THAN CHUNG ONG MACH
(Truncus Arteriosus)

PGS.TS. PHAM NGUYEN VINH

Thuoc nhom benh : Noi lien bat thng TThat - M

- BTBS phc tap

- Tan suat 1% - Nam = N

- Than ong mach oc nhat t ay tim

- Suy tim sung huyet sm

GIAI PHAU HOC (1)

1. Bat thng trong tim :

Thong lien that rong

Co s lien tuc ve mo si gia van than chung ong mach vi van 2 la hoac vi ca 2 van 2 la, van 3 la

Cac bat thng phoi hp khac thng t thay : noi lien bat thng tnh mach phoi, khong lo van 3 la, kenh nh that, tam that oc nhat

2. Bat thng van cua than chung :So van sigmoide cua than chung thay oi t 1 en 6 van. Van 3 manh chiem 60% trng hp, tiep o la van 4 manh (25%) va van 2 manh (7-8%).

THAN CHUNG ONG MACH

GIAI PHAU HOC (2)

3. Cac ong mach xuat phat t than chung :- ong mach vanh :

Bat thng t cho xuat phat va lo trnh cua ong mach vanh chiem 30 - 40%

Hai ong mach vanh xuat phat t mot lo oc nhat (20% trng hp)

- Cung ong mach chu :

Ben trai truc kh quan, thc quan (3/4 trng hp)

Ben phai (1/4 trng hp)

- ong mach phoi : Phan ra nhieu nhom than chung ong mach

THAN CHUNG ONG MACH

GIAI PHAU HOC (3)

Loai I (hay A1) : 60 - 70% Than ong mach phoi xuat phat t than chung . Loai II (hay A2) : 20 - 30% trng hp Cac ong mach phoi phai va trai xuat phat trc tiep t than chung thng mat sauLoai III (hay A3) : hiemMot ong mach phoi xuat phat t than chungLoai IV : (hay A4) : Giong loai I nhng co t oan ong mach chu ngang

THAN CHUNG ONG MACH

1.unknown

GIAI PHAU HOC (3)

THAN CHUNG ONG MACH

3 KIEU THAN CHUNG ONG MACH

Tai lieu : Circulation 1973; 47: 393-398

3.unknown

GIAI PHAU HOC (4)

Hien nay, mot so tac gia coi kieu IV la mot dang cua khong lo van MP kem thong lien that (pulmonary atresia with ventricular septal defect)

83% TCM co than chung ci nga len vach lien that.

21-36% TCM co cung MC ve pha phai

Hiem co hep MP TCM

Cac bat thng phoi hp vi TCM :

Cung MC ben phai

t oan MC

Khong co ong ong mach (50% trng hp)

Ong ong mach con thong thng

Thieu MP mot ben

Bat thng lo MV

H van than chung

Thong lien nh

THAN CHUNG ONG MACH

LAM SANG

S sinh :

Tm nhe vai ngay mi sinh

Khong tm khi ALMP giam

Trieu chng suy tim : th nhanh, toat mo hoi, bo bu, khong len can.

Tren 5 thang tuoi :

Suy tim giam

Tm tang (bien chng EISENMENGER)

THAN CHUNG ONG MACH

TRIEU CHNG THC THE

Tre cham phat trien, gay yeu.

Tm ngay cang nang khi suy tim giam.

Mach manh va gon do o cach biet cc tieu cc ai cua huyet ap rong (do khoi lng mau ln, va h van than chung).

Vung trc tim tang ong.

T2 s thay lien sn trai. T2 manh, khong tach oi.

T1 bnh thng, co tieng phut theo sau (ejection sound)

Am thoi tam thu b trai xng c do mau qua thong lien that.

oi khi co am thoi lien tuc lien sn 2 trai.

Am thoi tam trng b trai xng c do h van than chung : t co.

Rung tam trng mom do lng mau cao qua van hai la.

THAN CHUNG ONG MACH

CAN LAM SANG : ECG

Nhp xoang

PR bnh thng hay hi dai

P co dang day 2 nh

TRuc QRS bnh thng hay hi lech phai

Dau day that trai hay day 2 that

THAN CHUNG ONG MACH

4.unknown5.unknown

CAN LAM SANG : X QUANG NGC

Dau tang tuan hoan phoi thu ong do suy tim

Vung cung ong mach phoi phang hoac lom vao do ong mach phoi phat xuat t than chung.

Dau hieu: dau phay ron phoi trai (left hilar comma), do ong mach phoi trai nho cao, kha hu ch trong chan oan than chung ong mach.

Nh trai, nh phai, that trai va that phai eu ln.

Than chung thng lech ve phai phong len cao giong nh ong mach chu len dan.

THAN CHUNG ONG MACH

X QUANG NGC

THAN CHUNG ONG MACH

11.unknown

SIEU AM TIM : MUC TIEU SIEU AM

Xac nh s noi lien bat thng gia tam that vi ai ong mach.

Xac nh situs va nh v that

o kch thc buong that.

Khao sat vach nh va vach lien that .

Khao sat van nh that (kch thc, co h hay hep hay h hep)

Khao sat ong mach phoi, o o hep (neu co)

Xac nh s o ve cua tnh mach phoi va tnh mach he thong.

THAN CHUNG ONG MACH

SIEU AM TIM

THAN CHUNG ONG MACH

12.unknown

THAN CHUNG ONG MACH

13 bis

61.unknown

SIEU AM TIM

THAN CHUNG ONG MACH

13.unknown

SIEU AM TIM

THAN CHUNG ONG MACH

14.unknown

SIEU AM TIM

THAN CHUNG ONG MACH

15.unknown

SIEU AM TIM

THAN CHUNG ONG MACH

16.unknown

SIEU AM TIM

THAN CHUNG ONG MACH

Mat cat canh c truc doc: Than chung t the ci nga so vi vach lien that

SIEU AM TIM

THAN CHUNG ONG MACH

Mat cat 5 buong di sn: MP (PA) bat nguon t than chung (TR) gi y than chung ong mach loai 1 (TR: truncus arterious)

CHAN OAN PHAN BIET

Cac benh tim bam sinh lam suy tim sm kem tm nhe hay khong tm

Thong lien that

Con ong ong mach

Ca so MC - MP

Khong lo van MP kem TLT phoi hp con ong ong mach hoac kem ong mach bang he ln (large collateral artery)

That phai hai ng ra

Tam that oc nhat

Noi lien bat thng hoan toan tnh mach phoi.

Than chung ong mach

THAN CHUNG ONG MACH

IEU TR

ieu tr suy tim : Digitalis + li tieu + UCMC

Nen mo vao tuan le th 6 cua s sinh

Mo tre (thang 6 en thang 12)

Thieu mau cuc bo c tim ph ai

T vong gap 2 lan so vi lo mo t tuan th 5 en thang th 6.

Giai phau tam thi : banding

Giai phau triet e : t vong 5-10 %

Bt thong lien that

Chuyen MP ve that phai bang ong co van (thng la dung homogreffe)

THAN CHUNG ONG MACH

IEU TR

THAN CHUNG ONG MACH

10.unknown