Y HOC VIET NAM SO DAC BIET - THANG 11/2010
of life: late results", Ann Thorac Surg (74), pp.
133-8.
Giannopoulos N.M., Chatzis A.K., Karros P., et al. (2002), "Early results after transatrial/transpulmonary repair of Tetralogy of Fallof, European Journal of Cardiothoracic Swrgery, (22), pp. 582-586.
Lee Jeong R., Kim Jun S., Hwang H.Y. et al.
(2004), "Complete repair of teUalogy of Fallot in infancy", Interactive Cardiovascular and Thoracic Surgery, (3), pp. 470-474.
Meyns B., Garsse L.V., Boshoff D., et al.
(2004), "The contegra conduit in the right
ventricular ouflow tract induces supravaKular stenosis", Journal of Tlioracic and Cardiovascular Surgery, 128(2), pp. 1-7.
9. Monro James L. (2005), "Transventricular repair of Tetralog>' of Fallot", Congenital Surgery, Elsevier, Paris, pp. 45-53.
10. Nollert Georg, Fischlein Teddy, Boutenvek Stefan et al. (1997), "Long-term survival in patients with repair of tetralogy of Fallot: 36 year follow-up of 490 survivors of the first year after surgical repair", J Am Coll Cardiol, (30), pp. 1374-83.
PHAU THUAT DIEU TRj CHUYEN GOC DONG MACH:
KINH NGHIEM TUTS TRlTOfNG HOP DONG MACH VANH DUY NHAT TAI DENH VIEN NHI TRUNG UrONG
yu'.'•;.'
Nguyen Ly Thinh Truo-ng*, Dang Hanh Tiep**, Cao Viet Tiing****,Tran Minh Dien***, Nguyen Thanh Liem*
ABSTRACTS
Transposition of the Great Arteries was a complex heart disease. Many attempts has been made to reduce the mortality and morbidity.
However, single coronary arteries in Transposition of the Great Arteries still be a challenge group to pediatric cardiac surgeon. We descibre our technique of total correction for baby has been diagnosed transposition of the Great Arteries with single coronary arteries in National Hospital of Pediatric in VietNam.
I.
OAT VANof
Phiu thuat dieu tri benh chuyin gdc dgng
mach d tre sa sinh va tre nho doi vdi nhirng truong hgp chi co mgt dgng mach vanh duy nhat van la mgt thach thiic va la yeu to nguy ca trong tien lugng tii' vong [5]. Da co nhieu cai tien ve ky thuat trong lai dgng mach vanh dugc dua ra nham nang cao kha nang chuyen dgng mach vanh thanh cong trong qua trinh phau thuat [9],[10]. Tir thang 11 nam 2009 den thang 8 nam 2010, chiing toi da tien hanh phau thuat cho 22 trudng hgp tre sa sinh va tre nhd dugc chan doan chuyen goc dgng mach hoan toan. Co 5 truong hgp mgt dgng mach vanh duy nhat da dugc phat hien trong qua trinh phau thuat.
* Khoa Ngogi - Benh vien Nhi Tnmg Uang:** Khoa GMHS - Benh vien Nhi Tnmg Udng
II. BENH NHAN VA PHUONG PHAP:
Tir thang 11 nam 2009 tai thang 8 nam 2010, CO 22 truong hgp chuyen goc dgng mach d tre sa sinh va tre nho da dugc tiln hanh phau thuat sira chiia toan bg tai Benh vien Nhi Trung Uang, trong do cd 5 trudng hgp dugc chan doan mgt dgng mach vanh duy nhat.
Tat ca cac benh nhan dugc chan doan chuyen goc dgng mach hoan toan co chi dinh phau thuat Jatene deu dugc chiing toi tiln hanh phau thuat theo quy trinh thing nhit chay may tim phoi nhan tao ha than nhiet miic do trung binh 25°C - 28°C. Sau khi tiln hanh ngimg tim vdi dung dich Custadiol, hai dgng mach chil va dgng mach phoi dugc cit rdi, thu thuat Lecompte dugc tien hanh nhim chuyen dgng mach chu ra phia sau dgng mach phoi, cac dgng mach vanh dugc cit rdi khdi dgng mach chii (dgng mach phdi mdi) vai ciic ao day dii va dugc trong lai vao dgng mach phoi (dgng mach chil mdi).
