, tai vien Tim mach Viet Nam, Chung tdi da bat diu thiic hien ky thudt triet ddt rdi loan nhip thdt trong xoang Valsalva va da dat dupc thanh cdng tir nhung ca dau tien. Tuy nhien. van de ludn ddt ra Id hidu qua vd tinh an toan cua phUdng phdp dieu tri mdi nay nhu the ndo kht dupc trien khai thUdng quy hon tren cac benh nhan*?
Do vdy, Chung tdi thuc hidn bao cao nay vdi muc tidu sau:
Bude dau ddnh gid ket qua phUdng phap tnet ddt ngoai tdm thu that/ tim nhanh that khdi phat ttf xoang Valsalva bang ndng luung sdng ed tan so radio qua dudng dng thdng.
0 0 1 TUONG VA PHUONG PHAP NGHIEN cQU 1. Dd'i tUdng nghien ciJfu
Ddi tupng nghien cifu dUde lira chpn tif cac trudng hdp TNT va/hoac NTTT di/dc ehi djnh tham dd dien sinh \p tim va triet dot bang RF tai vien Tim mach Vidt Nam.
Chi dmh thii thuat diia tren hudng ddn cCia Hoi Tim maeh hoe Hoa Ky/ t n i d n g mdn Tim mach Hoa Ky/Hdi Dien sinh ly va Tao nhip tim Bae My ndm 2006 (AHA/ACC/NASPE 2006) [1] cung nhif ddng thuan chuyen gia (expert consensus) cua Hdi nhip hoe chau Au/ Hdi nhip hoe Bae My ndm 2009 (EHRA/HRS 2009) [4].
Sau khi tien hdnh eae ky thudt lap ban dd dien hoc trong npi mac that phai va that trai nhung khdng tim dudc vi tri khdi phat rdi loan nhip. Chiing tdi tien hanh ldp ban do dien hpe va triet ddt trong xoang Valsalva.
Cae benh nhan dupc lua chpn vao nghien ciiu lien tidp theo trinh tU thdi gian tif thang 1/2010 den thang 4/2012.
2. PhUdng phap nghien cdu
2.1. Nghien cdu mo ta, theo doi dgc nhdm danh gia hieu qua m^t ky thu0t mdi nham diiu trj roi loan nhjp thdi bing RF.
Nghidn cOu duge tiin hanh qua eae budc sau:
Kham lam sang va can lam sang tim mach tdng quaL
Ghi didn tdm do thudng quy 12 chuyen dao va ghi Holler didn tdm dd 24 gid.
Y HOC THirC HANH (879) - s6 9/2013
Thdm dd dien sinh \p tim va triet ddt bang RF trong xoang Valsalva.
Cac BN duoc theo do! lam sdng va xet nghiem ngay sau thii thuat, dude tai kham sau mdi 3 thdng nhSm danh gia hidu qua vd bien chifng.
2.2. Thdm dd di^n sinh ly tim vd trift dot bdng RF
Chuin bi bdnh nhdn
BN duoc giai thich vd mue dich, Ipi ich, ede nguy ed cQa thO thuat vd 'kp giay cam ket tmdc khi Idm thii thuat.
Bit cdc di$n cgc
Gay td tai chd vi tri choc maeh mdu bang novocain.
Ddt cae dien cue thdm dd dien smh ly tim: 1 dien cifc ddt vdo viing cao nhT phai, 1 didn cue ddt vao viing bd His, 1 dien eifC ddt vao mdm that phai, 1 didn eiic xoang vdnh.
Dien cue ddt trong xoang Valsalva dupc dua qua dflng maeh dui phai.
dng thdng ehup DMV hodc chup gdc DMC (pigtail) se dupe dua qua mdt dudng choc dpng maeh thii hai (ddng mach diii trdi).
