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Tr?n Th? Ph??ng 34 T (H?i D??ng): Ti ? ???c m? thay van tim (van ??ng m?ch ch? v van hai l) cch ?y ba n?m t?i khoa ph?u thu?t tim m?ch l?ng ng?c b?nh vi?n Vi?t ??c, hi?n t?i s?c kh?e ti hon ton bnh th??ng, c dng thu?c ch?ng ?ng theo y l?nh v ki?m tra xt nghi?m ch?ng ?ng t?i nh (my t? ??ng), xin h?i BS bao gi? ti ph?i ??n vi?n ?? thay l?i van tim, c?m ?n !

tr? l?i:

Khi van tim b? t?n th??ng, tim s? b?m mu km hi?u qu? h?n, do v?y tim ph?i lm vi?c nhi?u h?n ?? b?m mu giu xy ?i nui c? th?. Khi tim ph?i lm vi?c qu nhi?u c th? d?n ??n b? suy, gy ra kh th?, ?au ng?c, m?t m?i v gi? n??c l?i trong c? th? gy ph. N?u cc tri?u ch?ng trn xu?t hi?n, c th? c?n ph?i nong van, s?a van hay thay van tim.

M?i m?t van tim c nhi?m v? khc nhau

Qu? tim c?a chng ta c 4 bu?ng: 2 bu?ng tim ? pha trn v 2 bu?ng tim ? pha d??i. Cc van tim ki?m sot h??ng ?i c?a dng mu gi?a 4 bu?ng tim. Cc bu?ng tim ? pha trn g?i l tm nh? ph?i v tm nh? tri; cc bu?ng tim ? pha d??i g?i l tm th?t ph?i v tm th?t tri. Cc tm nh? nh?n mu t? cc t?nh m?ch tr? v? tim v b?m mu xu?ng cc tm th?t. Cc tm th?t b?m mu ra kh?i tim vo cc ??ng m?ch. Cc van tim gi?ng nh? cc cnh c?a ch? m? m?t chi?u. Bnh th??ng tim c 4 van:

Van ba l: ? bn tim ph?i, cho php dng mu ch?y t? tm nh? ph?i xu?ng tm th?t ph?i.

Van hai l: ? bn tim tri, ki?m sot dng mu ch?y t? tm nh? tri xu?ng tm th?t tri.

Van ??ng m?ch ph?i: gip cho mu ch? ?i theo m?t chi?u t? tm th?t ph?i ln ??ng m?ch ph?i v t? ? mu ???c trao ??i xy ? ph?i.

Van ??ng m?ch ch?: gip cho mu ch? ?i theo m?t chi?u t? tm th?t tri ln ??ng m?ch ch? (l ??ng m?ch chnh ??a mu t? tim ?i nui c? th?).

Van ba l v van hai l ???c g?n v?i tm th?t b?i cc c?t c? v dy ch?ng ??c bi?t. Cc c?t c? v dy ch?ng ny ki?m sot s? ho?t ??ng c?a van tim.

Thay van tim.

Qu? tim s? suy y?u khi van tim b? h?ng

Th?p tim l nguyn nhn th??ng g?p nh?t gy b?nh van tim. Th?p tim c th? lm van tim b? vim, x? ha v dy ln theo th?i gian lm cho cc van tim khng th? m? ra ho?c ?ng l?i m?t cch bnh th??ng. M?t s? ng??i b? b?nh van tim t? khi m?i sinh nn ???c s?a hay thay van t? khi cn nh?. Cc van tim c?ng c th? b? t?n th??ng do nhi?m khu?n (vim n?i tm m?c nhi?m khu?n) hay nh?ng b?nh l khc nh? v?a x? ??ng m?ch, nh?i mu c? tim... Van tim b? t?n th??ng lm h?n ch? dng mu ch?y qua van g?i l h?p van tim. Van tim ?ng khng kn, lm cho dng mu ch?y ng??c l?i cc bu?ng tim g?i l h? van tim. C? hai t?n th??ng trn th??ng hay k?t h?p v?i nhau.

Khi van tim b? t?n th??ng, tim s? b?m mu km hi?u qu? h?n, do v?y tim ph?i lm vi?c nhi?u h?n ?? b?m mu giu xy ?i nui c? th?. Khi tim ph?i lm vi?c qu nhi?u c th? d?n ??n b? suy, gy ra kh th?, ?au ng?c, m?t m?i v gi? n??c l?i trong c? th? gy ph. N?u cc tri?u ch?ng trn xu?t hi?n, c th? c?n ph?i nong van, s?a van hay thay van tim.

Van tim s? s?a ch?a v thay nh? th? no?

Nong van tim b?ng bng qua da: Khi van hai l, van ??ng m?ch ph?i v m?t s? tr??ng h?p van ??ng m?ch ch? b? h?p kht ??n thu?n (khng km theo h? van hay ch? h? van ? m?c ?? nh?) v khng c huy?t kh?i ? trong cc bu?ng tim th cc bc s? c th? tch cc van b? h?p ny b?ng bng qua da. Bc s? s? lu?n m?t ?ng thng c g?n qu? bng ? ??u qua da theo ???ng ??ng m?ch ho?c t?nh m?ch ?i vo t?i v? tr van tim b? h?p. Bng s? ???c b?m c?ng ln v?i kch th??c ? ???c l?a ch?n tr??c lm cho van tim b? h?p ???c tch r?ng ra. Sau ? cc d?ng c? s? ???c rt ra ngoi.

