{"id":29996,"date":"2023-05-01T22:57:18","date_gmt":"2023-05-01T15:57:18","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=29996"},"modified":"2023-05-01T22:57:18","modified_gmt":"2023-05-01T15:57:18","slug":"van-tim-nhan-tao-va-cac-luu-y-lua-chon","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/01\/van-tim-nhan-tao-va-cac-luu-y-lua-chon\/","title":{"rendered":"Van tim nh\u00e2n t\u1ea1o v\u00e0 c\u00e1c l\u01b0u \u00fd l\u1ef1a ch\u1ecdn"},"content":{"rendered":"<p><strong><a href=\"https:\/\/www.vinmec.com\/vi\/tim-mach\/thong-tin-suc-khoe\/chon-van-tim-nhan-tao-nhu-the-nao\/\">Van tim nh\u00e2n t\u1ea1o<\/a> l\u00e0 m\u1ed9t thi\u1ebft b\u1ecb y t\u1ebf \u0111\u01b0\u1ee3c c\u1ea5y gh\u00e9p v\u00e0o trong c\u01a1 th\u1ec3 \u0111\u1ec3 thay th\u1ebf van tim b\u1ecb h\u1ecfng. Van tim nh\u00e2n t\u1ea1o gi\u00fap duy tr\u00ec l\u01b0u l\u01b0\u1ee3ng m\u00e1u v\u00e0 \u0111\u1ea3m b\u1ea3o ho\u1ea1t \u0111\u1ed9ng c\u1ee7a tim. Thi\u1ebft b\u1ecb n\u00e0y \u0111\u00e3 gi\u00fap nhi\u1ec1u b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 s\u1ed1ng s\u00f3t v\u00e0 kh\u00f4i ph\u1ee5c s\u1ee9c kh\u1ecfe sau khi ph\u1eabu thu\u1eadt thay van tim.<\/strong><\/p>\n<h2>1.C\u00e1c d\u1ea1ng van nh\u00e2n t\u1ea1o<\/h2>\n<p><strong><em>Van c\u01a1 h\u1ecdc<\/em><\/strong>: Ph\u1ed5 bi\u1ebfn nh\u1ea5t hi\u1ec7n nay l\u00e0 d\u1ea1ng van hai c\u00e1nh (St Jude Medical, Carbomedic). Ngo\u00e0i ra c\u00f2n c\u00f3 d\u1ea1ng van bi l\u1ed3ng (Starr-Edwards) ho\u1eb7c van \u0111\u0129a (Medtronic Hall)<\/p>\n<p><strong><em>Van sinh h\u1ecdc<\/em><\/strong>: Van tim l\u1ee3n c\u00f3 gi\u00e1 \u0111\u1ee1 hay kh\u00f4ng c\u00f3 gi\u00e1 \u0111\u1ee1 (Van Porcine) ho\u1eb7c van c\u1ea5u t\u1ea1o t\u1eeb m\u00e0ng tim b\u00f2 (Carpentier- Edwards).<\/p>\n<p><strong><em>Van ng\u01b0\u1eddi: <\/em><\/strong>Van ng\u01b0\u1eddi t\u1eeb ng\u01b0\u1eddi hi\u1ebfn t\u1ea1ng \u0111\u01b0\u1ee3c b\u1ea3o qu\u1ea3n, van t\u1ef1 th\u00e2n (van \u0111\u1ed9ng m\u1ea1ch ph\u1ed5i &#8211; ph\u0201u thu\u1eadt Ross).<\/p>\n<p><img decoding=\"async\" loading=\"lazy\" class=\" wp-image-29998 aligncenter\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/05\/tai-xuong-1.jpg\" alt=\"Van tim nh\u00e2n t\u1ea1o\" width=\"369\" height=\"209\" \/><\/p>\n<p style=\"text-align: center;\"><strong>Van tim nh\u00e2n t\u1ea1o<\/strong><\/p>\n<h3>1.1 Van c\u01a1 h\u1ecdc<\/h3>\n<p>Nguy c\u01a1 h\u1ecfng c\u1ea5u tr\u00fac van l\u00e0 r\u1ea5t nh\u1ecf. Nguy c\u01a1 ph\u0201u thu\u1eadt l\u1ea1i kh\u00f4ng do h\u1ecfng c\u1ea5u tr\u00fac van kho\u1ea3ng 5% su\u1ed1t \u0111\u1eddi k\u1ec3 t\u1eeb l\u00fac thay van.