SIEU AM Benh Dmv

SIEU AM 2D VA DOPPLER TRONG BENH ONG MACH VANH

PGS.TS PHAM NGUYEN VINH

Suy ong mach vanh man :
CTN on nhCTN PrinzmetalTMCT yen lang
Suy MV cap :
NMCT capCTN khong on nh
D dang MV

GIAI PHAU HOC ONG MACH VANH (1)

MV trai, MV phai : t MC,xoang Valsalva, ngay tren cho gan van MC

Than chnh MV trai :
Dai : 10 - 15mmng knh : 3 - 10mmChia oi :Nhanh xuong trc lien thatNhanh mu trai
MV phai : ng knh : 2- 3mm


GIAI PHAU HOC ONG MACH VANH (2)

Mat cat canh c truc ngang, ngang van MC giup thay cho xuat phat MV trai va MV phai

1.unknown

CAC MAT CAT GIUP KHAO SAT LO TRNH MV


LCA : MV mu trai

RCA : MP phai

LAD : Nhanh lien that

(nhanh xuong trc)

MV trai

LMCA : Than chung

MV trai
2.unknown

PHAN BO TI MAU THANH TIM CUA
CAC NHANH MV (1)

That trai :
Nhanh xuong trc lien that :. Mom tim
. Vach lien that

. Vach trc that trai
Nhanh mu trai :. Vach ben that trai
. Vach sau that trai
MV phai :. Vach lien that (phan ay)
. Vach di (phan ay)

That phai :
MV phai :. Vach trc
. Vach sau

. Mot phan vach lien that
Nhanh xuong trc lien that MV trai : Vach trc

PHAN BO TI MAU THANH TIM CUA
CAC NHANH MV (2)

3.unknown

DAU HIEU THIEU MAU CUC BO C TIM

2D :

Khu tru :
* Roi loan van ong thanh tim :Giam van ong (Hypokinesis)Vo van ong (Akinesis)Van ong nghch thng (Dyskinesis)* Roi loan o day thanh tim :Mong vao ky tam thu (Systolic thinning)
Toan the :
* Dan buong tim* Bien dang buong tim
Doppler :

Dong van MC : Van toc nh va trung bnh giam

Dong van 2 la : E , A

Doppler mau : H van 2 la xuat hien luc gang sc


15.unknown

LNG GIA C TIM THIEU MAU

Cac phng phap phan chia vung :
9 vung11 vung13 vung20 vung16 vung
Phng phap ng trung tam (The centerline method) phoi hp vi chat can am


PHAN CHIA 16 VUNG THANH TIM CUA HIEP HOI SIEU AM TIM HOA KY

7.unknown

LNG GIA C TIM THIEU MAU THEO 16 VUNG

Bnh thng (Normokinesis): 1

Giam van ong (Hypokinesis): 2

Vo van ong (Akinesis): 3

Van ong nghch thng hay

loan ong (dyskinesis): 4

Tui phnh: 5

Tong so thu c, chia cho so vung thay c


CAC MAT CAT GIUP LNG GIA THAT TRAI

Canh c truc doc

Canh c truc ngang :
Ngang van 2 laNgang cot cNgang mom tim
Bon buong t mom

Hai buong t mom


CAC MAT CAT GIUP LNG GIA THAT PHAI

53.unknown

NGUYEN NHAN CUA ROI LOAN VAN ONG KHU TRU VACH THAT TRAI

Nguyen nhan noi tai :

Thieu mau cuc bo c tim

X hoa c tim do tien s NMCT, benh c tim

Roi loan dan truyen trong that :

Bloc nhanh

Ngoai tam thu

Tao nhp that

Nguyen nhan ben ngoai :

He thong tham khao khong ung do xoay, lech

Bat thng hau tai khu tru (sc cang thanh)

Roi loan van ong vung ben canh khong thieu mau

Tng tac gia that phai that trai (TD : tang tai khoi lng that phai, han che do mang bao tim)


CHAN OAN NMCT

Hoai t c tim/ sieu am :

Roi loan van ong khu tru vach tim :

- Giam ong

- Khong van ong

- Van ong nghch thng

Thay oi o day vach that : mong hn

Thay oi cau truc c tim : di tia echo c tim hoai t sang, am hn bnh thng


PHAT HIEN CAC BIEN CHNG CUA NMCT CAP

Tui phnh that trai (ventricular aneurysm) :
. Tan suat 3,5 en 38%. Ngay 1 en ngay 14. Tai tui phnh, vach tim dan va mong hn thng.. Co tui phnh la cho noi gia tui phnh vi phan c tim con lanh
Tui phnh gia (pseudo - aneurysm) :
. Vach t do cua tim b v nhng mang bao tim con nguyen ven.. Ty le ng knh cua co tren ng knh tui phnh < 0,5.. Tui phnh gia thng ay mau cuc.


Thong lien that mac phai do nhoi mau c tim :
. Bien chng t gap.. Tuan au sau khi benh.
V vach t do tam that :

. 4 - 24% cua nhoi mau c tim cap.

. Tuan au cua benh

. Ngay sau khi echo khong phat hien c cho v nhng thay co tran dch mang tim kem vach tim b nhoi mau dan va mong cung can co ngay ch nh phau thuat.



Huyet khoi tam that :

. 20 en 60% nhoi mau c tim xuyen thanh

. Cuc mau thng ngay vung roi loan van ong c tim, thng ngay mom tim

. Nam sat thanh tam that hoac nam trong buong that ch dnh vao thanh tim bang mot cuong (pedicle)

. Tranh dng gia hay am gia, can thc hien nhieu mat cat vi o thu thap song thch hp.

H hai la :
. Roi loan chc nang c tru hay t c tru.. Tuan au.. C tru sau gia.

SIEU AM TIM


Tui phnh that trai : An
8.unknown9.unknown


TUI PHNH GIA
14.unknown11.unknown12.unknown

SIEU AM TIM GANG SC

Bang van ong :
Xe apTham lan
Bang thuoc :
DipyridamoleDobutamineArbutaminAdenosine

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