{"id":29851,"date":"2023-04-30T20:44:37","date_gmt":"2023-04-30T13:44:37","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29851"},"modified":"2023-05-01T15:05:45","modified_gmt":"2023-05-01T08:05:45","slug":"ho-van-hai-la-man-va-dieu-tri-noi-ngoai-khoa","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/04\/30\/ho-van-hai-la-man-va-dieu-tri-noi-ngoai-khoa\/","title":{"rendered":"H\u1edf van hai l\u00e1 m\u1ea1n v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i,ngo\u1ea1i khoa"},"content":{"rendered":"<p><strong>H\u1edf van hai l\u00e1 m\u1ea1n l\u00e0 t\u00ecnh tr\u1ea1ng 2 l\u00e1 van \u0111\u00f3ng kh\u00f4ng k\u00edn, l\u00e0m d\u00f2ng m\u00e1u tr\u00e0o ng\u01b0\u1ee3c t\u1eeb th\u1ea5t tr\u00e1i v\u1ec1 nh\u0129 tr\u00e1i khi tim co b\u00f3p. Do l\u01b0\u1ee3ng m\u00e1u tr\u00e0o ng\u01b0\u1ee3c v\u1ec1 nh\u0129 tr\u00e1i c\u1ed9ng th\u00eam l\u01b0\u1ee3ng m\u00e1u b\u00ecnh th\u01b0\u1eddng t\u1eeb ph\u1ed5i \u0111\u1ed5 v\u1ec1 l\u00e0m t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u1edf tim tr\u00e1i, h\u1eadu qu\u1ea3 l\u00e0 gi\u00e3n l\u1edbn nh\u0129 tr\u00e1i v\u00e0 th\u1ea5t tr\u00e1i n\u1ebfu h\u1edf van n\u1eb7ng v\u00e0 k\u00e9o d\u00e0i.<\/strong><\/p>\n<h2><strong>1.Nguy\u00ean nh\u00e2n<\/strong><\/h2>\n<h3>1.1 C\u00e1c nguy\u00ean nh\u00e2n nguy\u00ean ph\u00e1t<\/h3>\n<ul>\n<li>Di ch\u1ee9ng th\u1ea5p tim.<\/li>\n<li>Tho\u00e1i h\u00f3a nh\u1ea7y (sa van hai l\u00e1).<\/li>\n<li>H\u1ed9i ch\u1ee9ng Marfan, h\u1ed9i ch\u1ee9ng Hurler.<\/li>\n<li>Tho\u00e1i h\u00f3a \u1edf ng\u01b0\u1eddi gi\u00e0, t\u0103ng huy\u1ebft \u00e1p, \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng. B\u1ec7n h l\u00fd th\u00e2m nhi\u1ec5m c\u01a1 tim: A myloid, sarcoid.<\/li>\n<\/ul>\n<h3>1.2 C\u00e1c nguy\u00ean nh\u00e2n th\u1ee9 ph\u00e1t<\/h3>\n<p>Khi t\u00ecnh tr\u1ea1ng c\u1ea5u tr\u00fac van hai l\u00e1 b\u00ecnh th\u01b0\u1eddng, h\u1edf van x\u1ea3y ra khi c\u00f3 r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i n\u1eb7ng, th\u1ea5t tr\u00e1i gi\u00e3n l\u00e0m c\u01a1 nh\u00fa v\u00e0 d\u00e2y ch\u1eb1ng b\u1ecb k\u00e9o c\u0103ng, \u0111\u1ed3ng th\u1eddi gi\u00e3n v\u00f2ng van khi\u1ebfn hai l\u00e1 van kh\u00f4ng \u00e1p s\u00e1t \u0111\u01b0\u1ee3c v\u00e0o nhau.<\/p>\n<h2>2.Ph\u00e2n lo\u1ea1i<\/h2>\n<p>C\u00f3 r\u1ea5t nhi\u1ec1u h\u00ecnh th\u00e1i tho\u00e1i h\u00f3a nh\u1ea7y van hai l\u00e1 t\u1eeb sa m\u1ed9t \u0111o\u1ea1n tr\u00ean l\u00e1 van nh\u1ecf (b\u1ec7nh l\u00fd thi\u1ebfu h\u1ee5t m\u00f4 x\u01a1 \u0111\u00e0n h\u1ed3i) \u0111\u1ebfn sa nhi\u1ec1u \u0111o\u1ea1n tr\u00ean l\u00e1 van l\u1edbn (b\u1ec7nh Barlow).