THONG LIEN THAT

(TLT)
BS. ao Hu Trung

 nh ngha: Khiem khuyet tai VLT ->

thong thng TH HT - Phoi
Tan suat: 20% cac benh TBS

PHOI THAI HOC - GIAI PHAU

BENH
Qua trnh hnh thanh VLT
V tr:
- 85% phan mang ( lan tren, sau, di)
- 15% con lai phan pheu, phan c,
phan nhan
3

10

Conditions that may mimic large

VSD
a. Single (common) ventricle
without pulmonary stenosis
b. Double-outlet right ventricle
without pulmonary
stenosis.Note that defect is
remote from both semilunar
valves

11

SINH LY BENH HOC

Yeu to:
Kch thc lo thong
Ty le khang lc
He thong tuan hoan phoi /
He thong
Phan loai huyet ong hoc:
The benh (Typ)
I ab - II ab - III - IV
12

THONG LIEN THAT

BANG PHAN LOAI HUYET ONG
------------------------------------------------------------------------------------The benhKch thc
PAP/Ps RP/RS QP/QS
Gr VD/AP
-------------------------------------------------------------------------------------- Ia
nho
< 0,3 < 0,3 1 - 1,5 0
Ib
nho
< 0,3 < 0,3 1,5 - 2 0
--------------------------------------------------------------------------------------IIa
ln
0,3 - 0,7
< 0,5 > 2 < 25
IIb
ln
0,7 - 1 < 0,8 > 2
< 25
-------------------------------------------------------------------------------------III
ln
>1
>1<1
< 25
-------------------------------------------------------------------------------------IV
ln +
< 0,7 < 0,5 > 2
> 25
13
hep pheu MP

BENH CANH LAM SANG

1.
2.
3.
4.

TLT
TLT
TLT
TLT

lo nho - Benh Roger

trung bnh
vi tang ap MP
vi hep MP

14

TIEN TRIEN VA TIEN LNG

VAI TRO CUA SIEU AM TRONG BENH
TLT
CH NH PHAU THUAT - NGUY C VA
KET QUA

15

MUC CH TRONG SIEU AM

THONG LIEN THAT (1)

I. CHAN OAN
Kch thc
V tr khuyet tat:
tren
- Phan quanh mang (lan
trc)
sau
- Vach lien that phan nhan
- Vach lien that phan c be
- Vach lien that phan pheu
Chieu hng luong thong
16

MUC CH TRONG SIEU AM

THONG LIEN THAT (2)
II. LNG GIA HUYET ONG HOC
- that T, nh T, that P, MP
- QP - QS
- ALMP tam thu (PAPS)
- ALMP trung bnh (PAPM)
*Dong mau h 3 la, h MP
* Dong mau luong thong
* Hnh dang vach lien that
- P TT/TP = 4V2 (van toc dong mau luong
thong)
- ALTP tam thu = HA tam thu - P (neu khong co
hep ong mach phoi)
17

MUC CH TRONG SIEU AM

THONG LIEN THAT

III. PHAT HIEN BIEN CHNG

- Hoi chng EISENMENGER
- H van MC
- Hep di van MC
- Hep pheu MP
- Viem noi tam mac...
IV. THEO DOI HAU PHAU
- Shunt ton tai
- AL ong mach phoi
18

19

20

QUY TRNH SIEU AM (1)

Mat cat canh c truc doc
- Hnh anh lo thong (2D), hnh anh
dong chay xoay manh mau xanh
luc lap the chay qua lo thong
(Doppler mau).
- Kch thc cac buong tim. Chc
nang tam thu cua tim.
- Khao sat van MC: day, sa van,
h van.
21

QUY TRNH SIEU AM (2)

Mat cat canh c truc ngang - ngang van
MC
- V tr lo thong
- o kch thc lo thong
- Khao sat chieu luong thong
- Khao sat Doppler lien tuc dong mau qua lo
thong
lien that
- Ap lc MP tam trng va trung bnh - theo
dong h van MP
- Tm hep van MP phoi hp
22
- o kch thc lo van MP, than MP

QUY TRNH SIEU AM (3)

Mat cat 4 buong t mom

- Khao sat tong quat 4 buong tim
- V tr lo thong, kch thc lo
thong
- Dong h 3 la, ap lc MP tam
thu
(dong h van 3 la)
23

QUY TRNH SIEU AM (4)

Mat cat 5 buong t mom

Khao sat ton thng van MC i
kem
Mat cat di sn
Khao sat thong lien that, ac
biet thong lien that phan c be
24

Mat cat
canh c truc
doc giup
thay hnh
anh lo TLT
co dong
mau xoay
chay ngang.
o chenh
ap lc that
trai/that
phai la
78mmHg (AB). Mat cat
canh c truc
ngang-ngang25
van MC : TLT

Mat cat canh c truc ngang ngang

van MC cho thay TLT phan mang

26

Parasternal long-axis scan with slight medial tlt of the

transducer. A large membranous ventricular septal defect
(arrows) is visualized just beneath the aortic valve (AV).
A : anterior
LA : left atrium
LV : left
ventricle
P : posterior
RV : right ventricle VS : ventricular
septum

27

Parasternal short-axis scan at the level of the left ventricular

outflow tract (LVO) shows a ventricular septal defect that is
subtricuspid (arrows) and partially closed by septal leaflet of
the tricuspid valve (arrowheads)

28

Subcostal four-chamber scan at aortic valve (AV level

demonstrating an aneurysm of the membranous septum (small
arrows). A large membranous ventricular septal defect is
vusualised (large arrow). This patient had aa very small left to
right shunt.

29

Mat cat 4 buong t mom : TLT buong nhan co

kch thc ln (d=14mm) (A). Mat cat 5 buong t
mom cho thay TLT phan mang co tui phnh vach
mang (B).

30

Mat cat 4 buong canh c : TLT phan mang co

kem thong noi that trai-nh phai. Dong mau
xoay mau xanh luc lap the chay qua lo TLT hng
ve pha nh phai (A). Pho Doppler dong mau ngang
qua lo TLT co van toc = 4m/s (B)

31

CH NH PHAU THUAT
Tuoi
Ch nh phau thuat
Di 6 thang Neu khong chong che c
suy tim
6 - 24 thang
Neu co cao ap MP hoac
co trieu chng lam sang
Tren 2 tuoi
Neu QP/QS > 2
Chong ch nh
Tuyet oi
Khi KLMP/KLMHT > 1/1
Tng oi
Neu KLMP/KLMHT > 0,75/1
32

a. Tam mach o can quang that phai. Tre 1 ngay

tuoi cho thay xoang mach trong c tim (intramyocardial
sinusoids) (mui ten nho). H van 3 la nang (mui
ten am)
b. Xquang phim thang (trc sau) cung trng hp o :
Phe trng trong va b nh phai dan ln

33