Ky thuat trong lai dgng mach vanh dugc chung toi sir dung trong 5 trudng hgp tren la ky thuat "cira lat" [4],[9]. Phin mo khuylt tren dgng mach phoi mdi dugc thay thi bing mang tim tuai, sau do dgng mach chu va dgng mach phoi dugc noi lai vai nhau. Cac thuong ton phoi hgp trong tim dugc tiln hanh sira chira truac hoac sau khi chuyin dgng mach vanh tuy theo timg truong hgp cu the. Sau khi tha clamp dgng mach chii, tim dugc chay ho trg va benh nhan dugc tiln hanh cai may tim phoi nhan tao.
Benh nhan thii nhat 30 ngay tuli, can nang 4kg, vao vien trong tinh trang suy tim sung huyet, tim nhe toan than. Tre dugc tiln hanh hoi siic trong vdng 2 ngay va hoan thanh cac xet nghiem chin doan. Sieu am tim phat hien ton thuong chuyin gic dgng mach, tuong quan hai dai dgng mach trudc - sau.
thong lien that quanh mang duong kinh 6mm, ong dgng mach ldn shunt 2 chieu vai dudng kinh 6 - Smm, lo bau diic ma 4mm shunt phai - trai la chii yeu. Trong qua trinh phiu thuat chung toi phat hien benh nhan co mgt dgng mach vanh duy nhat xuat phat tir xoang Valsava ben phai (Hinh 1). Dgng mach vanh trai chay vong phia sau dgng mach phoi va chia thanh 2 nhanh dgng mach mii va dgng mach lien that trudc, dgng mach vanh phai theo dudng di binh thudng theo kieu (2R,AD,Cx) theo phan loai Leyden [5],[8]. Ciic ao chung cua dgng mach vanh duy nhat dugc cat rdi va phau tich giai phdng dii rgng de khi trong lai vao dgng mach chu mdi khdng bj cang hay xoan van. Lo thong lien that dudi van dgng mach chu dugc tien hanh va qua dudng van dgng mach chii sau khi ciic ao dgng mach vanh da dugc giai phong. Lo bau due dugc de md. Benh nhan sau phau thuat dugc tien hanh cai may tim phoi nhan tao khong co bat cii vin dl gi vl huyet dgng va dugc dong xuong iic ngay sau mo. Thdi gian benh nhan nam hdi sire la 4 ngay, tre ra vien vao ngay thir 12 sau phau thuat. Tai kham sau mo cho thay van dgng ciia cac thanh tim hoan toan binh thuong, chiic nang tim tot vai EF > 60%), khdng c6 shunt tdn luu qua thong lien thit, khong c6 hep phoi, khdng cd hd van dgng mach chii.
Benh nhan thii hai la mgt tre nam 5 ngay tuoi, can nang 3.6 kg, vao vien vai chin doan benh tim bam sinh tim sdm. Benh nhan dugc sieu am tim va chan doan mic benh chuyen goc dgng mach hoan toan - thong lien that lon - con ong dgng mach, tuang quan hai dai dgng mach truac - sau, kich thuac cua dgng mach phoi gan tuong duong vai dgng mach chu. Qua trinh phau thuat phat hien thay benh nhan cd hai lo mach vanh nim sat canh nhau kieu "nong siing san", hai lo dgng
Y HOC VIET NAM SO DAC BIET - THANG 11/2010
mach vanh nim dudi mep van to chim giira la vanh phai va la vanh trai. Tir 16 dgng mach vanh nim phia ben phai tach ra dgng mach vanh phai va dgng mach vanh trai. Dgng mach vanh trai chay vong phia sau dgng mach phdi va chia thanh hai dgng mach mii va dgng mach lien that trudc. Tir 16 dgng mach vanh nam phia ben trai mgt nhanh dgng mach vanh nhd chay trong thanh cua dgng mach chii kieu intramural, cap mau cho phin phlu ciia that phai. Chiing t6i tien hanh tach rdi mep cua hai la van to chim khoi thanh dgng mach chii, roi tien hanh cat rai ciic ao chung cua ca hai dgng mach vanh sau do tien hanh chia ddi cue ao chung co chira hai 16 dgng mach vanh thanh hai ciic ao rieng biet. Sau do tren ciic ao dgng mach vanh ben trai cd hinh thai intramural dugc chiing tdi tien hanh md rgng 16 vao cua dgng mach vanh tdi sat nguyen uy cua dgng mach nay (Hinh 2). Hai cue ao dgng mach vanh dugc giai phong rgng rai va trong lai vao dgng mach chil mdi. Cac thuong ton ph6i hgp dugc tien hanh sua chiia ciing mgt thi. Sau khi tha clamp dgng mach chu, chiing toi phat hien chay mau tai vi tri cua ciic ao dgng mach vanh nam ben trai. Benh nhan dugc tien hanh ngimg tim trd lai va mieng ndi cua dgng mach vanh nam ben trai dugc lam lai.