<\/p>\n<p><strong>Ph\u00e2n lo\u1ea1i Carpentier&#8217;s <\/strong>h\u1edf van hai l\u00e1 theo c\u01a1 ch\u1ebf h\u1edf van:<\/p>\n<ul>\n<li>Type 1: V\u1eadn \u0111\u1ed9ng c\u00e1c l\u00e1 van b\u00ecnh th\u01b0\u1eddng (h\u1edf van hai l\u00e1 do gi\u00e3n v\u00f2ng van ho\u1eb7c th\u1ee7ng van).<\/li>\n<li>Type 2: Sa l\u00e1 van (h\u1edf van hai l\u00e1 do gi\u00e3n ho\u1eb7c \u0111\u1ee9t d\u00e2y ch\u1eb1ng, c\u1ed9t c\u01a1).<\/li>\n<li>Type 3: H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng c\u00e1c l\u00e1 van. Type 3 \u0111\u01b0\u1ee3c chia l\u00e0m 2 lo\u1ea1i:<\/li>\n<li>Type 3a: H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng c\u00e1c l\u00e1 van th\u00ec t\u00e2m tr\u01b0\u01a1ng do d\u00e0y l\u00e1 van, co r\u00fat d\u00e2y ch\u1eb1ng, c\u1ed9t c\u01a1 (th\u01b0\u1eddng g\u1eb7p trong th\u1ea5p tim).<\/li>\n<li>Type 3b: H\u1ea1n ch\u1ebf v\u1eadn \u0111\u1ed9ng c\u00e1c l\u00e1 van trong th\u00ec t\u00e2m thu (th\u01b0\u1eddng g\u1eb7p trong HoHL do b\u1ec7nh tim thi\u1ebfu m\u00e1u c\u1ee5c b\u1ed9, b\u1ec7nh c\u01a1 tim gi\u00e3n, do gi\u1ea3m ch\u1ee9c n\u0103ng tim).<\/li>\n<\/ul>\n<h2>3.Sinh b\u1ec7nh h\u1ecdc<\/h2>\n<ul>\n<li>T\u1ed5n th\u01b0\u01a1ng l\u00e1 van, d\u00e2y ch\u1eb1ng, c\u01a1 nh\u00fa, ho\u1eb7c th\u1ea5t tr\u00e1i \u0111\u1ec1u c\u00f3 th\u1ec3 g\u00e2y ra h\u1edf van. M\u00e1u ph\u1ee5t ng\u01b0\u1ee3c l\u00ean nh\u0129 tr\u00e1i th\u1eddi k\u1ef3 t\u00e2m thu, gi\u1ed1ng nh\u01b0 t\u1ed1ng m\u00e1u v\u00e0o \u0110M ch\u1ee7.<\/li>\n<li>Trong h\u1edf van hai l\u00e1 n\u1eb7ng k\u00e9o d\u00e0i, c\u00f3 hi\u1ec7n t\u01b0\u1ee3ng gi\u00e3n nh\u0129 tr\u00e1i, do \u0111\u00f3 l\u01b0u l\u01b0\u1ee3ng v\u00e0 \u00e1p l\u1ef1c nh\u0129 tr\u00e1i t\u0103ng \u00edt. Th\u1ea5t tr\u00e1i gi\u00e3n v\u00e0 th\u1ec3 t\u00edch t\u1ed1ng m\u00e1u l\u1edbn b\u00f9 tr\u1eeb cho d\u00f2ng h\u1edf, duy tr\u00ec \u0111\u01b0\u1ee3c ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u. Suy th\u1ea5t tr\u00e1i l\u00e0 do qu\u00e1 t\u1ea3i th\u1ec3 t\u00edch k\u00e9o d\u00e0i. Ch\u00eanh \u00e1p qua l\u1ed7 van th\u1ea5p l\u00e0m che l\u1ea5p \u0111i d\u1ea5u hi\u1ec7u suy ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i. Ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u c\u00f3 th\u1ec3 b\u00ecnh th\u01b0\u1eddng m\u1eb7c d\u00f9 ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i \u0111\u00e3 gi\u1ea3m.