Những vấn đề cần theo dõi ở bn sau pt tứ chứng fallot

NHVUANIDE NCANGTHEO DOI BEN NHAN

SAU PHAU THUAT TU CHUNG FALLOT

1s, Bs, Kim Tuyen

Truong DHYK PNT

JTim Tâm Đức

be SIVA

TR a gly 0-0 hin hm 04 Cy, acHh 2M amish) 2 fr

He

MO DAU

Tit ching Falot (TOF bénh tim bm sin (TBS) in

thuong gap

+ Phau thutsatcan hTo idlugahthguolinddnt

vo nim 1955 (Glut glam th ti |: Đồng Tháng miền v

val quyet tc nh cdg ra that ph

+ biến ching can theo di sau PT:

(1) Ho-vDaMnP,

(2) én, phinh that pha, eo
(3) Hep ducing thoat that pha ton lu,
(4) LT ton leu

jra con cd bien ching dn vong van va gc DMC, LN va dt t

Cac yet anh hundgn rion
che mn that phat trang im

Sdnng sau Kh sia cha te chimg Fallot

rapa ology of Fale witha foot advancs inechocardiography’, Cur Cin Card, 3200-

II

CAC iN CHUNG DA HAN SAU PHAUTHUAT CHUNG ALOT tn cn PR ul 28,

Bln ching Ghinhdn

HnWP gn ih PR py let pio ik cha pl bt

Sua cha ta ghd ming ny ving van dn PR nd, Kody 262

Hep RVOTIdn Hap hh gmc pl hn gb hyp PAG ng didn ON) mi gy hn pd in

Cacngyn hin dha gh lon dui van, gm sin ig van hap van pha nan tl,

Henn tug dang nap gh nj tc ptt can i bing dg thing,

RAllog hn Pahl kn hu qu cas dV dR rn i,

Nuc iv la PVR cin cle TP hud kt lon ching TP dng, i tid,
Glin gd dng nach Sy gn go dng mach ch ug hy 90-50 bik hn TOF butannsacha tung dpe dung it,
ch Nbc dn dn kh hn kn la van dng mach ch Bd ch ng mach ch am bn ching hm gp,

Viatinm mg Handng mach ch tung dn nn ya tong dns qui TOF sacha,

Cay nh dg i guy co ohn bh kb TO sba ca:

Vantin go: Tong tn bh dn angi phat hoe ua rg ting guy co mc Ean ht

shdng nu van nhd mach dh bd,

Nip nhanh nti Cacktuy cn ti oc dn yj cla urd an

TWH mbcAT Gln adn tung hihi TOF go sba ca tng 20 Ny coin gh sa 46h,

{uy utc tong quln tb nyu phic bg (vlc hihi ph co oh cy lacing

Cayut gycna ATs bao gb iu dnp tim bul ie ba cha,
Riilog hp ht THe oh a nh ttn dng in tT gestae dn 0 dn 18,

Cacybut quo cana bao lm hun pha tli ud ph og cng gin

CRS Wo div i caohon th du

Ayo rg nt Tl hm yl 6 ry in.

Cach thire theo doi

+ Nhóm lâm séng

+ Cac xn cén lém sang
1) sigu ém tin
2)ECG, holter ECG

3)0MR
4\CTA

5) Test gang ste

6) Théng tim, chup mach meu

hao sat dién sin I

TB Ldn

Sieu am tim

+ Phathidn va do Kch thu TLT fon wu

«ae dnt mi d ho hl

+ Xéo inh ve oc tac gn crn ra that pion va

fac nghén

«Dan oa kch thước, thức rắn) tà tật độn từng tủa ái

ohahlatvtl

«Phat ign gin goc BMC vl hod hd van BMC

Thong fen that tOn lu

Ria ieng Vé

TT phincaba

Do kich ướt

«Dan gid énh hung huyet dng

mau ‘6 rong dng ho, dt va 46 lan dong

+ Dé lan dng mau <40 mm ho nhe w
+ )rịt tồn tử hườn đượt bắi ịllntj
(eso voi ducing Kinh vong van DMP,

