TIM MOT TAM THAT HAY TAM THAT OC NHAT(Single Ventricle or Univentricular atrioventricular connection)

PGS.TS PHAM NGUYEN VINHNhom benh Noi lien nh that vi mot tam that bao gom :Tam that oc nhat : 0.5 - 1% BTBSKhong lo van 2 la (Mitral atresia)Khong lo van 3 la (Tricuspid atresia)

GIAI PHAU HOC (1)TAM THAT OC NHAT

GIAI PHAU HOC (2)TAM THAT OC NHATDouble Inlet

GIAI PHAU HOC (3)TAM THAT OC NHAT

GIAI PHAU HOC (4)TAM THAT OC NHAT

GIAI PHAU HOC (5)V tr cua tim : levocardie, dextrocardie, mesocardie, ectopia cordisSitus nh : solitus, inversus, isomerisme phai, isomerisme traiKieu noi lien tam that - ong mach : ch tng hp trong 15% benh, con lai co chuyen v ong mach.Tng quan v tr gia buong that chnh va buong phu.Cac ton thng phoi hp, chu yeu la tren van nh-that va ton thng tac nghen cac ai ong mach.Van nh-that hai manh hay teo nhoVan nh-that co ranh (fente), co lo phuH van nh-thatBat thng o ve cua tnh mach toan than, tnh mach phoiHep van hay pheu ong mach phoiHep hay khong lo van ong mach chu, hep eo ong mach chu, t oan cung ong mach chu Bat thng ve ng dan truyen (tam that oc nhat dang that trai)TAM THAT OC NHAT

LAM SANGTan suat benh : nam > n (3,4 lan)Trieu chng c nang : Trieu chng suy tim : kho th toat mo hoi, khong chu buNgoi xom : t gapCn tm thieu oxy : t gapTAM THAT OC NHAT

TRIEU CHNG THC THE tam that oc nhat co tang tuan hoan phoi : Am thoi au va gia tam thu b trai xng c (do mau qua foramen bulbo-ventriculaire). Am thoi nho dan khi lo nay hep hn.T1 bnh thng.T2 tach oi va manh; T2 n oc khi ap lc ong mach phoi tang cao.Am thoi tam trng nghe c mom tim khi lng mau len phoi nhieu. Co the nghe am thoi Graham Steel b trai xng c khi ap lc ong mach phoi tang cao. tam that oc nhat co kem hep ong mach phoi : Am thoi tam thu lien sn 2 trai do hep ong mach phoi. Khong co tieng phut van phoi (pulmonic ejection sound) v thng la hep di van ong mach phoi.T1 bnh thng.T2 nho va n oc.TAM THAT OC NHAT

CAN LAM SANG : ECGTAM THAT OC NHAT

CAN LAM SANG : ECGTAM THAT OC NHAT

X QUANG NGCGiup phan biet the co tang tuan hoan phoi va the khong tang hay giam tuan hoan phoi.Tang tuan hoan phoi :Thng gi y tam that oc nhat dang that traiBong tim ln v lng mau ve that trai nhieuNh trai, nh phai lnong mach phoi phai dan, b ay len cao, cho dang thac nc (waterfall)Bo ai ong mach hep, giong hoan v ai ong machKhi co hep ong mach phoi nang : Tuan hoan phoi bnh thng hay giamBong tim khong ln hoac ln rat tKhi khong co lo van ong mach phoi (pulmonary atresia)TAM THAT OC NHAT

MUC TIEU SIEU AM TIMXac nh situs cua nh.Khao sat dang cua that troi (that phai, that trai hay khong thuoc the nao) va v tr cua that teo nho.Xac nh tng quan nh-that va that-ai ong mach.o kch thc cua thong lien that va o o hep cua buong tong cua that.Khao sat van nh-that va van sigmoide : khong lo van hay hep van.Khao sat s o ve cua tnh mach chu va tnh mach phoi.o kch thc va khao sat s phan chia cua ong mach phoi trung tam.TAM THAT OC NHAT

DANG CUA THATTm buong that troi thuoc TT hay TPV tr buong that phu : mat cat di sn pha trc --> dang that phai pha sau --> dang that traiV tr c truTAM THAT OC NHAT

SIEU AM TIMTAM THAT OC NHATMat cat 4 buong t mom: tam that oc nhat va thong lien nh tien phat ln gan nh tam nh oc nhat

SIEU AM TIMTAM THAT OC NHATMat cat di sn: Doppler lien tuc dong mau ngang van MP hep MP nang vi o chenh ap > 75 mmHg

IEU TR the phc tap tien trien t nhien thng xau, 50% khong song qua 6 thang tuoi.ieu tr ngoai khoa bao gom giai phau tam thi va giai phau sa cha toan dien.1.Giai phau tam thi : da tren nguyen tacTang mau len phoi khi co hep ong mach phoi.Giam mau len phoi khi lng mau phoi qua nhieu.Tranh ong cham en nh phai e sau nay co the thc hien de phau thuat Fontan.TAM THAT OC NHAT

IEU TR2.Giai phau sa cha toan dien : giup phan chia tuan hoan toan than va tuan hoan phoi.Tao vach that (septum ventriculaire)Dung Dacron e tao tam that oc nhat thanh hai ngan rieng biet. Phau thuat do Kirklin thc hien t 1956. T vong len ti 50% nen nhieu ni khong thc hien phng phap nay. Tuy nhien nhng benh nhan song con, co i song gan bnh thng.Phau thuat kieu FontanBao gom bt lo van nh-that phai, va thong lien nh (neu co) va noi lien nh phai vi ong mach phoi. Hien nay phng phap nay c s dung nhieu nhat.ieu kien e thc hien c la : chc nang that con tot, ap lc ong mach phoi trung bnh < 20mmHg va sc can mach phoi con bnh thng.TAM THAT OC NHAT