<\/li>\n<\/ul>\n<h2>4.Tri\u1ec7u ch\u1ee9ng l\u00e2m s\u00e0ng<\/h2>\n<h3>4.1 Tri\u1ec7u ch\u1ee9ng c\u01a1 n\u0103ng<\/h3>\n<ul>\n<li>Th\u01b0\u1eddng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng trong nhi\u1ec1u n\u0103m. \u0110\u1ee3t ti\u1ebfn tri\u1ec3n c\u00f3 th\u1ec3 g\u1eb7p: M\u1ec7t (do gi\u1ea3m cung l\u01b0\u1ee3ng tim), kh\u00f3 th\u1edf khi g\u1eafng s\u1ee9c, kh\u00f3 th\u1edf khi n\u1eb1m.<\/li>\n<li>\u0110\u00e1nh tr\u1ed1ng ng\u1ef1c (do t\u0103ng th\u1ec3 t\u00edch t\u1ed1ng m\u00e1u ho\u1eb7c rung nh\u0129).<\/li>\n<li>Suy th\u1ea5t ph\u1ea3i \u1edf giai \u0111o\u1ea1n cu\u1ed1i.<\/li>\n<\/ul>\n<h3>4.2 Tri\u1ec7u ch\u1ee9ng th\u1ef1c th\u1ec3<\/h3>\n<ul>\n<li>Nh\u1ecbp tim kh\u00f4ng \u0111\u1ec1u n\u1ebfu c\u00f3 rung nh\u0129.<\/li>\n<li>M\u1ecfm tim l\u1ec7ch tr\u00e1i v\u00e0 di\u1ec7n \u0111\u1eadp r\u1ed9ng khi c\u00f3 gi\u00e3n th\u1ea5t tr\u00e1i.<\/li>\n<li>T1 th\u01b0\u1eddng m\u1edd ho\u1eb7c b\u00ecnh th\u01b0\u1eddng n\u1ebfu do sa van ho\u1eb7c r\u1ed1i lo\u1ea1n ho\u1ea1t \u0111\u1ed9ng c\u1ee7a d\u00e2y ch\u1eb1ng.<\/li>\n<li>T2 t\u00e1ch \u0111\u00f4i r\u1ed9ng, xu\u1ea5t hi\u1ec7n T3 khi t\u0103ng d\u00f2ng ch\u1ea3y t\u00e2m tr\u01b0\u01a1ng. \u0110\u00f4i khi nghe th\u1ea5y ti\u1ebfng T4 nh\u1ea5t l\u00e0 trong h\u1edf van hai l\u00e1 c\u1ea5p.<\/li>\n<li>Ti\u1ebfng th\u1ed5i to\u00e0n t\u00e2m thu: Nghe r\u00f5 \u1edf m\u1ecfm lan ra n\u00e1ch (c\u00f3 th\u1ec3 th\u1ed5i gi\u1eefa t\u00e2m thu n\u1ebfu do sa van ho\u1eb7c r\u1ed1i lo\u1ea1n ho\u1ea1t \u0111\u1ed9ng c\u01a1 nh\u00fa).<\/li>\n<li>C\u00e1c d\u1ea5u hi\u1ec7u suy tim tr\u00e1i: Nh\u1ecbp tim nhanh, huy\u1ebft \u00e1p th\u1ea5p, ran \u1ea9m \u1edf ph\u1ed5i.<\/li>\n<li>C\u00e1c d\u1ea5u hi\u1ec7u suy tim ph\u1ea3i: Gan to, t\u0129nh m\u1ea1ch c\u1ed5 n\u1ed5i, ph\u00f9 hai chi d\u01b0\u1edbi khi b\u1ec7nh ti\u1ebfn tri\u1ec3n n\u1eb7ng.<\/li>\n<\/ul>\n<h2>5.C\u00e1c th\u0103m d\u00f2 c\u1eadn l\u00e2m s\u00e0ng<\/h2>\n<h3><strong>5.1 \u0110i\u1ec7n t\u00e2m \u0111\u1ed3<\/strong><\/h3>\n<ul>\n<li>Nh\u0129 tr\u00e1i gi\u00e3n, ph\u00ec \u0111\u1ea1i th\u1ea5t tr\u00e1i, gi\u00e3n nh\u0129 ph\u1ea3i n\u1ebfu c\u00f3 t\u0103ng \u00e1p \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i. Rung nh\u0129 th\u01b0\u1eddng g\u1eb7p trong h\u1edf van hai l\u00e1 m\u1ea1n t\u00ednh.<\/li>\n<li>Xquang tim ph\u1ed5i<\/li>\n<li>B\u00f3ng tim to, gi\u00e3n nh\u0129 tr\u00e1i, th\u1ea5t tr\u00e1i, \u1ee9 d\u1ecbch t\u0129nh m\u1ea1ch ph\u1ed5i. C\u00f3 th\u1ec3 th\u1ea5y v\u00f4i h\u00f3a v\u00f2ng van hai l\u00e1.