Vl 0.5 c6 tong quan voi PR néng duoc do

bang CMR Sovore
PR

(hoic DT }, PR ning

+ Doppler qua phi ci sO PR * AB, chiso

inde 46 ning PR, Dinh lvong Ket thic som

dong à0 tt I0,

PRniang

Loghbi etal (2017), Journal o the American Socley of Echocardiography

SIFU AM DANH GIA HO! VAN DMP

§, Doplr coh igng Te tih phn sud do nguge

trong PR

RVol = SV(RVOT) - SY[LVOT)

If:Rl9IfN01

+ Vong van OMP dod true nga, ngay chd movan ddu TT

* PID in RVOT from PSAX

* Vong van BMC do PLAX dau tam thu

* PWD in WO0TSCV,

+ VOT: do trong qué tinh tong mau som (ha bafame

hinh sau song R trén ECG) ngay dui PV trong mat cat true

ngan canh xvong it,

+ Mic dl Khdng durge ching minh dé dinh lvgmng PR, cde dong

chay trong RVOT 0 the duge so sanh voi cde da dem khae

(Í tinh RVol vi phan suat rao nguge,

Loghb etal (2017), Journal ofthe American Socey of Echocardiography

SIEU AM DANH GIA HO VAN DMP

Céc thing sb seu dm tim vi Doppler hou ch tong vig phn oa md ho ph

Tit tri opi pend engi ty

howe M lu ew * Unlss ; aroha rasa for RY

nna lui Na aroma MundilhJ10lW enlarge

Wi Nin Wmluft thư tư val PR,

MiUUMÙME TaiDmg HUNỚP Bodie! Naliulsllntf§M)tmle,
far poeta
fade hry §CMRoved PR acon» A,
W Wï PR inde: Defasithendretodn of PR
wis
Oe Iwwmlimhluubsge signal ddd by le ti dualion of
kihlnHtbi| fv
Sit dion Gist, wih tis ao danifing @ CMR:
Onin Pig
an = dePRrHaleond26,

Dp ‘No eben the presence oh RV end
tat aso pressure,
Posen Pt
Fi! to #Cul vaflv sVol and faanre not

oa gu wel alate,
{ Seep decderain is not specie fr
Peace) Shi
sitoaPR, ay did on CR
CoanLOT
Lined applica wh chocarograhy,
nn

l

LaJounai l ote Amt e Sit, o ody

Thuaoatn th hop niu tham sOvé mre 6 hophi

Chum aguaon by clo up

Vt th cửa PR ob th Ang

vu do: chit ong inh

7 anh er, vn lý hư vl

iu, sy Kd thing thí tội lên

gia Wt qud ecto bode sy Khtng

ph bi cd Kt qu msg,

neu inh anh Whdng dat yu cu: CMR

hod TEE,

PHT, Pressure halftime,

| Anil, Ja oe Ameria Sito herds

lút [nh ức nên đường ath pha

Và vi ti tac nghén

SOU AA ULES

Parameter Ml Moderate Severe

Peak Doppvelloce(rms) ở H 4
Peak Doppler gradient — ó MH On

(nn) - M

Mean Doppler gradient - NUNG:

(uml)

AV sytolicprewurellY <5)

4J9Ilt Jtldtt(Ä)

Adapted fom Stout KK Daniels), Abowhown fetal 2018 AHA/ACC guideline
forthe management of adls with congenital hart dsase:a report ofthe American
College of Crdicogy/Amercan Heart Associaton Tak Force on Clinical Practice

Guidlines, Am Col Cdl. 2019,73(12}e81-e192 Cuypers JA, Wisenbrug M, vaner

Linde D,Ros-Heslnk]WPulronary stenosis update on dagnos and therapeutic

opin Hert, 20139933047,"

Kich thud that pha

|, BasaRV l dameter » 4D em indicates dlatation

2, Mid cavitary RV dameter > 3S.em indicates dltation

} RV longitudinal dimension > 86cm indicates RV enlargement

Kich thutdat hal

QU diém ONhvo diem

+Dedingghinhin @4CV- »Kich thud T phy
DauHychi dnt chow
pha ot
+ Lam dh gi sal bé rd
Mihi a

Do budng thoat that phai

(N:4.7-2.7cm)

‘Thay 6 cat ct anh tri va dưới ườn

4Nén do vao cui âm tương dựa tt sóng QRS

QUuden Nhuge diém
'lihuúeN0Tgibi › Adidtdilaô

CEO matcatPSAX ti 0adipthtMeRNUT

Nataltn tong the chu ge chan

anh huongch yeulén Cth th nh gi el
NI Ke tude

Table| Strengths imitationsan,d value inthe clinical seting ofeach imaging modality forthe asessment of RV
function