Ph?u thu?t s?a van tim: Khi l van b? t?n th??ng, b? cc l van b? dy ln, co ko hay khi b? sa l van lm cho van ?ng khng kn, h?u qu? l lm cho dng mu c th? ph?t ng??c tr? l?i bu?ng tim. Van hai l c th? ???c s?a b?ng cch l?y ?i ph?n l van th?a v khu ph?n cn l?i v?i nhau, ho?c b?ng cch t?o hnh l?i cc dy ch?ng. Cc ph?u thu?t vin c th? ??t thm m?t vng ??c bi?t g?i l vng t?o hnh vng van ?? lm thu nh? l?i vng van b? gin. M?t ?u ?i?m c?a ph?u thu?t s?a van tim l b?nh nhn v?n ti?p t?c ???c s? d?ng van tim c?a chnh mnh.

Ph?u thu?t thay van tim: N?u van tim c?a b?nh nhn b? t?n th??ng qu nhi?u khng th? s?a ???c n?a th c?n ???c c?t ?i v thay th? b?ng van tim nhn t?o. Cc van nhn t?o ???c chia ra thnh 2 nhm: van sinh h?c v van c? h?c (???c lm b?ng kim lo?i, hay cc ch?t t?ng h?p khc...).

Ng??i b? b?nh van tim hay sau ph?u thu?t van tim c nguy c? b? m?t nhi?m khu?n ??c bi?t g?i l vim n?i tm m?c nhi?m khu?n. Vim n?i tm m?c nhi?m khu?n xu?t hi?n khi vi khu?n xm nh?p vo trong dng mu v lm lot si van tim. ?i?u ? c th? gy nhi?u bi?n ch?ng tr?m tr?ng. B?nh nhn hy dng thu?c khng sinh tr??c v sau m?t s? th? thu?t nh?:

T?t c? cc th? thu?t c lin quan ??n r?ng mi?ng, bao g?m l?y cao r?ng, ?nh bng r?ng. ?? lm gi?m vi khu?n trong mi?ng, hy ?nh r?ng v st khu?n mi?ng hng ngy, ki?m tra r?ng mi?ng ??nh k? 6-12 thng m?t l?n.

B?t c? m?t ph?u thu?t l?n no; cc ti?u ph?u v trong m?t s? tr??ng h?p khc nh? sinh con; cc th? thu?t c gy t?n th??ng cho t? ch?c c?a c? th?, nh? soi bng quang, th?m tr?c trng...

Nguy c? b? nhi?m khu?n trong cc tnh hu?ng ny r?t nh? n?u ng??i b?nh ???c dng thu?c khng sinh. Hy lin h? ngay v?i bc s? n?u c b?t c? d?u hi?u no nh? s?t, v m? hi, ?n khng ngon, s?t cn hay m?t m?i ko di.

M?t s? l?u v? van tim

Van c? h?c

- Van bng trong khung (Caged-ball = Starr Edwards)

- Van m?t ??a nghing (Single titing disk = Bjork Shiley, Medtronic Hall).

- Van hai ??a nghing (Bileaflet titing disk = St. Jude Medical)

- ??c ?i?m: dng r?t lu, l? van r?ng, nh?ng gy t?o huy?t kh?i.

Van sinh h?c

- Van d? ghp (heterograft = Carpentier - Edwards)

- Mng ngoi tim

- ??c ?i?m: dng t lu h?n, l? van nh?, nh?ng t?o huy?t kh?i r?t t.

Khm th?c th?

- Bnh th??ng: ti?ng kh gin, c th? c m th?i nh? khi mu ch?y qua (bnh th??ng c khuynh ?? nh? qua van).

- B?t th??ng: ti?ng th?i tro ng??c, khng c ti?ng ?ng van c? h?c.

Van bng trong khung

INR 4.0 4.9

Van m?t ??a nghing

INR 3.0 3.9

Van hai ??a nghing

INR 2.5 2.9

Van c? h?c nguy c? cao (nhi?u van, bi?n c? thuyn t?c tr??c ?, EF, rung nh?, nh? T l?n).

INR 3.0 4.5

Van sinh h?c

? INR 2.0 3.0 x 2-3 thng (tr? khi nguy c? cao khng h?n ??nh)

Th? thu?t nh? (vd: nh? r?ng)

th??ng c th? ti?p t?c khng ?ng

Th? thu?t l?n (vd: ph?u thu?t)

Ng?ng Warfafin tr??c ph?u thu?t v b?t ??u dng l?i sau ?.

Th? thu?t l?n nh?ng nguy c? cao gy huy?t kh?i thuyn t?c (vd: van bng trong khung, van hai l nhn t?o, c bi?n c? thuyn t?c m?ch tr??c ?).

Tr??c m?: ng?ng Warfafin v b?t ??u heparin; 2-4 gi? tr??c m?: ng?ng haparin. Sau m?: b?t ??u l?i heparin v wafafin cng s?m cng t?t n?u c th?.

(N Engl J Med 335:407, 1996; Mayo Clin Proc 73: 665, 1998)

D? phng vim n?i tm m?c

Bi?n ch?ng

- Huy?t kh?i t?i van (??c bi?t l v?i van bng trong khung).

- L?p m?ch ( lo?i tr? vim n?i tm m?c).

- Suy c?u trc: van c? h?c: hi?m, ngo?i tr? Bjork- Shiley.

- Van nhn t?o: 30% b? suy y?u trong vng 10-15 n?m.

- Tn huy?t ( ??c bi?t l v?i van bng trong khung).

- R? c?nh van (lo?i tr? vim n?i tm m?c).

Vim n?i tm m?c.

 

gigigi

2013-09-12 191209