<\/li>\n<\/ul>\n<h3>5.2 Si\u00eau \u00e2m tim qua th\u00e0nh ng\u1ef1c<\/h3>\n<ul>\n<li>\u0110\u00e1nh gi\u00e1 gi\u1ea3i ph\u0201u van hai l\u00e1 (lo\u1ea1i t\u1ed5n th\u01b0\u01a1ng v\u00e0 ph\u00e2n lo\u1ea1i h\u1edf van hai l\u00e1).<\/li>\n<li>Si\u00eau \u00e2m m\u00e0u \u0111\u1ec3 ph\u00e1t hi\u1ec7n v\u00e0 \u0111\u00e1nh gi\u00e1 m\u1ee9c \u0111\u1ed9 h\u1edf van hai l\u00e1.<\/li>\n<li>\u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i d\u1ef1a v\u00e0o ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u, \u0111\u01b0\u1eddng k\u00ednh cu\u1ed1i t\u00e2m thu v\u00e0 cu\u1ed1i t\u00e2m tr\u01b0\u01a1ng (ch\u00fa \u00fd: Trong h\u1edf van hai l\u00e1 c\u00f2n b\u00f9, ph\u00e2n su\u1ea5t t\u1ed1ng m\u00e1u lu\u00f4n b\u1ecb \u0111\u00e1nh gi\u00e1 qu\u00e1 m\u1ee9c do l\u1ef1c c\u1ea3n th\u1ea5p \u1edf d\u00f2ng ph\u1ee5t ng\u01b0\u1ee3c).<\/li>\n<li>\u0110\u00e1nh gi\u00e1 \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i v\u00e0 ch\u1ee9c n\u0103ng th\u1ea5t ph\u1ea3i.<\/li>\n<\/ul>\n<p><img decoding=\"async\" loading=\"lazy\" class=\"wp-image-29857 aligncenter\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/images-1-5.jpg\" alt=\"H\u1edf van hai l\u00e1 tr\u00ean si\u00eau \u00e2m\" width=\"420\" height=\"315\" \/><\/p>\n<p style=\"text-align: center;\"><strong><a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/suc-khoe-tong-quat\/danh-gia-hep-van-hai-la-tren-sieu-am-tim-doppler-mau\/\">H\u1edf van hai l\u00e1<\/a> tr\u00ean si\u00eau \u00e2m<\/strong><\/p>\n<h3>5.2 Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n<\/h3>\n<p>Khi c\u00f3 s\u1ef1 b\u1ea5t h\u1ee3p l\u00fd gi\u1eefa c\u00e1c th\u00f4ng s\u1ed1 ho\u1eb7c khi c\u1eeda s\u1ed5 si\u00eau \u00e2m qua th\u00e0nh ng\u1ef1c kh\u00f4ng \u0111\u01b0\u1ee3c r\u00f5 n\u00e9t, si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n cho ph\u00e9p \u0111\u00e1nh gi\u00e1 chi ti\u1ebft h\u01a1n v\u1ec1 gi\u1ea3i ph\u0201u v\u00e0 ch\u00ednh x\u00e1c h\u01a1n v\u1ec1 kh\u1ea3 n\u0103ng s\u1eeda van hai l\u00e1.<\/p>\n<p>Nghi\u1ec7m ph\u00e1p g\u1eafng s\u1ee9c \u0111\u01b0\u1ee3c ch\u1ec9 \u0111\u1ecbnh khi b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 s\u1ef1 ph\u00f9 h\u1ee3p gi\u1eefa l\u00e2m s\u00e0ng v\u00e0 m\u1ee9c \u0111\u1ed9 h\u1edf van.<\/p>\n<h3>5.3 Th\u00f4ng tim:<\/h3>\n<ul>\n<li>Kh\u00f4ng b\u1eaft bu\u1ed9c.<\/li>\n<li>Ph\u00e1t hi\u1ec7n c\u00e1c t\u1ed5n th\u01b0\u01a1ng van tim ph\u1ed1i h\u1ee3p v\u00e0 b\u1ec7nh m\u1ea1ch v\u00e0nh.