Sau khi tha cap dgng mach chii benh nhan dugc tien hanh cai may tim phdi nhan tao kh6ng CO gi khd khan, kh6ng co chay mau sau mo. Benh nhan dugc de hd xuang irc sau md va chuyen ra hoi siic vdi cac lieu thudc van mach d miic t6i thieu. Sau 36h sau m6, benh nhan dugc dong xuong iic va tien hanh cai va rut may tha sau 72h sau m6. Thdi gian nim hoi siic sau mo la 10 ngay va tre ra vien vao ngay thu 117 sau phau thuat. Tai kham kh6ng phat hien bat cu' van de nao nghiem trgng, chirc nang tim t6t, EF > 60%). khong
CO roi loan van dgng thanh thit. khong hep duong ra that phai.
Hinh 1: Dgng mach vanh duy nhat xuat phat tir xoang Valsava phai
Hinh 2: Chia tach dta chung dgng mach vanh thanh 2 cue ao dgng mach vanh rieng
biet.
Benh nhan thu ba la mgt trudng hgp tre nam 12 ngay tuoi, 3.2kg, vao vien vi kho tha va tim tai. Sieu am chan doan phat hien chuyen g6c dgng mach - con 6ng dgng mach - lo biu due ban che. Benh nhan dugc tien hanh pha vach lien nhT bang bong va hoi sire ngi khoa. Phau thuat dugc tien hanh liic tre dugc 21 ngay tuoi. Trong mo phat hien bat
thudng mgt dgng mach vanh, dgng mach vanh duy nhat xuat phat tir xoang Valsava ben phai, dgng mach vanh trai chay vong phia sau dgng mach phdi chia thanh 2 nhanh mii va lien that truac kieu (2R,AD,Cx) theo phan loai Leyden [5],[8]. Ciic ao dgng mach vanh dugc giai phong rgng rai va trdng lai vao dgng mach chu mai, phan vach lien nhT dugc va lai bang mieng mang tim tuai. Sau phau thuat benh nhan dugc de ha xuong iic trong vong 48h. Sau khi ddng xuong lie, benh nhan dugc cai va riit may thd vao ngay thii 5 sau phau thuat. Sieu am sau mo cho thay chiic nang tim va van dgng thanh that tdt, kh6ng hep dudng ra that phai, van dgng mach chil hd rat nhe. Benh nhan ra vien sau 35 ngay sau phau thuat.
Trudng hgp thir tu la mgt tre nii 24 ngay tuoi, 2.9kg, nhap vien vai chan doan benh tim bam sinh tim sdm. Sieu am tim phat hien chuyen gdc dgng mach kem theo thdng lien that phan ca duong kinh 6mm. Trong qua trinh phau thuat, chiing tdi thay tuong quan hai dgng mach song song (side by side), dgng mach vanh trai va dgng mach vanh phai xuat phat tir sinus 2, dgng mach vanh trai vong phia sau dgng mach phdi chia thanh 2 nhanh lien that truac va nhanh md. Co mgt nhanh vanh nho xuat phat tir sinus 1 cap mau cho phan pheu ciia that phai. Chiing toi tien hanh hoc tach ca 2 ciic ao dgng mach vanh va trdng lai vao dgng mach chii mai theo ky thuat "cua lat". Lo thong lien that phan ca be dugc khau true tiep bang chi Prolene 7.0. Sau khi tha cap dgng mach chu, ho trg tim va cai may tim phoi nhan tao, chiing toi tien hanh ddng nguc cho benh nlian ngay trong phong mo. Sau phau thuat 3 ngay, benh nhan dugc riit may thd, sieu am sau phau thuat cho thiy chirc nang va van dgng cua tim tit. Benh nhan xuat vien sau 10 ngay sau phau thuat.
Hinh 3: Dgng mach vanh duy nhat trong bat thuong Taussig-Bing
Benh nhan cuoi cimg trong bao cao nay la trudng hgp tre nam, 5 thang tuoi, 5.2kg, vao vien vai tinh trang tim nhe toan than.
