NGHIEN CCU LAM SANG t
Ket qua phau thuat sufa van hai la tai Benh vien Da NSng
Nguyen Minh Hal, Phan Oinh Thao, Iran Ngpc Vu Benh vien Oa Nang
Muc dich: Dinh gii kit qaa phau diuat sda \Qn hai 11 tai benh vien Da Nang.Phif<ftig phap: Td dilng 7/2011 tdi 7/2014 da phlu thuit sda van hai 11 cho 45 binh nhan. Danh gia ket (jua phlu thuat dda tren theo ddi lam sang va silu Im tim. Ket qua: 45 benh nhan gdm 28 nam va 17 nd vdi tudi trmig binh 35,6±17,1 (nhd nhit 6 dilng va ldn nhit la 69 tudi). So sanh tnidc va sau md thiy d i diien cd y n ^ a ve trieu chdng ed nang, ap ldc dpng mach phdi tam thu, chenh Ip tdi da qua van hai ll. Theo doi trung binh 12,3±8,4 thing chda thiy trddng hpp nao td v o r ^ cd 2(4,4%) trtidng hpp hd van nang tai phat Kit luan: Kit qua suCa van hai ll tai Benh viln Da Nang ll kha cjuan. Chting tdi se tiep tue theo ddi, dinh gia kit qua lau dai beta vdi sd Iddng benh nhan ldn hcfti.
BATVJiNBi
Benh van tim hai ll ed die do nguyin nhin bam sinh hole mac phai. Phau thuat sda van 11 mot trong nhting biln phip dilu tri hieu cjul Ioai benh ly nay vdi nhilu tfu dilm hdn han so vdi md thay van. N ^ l n edu nhim danh gia kit cjua dieu tri phlu thuat sda van hai la tai Benh vien Da Nang.
PHUDNG PHAP NGHIEN CQU
Nghien ctiu tiln cdu tU 7/2011 den 7/2014, ed 45 benh nhan diipc ehi dinh phau diult sda van hai 111^ b | n h viln Da Nang. Loai khdi nghien cdu cac tnidng h ^ hd van hai 11 bim sinh brong benh ly kenh nhi thiL
Tat d benh nhan deu dddc ehuan hi tnidc md, ky thu|t thdc hi?n, cham sdc hau phau va theo ddi sau md theo mpt chdcftig trinh soan sin,
Phlu thuat dddc dide hi?n tjtia dtidng md
dpc gida xiicftig t^e, thiet lap tuin hoan ngoai cd the thiidt^ qui, ha thin nhiet 32" C, bio vl ed tim bang dung dieh lilt tim mlu am, tilp can van hai la qua ddcftig md nhi trai song song vdi ranh lien nhi hole md vieh lien nhiPhan tich tdn didcftig va ap dung d c nguyin ly sij^ van hai la ed ban cnia A,Carpentier.
Kit qua sda van hai 11 difdc danh gia diia trin sieu am tim qua diidng thiic quan hole thanh ngtic.
KETQUA
Cd 45 benh nhan gdm 28 nam va 17 nii; tudi trur^bmh 35,6±17,1 (10 thing - 69 tudi), tre em (dddi 16 tudi) chiem 13,3%Tid nang van hai la chiem 75,6% edn Iai la ton thddng hep hd van vcfi dienh Ip tdi da cjua van hai la la 28,0±8,6 mmHg.
Mpt so die dilm tdn thdcftig vl ley thuat sda van dddc g)ii nh|n theo d e bang dddi day.
TAPCHITIMMACH HOCVIETNAM-SO 68.2014!191
* NGHIEN ClAJ LAM SANG
Bdngl. Mot so dqc diim
D|ic diem Trieu chting
Phlu thua,t phdi hdp
Nguyen nhan
NYHA (II/UI) Rung nhi
PAPs Va thong liln nhi Va thong lien that Cat xd hep difdi van chd
Sda van ba la (dat dai mang tim II sau va la tnidc)
Thay van chu Thap tim Bam sinh Thoai hoi Viem noi tim mac
Thdn^sd 45 (100%) 12 (26,7%) 56,l±16,0mmHg
3 (6,7%) 5(11,1%) 1 (2,2%) 11 (24,4%)
4(8,9%) 14(31,1%) 19 (42,2%) 9 (20%) 3 (6,7%) Bdng 2. Thudng ton van hai Id
Ihi^tf ng t6a van hai l i Danvongvan
Ch^ la tnidc Sa la tnidc Salasau Dinh mep van Day/vol la van
S6 trildng htfp 45
1 13 13 12 13
Tan suat 100%
2,2%
28,9%
28,9%
26,7%
28,9%
Bang 3. Ky thudt can thiip tren van hai Id Kythu^t
Dat vongvan nhan tao Dat dai mang tim cho vong van sau Dongchetrenlavan tnJdc Khau gap nep bd tu do la tnlclc Khau hd tu do la tnidc vdi la sau Rut ngSn day ching Chuyen day chiing Cat hinh tam giac la van sau Xe mep van
Got mong la van Md rong la trade
S 6 t r t i d a f i h ^ 37 8 1 1 3 5 10 13 12 6 1
' H n s u i t 82,2%
17,8%
2,2%
2,2%
6,7%
11,1%
22,2%
28,9%
26,7%
13,3%
2,2%
Khdng CO tnidng hdp nao td vong benh viln, d c biln chdng sau md bao gdm: md lai d m mau I tnidnghpp (2,2%)j nhilm tiling vlt md 2 tnidng hdp (4,4%). Cd4tnidnghpp (8,8%) rung nhi tirdvl 1^ nhip xoang sau md. Kiem tra sieu am tim tnidc khi ra viln 100% tnicftig hc^ hd van hai la nhe hole khong dang ke.