<\/p>\n<p>Nguy c\u01a1 g\u00e2y huy\u1ebft kh\u1ed1i, do v\u1eady y\u00eau c\u1ea7u d\u00f9ng ch\u1ed1ng \u0111\u00f4ng kh\u00e1ng vitamin K su\u1ed1t \u0111\u1eddi v\u00e0 c\u00f3 th\u1ec3 ph\u1ea3i d\u00f9ng th\u00eam aspirin n\u1ebfu nguy c\u01a1 huy\u1ebft kh\u1ed1i cao. Th\u1eadm ch\u00ed v\u1edbi PT-INR \u0111\u1ea1t \u0111\u00edch \u0111i\u1ec1u tr\u1ecb, v\u0201n c\u00f3 t\u1ef7 l\u1ec7 kho\u1ea3ng 2 &#8211; 4% h\u00e0ng n\u0103m, c\u00f3 nguy c\u01a1 b\u1ecb huy\u1ebft kh\u1ed1i ho\u1eb7c xu\u1ea5t huy\u1ebft bao g\u1ed3m c\u1ea3 \u0111\u1ed9t qu\u1ef5 n\u00e3o.<\/p>\n<h3>1.2 Van sinh h\u1ecdc<\/h3>\n<p>Van nh\u00e2n t\u1ea1o sinh h\u1ecdc ho\u1eb7c van ng\u01b0\u1eddi kh\u00f4ng y\u00eau c\u1ea7u ch\u1ed1ng \u0111\u00f4ng nh\u01b0ng kh\u00f4ng b\u1ec1n nh\u01b0 van c\u01a1 h\u1ecdc. T\u1ef7 l\u1ec7 b\u1ecb suy ch\u1ee9c n\u0103ng van, h\u1ecfng van sau 15 n\u0103m l\u00e0 5 &#8211; 20%. T\u1ef7 l\u1ec7 n\u00e0y ph\u1ee5 thu\u1ed9c \u0111\u1ed9 tu\u1ed5i b\u1ec7nh nh\u00e2n, b\u1ec1n nh\u1ea5t \u1edf ng\u01b0\u1eddi gi\u00e0.<\/p>\n<p>Nguy c\u01a1 huy\u1ebft kh\u1ed1i h\u00e0ng n\u0103m l\u00e0 0,5%. Van sinh h\u1ecdc hay b\u1ecb ch\u00eanh \u00e1p cao qua van sau ph\u0201u thu\u1eadt nhi\u1ec1u h\u01a1n van c\u01a1 h\u1ecdc \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng van k\u00edch th\u01b0\u1edbc nh\u1ecf.<\/p>\n<p>C\u00e1c lo\u1ea1i van nh\u00e2n t\u1ea1o kh\u00e1c nhau c\u00f3 c\u1ea5u t\u1ea1o ri\u00eang bi\u1ec7t v\u00e0 di\u1ec7n t\u00edch l\u1ed7 hi\u1ec7u d\u1ee5ng kh\u00e1c nhau.<\/p>\n<h2>2. \u0110\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng van nh\u00e2n t\u1ea1o<\/h2>\n<h3><strong>2.1 L\u00e2m s\u00e0ng<\/strong><\/h3>\n<p>M\u1ed7i van nh\u00e2n t\u1ea1o \u0111\u1ec1u c\u00f3 \u00e2m thanh \u0111\u1eb7c bi\u1ec7t. R\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng van nh\u00e2n t\u1ea1o c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c nh\u1eadn bi\u1ebft b\u1edfi s\u1ef1 xu\u1ea5t hi\u1ec7n \u00e2m thanh m\u1edbi, thay \u0111\u1ed5i \u00e2m thanh ho\u1eb7c \u00e2m l\u01b0\u1ee3ng c\u1ee7a \u00e2m thanh, ho\u1eb7c ti\u1ebfng th\u1ed5i m\u1edbi.<\/p>\n<p>C\u00e1c tri\u1ec7u ch\u1ee9ng kh\u00e1c k\u00e8m theo do r\u1ed1i lo\u1ea1n ch\u1ee9c n\u0103ng van (c\u00f3 th\u1ec3): \u0110au ng\u1ef1c, kh\u00f3 th\u1edf, ran \u1ea9m \u0111\u00e1y ph\u1ed5i, ph\u00f9 ph\u1ed5i, h\u1eadu qu\u1ea3 c\u1ee7a t\u1eafc \u0111\u1ed9ng m\u1ea1ch do huy\u1ebft kh\u1ed1i b\u1eafn \u0111i.<\/p>\n<h3>2.2 Ch\u1ea9n \u0111o\u00e1n h\u00ecnh \u1ea3nh<\/h3>\n<ul>\n<li><strong><em>Soi d\u01b0\u1edbi m\u00e0n h\u00ecnh t\u0103ng s\u00e1ng <\/em><\/strong>c\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a c\u00e1c c\u00e1nh van v\u1edbi van c\u01a1 h\u1ecdc. Chuy\u1ec3n \u0111\u1ed9ng van b\u1ecb h\u1ea1n ch\u1ebf n\u1ebfu c\u00f3 huy\u1ebft kh\u1ed1i, pannus ho\u1eb7c chuy \u1ec3n \u0111\u1ed9ng qu\u00e1 m\u1ee9c n\u1ebfu v\u00f2ng van b\u1ecb bong.