Kết quả sớm phẫu thuật một thì sửa chữa hai thất bệnh lý hẹp eo động mạch chủ-thông liên thất kèm theo hẹp đường ra thất trái tại Bệnh viện Nhi Trung ương

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Vương Anh Doãn, Lý Thịnh Trường Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại: 611.124 Human anatomy, cytology, histology

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2022

Mô tả vật lý: 148-152

Bộ sưu tập: Metadata

ID: 499443

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Đánh giá kết quả sớm sau phẫu thuật một thì sửa chữa hai thất, bao gồm sửa chữa quai và eo động mạch chủ kèm theo vá lỗ thông liên thất, cho các bệnh nhân mắc bệnh tim bẩm sinh hẹp eo động mạch chủ kèm theo lỗ thông liên thất và có tổn thương hẹp đường ra thất trái cần phải can thiệp trong quá trình phẫu thuật. Đối tượng-phương pháp nghiên cứu: Từ tháng 12 năm 2013 đến tháng 10 năm 2020, các bệnh nhân được chẩn đoán hẹp eo-thiểu sản quai động mạch-thông liên thất có hẹp đường ra thất trái do vách nón lệch sau, được phẫu thuật tim hở 1 thì sửa chữa hai thất và phù hợp với tiêu chuẩn được tiến hành nghiên cứu hồi cứu. Kết quả: Có tổng số 43 bệnh nhân phù hợp với tiêu chuẩn được đưa vào nghiên cứu. Tuổi trung bình của các bệnh nhân trong nhóm nghiên cứu là 37 ngày (IQR, 22-62), cân nặng trung bình của các bệnh nhân khi phẫu thuật là 3.7kg (IQR, 3.2-4.1). Có 29 bệnh nhân (67.4%) nam và 14 bệnh nhân nữ. Thời gian cặp động mạch chủ trung bình của nhóm nghiên cứu là 98.7 ± 26.3 phút, thời gian chạy máy trung bình là 135.6 ± 41.5 phút, thời gian tưới máu não chọn lọc trung bình là 32 cộng trừ 11.2 phút. Có 18 bệnh nhân (41.9%) được cắt vách nón, và 25 bệnh nhân (58.1%) được khâu kéo vách nón sang phải nhằm mở rộng đường ra thất trái. Không có bệnh nhân nào có tổn thương van động mạch chủ hoặc tổn thương đường dẫn truyền cần đặt máy tạo nhịp vĩnh viễn sau phẫu thuật. 2 bệnh nhân cần hỗ trợ ECMO sau phẫu thuật. Có 2 bệnh nhân (4.7%) trong nhóm nghiên cứu tử vong sớm tại bệnh viện sau phẫu thuật và 1 bệnh nhân (2.3%) tử vong muộn, tỷ lệ tử vong chung trong nhóm nghiên cứu là 7%. Có 2 bệnh nhân (5%) cần mổ lại do hẹp đường ra thất trái sau phẫu thuật, 1 bệnh nhân (2.5%) cần nong van ĐMC sau phẫu thuật trong thời gian theo dõi trung bình sau phẫu thuật là 1.5 năm (IQR, 0.6-4). Tỷ lệ sống sót và tỷ lệ sống sót không cần mổ lại sau phẫu thuật ở thời điểm 7 năm lần lượt là 88.5% và 88.5%. Kết luận: Phẫu thuật 1 thì sửa chữa hai thất điều trị bệnh hẹp eo động mạch chủ-thông liên thất và hẹp đường ra thất trái do vách nón lệch sau là an toàn và hiệu quả. Mổ lại do hẹp đường ra thất trái sau chiếm tỷ lệ thấp, tuy nhiên đây là nhóm bệnh nhân, cần được tiếp tục theo dõi lâu dài sau phẫu thuật.Evaluation of the early results of single-stage biventricular repair, which includes aortic arch reconstruction, ventricular septal defect closure and release of the left ventricular outflow tract obstruction. Methods: From December 2013 to October 2020, all patients diagnosed with aortic arch obstruction, ventricular septal defect and left ventricular outflow tract obstruction who underwent single-stage biventricular repair were retrospectively studied. Results: There were 43 patients who underwent single-stage repair combined with left ventricular outflow tract obstruction release. The median age at operation was 37 days (IQR, 22-62), and median weight was 3.7kg (IQR, 3.2-4.1). There were 29 males (67.4%) and 14 females. The mean time of aortic cross-clamp time was 98.7 ± 26.3 minutes, the mean time of bypass was 135.6 ± 41.5 minutes, and the mean time of regional cerebral perfusion was 32 ± 11.2 minutes. There were 18 patients (41.9%) who underwent conal septum resection, and 25 patients who underwent placement of the superior border of the ventricular septal defect patch to the left side of the conal septum, in order to release the left ventricular outflow tract obstruction. No patient suffered from aortic valve injury or complete atrioventricular block requiring permanent pacemaker implantation. Two patients required extracorporeal oxygenation membrane support postoperative. There were 2 early deaths (4.7%) and 1 late death (2.3%), and the overall mortality was 7%. There were 2 patients (5%) who required reoperation due to recurrent left ventricular outflow tract obstruction during follow-up, and 1 patient (2.5%) need balloon angioplasty for aortic valve stenosis during the follow-up time of 1.5 years (IQR, 0.6-4). The overall survival and the survival without reoperation at 7-year were 88.5% and 88.5%, respectively.

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