Thdm dd didn sinhjp tim
Do cae khoang ddn tmyen ed ban' PA, AH, HH, HV.„
Kich thich tim ed chuong trinh (programmed stimulation)' Nham danh gia dap ifng eua tim vdi eae kich thich dien theo ehifong trinh bdi phdn mem may tinh. Qua dd cho phep danh gia cae thdng sd dien sinh
\'jf hpc eOng nhu gay TNT-NTTT.
idp bin dd didn hgc di xac dinh vi tri khdi phat loan nhip (mapping)
- Phuong phap mapping bang tao nhip Nguyen \p ciia phUdng phap nay la neu dau dien cifc ddt dupe dua vao diing vi tri khdi phat CLJa TNT- NTTT thi kill tao nhjp qua dien cue se gdy ra cac phife bo QRS gidng vdi rdi loan nhip tu phat (d tren 10-12 cap chuyen dao) va dUOe coi la vj tri khdi phat hay v\ tri dich dd triet ddt.
- Phuong phdp tim hoat ddng dien that sdm rihat Nguyen 1^ ci!ia phuong phdp nay la neu dau dien cut dot duoe dda vdo dung vj tri khdi phdt cCia TNT- NTTT, qua dd se ghi dUde hoat ddng dien eua that sdm nhat, thdng thudng tif -6 den -100 ms so vdi eac dien do that khdc.
Chyp xoang Valsalva bang thude can quang Ngay trudc khi tnet ddt, ehiing tdi tien hanh ehup gdc OMC bang dng thdng pigtail vd may bdm thude can quang (30 ml can quang/1 lan ehup) vdi hai muc dich: (1) Xac dinh vj tri dich bang hinh anh giai phau vd (2) Dam bao ddu dng thdng dot khdng chpc vao eae Id d6ng maeh vdnh phai vd trai.
Triet ddt bang ndng luong tdn sd radio Bdnh nhan se dude tiem heparine TM, lieu tif 2000- 3000 Ul (50 Ul/kg cdn ndng). Triet dot dudc thiic hien vdi nang luong 10-50W va nhiet dp dieh BS^C. Sau '10 giay, ndu cd ket qua se tiep tue dot ciing cd den 60 gi^y. Neu khdng ed ket qua thi tien hdnh xac ^ n h lai vi tri dich,
2.3. Danh gid kit qua.
Ngay sau thd thudt: Khdng edn thay TNT-NTTT tii phat hoac khi kich thich tim theo chuong trinh vd/ hodc tmydn Isuprel hodc tiem Atropin.
Theo ddi dgc: Kham Idm sang va ghi dien tam dd tmdc khi ra vien vd theo ddi mdi 3 thang vd ldm sdng, sieu am tim vd eae thdm dd can thiet khac. Tat ea cdc BN deu dudc ghi Holter didn tam do 24 gid sau 3 thang de danh gia tai phat.
2.4. Ddnh gid tidu chf an todn
Biin ehdng maeh mdu: Tu mdu tai chd, huyet khdi ddng mach..,
Cac biin chimg chung lidn quan din tim mach can thidp: Trdn khi mang phdi, tran mau mdng ngodi tim, dot quy, nhdi mdu ed tim, tCf vong.
Cde biin chimg ddc thu eda thO thudt thdm do didn sinh ly tim va ddt didn: Tdn thuong nut nhT that gdy bide nhT that hoan toan can phai cdy may tao nhjp tim.
Rdi loan nhip tim ndng: mng that, nhanh that phai shock dien.
Cac biin chimg lien quan den tridt ddt tmng xoang Valsalva: t d n t h u O n g g d e v a v a n O M C ( V D : h d v a n D M C m d i x u a t h i e n )
X ( 3 * / y s d / / e u , s C f d u n g c a c p h a n m e m S P S S 1 7 . 0 v a E x e l 2 0 0 7
K E T Q U A N G H I E N C L f U
4 9 b e n h n h a n triet dd't rdi l o a n n h i p t h a t k h d i p h a t t i r x o a n g V a l s a l v a t r o n g t h d i g i a n tir t h a n g 1/2010 d e n 4 / 2 0 1 2 d u o c d u a v d o n g h i e n c i i u .
1 . O l i e d i e m c h u n g c i j a d o i t i r o n g n g h i e n clTu.