<\/li>\n<\/ul>\n<p><strong>\u01af\u1edbc t\u00ednh m\u1ee9c \u0111\u1ed9 h\u1edf van hai l\u00e1 theo Seller:<\/strong><\/p>\n<p>1\/4: Ch\u1ec9 c\u00f3 v\u1ec7t c\u1ea3n quang v\u00e0o nh\u0129 tr\u00e1i kh\u00f4ng \u0111\u1ee7 vi\u1ec1n r\u00f5 h\u00ecnh nh\u0129 tr\u00e1i.<\/p>\n<p>2\/4: C\u1ea3n quang tr\u00e0n v\u00e0o kh\u1eafp nh\u0129 tr\u00e1i nh\u01b0ng \u0111\u1eadm \u0111\u1ed9 c\u1ea3n quang kh\u00f4ng b\u1eb1ng th\u1ea5t tr\u00e1i v\u00e0 m\u1ea5t \u0111i sau 2 &#8211; 3 nh\u00e1t b\u00f3p.<\/p>\n<p>3\/4: \u0110\u1eadm \u0111\u1ed9 c\u1ea3n quang \u1edf nh\u0129 tr\u00e1i v\u00e0 th\u1ea5t tr\u00e1i b\u1eb1ng nhau.<\/p>\n<p>4\/4: \u0110\u1eadm \u0111\u1ed9 c\u1ea3n quang \u1edf nh\u0129 tr\u00e1i \u0111\u1eadm h\u01a1n \u1edf th\u1ea5t tr\u00e1i, xu\u1ea5t hi\u1ec7n c\u1ea3 c\u1ea3n quang \u1edf t\u0129nh m\u1ea1ch ph\u1ed5i.<\/p>\n<h2>6.\u0110i\u1ec1u tr\u1ecb<\/h2>\n<h3><strong>6.1 \u0110i\u1ec1u tr\u1ecb n\u1ed9i khoa<\/strong><\/h3>\n<ul>\n<li>C\u00e1c b\u1ec7nh nh\u00e2n c\u00f3 h\u1edf van hai l\u00e1 m\u1ee9c \u0111\u1ed9 nh\u1eb9-v\u1eeba kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng \u0111\u01b0\u1ee3c theo d\u00f5i \u0111\u1ecbnh k\u1ef3 th\u01b0\u1eddng xuy\u00ean b\u1eb1ng si\u00eau \u00e2m tim.<\/li>\n<li>C\u00e1c nh\u00f3m thu\u1ed1c gi\u00e3n m\u1ea1ch (\u1ee9c ch\u1ebf men chuy\u1ec3n, \u1ee9c ch\u1ebf th\u1ee5 th\u1ec3) c\u00f3 t\u00e1c d\u1ee5ng l\u00e0m t\u0103ng cung l\u01b0\u1ee3ng t\u1ed1ng m\u00e1u c\u1ee7a tim v\u00e0 h\u1ea1n ch\u1ebf th\u1ec3 t\u00edch d\u00f2ng h\u1edf.<\/li>\n<li>N\u1ebfu c\u00f3 rung nh\u0129 c\u1ea7n \u0111i\u1ec1u tr\u1ecb kh\u1ed1ng ch\u1ebf t\u1ea7n s\u1ed1 tim th\u00edch h\u1ee3p v\u00e0 \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng (gi\u1eef m\u1ee9c PT-INR t\u1eeb 2 &#8211; 3).<\/li>\n<li>Ph\u00f2ng ng\u1eeba vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c: Kh\u00f4ng khuy\u1ebfn c\u00e1o th\u01b0\u1eddng quy.<\/li>\n<\/ul>\n<h3>6.2 \u0110i\u1ec1u tr\u1ecb ph\u1eabu thu\u1eadt (theo AHA\/ACC 2017)<\/h3>\n<h4><strong>6.2.1 Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt H\u1edf van hai l\u00e1 nguy\u00ean ph\u00e1t:<\/strong><\/h4>\n<ul>\n<li>H\u1edf van hai l\u00e1 n\u1eb7ng c\u00f3 tri\u1ec7u ch\u1ee9ng, m\u1eb7c d\u00f9 \u0111\u00e3 \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u1ed1i \u01b0u.<\/li>\n<li>H\u1edf van hai l\u00e1 n\u1eb7ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng c\u00f3 th\u1ec3 c\u1ea7n ph\u0201u thu\u1eadt n\u1ebfu c\u00f3 th\u00eam m\u1ed9t trong c\u00e1c y\u1ebfu t\u1ed1 sau:<\/li>\n<li>Ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i gi\u1ea3m (EF 30 &#8211; 60% ho\u1eb7c \u0111\u01b0\u1eddng k\u00ednh th\u1ea5t tr\u00e1i cu\u1ed1i th\u00ec t\u00e2m thu \u2265 40 mm).