Sieu am tim phat hien bat thudng Taussig- Bing, 16 thong lien that nam dudi van dgng mach phdi, hai dai dgng mach xuat phat song song (side by side), tang ap lire dgng mach phdi rat nang. Trong qua trinh phau thuat chiing t6i phat hien dgng mach vanh duy nhat xuat phat tir sinus 2, tir d6 chia thanh hai dgng mach vanh trai va dgng mach vanh phai. Dgng mach vanh trai chay vong phia sau dgng mach phoi roi chia thanh 2 dgng mach lien that truac va dgng mach md. Co mgt nhanh nhd xuat phat tir sinus 2 cap mau cho pheu that phai (Hinh 3). Sau khi trong lai hai button dgng mach vanh vao dgng mach chil mai, chiing toi tien hanh tao duong ham trong that tir 16 th6ng lien that len dgng mach chil mai (dgng mach phdi cii). Benh nhan sau phau thuat dugc dong nguc ngay, thdi gian tha may keo dai 4 ngay. Benh nhan dugc , sieu am sau phau thuat cho thay van dgng cac thanh that va chirc nang tim t6t, benh nhan ra vien sau 15 ngay sau phau thuat.
Y HOC VIET NAM SO DAC BIET - THANG 11/2010
IV. BAN LUAN
Chuyin gic dgng mach kem theo bat thudng mach vanh duy nhat van la mgt thach thiic ve mat ky thuat va la mgt trong cac yeu t6 nguy ca tien lugng tir vong trong qua trinh phiu thuat [2],[5]. Ngoai ra, mgt s6 nghien ciiu ve cac yeu t6 tien lugng va nguy ca tir vong hien nay cho thay yeu to th6ng lien that, can nang thap, thdi gian cap dgng mach chu dai, va xuong iic de hd sau phiu thuat la nhirng yeu to nguy ca doc lap c6 lien quan mat thiet tdi ty le ttr vong sau phau thuat [2],[6],[7],[8].
Tai Benh vien Nhi Trung Uong, phau thuat sira chiia chuyen g i c dgng mach a tre sa sinh da tien hanh tir nam 2009 va van tilp tuc trong qua trinh hgc hdi va nang cao kinh nghiem. Doi vdi phlu thuat chuyin gic, ky thuat quan trgng nhit va cdng kho khan nhit la tr6ng lai dgng mach vanh. Phin ldn kit qua ciia cuoc phau thuat phu thuoc vao sir thanh c6ng cua ky nang tr6ng lai dgng mach vanh vao dgng mach chu mai. Co nhilu ky thuat trdng lai dgng mach vanh duy nhit vao dgng mach chu mdi da dugc mo ta vdi nhiing ket qua khac nhau. Parry va cong sir m6 ta ky thuat "mang tim phu" nhim duy tri hinh thai hgc cua dgng mach vanh va nhan manh sir duy tri hinh thai hgc cua dgng mach vanh sau khi chuyen vj tri c6 anh huong quyet dinh tdi ket qua lau dai sau phiu thuat [4]. Hg da thanh cong khi sir dung ky thuat nay cho 4 trong 5 benh nhan phai tien hanh sira lai dgng mach vanh. Tuy nhien vdi nguy ca canxi hda ciia mang tim, nguy ca hinh thanh huyet khoi trong xoang mach vanh mai, va nguy ca xoang dgng mach vanh mai bi de ep boa dgng mach phoi mdi van la nhiing lo ngai con tin tai khi tien hanh ky thuat nay. Mgt nhdm tac gia tir An Do cung sir dung ky thuat chuyin dgng mach vanh tai cho nham tranh
nguy ca xoan van dgng mach vanh khi tiln hanh chuyin dgng mach vanh [3]. Tu>- kit qua ngin han va trung han cho thi>' khong co hep duong ra ciia hai thit hoac ha van dgng mach chil hay dgng mach phii kem theo tudi mau mach vanh In dinh, vin tin tai nhiing nghi rigai vl anh huong lau dai cua ky thuat nay dli vdi hinh thai cua dudng ra thit co thi gay hd van dgng mach chu sau m l va hep duong ra thit phai. Vdi kinh nghiem con ban che ciia chimg tdi, ca 3 trudng hgp dgng mach vanh duy nliit diu c6 thi tiln hanh chuyin vi tri ma khong gap phai bit ky vin dl khd khan nao. Ky thuat "cira lat" dugc chiing tdi ap dung cho ca 3 truong hgp tren trong qua trinh tring lai dgng mach vanh vao dgng mach chu mdi. Kit qua ngin ban cho thay tudi mau mach vanh hoan toan In dinh va khdng co bat cir ghi nhan nao vl kha nang hep dudng ra ciia that. Doi vdi trudng hgp co hd van dgng mach chii nhe sau m6, sieu am tim truac phau thuat cting da ghi nhan c6 ha nhe van dgng mach phoi (van dgng mach chu mdi) trudc khi tien hanh phau thuat.