B a n g 1 : M d t s d d d c d i e m c h u n g cCia d d i tUong n g h i e n c i f u
Tudi trunq binh Giiii ThC^ gian tCr xuat hiSn tneu chirnq Benh ly fim macti thuc t6n R6\ loan nhjp thit Sdlircingr5iloan nhip thal/24 qid Thdi gian theo doi Irunq binh
51.1 ± 13.7 nam (cao nhSt 73; thap nhat: 20) 24 nam (49%) v& 25 ntf (51%) 2,9 ± 2,5 nam (ICi 3 thSng &6n 10 nam) 14/49 (20,4%), trong do, THA: 9; b6nh mach vanh: 2; suv tim, 2, b&nh van tim do thap: 1
NTTT. 39/49 (79,6%) N H T v ^ con TNT: 10/49 (20,4%)
22887±12165(21,3±10,6%) 12,5 ± 6,6 thSng (tCr 3 d^n 26 Ih^ng) 2. Chan doan dien sinh ly tim: Vj tri khdi phat cua rd'i loan nhjp that tir cac xoang Valsalva.
6/49 1 ^..^^ I 5/4-9 • 12-3% j ?^h^%^/>^ ^"--^^^
Hinh 1: Vj tri k h ^ phat roi loan nhjp tim. LCC: la vanh trai;
RCC: la vanh phai; NCC: la khong vanh;
L-RCC; cho ndi qiifa la vanh phai va trai
V HOC THUC HANH (879) - S6 9/2013
NTTT-TNT khdi phdt tif xoang Valsalva Id vanh tr^i gdp d 36 ca (73,4%); la vSnh phfii 5 (10.2%), la khdng vdnh 2 (4,1%) vd chd ndi giija la vdnh trdi vd ph& 6 (12,3%).
3. Tl le thdnh cong, tai phdt.
Tl Id thdnh cdng ngay sau thii thudt. 46/4g (g3,9%).
Cd 3 trudng hdp mapping x^c dinh 6 khdi phdt d vLing xoang Valsalva. Tuy nhidn tridt ddt nhidu Idn nhung khdng dem lai kdt qua (6,1%).
Sau 3 thdng, c6 thdm 5 tmdng hop tdi phdt (10,2%), Khdng ed tmdng hpp ndo tdi phdt thdm dupe ghi nhdn trong nhiJfng th^ng theo doi tidp theo,
Ti Id thdnh edng chung sau 12,5 ± 6,6 thdng theo ddi Id'41/49 (83,7%).
4. Mpt so' thong so lien quan den thu thuat.
Bang 2: Mdt sd thdng sd lidn quan ddn thO thudt Thdi gian thiJ thuat
ThOi gian chi^u tia X Tha gian difinlh^ sdm lai
vj tri dich Nhi^tdOvjlridlch _06n trd luc tnet ddt
80,9 ±25,1 phiil (Hi 40 dgn 120 phut) 15.2±7.7phul(tii4dgn32phiil) -30 3 ± 10.5 ms (lu -62 dfin -14 ms)
93.4 ±10.5 Ohms.
Bidn ehifng'
Bidn chimg nhe ( t u mau tai vi tri choc mach)' 3 tmdng hop (6,9%).
Bien chiing ndng. tij'vong, nhdi mau ed tim cap, dot quy, tdn thuong gdc va van ddng maeh chQ, block nhT that..: 0 tmdng hpp (0%),
BAN LUAN
1. Ve vj tri khdi phat roi loan nhjp that.
Trong nghien edu ehung tdi, rdi loan nhip that thudng khdi phat d xoang Valsalva Id vanh trai, tiep den la la vanh phai va hiem gdp d la khdng vanh. Ke't qua nay cung phii hpp vdi cae tac gia khac nhU Kanaganatman [5], Yamada [3], Rillig [6]... Theo nhieu nghien cifu ve giai phdu hoe xoang Valsalva, trong Id vanh trai va Id vanh phai ed nhieu cd'u true bd ed tim vdi dde tinh dien smh 1^ hoc vd ed the trd thanh co ehat gay rdi loari nhip. Trong khi Id khdng vdnh cau tao chQ yeu bang to ehifc lien kdt xd [8, 9, 10], ChOng tdi cung gap mpt sd trudng hop d khdi phat nam d chd ndi giua la vanh trai va la vanh phai nhu theo bao cao ciia Yamada [7],
Kinh 2: Ngoai thm thu that khdi phat tifxcang Valsalva \i v^nh trai d mot BN n052 tudi. LCC: la vinh trai; RCC: \i vanh phai: NCC: la
kh&ng vanh; ABL: dien cifc ddt
nhanh that khd^ phat tir xoang Valsalva la vanh phai d mot benh nhan nu'50 tuoi
Hinh 4: Ngoai t^m thu th3t khdt phat tir cho not glO^ xoang Valsalva Id v^n'h trit vi \k vinh phai d mdt b£nh nhan na'25 tuoi
2. Ve cdc ky thuat lap ban do dien hpc tim 6 khdi phat:
Chiing tdi nhdn thay, trong da sd cdc tnfdng hdp, mapping bang tao nhjp khong td ra hieu qua trong viec xde djnh d khdi phat trong xoang Valsalva. Ngay ca vdi eudng dp xung ki'eh thich tuong ddi eao (10 m/V0,4 ms) vdn khdng the gdy khur c u t cd tim Chi ed 1/49 ea lao nhjp tnang xoang Valsalva " d i n " dupc ra cd thdt. Do vdy, ky thudt chinh duoc ap dung vdn Id tim vj tri hoat hda dien hoe sdm nhat trong xoang Valsalva, Ghi nhan ciia chung tdi cung phu hdp vdi ket ludn eOa eae tac gia khac [3 5 6]
- ^
' h - - —
-1 .