<\/li>\n<li>Rung nh\u0129 m\u1edbi xu\u1ea5t hi\u1ec7n.<\/li>\n<li>T\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i &gt; 50 mmHg.<\/li>\n<li>C\u00e2n nh\u1eafc trong c\u00e1c tr\u01b0\u1eddng h\u1ee3p n\u1eb7ng kh\u00f4ng c\u00f3 tri\u1ec7u ch\u1ee9ng nh\u01b0ng theo d\u00f5i th\u1ea5y ch\u1ee9c n\u0103ng th\u1ea5t tr\u00e1i gi\u1ea3m d\u1ea7n, k\u00edch th\u01b0\u1edbc th\u1ea5t tr\u00e1i gi\u00e3n d\u1ea7n tr\u01b0\u1edbc khi EF &lt; 60%, v\u00e0 \u0111\u01b0\u1eddng k\u00ednh th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m thu &lt; 40 mm.<\/li>\n<\/ul>\n<h4><strong>6.2.2 Ch\u1ec9 \u0111\u1ecbnh ph\u1eabu thu\u1eadt H\u1edf van hai l\u00e1 th\u1ee9 ph\u00e1t:<\/strong><\/h4>\n<ul>\n<li>Can thi\u1ec7p trong tr\u01b0\u1eddng h\u1ee3p h\u1edf van hai l\u00e1 th\u1ee9 ph\u00e1t ch\u1ec9 c\u00e2n nh\u1eafc trong m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p nh\u01b0:<\/li>\n<li>B\u1ec7nh nh\u00e2n h\u1edf van hai l\u00e1 n\u1eb7ng c\u1ea7n ph\u0201u thu\u1eadt b\u1eafc c\u1ea7u n\u1ed1i ch\u1ee7 v\u00e0nh ho\u1eb7c thay van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/li>\n<li>B\u1ec7nh nh\u00e2n h\u1edf van hai l\u00e1 n\u1eb7ng, tri\u1ec7u ch\u1ee9ng dai d\u1eb3ng khi \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u1ed1i \u01b0u.<\/li>\n<li>C\u00e1c ph\u01b0\u01a1ng ph\u00e1p ph\u0201u thu\u1eadt: S\u1eeda van hai l\u00e1 ho\u1eb7c thay van hai l\u00e1 b\u1eb1ng van nh\u00e2n t\u1ea1o. Kh\u1ea3 n\u0103ng ph\u0201u thu\u1eadt thay van hay s\u1eeda van ph\u1ee5 thu\u1ed9c v\u00e0o t\u1ed5n th\u01b0\u01a1ng van v\u00e0 kinh nghi\u1ec7m c\u1ee7a t\u1eebng ph\u0201u thu\u1eadt vi\u00ean. Van hai l\u00e1 b\u1ecb sa nhi\u1ec1u v\u00f9ng v\u00e0 b\u1ecb v\u00f4i h\u00f3a n\u1eb7ng s\u1ebd kh\u00f3 ti\u1ebfn h\u00e0nh s\u1eeda h\u01a1n t\u1ed5n th\u01b0\u01a1ng sa m\u1ed9t v\u00f9ng van v\u00e0 l\u00e1 van \u00edt b\u1ecb th\u01b0\u01a1ng t\u1ed5n v\u00f4i h\u00f3a.<\/li>\n<li>S\u1eeda van hai l\u00e1 qua \u0111\u01b0\u1eddng \u1ed1ng th\u00f4ng (MitraClip)<\/li>\n<li>S\u1eeda van hai l\u00e1 qua \u0111\u01b0\u1eddng \u1ed1ng th\u00f4ng (hay c\u00f2n g\u1ecdi l\u00e0 th\u1ee7 thu\u1eadt k\u1eb9p van hai l\u00e1) l\u00e0 m\u1ed9t can thi\u1ec7p x\u00e2m l\u1ea5n t\u1ed1i thi\u1ec3u, d\u1ee5ng c\u1ee5 \u0111\u01b0\u1ee3c \u0111\u01b0a qua \u0111\u01b0\u1eddng