T3t ca benh nhin deu diidc theo ddi sau md vdi thdi gian dieo ddi tnmg binh la: 12,3±8,4 dilng.
Chda ghi nhan cd td vong mupn khi theo doi dai ban, hd van hai la tii phat 3 tnidng hdp, trong do: I 192ITAP CHi TIM MACH HOCVIETNAM-SO 68.2014
NGHIEN CL/U LAM SANG t^
tnidng hpp hd trung binh 2/4 tilp tue dddc dieo doi; edn Iai 2 trddng hdp hd van nang 3/4 ed chi dinh md Igd. Ket qua kilm tra eho thay ed sd d i thiln rd ret vl trilu chting so vdi trddc md.
Bdng 4. kit qud him tra sau md
NYHAII/Ill PAPs (mmHg) Gdmax qua van hai la
(mmHg)
Trntfcmd 100%
56,1±16,0 28,0±8,6
Ravien 33,9±6,9 9,3±4,7
Lau dai 4,4%
33,0±-9 11,6±6,6
P so voi trtftfc mo
<0,05
<0,05
<0,05
BAN LUAN
Phlu thuat thay van hai la eho din nay van la mdt phddng phip dieu tri hieu qui cho d e tnidng hop tdn diifcftig van hai la dl qui nang. Tuy nhiln, siia van hai la eho thay kit tjul lau dai dn dinh vi CO nhieu du diem vddt troi nhd: bao tdn chdc nang that traij tranh diipc d c bien chiilig do dung thude khang ddng; ty 1| td vong phlu thuat thip hcfti thay van [2,4,5,6]. Do vay sda van hai II ludn la ky thuat dtipc ehiing tdi da tien Ida chpn bit cd khi nao cd the, dac biet la d tre em.
Cae thtidng tdn van hai la dddc phin tich dda tren phan loai cua A. Carpentier: type I - cd ddng binh thddng eua d e la van, dan vdng van hole bi thimg ll van; type II - sa II van do thilu diy chang, dut hole keo dai day ehIng hay ed nhu; type HI - han ehe ed ddng d e 11 van hole bp miy diidi van. Cae ky thuat sda van hai ll kinh dien cua A.
Carpentier eiing dddc chting tdi ap dimg trong qui trinh dilu tri [3].Tuy nhien, ddi vdi d e tdn thtidng sa 11 van sau ehung tdi sd dung ky thuat eat hinh tam giic la sau thay eho vile d t hinh td giac kmh diin. Sau khi dddc d t hinh tam giae d n vdi day la bd td do cua la van va dinh tam gilc quay vl phia vdng van, md la van se dddc khiu lai vdi chi 5/0, khau vit hai Itfpt de dam bao tinh chae chan.
Ky thuat nay kha ddn giln, de thdc hien, bao ton diidc md 11 van tdt hdn, tranh dtide viec phai khau glp nip vong van 11 sau nhd khi cat td gilc, nhiing vin dam bio dddc tinh dn dinh Uu dai cda kit qua sda van [5,6]. Da cd 13(28,9%) tnidng hdp sa la van sau d eic vi tri khic nhau dddc ehiing tdi sd dyng 1^ thuat nay Ngoai ra cdn cd thim 3(6,7%) tnidng hpp tdn diiicftig sa vung A2,nhting do cac
day chang tjul thanh manh, khdng dam bao tinh chic ehan nlu chuyin vi day chang dcfti thuan nen cJuing tdi thiJc hien cat tam gilc d vung P2 de ehuyen ra tnidc khau vao vung A2. Kit qua scftn sau md eung nhd trong qui trinh theo ddi,tat cl eae trddng hpp nay ehi edn hd van nhe hoae khdng ding kl. Nhtidc diem cua ky thuat d t tam gilc niy la khdng ap dung dddc eho cic trddng hdp cd vung la sau bi tdn thdcftig qua ldn, thddng la khi vddt qui 1/3 dien tich la van sau.
Mdt ky thuat sda van khie ciing kha dcfti giln va dl thdc hien llky thuat Alfieri.Chiing tdi da ap dung cho 3 tiiidng hpp sa vung mep van bang d e h khiu dinh vung sa la van tnidc vdi la van sau d vi tri ddi dien tdcftig xdng, dung dddng khau vlt 2 liidt, ehi 5/O.Kilm tra sau md eho din nay eho kit tjul tdt, khdng hep van va ehi edn hd nhe.