<\/li>\n<li><strong><em>Si\u00eau \u00e2m tim qua th\u00e0nh ng\u1ef1c <\/em><\/strong>b\u1ecb h\u1ea1n ch\u1ebf do b\u00f3ng c\u1ea3n c\u1ee7a l\u00e1 van kim lo\u1ea1i. C\u00f3 th\u1ec3 s\u1eed d\u1ee5ng \u0111\u1ec3 quan s\u00e1t chuy\u1ec3n \u0111\u1ed9ng c\u1ee7a v\u00f2ng van, c\u00e1nh van, \u0111o ch\u00eanh \u00e1p qua van, \u0111o d\u00f2ng h\u1edf c\u1ea1nh ch\u00e2n van, \u0111\u00f4i khi c\u00f3 th\u1ec3 quan s\u00e1t th\u1ea5y huy\u1ebft kh\u1ed1i. C\u1ea7n so s\u00e1nh v\u1edbi b\u1ea3n si\u00eau \u00e2m tim c\u1ee7a b\u1ec7nh nh\u00e2n l\u00fac m\u1edbi ra vi\u1ec7n ho\u1eb7c l\u1ea7n kh\u00e1m g\u1ea7n nh\u1ea5t (ph\u00e2n bi\u1ec7t v\u1edbi k\u1eb9t van do pannus ho\u1eb7c do b\u1ea5t t\u01b0\u01a1ng x\u1ee9ng gi\u1eefa k\u00edch th\u01b0\u1edbc v\u00f2ng van nh\u00e2n t\u1ea1o v\u00e0 k\u00edch th\u01b0\u1edbc v\u00f2ng van th\u1eadt c\u1ee7a b\u1ec7nh nh\u00e2n)<\/li>\n<li><strong><em>Si\u00eau \u00e2m tim qua th\u1ef1c qu\u1ea3n <\/em><\/strong>t\u1ed1t h\u01a1n trong \u0111\u00e1nh gi\u00e1 ch\u1ee9c n\u0103ng van hai l\u00e1 nh\u00e2n t\u1ea1o nh\u01b0ng h\u1ea1n ch\u1ebf h\u01a1n trong \u0111\u00e1nh gi\u00e1 van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 nh\u00e2n t\u1ea1o, \u0111\u1ed3ng th\u1eddi c\u00f3 th\u1ec3 quan s\u00e1t r\u00f5 ho\u1ea1t \u0111\u1ed9ng c\u1ee7a c\u00e1c c\u00e1nh van, ph\u00e2n bi\u1ec7t k\u1eb9t van do huy\u1ebft kh\u1ed1i v\u00e0 pannus, \u0111o \u0111\u01b0\u1ee3c k\u00edch th\u01b0\u1edbc c\u1ee7a huy\u1ebft kh\u1ed1i.<\/li>\n<li><strong><em>C\u1ed9n g h\u01b0\u1edfng t\u1eeb <\/em><\/strong>an to\u00e0n trong ph\u1ea7n l\u1edbn van c\u01a1 h\u1ecdc hi\u1ec7n \u0111\u1ea1i nh\u01b0ng t\u1ed1n k\u00e9m v\u00e0 m\u1ea5t th\u1eddi gian, n\u00ean ch\u1ec9 l\u1ef1a ch\u1ecdn khi kh\u00f4ng \u0111\u00e1nh gi\u00e1 \u0111\u01b0\u1ee3c b\u1eb1ng si\u00eau \u00e2m qua th\u00e0nh ng\u1ef1c ho\u1eb7c qua th\u1ef1c qu\u1ea3n.<\/li>\n<\/ul>\n<h2>3. Th\u00f4ng tim<\/h2>\n<p>C\u00f3 th\u1ec3 \u0111\u00e1nh gi\u00e1 ch\u00eanh \u00e1p qua van, di\u1ec7n t\u00edch van. C\u00f3 th\u1ec3 ph\u00e2n \u0111\u1ed9 h\u1edf van. C\u00f3 nguy c\u01a1 \u1ed1ng th\u00f4ng \u0111i qua van c\u01a1 h\u1ecdc n\u00ean ch\u1ec9 s\u1eed d\u1ee5ng tr\u01b0\u1edbc khi m\u1ed5 l\u1ea1i ho\u1eb7c khi c\u00e1c bi\u1ec7n ph\u00e1p<\/p>\n<p>kh\u00f4ng x\u00e2m l\u1ea5n kh\u00f4ng k\u1ebft lu\u1eadn \u0111\u01b0\u1ee3c.<\/p>\n<h2>4. L\u1ef1a ch\u1ecdn van nh\u00e2n t\u1ea1o<\/h2>\n<p><strong>\u01afu ti\u00ean van c\u01a1 h\u1ecdc n\u1ebfu:<\/strong><\/p>\n<ul>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 nguy\u1ec7n v\u1ecdng v\u00e0 kh\u00f4ng c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng l\u00e2u d\u00e0i. B\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 tho\u00e1i h\u00f3a van sinh h\u1ecdc nhanh.