CON ONG ONG MACH(PCA-PDA)

Tan suat:5-10% cac benh TBSPhoi thai Giai phau hoc:Bat nguon t cung MC VIPhan gan: MP traiPhan xa:Ong MTuan th 6:55% lu lng tim phoi thaiong: 2 giai oan: 10-16 gico that c (Vai tro PGE1 E2 2-3 tuanhanh lap mo si oxygen) 8 tuan # 90%ongKch thcL2-15mm5-15mmBen trai ( Ben phai? Hai ben?)

Sinh ly benhBenh ly Shunt T->PYeu to : - Kch thc lo thong- Tuan hoan phoi Lu lng Ap lc (TP)- Tang ganh TT that trai- Tuoi thieu thangS sinhTre ln

Con ong ong machDang co ien, khong kem tang ap MP, khong day that phaiCon ong ong mach (ong ln0, lam tang ap MP va day that phaiCon ong ong mach vi luong thong phai trai. V tr luong thong lam mau en chay ve pha ong mach chu xuong

Lam sang Can lam sang3 the lam sang1. Kch thc ong nho Shunt t- Ap lc MP bnh thngTrieu chng c nangPhat trien tng oi bnh thngAT lien tuc (+)Xquang TP : bnh thngECG : cha tang taiSieu am : ong thong nho. Pho SA Doppler van toc lnShunt ln

2. Kch thc ong ln Shunt nhieu Ap lc MP caoTrieu chng c nang ++ - giam canKho th mach nayAT lien tuc T2 vang A6TTTrng mom T1 anhXqTP: Tim to TH phoi tangECG: Tang ganh 2 TSA : ong thong ln. Pho SA Doppler van toc kemBien chng : Suy ho hap. H 2 la. H MC. Suy that trai. VNTMX tr : GP khong ch i

Tang ap MP nang Khong con Shunt ao shuntTrieu chng: Cao ap MP tmSA: Ong thong ln Shunt 2 chieuSA Doppler van toc rat thapTrieu chng tang ap MP

Lam sang Can lam sangI. Kch thc ong nho Shunt t Ap MP BTt trieu chng c nang Phat trien tng oi BT

II. Kch thc ong ln 8mm Shunt nhieu- ALMP caoTrieu chng c nang +++Giam can Bien dang long ngc kho th.

III. Tang ALMP nangKhong con ShuntShunt ao- Khang lc MP cao

CON ONG ONG MACH

Muc tieu sieu amChan oan xac nh: v tr ong ong mach, kch thc.Xac nh chieu luong thong, lu lng, dong chay thong.anh gia ap lc MPKch thc, chc nang buong timCac ton thng phoi hp.

Quy trnh sieu amMat cat canh c truc doc.Khao sat kch thc buong tim, anh gia chc nang tim.Cac ton thng phoi hp.

Mat cat canh c truc ngang- ngang van MC hay cao hn.Hnh anh ong ong mach tren ong mach phoi (MP) trai, noi lien vi ong mach chu (MC) xuong 2D.Sieu am Doppler ghi nhan dong lien tuc cua luong thong, dng tnh t trai sang phai, vi van toc toi a gia va cuoi tam thu.Xac nh chieu luong thong, o chenh, ap gia MC/MP.

Mat cat di sn theo truc ngang: hnh anh ong ong mach.

Mat cat tren hom c truc doc:Hnh anh ong ong mach 2D, va hnh anh Doppler mau dong mau qua ong ong mach.Dau gian tiep cua con ong ong mach vi pho dng th tam trng ngc chieu pho ong mach chu xuong pha di so vi ong ong mach.

Mat cat tren hom c truc doc hi nghieng au do giup thay ro ong ong mach (mui ten) (A-B). (Ao Arch : Cung MC ; PDA : ong M : DA : ong ong mach chu xuong)

Mat cat di sn theo truc ngang cho thay dong mau xoay cua ong ong mach, di Doppler mau co hnh anh nhieu mau

Canh c truc ngang cao : Hnh anh Doppler mau dong mau xoay chay t ong mach chu sang MP qua ong ong mach (A-B-C). Pho Doppler lien tuc dong mau qua ong ong mach. o chenh ap lc MC/MP la 92mmHg (D). Shunt 2 chieu dong mau ngang ong M tren benh nhan con ong M, tang ap MP (E) (DA : MC xuong; AO : MC; FA : dong mau xoay)

SIEU AM TRONG BENH CON TON TAI ONG ONG MACH

MUC CH SIEU AMXac nh ton thngV tr va ng i cua ong ong mach+Mat cat canh c truc ngang chuan ca cao.+Mat cat tren cXac nh luon thongBang sieu am Doppler+Chieu luong thong+Gradient AO/AP3.anh gia ap lc ong mach phoi:PAPS (PAPM?)

CH NH PHAU THUATTHEO DOI HAU PHAU + Con ton tai luong thong+ Ap lc ong Mach Phoi.