Kỹ thuật đóng ống động mạch bằng dụng cụ quada - Lê Hồng Quang

KỸ THUẬT ĐÓNG ỐNG ĐỘNG MẠCH 
BẰNG DỤNG CỤ QUA DA 
TS.BS. Lê Hồng Quang - BV Nhi Trung ương 
 Hà Nội, 09 – 10 - 2016 
GIẢI PHẪU 
TỶ LỆ MẮC 
 Trẻ sinh đủ tháng: 1/2000 
• Chiếm 5-10% trong TBS 
• Nam/nữ: 1/3 
 Trẻ đẻ non tháng: 8/1000 
• Trẻ < 1750g: 45% 
• Trẻ < 1200g: 80% 
SINH LÝ HUYẾT ĐỘNG 
SIÊU ÂM TIM 
SIÊU ÂM TIM 
SIÊU ÂM TIM 
SIÊU ÂM TIM 
PHÂN LOẠI ỐNG ĐỘNG MẠCH 
Phân loại theo Krichenko 
Krichenko A, Benson LN, Burrows P, Möes CA, McLaughlin P, et al. (1989) Angiographic 
classification of the isolated, persistently patent ductus arteriosus and implications for 
percutaneous catheter occlusion. Am J Cardiol 63: 877- 880. 
PHÂN LOẠI 
CHỈ ĐỊNH 
CHỈ ĐỊNH 
Class I 
 1. Transcatheter PDA occlusion is indicated for the 
treatment of a moderate-sized or large PDA with left-
to-right shunt that results in any of the following: 
Congestive heart failure, failure to thrive, pulmonary 
overcirculation (with or without pulmonary 
hypertension), or an enlarged left atrium or left 
ventricle, provided the anatomy and patient size are 
suitable (Level of Evidence: B). 
CHỈ ĐỊNH 
Class IIa 
1. Transcatheter PDA occlusion is reasonable in the 
presence of a small left-to-right shunt with normal-sized 
heart chambers when the PDA is audible by standard 
auscultation techniques (Level of Evidence: C). 
CHỈ ĐỊNH 
Class IIb 
1. In rare instances, transcatheter PDA occlusion may be 
considered in the presence of a bidirectional PDA 
shunt due to pulmonary hypertension and obstructive 
pulmonary vascular disease but reversible to pure 
left-to-right shunting with pulmonary vasodilator 
therapy (Level of Evidence: C). 
CHỈ ĐỊNH 
Class IIb 
2. Transcatheter PDA occlusion may be considered in a 
PDA associated with a small left-to-right shunt with 
normal heart size and an inaudible murmur (Level of 
Evidence: C). 
CHỈ ĐỊNH 
Class III 
1. Transcatheter PDA occlusion should not be attempted 
in a patient with a PDA with severe pulmonary 
hypertension associated with bidirectional or right-to-
left shunting that is unresponsive to pulmonary 
vasodilator therapy (Level of Evidence: C). 
DỤNG CỤ 
DỤNG CỤ