<\/li>\n<li>B\u1ec7nh nh\u00e2n \u0111\u00e3 c\u00f3 m\u1ed9t van c\u01a1 h\u1ecdc kh\u00e1c.<\/li>\n<li>C\u00e2n nh\u1eafc \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n &lt; 60 tu\u1ed5i n\u1ebfu thay van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 v\u00e0 &lt; 65 tu\u1ed5i n\u1ebfu thay van hai l\u00e1.<\/li>\n<li>Tu\u1ed5i &lt; 65-70 v\u00e0 k\u1ef3 v\u1ecdng s\u1ed1ng d\u00e0i (theo tu\u1ed5i, gi\u1edbi t\u00ednh, b\u1ec7nh \u0111\u1ed3ng m\u1eafc v\u00e0 tu\u1ed5i th\u1ecd trung b\u00ecnh c\u1ee7a qu\u1ed1c gia) c\u1ed9ng th\u00eam vi\u1ec7c ph\u0201u thu\u1eadt van l\u1ea1i trong t\u01b0\u01a1ng lai c\u00f3 th\u1ec3 c\u00f3 nguy c\u01a1 cao.<\/li>\n<\/ul>\n<p><strong>\u01afu ti\u00ean thay van sinh h\u1ecdc n\u1ebfu:<\/strong><\/p>\n<ul>\n<li>Mong mu\u1ed1n c\u1ee7a b\u1ec7nh nh\u00e2n sau khi \u0111\u01b0\u1ee3c t\u01b0 v\u1ea5n.<\/li>\n<li>Kh\u00f4ng c\u00f3 \u0111i\u1ec1u ki\u1ec7n \u0111i\u1ec1u tr\u1ecb ch\u1ed1ng \u0111\u00f4ng t\u1ed1t (ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh ho\u1eb7c c\u00f3 r\u1ee7i ro cao khi d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng, kh\u00f4ng c\u00f3 \u0111i\u1ec1u ki\u1ec7n ki\u1ec3m tra \u0111\u00f4ng m\u00e1u \u0111\u1ecbnh k\u1ef3, v\u1ea5n \u0111\u1ec1 tu\u00e2n th\u1ee7 \u0111i\u1ec1u tr\u1ecb, l\u1ed1i s\u1ed1ng, ngh\u1ec1 nghi\u1ec7p).<\/li>\n<li>Thay van sinh h\u1ecdc \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o cho b\u1ec7nh nh\u00e2n m\u1ed5 l\u1ea1i do huy\u1ebft kh\u1ed1i van c\u01a1 h\u1ecdc m\u1eb7c d\u00f9 ch\u1ed1ng \u0111\u00f4ng v\u0201n \u0111ang \u0111\u01b0\u1ee3c ki\u1ec3m so\u00e1t t\u1ed1t.<\/li>\n<li>B\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 th\u1ea5p ph\u0201u thu\u1eadt l\u1ea1i van trong t\u01b0\u01a1ng lai. Ph\u1ee5 n\u1eef tr\u1ebb mong mu\u1ed1n mang thai<\/li>\n<\/ul>\n<h2>5. Qu\u1ea3n l\u00fd b\u1ec7nh nh\u00e2n sau thay van nh\u00e2n t\u1ea1o<\/h2>\n<p><strong>Li\u1ec7u ph\u00e1p ch\u1ed1ng \u0111\u00f4ng <\/strong>\u1edf b\u1ec7nh nh\u00e2n van tim nh\u00e2n t\u1ea1o ho\u1eb7c s\u1eeda van:<\/p>\n<h3>5.1 Van c\u01a1 h\u1ecdc<\/h3>\n<p>S\u1eed d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng v\u1edbi van c\u01a1 h\u1ecdc<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"541\">Ch\u1ed1ng \u0111\u00f4ng m\u00e1u VKA \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o su\u1ed1t \u0111\u1eddi cho t\u1ea5t c\u1ea3 b\u1ec7nh nh\u00e2n.<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>I<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>B<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"541\">Li\u1ec7u ph\u00e1p b\u1eafc c\u1ea7u b\u1eb1ng UFH ho\u1eb7c LMWH \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o khi \u0111i\u1ec1u tr\u1ecb VKA b\u1ecb gi\u00e1n \u0111o\u1ea1n.