Phẫu thuật điều trị bệnh hẹp van động mạch chủ hai cánh

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Tác giả: Vũ Ngọc Tú

Ngôn ngữ: Vie

Ký hiệu phân loại: 612.1 Blood and circulation

Thông tin xuất bản: Phẫu thuật tim mạch và Lồng ngực Việt Nam 2023

Mô tả vật lý: 54-63

Bộ sưu tập: Metadata

ID: 400631

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Bệnh hẹp van động mạch chủ hai cánh xuất phát từ bất thường bẩm sinh dạng hai cánh của van động mạch chủ. Bệnh tiến triển trong thời gian dài dẫn đến tổn thương đồng thời của van và động mạch chủ. Phẫu thuật là biện pháp hiệu quả điều trị đồng thời cả hai tổn thương này. Nghiên cứu được thực hiện nhằm mô tả một số đặc điểm quan trọng về chẩn đoán và điều trị bệnh hẹp van động mạch chủ hai cánh.Đối tượng và phương pháp nghiên cứu:Tất cả các bệnh nhân được chẩn đoán bệnh hẹp van động mạch chủ hai cánh, được thực hiện phẫu thuật thay van động mạch chủ và các tổn thương khác đi kèm tại Bệnh viện Đại học Y Hà nội, từ tháng 3/2020 đến tháng 3/2023. Nghiên cứu được thực hiện theo phương pháp mô tả cắt ngang hồi cứu.Kết quả:Nghiên cứu được thực hiện với 25 bệnh nhân. Tất cả các bệnh nhân có tổn thương hẹp khít van động mạch chủ do vôi hóa và giãn, phồng động mạch chủ lên với chênh áp trung bình là 56,7mmHg và 36,0% phồng động mạch chủ lên đường kính từ 45mm trở lên. Dạng bất thường hai cánh của van động mạch chủ yếu là dạng cánh chung vành phải - vành trái. 8,0% bệnh nhân được phẫu thuật khi đã có suy tim nặng (EF <
30%) do bệnh tiến triển trong thời gian dài. 36,0% được thay van động mạch chủ đơn thuần, 36,0% được thay đồng thời van động mạch chủ và động mạch chủ lên, 24,0% được bọc động mạch chủ lên bằng mạch nhân tạo. Biến chứng: 1 bệnh nhân tử vong do lóc động mạch chủ Stanford A trong mổ dẫn tới suy đa tạng sau mổ
1 trường hợp mổ lại vì chảy máu và 1 mổ lại tạo hình xương ức do toác xương ức. 96,0% bệnh nhân ra viện với kết quả tốt.Kết luận:Phẫu thuật là phương pháp cho phép điều trị đồng thời cả tổn thương van tim cũng như động mạch chủ trong bệnh hẹp van động mạch chủ hai lá vôi hóa. Bên cạnh kĩ thuật thay thế bằng mạch nhân tạo, phồng động mạch chủ lên có kích thước không quá lớn có thể được bọc bằng mạch nhân tạo với mục đích giảm thiểu nguy cơ của phẫu thuật và đảm bảo kết quả lâu dài cho người bệnh., Tóm tắt tiếng anh, Patients with bicuspid aortic valve may develop isolated aortic valve disease, including isolated aortic stenosis. This disease progresses over a long period of time leading to simultaneous damage of the valves and aorta.Surgery is an effective treatment of both lesions simultaneously. This study objective is to describe the characteristic features of the diagnosis and surgery results of this disease.Methods: All of patients diagnosed aortic stenosis due to bicuspid aortic valve were performed aortic valve replacement and asscociated aortic lesions. Tills retrospective descriptive study used data from the Hanoi Medical Uninversity Hospital from 3/2020 to 3/2023.Results: This study include 25 patients who met review criteria. Aortic stenosis was in all of patients associated with ascending aortic aneurysm. Mean aortic gradient was 56,7mmHg and 36,0% of patients had ascending aortic diameter above 45mm. The most common morphology of bicuspid aortic valve was right - left coronary leaflet. 8,0% of patients had poor left ventricle function (EF <
30%). 36,0% of patients were perfomed single aortic valve replacement, 60,0% were correctedsimultaneously lesions of aortic valve and ascending aorta in which 24,0% using wrapping with dacron graft. Complications: One death due to intraoperative Stanford A aortic dissection
one bleeding due to lateral wound close distal aortic anastomosis required an operation and one of sternal instability require a sternal plasty. 96,0% of patients have discharged uneventfully.Conclusions: Surgery is an effectivetreatment of both lesions simultaneously o f aortic valve and descending aorta in aortic stenosis due to bicuspid aortic valve malformation. Wrapping of the ascending aorta may be useful in patients who need to undergo aortic valve surgery without increasing the risk o f surgery.

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