-4
Hinh 6 Mapping b^ng phuijng phap tim dl§n th^ hoat dong that sdm II phuUng phip chu yeu dUdc ap dung de tim o khdi phat trong xoang Valsalva. Oien do thii't ghi dUOc tai diu dng thong dot
\h sdm nhat va sdm hdn QRS -52 ms.
3. Ve t i le thanh cong va bien chumg.
Tl le thanh cdng trong nghien cifu cua chiing tdi Id 83,7%. Tl le nay trong nghien cifu cCia Rillig [6] la 86,6% va mdt sd tac gia khac [3,5] la 100% (khdng c6 tdi phdt). Trong nghien eCiu eCia Yamada [3], mdt sd
Y HOC THirc HANH (879) - SO 9/20ir
benh nhan cdn thuc hien 2 lan thii thuat mdi cd kdt qua. Trong nghidn cifu ciia Kanagaratnam [2], tl Id Ihanh cdng 100% bao gdm ca nhCfng ca duoc tnet ddt ciua con dudng tiep can mdng ngoai tim. Mdt khac, sir khac biet ed thd do sd luong BN trong nghien cifii chiing tdi Idn hdn va thdi gian theo doi sau thO thudt Id dai hon so vdi bao cao cOa cac tae gia khdc.
Theo nhieu tae gia, ngay ca khi tiep cdn them qua con dudng xoang Valsalva bdn canh dUOng ndi mac kinh dien, v i n cdn tdn tai nhung trudng hpp rdi loan nhip that khdng thd triet ddt duoe. Oieu ndy neu len tinh cap thidt phai cd them nhOng hudng tidp cdn mdi trong tifong lai.
Chiing tdi cd nhan xet Id cac trudng hop tdt phat thudng xay ra trong vdng 3 thdng ddu tidn sau thO tiiuat. Sau thdi gian nay, khong thay cd ca tai phat them. Khi thii thudt dd trd ndn thudng quy hdn, cd the khuyen cdo chi can theo doi benh nhan sau ddt dien 3 thang Id 6ii.
TrSn 49 ca trong nghien eifu, thO thuat ddt dien la an toan khi khdng ed bidn chifng ndng nao duoc ghi nhan, ede bie'n chdng nhe eijng it gdp vd sau xCf tri khdng dd lai di chimg.
K^'TLUAN
Tnet ddt bang ndng luong sdng cd tan sd radio qua dudng dng thdng cd hieu qua cao vd an todn trong S4u tri cae rdi loan nhip that khdi phat tif xoang Valsalva.
TAI Ll£u THAM K H A O 1.ACC/AHA/ESC(2006).
Guidelines for management of patients with ventncular affhythmias and the prevention of sudden cardiac death. J Am Coll Cardiol 2006. Vol. 48, No. 5.
2. Rillig A, Meyerfeldt U, Birkemeyer R, Jung W (2009).
Ablation within the sinus of Valsalva for treatment of
supraventricular and ventricular tachycardias: what Is known so far? Eumpace 2009 Sep;11(9):1142-50.