<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>I<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>C<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"541\">B\u1ed5 sung aspirin li\u1ec1u th\u1ea5p (75 &#8211; 100 mg\/24h) k\u1ebft h\u1ee3p VKA n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t sau khi x\u1ea3y ra bi\u1ebfn c\u1ed1 thuy\u00ean t\u1eafc m\u1eb7c d\u00f9 PT-INR \u0111\u1ea1t<\/p>\n<p>ng\u01b0\u1ee1ng \u0111i\u1ec1u tr\u1ecb.<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>IIa<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>C<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"541\">Vi\u1ec7c b\u1ed5 sung aspirin li\u1ec1u th\u1ea5p (75 &#8211; 100 mg\/24h) k\u1ebft h\u1ee3p VKA c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c xem x\u00e9t trong tr\u01b0\u1eddng h\u1ee3p c\u00f3 b\u1ec7nh x\u01a1 v\u1eefa \u0111\u1ed9ng m\u1ea1ch k\u00e8m theo.<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>IIb<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>C<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"541\">\u1ede nh\u1eefng b\u1ec7nh nh\u00e2n mang van c\u01a1 h\u1ecdc \u0111\u01b0\u1ee3c \u0111\u1eb7t stent m\u1ea1ch v\u00e0nh, \u0111i\u1ec1u tr\u1ecb k\u1ebft h\u1ee3p 3 thu\u1ed1c aspirin (75 &#8211; 100 mg\/24h), clopidogrel (75 mg\/24h) v\u00e0 VKA n\u00ean \u0111\u01b0\u1ee3c xem x\u00e9t trong 1 th\u00e1ng, kh\u00f4ng ph\u00e2n bi\u1ec7t<\/p>\n<p>lo\u1ea1i stent \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng v\u00e0 bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng (v\u00ed d\u1ee5 h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p hay b\u1ec7nh m\u1ea1ch v\u00e0nh \u1ed5n \u0111\u1ecbnh)<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>IIa<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>B<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"541\"><strong>\u00a0<\/strong><\/p>\n<p>Li\u1ec7u ph\u00e1p ba thu\u1ed1c g\u1ed3m aspirin (75 &#8211; 100 mg\/24h), clopidogrel (75 mg\/24h) v\u00e0 VKA trong &gt; 1 th\u00e1ng v\u00e0 t\u1ed1i \u0111a 6 th\u00e1ng s\u1ebd \u0111\u01b0\u1ee3c xem x\u00e9t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n mang van c\u01a1 h\u1ecdc xu\u1ea5t hi\u1ec7n h\u1ed9i ch\u1ee9ng v\u00e0nh c\u1ea5p c\u00f3 nguy c\u01a1 huy\u1ebft kh\u1ed1i cao ho\u1eb7c c\u00e1c \u0111\u1eb7c \u0111i\u1ec3m gi\u1ea3i ph\u0201u\/b\u1ec7nh l\u00fd kh\u00e1c.<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>IIa<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>B<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"541\">Li\u1ec7u ph\u00e1p hai thu\u1ed1c g\u1ed3m VKA v\u00e0 clopidogrel (75 mg\/24h) \u0111\u01b0\u1ee3c xem x\u00e9t thay th\u1ebf cho li\u1ec7u ph\u00e1p ba thu\u1ed1c \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n nguy c\u01a1 ch\u1ea3y m\u00e1u cao h\u01a1n nguy c\u01a1 huy\u1ebft kh\u1ed1i.