t\u0129nh m\u1ea1ch \u0111\u00f9i, xuy\u00ean qua v\u00e1ch li\u00ean nh\u0129 qua nh\u0129 tr\u00e1i, sau \u0111\u00f3 k\u1eb9p 2 m\u00e9p van b\u1eb1ng m\u1ed9t d\u1ee5ng c\u1ee5 \u0111\u01b0\u1ee3c thi\u1ebft k\u1ebf \u0111\u1eb7c bi\u1ec7t gi\u00fap l\u00e0m gi\u1ea3m d\u00f2ng h\u1edf van hai l\u00e1 trong nh\u1eefng tr\u01b0\u1eddng h\u1ee3p h\u1edf van hai l\u00e1 n\u1eb7ng. Qu\u00e1 tr\u00ecnh l\u00e0m th\u1ee7 thu\u1eadt \u0111\u01b0\u1ee3c theo d\u00f5i li\u00ean t\u1ee5c b\u1eb1ng si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n \u0111\u1ec3 \u0111\u1ea3m b\u1ea3o th\u1ee7 thu\u1eadt hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n.<\/li>\n<\/ul>\n<p><strong>Ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n<p>Nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 ch\u1ec9 \u0111\u1ecbnh lo\u1ea1i I ph\u0201u thu\u1eadt s\u1eeda ho\u1eb7c thay van hai l\u00e1, theo khuy\u1ebfn c\u00e1o n\u0103m 2014 v\u00e0 c\u1eadp nh\u1eadt 2017 c\u1ee7a<\/p>\n<p>Hi\u1ec7p h\u1ed9i Tim m\u1ea1ch Hoa K\u1ef3\/Tr\u01b0\u1eddng m\u00f4n Tim m\u1ea1ch Hoa K\u1ef3 (AHA\/ACC 2014), bao g\u1ed3m:<\/p>\n<ul>\n<li>H\u1edf van hai l\u00e1 (3+) ho\u1eb7c (4+), c\u00f3 tri\u1ec7u ch\u1ee9ng m\u1eb7c d\u00f9 \u0111\u00e3 \u0111i\u1ec1u tr\u1ecb n\u1ed9i khoa t\u1ed1i \u01b0u, EF&gt; 30%, v\u00e0\/ho\u1eb7c \u0111\u01b0\u1eddng k\u00ednh th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m thu (Ds) \u2264 55 mm.<\/li>\n<li>H\u1edf van hai l\u00e1 (3+) ho\u1eb7c (4+), kh\u00f4ng tri\u1ec7u ch\u1ee9ng, nh\u01b0ng c\u00f3 \u00edt nh\u1ea5t m\u1ed9t trong s\u1ed1 nh\u1eefng d\u1ea5u hi\u1ec7u sau \u0111\u00e2y:<\/li>\n<li>EF 25 &#8211; 60%<\/li>\n<li>\u0110\u01b0\u1eddng k\u00ednh th\u1ea5t tr\u00e1i cu\u1ed1i t\u00e2m thu \u2265 40 mm<\/li>\n<li>T\u0103ng \u00e1p l\u1ef1c \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i<\/li>\n<li>Rung nh\u0129<\/li>\n<li>H\u00ecnh th\u00e1i van hai l\u00e1 ph\u00f9 h\u1ee3p v\u1edbi k\u1ef9 thu\u1eadt k\u1eb9p van hai l\u00e1: Sa van v\u00f9ng gi\u1eefa (A2, P2) v\u1edbi kho\u1ea3ng c\u00e1ch cho ph\u00e9p (&lt; 2 cm) ho\u1eb7c gi\u00e3n v\u00f2ng van g\u00e2y h\u1edf van m\u00e0 kho\u1ea3ng c\u00e1ch gi\u1eefa hai l\u00e1 van khi \u0111\u00f3ng to\u00e0n b\u1ed9 c\u00f2n ch\u1ea1m nhau.<\/li>\n<li>B\u1ec7nh nh\u00e2n kh\u00f4ng th\u1ec3 ph\u0201u thu\u1eadt\/ph\u0201u thu\u1eadt nguy c\u01a1 cao ho\u1eb7c t\u1eeb ch\u1ed1i ph\u0201u thu\u1eadt.