Các biến chứng muộn hiếm gặp sau thay van động mạch chủ
Nội dung chính của bài viết
Tóm tắt
Đặt vấn đề: biến chứng muộn sau thay van động mạch chủ bằng phẫu thuật thường rất ít gặp ngoại trừ viêm nội tâm mạc nhiễm khuẩn. Chúng tôi báo cáo 6 trường hợp lóc tách, giả phình và hở cạnh van không do nhiễm trùng sau thay van ĐMC.
Phương pháp: hồi cúu các trường hợp có biến chứng muộn sau phẫu thuật thay van động mạch chủ từ năm 2022 đến 2024 tại Viện Tim Thành phố Hồ Chí Minh
Kết quả: ghi nhận một trường hợp lóc tách động mạch chủ lên, một trường hợp giả phình đi kèm dò động mạch chủ và 4 trường hợp hở nặng cạnh van cơ học không do nhiễm trùng. Tất cả đều được mổ lại với kết quả tốt. Không có tử vong và không có biến chứng nặng.
Kết luận: tiếp tục theo dõi sau thay van động mạch chủ về dài hạn là cần thiết để có thể điều trị kịp thời các biến chứng muộn ít gặp.
Từ khóa
thay van ĐMC, lóc tách ĐMC, giả phình, Behcet
Chi tiết bài viết
Tài liệu tham khảo
1. BC. Astor, RG. Kaczmarek, B Hefflin, and WR Daley. Mortality After Aortic Valve Replacement: Results From a Nationally Representative Database. Ann Thorac Surg 2000;70:1939–4. DOI: 10.1016/s0003-4975(00)01670-2.
2. Phan Thanh Nam, Dương Đức Hùng, Nguyễn Trường Giang, Trần Thị Bích Phương, Đặng Đình Mạnh, Nguyễn Văn Tạo và CS. Đánh giá kết quả sớm phẫu thuật thay van động mạch chủ bằng van sinh học không gọng Freedom Solo. Tạp Chí Nghiên Cứu Y Học 2023; 168 (7). https://doi.org/10.52852/tcncyh.v168i7.1721.
3.N Pham, H Zaitoun, T Lucien Mohammed, E DeLaPena-Almaguer, F Martinez, GM. Novaro, J Kirsch. Complications of Aortic Valve Surgery: Manifestations at CT and MR Imaging. RadioGraphics 2012; 32:1873–1892 Published online 10.1148/rg.327115735.
4. K. Prenger, F. Pieters, and E. Cheriex. Aortic Dissection After Aortic Valve Replacement: Incidence and Consequences for Strategy. J Cardiac Surg 1994;9: 495-499. https://doi.org/10.1111/j.1540-8191.1994.tb00882.x
5. P Y. von Kodolitsch, R. Loose, J. Ostermeyer, A. Aydin, DH. Koschyk, A. Haverich, and CA. Nienaber. Proximal Aortic Dissection Late After Aortic Valve Surgery: 119 Cases of a Distinct Clinical Entity. Thorac Cardiov Surg 2000; 48: 342 – 346. DOI: 10.1055/s-2000-8346
6. HJ Koo , HN Lee, Xuan Anh Tran Thi, J-W Kang, DH Yang, J-K Song et al.Postoperative Complications after Surgical Aortic Valve Replacement. Cardiovasc Imaging Asia. 2017 Oct;1(4):222-230. https://doi.org/10.22468/cvia.2017.00115
7. International Team for the Revision of the International Criteria for Behcet’s Disease (ITR-ICBD): F. Davatchi, S. Assaad-Khalil, K.T. Calamia, J.E. Crook, B. Sadeghi-Abdollahi, M. Schirmer, et al. The International Criteria for Behcet’s Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. Journal of the European Academy of Dermatology and Venereology 2014; 28: 338–347. DOI: 10.1111/jdv.12107.