Parameter Strengths Limitations Uselvale in the clinical setting

thoi " Fay fi andwidl avalible Reflects onlongudalfnction Use or the rst assesment bed

TARE " Reyroducle "Neglect contrbton IVS ad se) and in emergency sets

* Fabled prognostice NOT "Not addin postcard surgery

" Ussonracardacreerencepoht pats

" Anand load. doenden * Needs tobe lays combined with

chor measures of RV function

$10) " Fay andl "Reoly e lngudat l faction of * Not ached in pot ardic ugery

" Reproucble bas tral segment pavers

" Eeablied prognostic vale" Negletsconibtionof NS and Needs tobe alas combined with

NOT other measofuRVrfeactsion

"Anges and lod dependent

" fay and widely aalbe "Healy dependent onimagequalty "Should be wed nadton to parame:

" Reflects bthlongtudal andra: Poorrprodublty ters reflecting longa function,
Haas) dalcotactn " NeectsconbtonfthVOeT ely inpwaih gtood nedoscada

ffiorldlmwHhM, — ® loddgpedet border delineation

deeAV EF " Conrat shud be condepoor

" Fsublshed prognstcae acoustic window

ANP (TD)) " Provides information on ba " Unlable when RA presures are " Couldbe usd apaof ruttgua

RV faction elevated ft approach, expel in patents

Lays dependent on couse Linked wen omal RY with suboptial image quay, whan

window cfher parameters are ess relable

% Fay and widely avalible " Topple inpaens wth nol " Not widely recommended fo rote

1 TRorsevere TR tlncal we
"Loud dopendet
" Shouldbe wed rote fr ddd
ADE lng! st in "Hass logtudal myoada " Reavis oodinag Q0l\
deformation AV assesment, especialy in subgroups
" Neqects conirbuton of he RVOT
"Las angle and load dependent of patents wth RV involvement
" Loss cofunded by BV geomet " Reauires pos. groceing
" nportn propos are, superior
and pasove maton " Vendor depend, fr wih cu to other conerlonal RV paranaters

© Revd tin sree i fll yp studies "Alls to dynose clic AV
† Eyublihed prognostic valu, adh " Relatively ited ally
¢ystunction
theto other RY parameters
Mechanical dpersin nde can be wed
wa measure ofRV dysynhrony

1E " ‘odopenden of geome "Heauy dependent on imag uty "‘nechocaroyaptic borates wth

Assumptions " Neud for tin coger ood epee SDechocardgraphy

"Exum vldatptdCMR (regularRR intervals n case of 4Ddered RV EF shouldbe wed ros

" Fabled prognatva mnukhbet acquston) nal forasseasmant of RV tole

par to other RV parameters " Lintd avalabity {unto n pans wih good acoustic

* Repaec iquesnt and window

Cediatanea d sotware

*Racin pontproceing

* Reaspvectitsring

Dhụ " Provides addi propnt i "Not yetaabefor othe clncal* Crenyfor secu aly

RY-PA coupling formation in spif patients Ut
populations
Myocardiwoarlk " Reais futher ps proceof
" Refets bah RV teroad and
5D fdllume datasets anal ita
contract
wane Í
* Fsublshed propo vaue
" laylablen pans wth olub> * Canbe usd inant cepa
* Reflects RV aero
pial TR Dogple sl eters of RV tt for dedateRdV
iyanddsynerony
" Conley andavlably depend assent expcaly in ubropf

the paramweed tfoersre pewithnR isnvent

mont of RV convactty (TAPS, Canbe ued inationothr parm

FAC, sal, 30 RV ER with thle eters ofV fonction for dedated RV
Lntatiaoppsly
assent (nda folonsp
" lopplate inpatwiteh notks»
studies) howeve dita on lng
optinal TR Doplr sal
nos value are stl Umted
fjÌlnildlwwd(lDfglulnl

syaln apply

Ts Bs Lb Kim Tuyén

Dahaa chit ning that ph

HFSRVOT 254FA+ > REF <5 (Sr

79%, Spec 86%

HRVAd < 20em2 => EDRVV <470min2

+ TAPSE <{8mm; TAPSE! RV LDd «25%

+ Snhj han oh tht pha: EDFF én tyo 3 chu chyen im