Siu m mt s bnh tim

bm sinh thng gp

Bs. Don Li
B mn Tim mch
Vin Tim mch

Thng lin nh

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Bnh sinh:
1. Shunt T - P do c l TLN v Pnt > P np
. Tng gnh th tch NP v TP
. Tng lu lng qua tiu tun hon.
--> Cc tiu ng mch phi co phn x
--> Ri lon chuyn ho
2. Thnh cc tiu M phi dy v x (Pulmonary vascular disease)
. Tng sc cn c nh tiu tun hon
. i chiu shunt: phi-tri
. Suy tim phi, tr tun hon ngoi bin
(hi chng Eisenmenger)

Thng lin nh

Thng lin nh

Thng lin nh

Tng gnh tht phi

Bung tht phi gin

Vch lin tht di ng nghch thng

Van MP dng tng p

Dc tm trng gim
Mt sng a
ng van gia tm thu

Shunt trn Doppler xung

Tn s thp
--> gim Wall filter

Phn bit vi dng:

- TMC
- Xoang vnh
- HoBL

- TMP lc ch

Shunt trn Doppler mu

Tn s thp
--> gim Wall filter

Phn bit vi dng:

- TMC
- Xoang vnh
- HoBL

- TMP lc ch

TLN

TLN

Siu m cn m

Siu m cn m

Siu m qua thc qun

Siu m qua thc qun

Siu m qua thc qun

Siu m qua thc qun

TLN - nh gi mc bnh
+ Kch thc l thng

< 10 mm

10 - 20 mm

> 20 mm

+ Gin NP, TP, VLT d/ nghch thng

+ Din tch dng shunt (Doppler mu): Ss > Snp/3
+ p lc MP: HoBL, HoP
+ Qp/Qc > 1,3

p lc ng mch phi
AL tb = 4V .t.tr2 + 10
Bnh thng: < 20 mmHg

AL t.tr = 4V c.t.tr2 + 10
Bnh thng: < 15 mmHg

AL tt

= 3 AL tb - 2 AL t.tr

Thng lin nh
Cc bnh phi hp:
. Nhiu l TLN
. HoHL: van dy, vng, sa van

. TMP lc ch
. Hp MP

tng lu lng

. HHL (Lutembacher)

...

Thng lin nh
Cc du hiu trc tip:
1. L TLN trn 2D
2. Shunt trn Doppler mu
3.

--------

xung

4. Ra bt cn m
5. Bt cn m sang nh tri

Thng lin nh
Cc du hiu gin tip:
1. Gin: NP, TP, MP
2. VLT di ng nghch thng
3. Van MP dng tng p
4. Vn tc dng MP ln - Gradient lu lng
5. Qp > Qc
6. Tng p lc MP: HoBL, HoP

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Vena contracta

Thng lin tht

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Thng lin tht

TLT - nh gi mc bnh
+ V tr l thng
+

Kch thc l thng

+ Vena contracta
+ Tng gnh cc bung tim
+ Tng p lc MP: HoBL ?, HoP, qua Shunt
+ Qp/Qc

TLT - nh gi mc bnh
TLT

shunt nh

shunt ln

Vena contracta

< 3 mm

> 5 mm

Cc bung tim

khng gin

gin

AL mp

bnh thng

tng

Qp/Qc

< 1,3

> 1,3

TLT - Cc bnh phi hp

Nhiu l TLT

H ch

Cn ng M

Phnh/v phnh xoang Valsalva

Hp MP

T chng Fallot

Thng sn nh tht

o gc cc M ln

Cn ng ng mch

Cn ng ng mch

Cn ng ng mch

Cn ng ng mch

Cn ng ng mch
+ Kch thc ng, hnh dng ng ?
+ Gin NT, TT
+ Chc nng tm thu TT
+ p lc MP: HoBL, shunt qua M
+ Qc/Qp

Cn ng ng mch

Cn ng ng mch

Cn ng ng mch

Cn ng ng mch
Chn on phn bit
+ D ng mch vnh

Cn ng ng mch
Chn on phn bit
+ D ng mch vnh vo MP

Cn ng ng mch
Chn on phn bit
+ D ng mch vnh vo MP

Cn ng ng mch
Chn on phn bit
+ D ng mch vnh

+ V phnh xoang Valsalva

Cn ng ng mch
Chn on phn bit
+ D ng mch vnh
+ V phnh xoang Valsalva
+ D ch ph
+ D ng - tnh mch phi

Hp ng ra tht phi

Cc thit

Cc thit

Cc thit

Hp ng ra tht phi

Hp di van MP
- Tht phi hai bung

- Hp phu

Hp vng van MP

Hp van MP

Hp trn van MP
- Hp thn
- Hp nhnh

Hp ng ra tht phi

Hp di van MP

- Tht phi hai bung

- Hp phu

Hp phu

Hp phu

Hp phu

Hp van MP

Hp van MP

Hp van MP

Hp phu v van MP

Hp trn van MP

Hp trn van MP

T chng Fallot

T chng Fallot

nh gi p lc t.thu MP
ALttTP - ALttNP = 4 VHoBL2
chuyn v phng trnh:
ALttTP = 4 VHoBL2 + ALttNP

AlttMP = 4 VHoBL2 + ALttNP

nh gi p lc t.thu MP
5 mmHg
ALttNP:

10 mmHg
15 mmHg

B.thng: AlttMP = 18-25 (22,5 3) mmHg

Tng nh:
--- va:
--- nhiu:

30-40
40-70
> 70

nh gi p lc t.trng MP
ALttrMP - ALttrTP = 4 V2
Chuyn v
ALttrMP = 4 V2 + ALttrNP
Cho ALttrNP = ALttrTP = 10 mmHg

ALttrMP = 4 V2 + 10 (mmHg)

nh gi p lc tr.bnh MP

ALtbMP = 4 V2 + 10 (mmHg)

ALttMP = 3 ALtbMP - 2 ALttrMP