Vihe sd dung vong van nhan tao trong sda van hai ll nham giup lly lai hinh dang vdng van da bi bien dang, thu hep vdng van bi dan vl kich thtidc binh thddng, tang dien tiep xue hai la vanva ngin ngda tinh trang dan vdng van tien triln ve sau [2,4]. Chung toi da sd dung vdng van nhin tao Ideu hd va nda cdng eho hau het d c tnidng hc^
(82,2%), nhim dim bao tinh dn dinh kit qui sda chda, Tuy nhien d tre em nlu sd dung vdng van nhan tao nhd se lam anh hdcftig sd phat trien ldn len eua vdng van va gay ra nguy ed hep van hai la visau [ 1 ]. Chinh ^ vay vdi d c trdcftig hdp tre em trong nghien cdu nay (13,3%), chiing tdi thay die vong van nhan tao bang dat dai mang tim eho toan bp vdng van sau. Qua theo doi din nay, tinh trang van hai la van dn dinh chda thay hd van tai phit ciing nhti biln chting hep van xuit hien.
TAP CH i TIM MACH HOC VIET NAM - SO 68.20141193
Ji NGHIEN CUlJ LAM SANG
Nghien cdu eho thiy sd eai thiln rd ret va cd y nghia ve d e trieu chdng ngay sau md eiing nhd trong qua trinh theo doiso vcft luc trddc md (Bdng 4). Khdng cd tnidng hdp nao td vong benh vi$n, ty II bien chdng phau thuat thap bao gdm: 2,2%
md lai elm mau; 4,4% nhilm trung vet md. Kiem tra tnidc khi ra vien eho dily 100% trddng hc^ chl con hd van hai II nhe hoac khdng ding ke.Tuy v|y, ed 3trddng hdp hd van hai la hau thip bitii phat tdn ditidng sau md khoing 1-2 nim (6,7%). Trong dd bao gdm: 1 tnidng hdp hd van hai II trung binh nen tiep tue dddc dieo ddi va dieu tri ndi khoa; 2 tnidng hpp hd van hai la nang (4,4%) do dan vdng van,c6 ehi dinh md lai. C l hai tnidng hc^ hd van tai phit nang nay deu ed ddcftig kinh that trai cudi tim tnidng trin sieu am tira tnidc md lin Iddt la 65nim va 67nini. Kha nang do loai vdng van hai U nhin tao kiiu hd,nda cdng dddc d|t cho vdng van sau ma chiing tdi sd dung d hai benh nhan nay da khdng ngan ngda diidc tinh trang dan vdng van tiep tue tien trien d benh nhin diap tim cd budng that trai da dan qua Icftitd tnidc md.
KETLUAN
Trong ba nam qua, Binh viln Da Nang da tien hanh phau thuait sda van hai la eho 45 tnidng
hc^.Klt qua bddc dau rat dang khich 1?, 95% binh nhan d i thiln ro ret vl trilu ciidng ciing nhd tinh trang hep hd van hai la eho din thdi diem hi|n tai, vdi ty 11 biln chiing thip va khdng cd td vong.
Chung tdi se tiep tue theo ddi va danh gia kit qua Uu dii, vdi ed mlu ldn hdd trong thdi gian tcS.
SUMMARY
Obiective:To evaluate the results of surgical repair of mitral valve at Da Nang hospital.
Methods: From July 2011 to July 2014, we performed 45 surgical repairs of mitral valve.
Clinical examination and echocardiography assessed the post-operative results. Re5alts:45 patients with a mean age of 35,6±I7,1 (range 10 months to 69 years) underwent repair. There were 28 males and 17 females. The comparison of pre and post-operative data showed significant reduction of pulmonary arterial pressure and mitral valve regurgitation grade, improvement in die functional class ofheart feilure. Mean follow- up was 12,3±8,4 months with no death. Two patients (4,4%) required reoperation because of severe mitral regtirgitation.ConcliisiDn: Our results of suigical repair of mitral valve in 45 patients are satisfactory
T A I L I E U THAM K H A O
Pham Hflu Minh Nhiit va cpng sii, Ket qua phau thuat ddng thdng lien that kit hdp vdi tao hinh van hai 11 tai Vien Tim thanh phd Hd Chi Minh. Tap ehi y hoc Vilt Nam, sd 2, thang 11 /2008
Nguyen Vzn Phan. Tong quan di^u tri ngo^ khoa benh ly van tim. Tap chi y hpc Vi|t Nam, sd 2, thing 11/2008
Caipentier.A, BrizardC. Congenital malfomiation of the mitral valve. In surgery for congenital heart defect. 2006 John Wiley&Sons, Ltd: Englandp 573-590
Dan Spiegelstein et al. Midterm results of mitial valve repair: closed versus open annuloplasty ring Ann diorac surg 2010;90:489-96
Kristopher MCeorge, Tomislav Mihaljevic, A. Mare Gillinov. Triar^ular resection for posterior mitral prolapse: rationale for a simpler repair. The joumal of heart valve disease 2009; 18:119-121 Leo M. Gazoni et aL A simplified approach to degenerative disease: triangular resection ofthe mitral valve.
Ann thorac surg 2007;83:1658-65
194 TAP CHI TIM MACH HOC VIET NAM - SO 68.2014