Chuyen vi dgng mach vanh ciia dgng mach vanh duy nhat vdi hai lo mach vanh rieng biet dugc ghi nhan la phiic tap hon nhieu so vdi chuyen vi dgng mach vanh binh thudng. Ve ca ban co hai ky thuat dugc mo ta va ap dung ddi vai truong hgp nay. Mgt ky thuat duy tri hinh thai ciia dgng mach vanh va tudi mau cua dgng mach vanh qua mgt xoang c6 phu mang tim sat canh dgng mach chil mdi. Ky thuat con lai c6 gang chia tach dgng mach vanh thanh 2 cue ao vanh rieng biet. Moi mgt ky thuat bao ham trong n6 nhirng uu diem va nhugc diem rieng biet.
Ddi vdi truong hgp thir 2 cua chiing toi, ky thuat chia ddi dgng mach vanh chung thanh 2 ciic ao rieng biet da dugc ap dung thanh cong. Tuy nhien sau khi chuyen vi dgng
mach vanh, cue ao cua dgng mach vanh trai bi rach doi hoi mieng n6i dgng mach vanh phai lam lai, chung tdi quyet dinh lam ngimg tim trd lai, mieng n6i dgng mach vanh ben trai dugc thao rdi ra va lam lai. Benh nhan sau phau thuat khong gap phai van de ve chay mau, tuy nhien chiing tdi bat huge phai de ha xuong uc cho benh nhan do tinh trang phii ne ca tim sau mo. Sau phau thuat 36h benh nhan dugc dong xuong uc ma khong co bat cii anh hudng nao tai huyet dgng. Tir kinh nghiem doi vai trudng hgp nay, chiing toi thay rang khong nen do du ma nen tien hanh kiem tra va neu can thiet thi phai tien hanh ngimg tim va lam lai cac mieng noi trong bat ky truong hgp nao c6 tinh trang chay mau khd kiem soat sau mo doi vai benh nhan chuyen goc dgng mach sa sinh.
Doi vai nhiing trucmg hgp hai dai dgng mach xuat phat song song tir day tim (side by side), theo cac tong ket ciia cac trung tam tim mach tren the giai thay rat hay gap bat thuong ve dgng mach vanh kem theo [4],[5],[6]. Khi CO bat thudng dgng mach vanh trong nhiing truong hgp nay, nguy ca ton thuong dgng mach vanh sau phau thuat rd rang cao hon so vdi nhiing trudng hgp cd tuong quan dgng mach, trudc-sau. Khi sir dung ky thuat "cira lat" kem theo thu thuat Lecompte, chung toi thay ket qua buac dau ciia phau thuat la kha quan, tuy nhien can them thdi gian va so lugng benh nhan nhieu hon nira mai c6 the danh gia chinh xac vl hieu qua dieu tri cua ky thuat "cira lat" doi vdi dang bat thudng cua benh ly chuyin goc dgng mach nay.
De ket luan, ket qua buac diu dilu tri nhung trudng hgp chuyin gic dgng mach hoan toan co mgt dgng mach vanh duy nhit tai Benh vien Nhi Trung Uong da dat dugc la klia quan vai ky thuat "cira lat". Mgt nghien
cim trong tuong lai vai so lugng benh nhan nhilu ban. thdi gian theo ddi dai ban la rat cin thilt dl danh gia chinh xac hieu qua ciia dilu tri phau thuat dli vdi hinh thai tim bam sinh phirc tap nay.
TAI LIEU THAM KHAO
1. Chang YH, Sung SC, Lee HD, Kim S, Woo JS, Lee YS. Coronary reimplantation after neoaortic reconstruction can yield better result in arterial switch operation:
comparison with open trap door technique.
Ann Thorac Surg 2005;80:1634-1640.