<\/li>\n<\/ul>\n<p><strong>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh:<\/strong><\/p>\n<ul>\n<li>HoHL do c\u00e1c nguy\u00ean nh\u00e2n kh\u00e1c (th\u1ea5p tim; vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c&#8230;). Nh\u1ed3i m\u00e1u c\u01a1 tim trong v\u00f2ng 12 tu\u1ea7n.<\/li>\n<li>C\u1ea7n can thi\u1ec7p ph\u0201u thu\u1eadt m\u1ed9t t\u1ed5n th\u01b0\u01a1ng kh\u00e1c \u1edf tim (nh\u01b0 l\u00e0m c\u1ea7u n\u1ed1i ch\u1ee7 v\u00e0nh, thay van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.).<\/li>\n<li>Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n.<\/li>\n<li>H\u00ecnh th\u00e1i van hai l\u00e1 kh\u00f4ng ph\u00f9 h\u1ee3p v\u1edbi k\u1ef9 thu\u1eadt k\u1eb9p van hai l\u00e1.<\/li>\n<li>Huy\u1ebft kh\u1ed1i t\u0129nh m\u1ea1ch \u0111\u00f9i, t\u0129nh m\u1ea1ch ch\u1ee7 d\u01b0\u1edbi ho\u1eb7c huy\u1ebft kh\u1ed1i trong bu\u1ed3ng tim.<\/li>\n<\/ul>\n<p><strong>Bi\u1ebfn ch\u1ee9ng th\u01b0\u1eddng g\u1eb7p:<\/strong><\/p>\n<ul>\n<li>Ch\u1ea3y m\u00e1u t\u1ea1i v\u1ecb tr\u00ed ch\u1ecdc m\u1ea1ch do d\u00f9ng d\u1ee5ng c\u1ee5 k\u00edch th\u01b0\u1edbc l\u1edbn. Tuy nhi\u00ean t\u1ef7 l\u1ec7 ch\u1ea3y m\u00e1u n\u00e0y v\u0201n th\u1ea5p h\u01a1n ch\u1ea3y m\u00e1u sau ph\u0201u thu\u1eadt.<\/li>\n<li>Huy\u1ebft kh\u1ed1i d\u1ee5ng c\u1ee5 k\u1eb9p van. D\u1ee5ng c\u1ee5 b\u1ecb bong ra m\u1ed9t ph\u1ea7n.<\/li>\n<li>H\u1eb9p van hai l\u00e1 th\u1ee9 ph\u00e1t sau th\u1ee7 thu\u1eadt. Vi\u00eam n\u1ed9i t\u00e2m m\u1ea1c nhi\u1ec5m khu\u1ea9n.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>H\u1edf van hai l\u00e1 m\u1ea1n l\u00e0 t\u00ecnh tr\u1ea1ng 2 l\u00e1 van \u0111\u00f3ng kh\u00f4ng k\u00edn, l\u00e0m d\u00f2ng m\u00e1u tr\u00e0o ng\u01b0\u1ee3c t\u1eeb th\u1ea5t tr\u00e1i v\u1ec1 nh\u0129 tr\u00e1i khi tim co b\u00f3p. Do l\u01b0\u1ee3ng m\u00e1u tr\u00e0o ng\u01b0\u1ee3c v\u1ec1 nh\u0129 tr\u00e1i c\u1ed9ng th\u00eam l\u01b0\u1ee3ng m\u00e1u b\u00ecnh th\u01b0\u1eddng t\u1eeb ph\u1ed5i \u0111\u1ed5 v\u1ec1 l\u00e0m t\u0103ng l\u01b0u l\u01b0\u1ee3ng m\u00e1u \u1edf tim tr\u00e1i, [&hellip;]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[7,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>H\u1edf van hai l\u00e1 m\u1ea1n v\u00e0 \u0111i\u1ec1u tr\u1ecb n\u1ed9i,ngo\u1ea1i khoa<\/title>\n<meta name=\"description\" content=\"H\u1edf van hai l\u00e1 m\u1ea1n\u00a0l\u00e0 t\u00ecnh tr\u1ea1ng 2 l\u00e1 van \u0111\u00f3ng kh\u00f4ng k\u00edn, l\u00e0m d\u00f2ng m\u00e1u tr\u00e0o ng\u01b0\u1ee3c t\u1eeb th\u1ea5t tr\u00e1i v\u1ec1 nh\u0129 tr\u00e1i khi tim co b\u00f3p. 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