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DEMA-CVN

GII THIU

CC TI BO CO TI HI
NGH TIM MCH MIN TRUNGTY NGUYN M RNG LN
TH VI TI BUN MA THUT
THNG 8 NM 2011

PHU THUT NG MCH CNH


Thay i g qua 15 nm?

F. MANTZ

D. THIBAUD
Trung tm Y khoa Orangerie
STRASBOURG

NGHIN CU SO SNH
T1/01/1994
n 31/12/1998

T 1/01/2006
n 31/12/2010

631 bnh nhn


705 lt PT

624 BN
662 lt PT

AG
401

AL
304
1

AG
49

AL
613
4

AG: Gy m ton thn; AL: Gy m cc b

TIN TRIN CA PHNG PHP


GY M

AG: Gy m ton thn; AL: Gy m cc b

CH NH HIN NAY CA GY
M TON THN
Gy m cc b tht bi
Yu cu ca BN / tnh trng ca BN

Shunt lp trnh
Hp M cnh ti pht??? (21/34)

PHN B THEO NAM V N

705 t phu
thut
Femme: N

662 t phu thut

Homme: Nam

PHN B THEO TUI V


GII

CC YU T NGUY C
HTA traite: tng HA
iu tr
DIND: T khng
ph thuc insulin
DID: T ph
thuc insulin
Atteinte coronaire:
Bnh mch vnh

BNH MCH VNH

TRIU CHNG

CT SCAN NO TRC PHU


THUT ( C CN QUANG)
1994 - 1998

13/705

1,84 %

2006 - 2010

2/662

0,3 %

K THUT M

Rimplantation: cm to hnh mch cnh


TEA simple: bc tch ni mc n gin
TEA+ patch: bc tch ni mc c patch
Autres: cc phng php khc

PHNG PHP BC TCH


NI MC C PATCH (TEA)

K THUT CM TO HNH
MCH CNH LN NGC

BC TCH NI MC VI
NG KHU N GiN

K THUT M

Rimplantation: cm to hnh mch cnh


TEA simple: bc tch ni mc n gin
TEA+ patch: bc tch ni mc c patch
Autres: cc phng php khc

TiN TRIN K THUT M


THEO KTV

Rimplantation: cm to hnh mch cnh


TEA simple: bc tch ni mc n gin
TEA+ patch: bc tch ni mc c patch

CC K THUT KHC
1994 1998
8
4

Ghp tnh mch


Gi
Dy chng M cnh
trong.

2006 2010
1
17
1

TO SHUNT M CNH

A GIC WILLIS

CC CH NH T SHUNT
1994 1998
20
23
35
5

2006 - 2010
Theo N
P tn d < 40
Tht bi vi
test kp
khc

0
10
47
2

TIN HNH T SHUNT


1994 1998
48
1

2006 - 2010
Di gy m ton thn
Di gy m cc b

35
(83/705) 11,7

7
2

52

TNG CNG

(59/662) 8,9 %

%
18/83 = 21,6 TC NG MCH I 11/59 = 18,6
BN

TI HP
1994 1998
22

2006 - 2010
Ti hp phu thut

34

1/01/1994 et
31/12/1998

Ti hp xut hin v
c m trong qua
trnh nghin cu:

2 % (6/244)
2,6 % (1/38)

sau TEA simple


sau TEA + patch

0
0,9 % (1/109)

Sau to hnh mch


cnh

0,93 % (5/535)

0,49 % (2/408)

1/01/2006 et
31/12/2010

KT QU: KIM SOT SAU M


1994 - 1998
683
14
5
1
703/705
gestes

2006 - 2010
AVV
Chp mch
Siu m
Chp mch Ct
scan
TNG CNG

578
0
72
21
671/662
gestes

KT QU
1994 1998

2006 - 2010

Nhim trng

Thuyn tc M cnh trong


khng triu chng ( khng
m)

0
0

Tc M cnh trong c triu


chng ( TBMMN) khng
m

09/705 = 1,2 %

T l ti can thip

15/662 = 2,2 %

Tc M cnh trong c triu


chng ( TBMMN) m li

mu t vng c

11

Hp tn d

Bc tch trn shunt

7 tc M cnh sau phu thut


(1994/1988):
1 ghp tnh mch
1 TEA + patch

2 Ti ghp ( mt bnh nhn)


3 TEA n gin

T l t vong
30 ngy

1994 1998
4 (AG)
0
1

5/705 = 0,7
%

2006 - 2010
TBMMN
Nhi mu
t t

0
1
1

2/662 = 0,3
%

Nhi mu sau phu thut


1994 1998

2006 - 2010

2 (gy m cc b)

Tai bin thong qua sau phu thut


(< 30 ngy sau phu thut)
(vi gi n vi ngy)

1994 1998

2006 - 2010

12/705

6/662

1,7 %

0,9 %

T vong do bnh l TK
1994 1998
4
3
2 (<6 thng)
1,27 %

2006 - 2010
TBMMN v t
vong
TBMMN khng
tin trin> 6 thng

0
0

TBMMN hi phc 4 (< 3 thng)


0,60 %

1994 1998

1,4 %

2006 - 2010

T l t vong 30 j
(t vong do mi
nguyn nhn +
TBMMN)

0,9 %

Cc bin chng thn kinh


ngoi bin (X, XII) > 30 ngy
1994 1998

2006 - 2010

7/705

7/662

1%

1%

Kt lun :
phu thut M cnh hin ti

Gy m cc b lm thng quy
Gy m cc b: hp l ha cc ch nh t shunt
Gy m cc b khng gy ra cc bin chng tim
mch nh gy m ton thn ngc li gip x tr tt
cc vn tim mch tin phu
K thut to hnh mch cnh : khng cn gy tc
mch sau m t 2006-2010
Scanner no+ cn quang= ch inh nht thi
Thi iu tr tch cc nu hp tn d sau phu
thut: khng xy ra TBMMN khng c t vong do
TBMMN trong nghin cu 2006 - 2010

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