3. Yamada T, McElderry HT, DoppalapudI rl, Murakami Y, Yoshida Y, Yoshida N et al (2008)
Idiopathic ventricular airhythmias originating from the aoriic root prevalence, electrocardiographic and electrophysiologic characteristics, and results of radiofrequeney catheter ablation. J Am Coll Cardiol 2008;52:139-47.
4. EHRA/HRS (2009)
Expert consensus on catheter ablation of ventricular arrhythmias. Heart mythm 2009. Vol. 6, No 6.
5. Kanagaratnam L, Tomassoni G, Schweikert R, Pavia S, Bash D, Beheiry S et al (2001)
Ventricular tachycardias arising from the aortic sinus of Valsalva, an under-recognized variant of left outflow tract ventncular tachycardia. J Am Coll Cardie^ 2001:
37:1408-14.
6. Rillig A, Meyerieldt U, Biri^emeyer R, Treusch F, Kunze M, Braseh M et al (2008)
Catheter ablation within the sinus of Valsalva - a safe and effective approach for treatment of atrial and ventricular tachycardias. Heart Rhythm 2008; 5:1265-72, 7. Yamada T, Yoshida N, Murakami Y, Okada T, Muto M, Murohara T et al (2008)
Electrocardiographic characteristics of ventricular an'hythmias originating from the junction of the left and right coronary sinuses of Valsalva in the aorta: the activation pattern as a rationale for the electrocardiographic characteristics. Heart Rhythm 2008,5:184-92.
8. Yamada T, Litovsky SH, Kay GN (2008) The left ventncular ostium: an anatomic concept relevant to idiopathic ventricular arrhythmias Circ Anhythm Electmphysiol 2008; 1: 396-404.
9. Suleiman M, Asin/alham SJ (2008)
Ablation above the semilunar valves' when, why, and how? Part 11 [Review]. Heart Rhythm 2008;5:1625-30.
10. Suleiman M, Asirvatham SJ (2008)
Ablation above the semilunar valves: when, why, and hoW Part 1 [Review]. Heart Rhythm 2008,5:1485-92.
THUC TRANG VA MOT SO YEU TO ANH HUffNG DEN TUAN THU QUY TRJNH THAY BANG THU&NG QUY CUA DIEU DUUNG BENH VIEN DAI HOC Y HA NOI NAM 2012
PHUNG THj HUYEN, N G U Y I N HOA PHAP, CHU VAN TUYEN, HOANG TH! HUYEN TRANG, TRUONG QUANG TRUNG, D 6 THj KIM OANH TOM TAT
iWuc lieu: (1) Xde dinh tp Id diiu dUdng (DD) dat fiim kha khi thuc hidn quy trinh thay bdng thudng quy va nbOng sai sdt thudng gdp trong qua trinh thay bdng:
(2) Tim hiiu mOt sdyiu tilidn quan din vide tudn thd quy trinh thay bdng.
Phuang phdp nghidn cdu: Md ta dt ngang.
Doi tuang: 93 diiu dudng dang cdng tdc tai 8 khoa lam sang BV Dai Hgc Y Hd Ndi.
Kit qui: PtJin Idn diiu dudng cd trinh do tmng cap (S7.7%,). Tp Id diiu dudng thuc hidn quy trinh dat loai 't/ia tra Idn cao (51.6%> dat diim gidi, 43%o dat diim l<i^aj. Yiu to vi tri cdng tdc la yiu td duy nhit inh huang tdi vide dat diim gidi eda diiu duong. Khoa
cdng tac la yiu td duy nhat lien quan tdi mde dd dat diim kha trd Idn eda diiu dudng. Diiu dudng nam gidi tuan thd quy trinh thay bdng kem han diiu dudng nd (24.16 vs. 25.84). Diiu dUdng lam vi tri hanh chinh tudn thd quy trinh thay bdng tdt han diiu dudng ehdm sdc (26.74 vs 24.74).
Kit luan: Tp le BD dat diim khd trd Idn tuang doi cao (94.6%,). Gidi, Vi tri edng tie eda diiu dudng vi khoa Idm sdng cd mdi lidn quan din kit qui tuan thd quy trinh thay bdng thudng quy
TCr khda: Thay bdng thudng quy; Diiu duang;
Benh vidn Dai hgc YHa Ndi
YHOC THUC HANH (879) - S6 9/2013