<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>IIa<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>A<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"541\"><strong>\u00a0<\/strong><\/p>\n<p>V\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n mang van c\u01a1 h\u1ecdc c\u00f3 can thi\u1ec7p \u0111\u1ed9ng m\u1ea1ch v\u00e0nh qua da, \u0111\u01a1n tr\u1ecb li\u1ec7u v\u1edbi VKA n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc sau 1 n\u0103m<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>IIa<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>B<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"541\">Vi\u1ec7c s\u1eed d\u1ee5ng k\u1ebft h\u1ee3p aspirin v\u00e0\/ho\u1eb7c clopidogrel v\u1edbi VKA, n\u00ean \u0111i\u1ec1u ch\u1ec9nh li\u1ec1u c\u1ee7a VKA \u0111\u1ec3 PT-INR \u1edf ng\u01b0\u1ee1ng d\u01b0\u1edbi c\u1ee7a ph\u1ea1m vi m\u1ee5c ti\u00eau v\u00e0 th\u1eddi gian \u0111\u1ea1t \u0111\u00edch \u0111i\u1ec1u tr\u1ecb &gt; 65 &#8211; 70%.<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>IIa<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>B<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"541\"><strong>\u00a0<\/strong><\/p>\n<p>Ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh v\u1edbi thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng th\u1ebf h\u1ec7 m\u1edbi.<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>III<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>B<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3><strong>5.2 Van sinh h\u1ecdc<\/strong><\/h3>\n<p>S\u1eed d\u1ee5ng ch\u1ed1ng \u0111\u00f4ng v\u1edbi van sinh h\u1ecdc<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"541\"><strong>\u00a0<\/strong><\/p>\n<p>Ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng VKA \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o s\u1eed d\u1ee5ng trong ba<\/p>\n<p>th\u00e1ng \u0111\u1ea7u sau s\u1eeda van ho\u1eb7c thay van hai l\u00e1, van ba l\u00e1 sinh h\u1ecdc.<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>IIa<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>C<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"541\">Aspirin li\u1ec1u th\u1ea5p (75 &#8211; 100 mg) \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc s\u1eed d\u1ee5ng trong ba<\/p>\n<p>th\u00e1ng \u0111\u1ea7u sau thay van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 sinh h\u1ecdc ho\u1eb7c ph\u0201u thu\u1eadt s\u1eeda van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7.