2. Daebritz SH, Nollert G, Sachweh JS, Engelhardt W, von Bernuth G, Messmer BJ. Anatomical risk factors for mortality and cardiac morbidity after arterial switch operation. Ann Thorac Surg 2000;69:1880-
1886.
3. Murthy KS, Coelho R, Kulkarni S, Ninan B, Cherian KM. Arterial switch operation with in situ coronary reallocation for transposition of great arteries with single coronary artery Eur J Cardiothorac Surg 2004;25:246-249.
4. Parry AJ, Thurm M, Hanley FL. The use of 'pericardial hoods' for maintaining exact coronary geometry in the arterial switch operation with complex coronary anatomy.
Eur J Cardiothorac Surg 1999;15:159-165.
5. Pasquali SK, Hasselblad V, Li JS, Kong DF, Sanders SP. Coronary artery pattern and outcome of arterial switch operation for transposition of the great arteries: a meta- analysis Circulation 2002;106:2575-2580.
6. Qamar ZA, Goldberg CS, Devaney EJ, Bove EL, and Ohye RG. Current Risk Factors and Outcomes for the Arterial Switch Operation.
Ann Thorac Surg 2007;84(3):871-879.
7. Sarris GE, Chatzis AC, Giannopoulos NM, et al. The arterial switch operation in
Y HOC VIET NAM SO DAC BIET - THANG 11/2010 Europe for transposition of the great arteries:
a multi-institutional study from the European Congenital Heart Surgeons Association. J Thorac Cardiovasc Surg 2006;132:633-639.
8. Scheule AM, Zurakowski D, Blume ED, et al. Arterial switch operation with a single coronary artery. J Thorac Cardiovasc Surg 2002; 123: 1164-1172.
9. Shukia V, Freedom RM, Black, MD.
Single coronary artery and complete
transposition of the great arteries: A technical challenge resolved? Ann Thorac Surg 2000;
69:568-571.
10. Si Chan Sung, Yun Hee Chang, Hyoung Doo Lee, Siho Kim, Jong Soo Woo, and Young Seok Lee. Arterial Switch Operation for Transposition of the Great Arteries With Coronary Arteries From a Single Aortic Sinus. Ann Thorac Surg 2005; 80: 636-641.
.. a)r
PHAU THUAT SUA TOAN DO DENH TIM DAM SINH THAT PHAI HAI DlTOfNG RA:
KET QUA SQfM SAU MO TAI DENH VIEN NHI TRUNG UTONG
' f'"• * Nguyen Ly Thinh Truong*, Dang Hanh Tiep**, Nguyen Thanh Liem*.
ABSTRACTS .:•.,.
Double outlet of the right ventricle is a heterogenity group of congenital cardiac surgery.
The longterm results of this congenital heart disease has been clearly identify in many cardiac center in the world. However, in VietNam, its still be a challenge open heart surgery. We sought to evaluate sort term results surgical treatment of this complex heart diseasse in National Hospital of Pediatric in VietNam.
1. OATVANOE
"Thit phai hai duong ra" (DORV) dugc dinh nghTa la benh tim bam sinh bat thudng kit nli giiia tam thit va dai dgng mach trong dd ca hai dgng mach chu va dgng mach phoi xuit phat hoan toan hoac gan nhu hoan toan tir thit phai [5]. Thong lien thit la thirong ton
* KIwa Ngogi - Benh vien Nhi Tnmg Udng
** Khoa Phdu thudt Gdy me-H6i sue - Benh vien Nhi Tr
gin nhu luon gap trong benh ly that phai hai duong ra. Dugc dinh nghTa la bat thudng tim bim sinh kit noi that - dai dgng mach, that phai hai dudng ra bao gom nhieu thay doi ve hinh thai giai phau va cac bat thuang di kem [6].
Phiu thuat sira toan bg benh ly that phai hai dudng ra dugc Kirklin va cong sir tien hanh lan diu tien vao nam 1957 tai Mayo Clinic, vai chan doan xac dinh Uong mo va ky thuat tao dudng him trong ting thit da dugc tien hanh. Ngay nay, niy theo thi giai phiu lam sang cua benh ma moi loai ky thuat sira chiia thich hgp dugc ap dung trong ning Uudng hgp cu the, tuy vay phau thuat sira toan bg thit phai hai dudng ra, dac biet vdi nhirng trudng hgp ton thuong phirc tap, van la mgt thach thiic dli vdi phau thuat dieu tri benh tim bam sinh.
Muc dich ciia bao cao nay nham danh gia
ung Uang
