TUI PHNH XOANG VALSALVABS. AO HU TRUNG

nh nghaTui phnh t ay 1-3 xoang Valsalva co the bam sinh (loan san Marfan Erlers danlos) hay mac phai (chan thng : VNTM, giang mai )

Tan suat : 0,15-0,35% cac benh TBS (Chau A 1,2%), Nam > n!

Giai phau benh lyTon thng c ban : mo hoc1. Ket dnh (khong hoan toan vach thanh MC x MP phan bulbis cordis (xoang vanh P va xoang khong vanh)

2. Mat lien tuc mo an hoi vung noi iep vong van x vach thanh MC -> giam be day -> tui phnh -> + v

Giai phau benh lyPhat trien t :Xoang vanh P : 75%Xoang khong vanh : 20%Xoang vanh T : 5%

V ra :Xoang vanh P : TP NPXoang khong vanh : NPHiem hn TT, NT, MP, TMC tren, mang ngoai tim, mang phoi

Giai phau benh lyTon thng phoi hp :25% cac ca : TLT (pheu)TLN, MC (2 manh hep eo)Ca so phe chu

Ruptured aortic sunus aneurysm. a, Aneurysm of the posterior aortic sinus leads into the righ atrium. The ventricular septum is intac. b, Aneurysm of the right aortic sinus leads from the aorta into the outflow tract of the right ventricle. Ventricular septal defect, commonly associated with this type of congenital aortic sinus aneurysm, is also shown

Lam sangThe cha v :* Ngi ln > tre em* Khong/t trieu chng (chan oan bang sieu am) AT th (vd : do hep MP v tui phnh)* Bien chng : roi loan nhp (that), RL dan truyen benh ly mach vanh (nghen), h MC, VNTM va v tui phnh

Lam sangThe v tui phnh :* Thng xay ra 30-40 tuoi (hiem s sinh)* V t nhien hay do chan thng, VNTM* Qua trnh v : ot ngot, au ngc, kho th, suy tim, phu phoi cap, dau hieu h MC* AT lien tuc v tr lien quan ni v (vd : TP : cao ; NP : LS4-5c)

Can lam sangXquang : tim to

T : Tang ganh tam trng TT, TP Roi loan dan truyen RL nhp

Sieu am tim

Sieu am trong benh phnh xoang ValsalvaXac nh chan oan :Mat cat hu ch :Canh c doc : xoang vanh trc phaixoang khong vanh sau

Canh c ngang : 3 xoang xoang > vong sauBat can xngMat lien tuc

Sieu am trong benh phnh xoang Valsalvaanh gia ton thng ;Gian tiep : TP dan n, vach lien that chuyen ong nghchTT dan nTang ong cac van 2 la, 3 laSa van MC

Ton thng phoi hpTLT (pheu), TLNMC 2 manh, hep eo, ca so P-C

Sieu am trong benh phnh xoang ValsalvaIV. Trc va sau mo

Mat cat canh c truc doc : hnh anh tui phnh xoang valsalva cha v (A) va a v (B. Hnh anh Doppler mau dong mau xoay chay t tui phnh v vao that phai (C)ABC

Mat cat canh c truc ngang ngang van MC : hnh anh tui phnh xoang Valsalva v vao vung pheu that phai. Pho Doppler dong mau t tui phnh v ghi nhan pho lien tuc.

Transthoracic echocardiogram parasternal long-axis view showing 5x5cm aneurysm in sinus of Valsalva arising from anterior aspect of aorta (AO) above aortic valves (AV). La indicates left atrium ; LV, left ventricle ; and MV, mitral valve

Transthoracic echocardiogram : apical five-chamber view, with color flow Doppler showing blood flow from left ventricular (LV) outflow tract into aortic (AO) root and aneurysm. RV indicates right ventricle ; RA, right atrium ; and LA, left atrium

Sinus of Valsalva PseudoaneurysmA huge cystic mass with a ball thrombus (arrowheads) in the parasternal long-axis view. Wall motion of this mass was parallel to interventricular septal motion. AO indicates aortic root ; LA, left atrium, and LV, left venctricle

Sinus of Valsalva PseudoaneurysmColor flow mapping shows mosaic images at junction of aortic root and neck of pseudoaneurysm

Sinus of Valsalva PseudoaneurysmDoppler flow shows systolic flow toward aortic root during systolic phase

Chan oan phan bietCon ong ong mach. Ca so phe chu

Do TM vanh. TLT + H MC

ng ham MC TT (Tunnel Ao V). Khong van MP (Agenesie valve pulmonaire)

ieu tr ch nh phau thuatNeu khong v : theo doi nh ky (SA)

PT khi co bien chng hay the tch tim tang

Can ieu tr cac ton thng kem theo