<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>IIa<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>C<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"541\"><strong>\u00a0<\/strong><\/p>\n<p>Li\u1ec7u ph\u00e1p kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u k\u00e9p \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng trong 3-6<\/p>\n<p>th\u00e1ng \u0111\u1ea7u sau TAVI sau \u0111\u00f3 duy tr\u00ec c\u1ea3 \u0111\u1eddi v\u1edbi m\u1ed9t thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u tr\u00ean nh\u1eefng b\u1ec7nh nh\u00e2n kh\u00f4ng c\u00f3 ch\u1ec9 \u0111\u1ecbnh d\u00f9ng thu\u1ed1c ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng.<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>IIa<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p><strong>C<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"541\"><strong>\u00a0<\/strong><\/p>\n<p>Li\u1ec7u ph\u00e1p m\u1ed9t thu\u1ed1c kh\u00e1ng k\u1ebft t\u1eadp ti\u1ec3u c\u1ea7u ngay sau TAVI c\u0169ng \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o tr\u00ean b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 ch\u1ea3y m\u00e1u cao.<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>IIb<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>C<\/strong><\/td>\n<\/tr>\n<tr>\n<td width=\"541\"><strong>\u00a0<\/strong><\/p>\n<p>Ch\u1ed1ng \u0111\u00f4ng \u0111\u01b0\u1eddng u\u1ed1ng \u0111\u01b0\u1ee3c xem x\u00e9t s\u1eed d\u1ee5ng trong 3 th\u00e1ng \u0111\u1ea7u sau thay van \u0111\u1ed9ng m\u1ea1ch ch\u1ee7 sinh h\u1ecdc.<\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>IIb<\/strong><\/td>\n<td width=\"60\"><strong>\u00a0<\/strong><\/p>\n<p><strong>C<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><strong>\u00a0<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Van tim nh\u00e2n t\u1ea1o l\u00e0 m\u1ed9t thi\u1ebft b\u1ecb y t\u1ebf \u0111\u01b0\u1ee3c c\u1ea5y gh\u00e9p v\u00e0o trong c\u01a1 th\u1ec3 \u0111\u1ec3 thay th\u1ebf van tim b\u1ecb h\u1ecfng. Van tim nh\u00e2n t\u1ea1o gi\u00fap duy tr\u00ec l\u01b0u l\u01b0\u1ee3ng m\u00e1u v\u00e0 \u0111\u1ea3m b\u1ea3o ho\u1ea1t \u0111\u1ed9ng c\u1ee7a tim. Thi\u1ebft b\u1ecb n\u00e0y \u0111\u00e3 gi\u00fap nhi\u1ec1u b\u1ec7nh nh\u00e2n c\u00f3 th\u1ec3 s\u1ed1ng s\u00f3t v\u00e0 kh\u00f4i [&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>Van tim nh\u00e2n t\u1ea1o v\u00e0 c\u00e1c l\u01b0u \u00fd l\u1ef1a ch\u1ecdn - Vinmec<\/title>\n<meta name=\"description\" content=\"Van tim nh\u00e2n t\u1ea1o \u0111\u01b0\u1ee3c c\u1ea5y gh\u00e9p v\u00e0o trong c\u01a1 th\u1ec3 \u0111\u1ec3 thay th\u1ebf van tim b\u1ecb h\u1ecfng, gi\u00fap duy tr\u00ec l\u01b0u l\u01b0\u1ee3ng m\u00e1u v\u00e0 \u0111\u1ea3m b\u1ea3o ho\u1ea1t \u0111\u1ed9ng c\u1ee7a tim.\" \/>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Van tim nh\u00e2n t\u1ea1o v\u00e0 c\u00e1c l\u01b0u \u00fd l\u1ef1a ch\u1ecdn - 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