8. Y.Tamagawa, M. Kawamura, K.Shibata, et al. Risk factor analysis for aortic dissection after aortic valve replacement in patients with tricuspid aortic valve. Gen Thorac Cardiovasc Surg 2024; 72: 305–310. https://doi.org/10.1007/s11748-023-01970-3
9.AA. Behranwala, SR. Handa and NP. Mehta. Aortic dissection one year after aortic valve replacement. Asian Cardiovascular & Thoracic Annals 2014, Vol. 22(9) 1099–1102. DOI: 10.1177/0218492313493793.
10.W. Derkac, H. Laks, LH. Cohn, JJ. Collins. Dissecting Aneurysm After Aortic Valve Replacement. Arch Surg 1974; 109: 388-390. DOI: 10.1001/archsurg.1974.01360030040010.
11. M. Chenier, KK. Patel, LG. Svensson, J. Navia, JF. Sabik III, LL. Rodriguez et al. Characteristics and outcomes of patients with postoperative cardiovascular pseudoaneurysms. J Thorac Cardiovasc Surg 2017;153:43-50. DOI: 10.1016/j.jtcvs.2016.08.065.
12. PG Manvindi, A Cappai et al. Analysis of Postsurgical Aortic False Aneurysm in 27 Patients. Texas Heart Inst J 2013;40(3):274-80) . PMID: 23914017.
13. A. Luk, TE. David, J. Butany. Complications of Bioglue postsurgery for aortic dissections and aortic valve replacement. J Clinical Pathol 2012; 65(11): 1008-12. DOI: 10.1136/jclinpath-2012-200809.
14. TE. David. False aneurysms after heart valve surgery. J Thorac Cardiovasc Surg 2017;153:51-2. DOI: 10.1016/j.jtcvs.2016.09.019
15. M Agarwal, M Ray, M Pallavi, S Sen, D Ganguly, P Josh et al. Device occlusion of pseudoaneurysm of ascending aorta. Annals of Pediatric Cardiology 2011 Vol 4 Issue 2: 195-199. PMID: 21976887
16. Graham R. McClure MD, MSc1,2 | Geemitha Ratnayake BSc3 | Albert Chan MD, MSc4,5 | Joel Gagnon. Percutaneous closure of a post-surgical ascending aortic pseudoaneurysm with an amplatzer septal occluder device and steerable guiding sheath. Catheter Cardiovasc Interv. 2021;98:E985–E989. DOI: 10.1002/ccd.29951.
17. M Randal, O Betageri , S Hanayneh and R. David Anderson. Paravalvular Leak: A Systemic Review. Current Cardiology Reviws, 2022, 18, e110522204571. DOI: 10.2174/1573403X18666220511113310.
18. Hung Dung Van, Chi Linh Chau, Minh Chau Van Nguyen. Technique for repair of recurrent aortic valve dehiscence. J Surg Case Report 2025; 2: 1-3. PMID: 40007566.
19. T. Azuma, K.Yamazaki, S. Saito, et al. Aortic valve replacement in Behcet’s disease: surgical modification to prevent valve detachment. Euro J Cardiothorac Surg 2009; 36: 771–2. Doi:10.1016/ j.ejcts.2009.05.031.
20. GK. Mani, JR. Kanwar, PK. Sharma, et al. Fourth recurrence of aortic annular dehiscence following AVR for aortic regurgitation. Apollo Med 2011; 8:238–42. Doi:10.1177/ 0976001620110314.
21. Elaine M.C. Chau, K-L Cheung, K-H Fub, Jan W.T. Lee. Recurrent aortic valve prosthesis dehiscence secondary to aortoarteritis: three case reports and literature review. International Journal of Cardiology 56 (1996) 113-118. https://doi.org/10.1016/0167-5273(96)02754-4.
2. Phan Thanh Nam, Dương Đức Hùng, Nguyễn Trường Giang, Trần Thị Bích Phương, Đặng Đình Mạnh, Nguyễn Văn Tạo và CS. Đánh giá kết quả sớm phẫu thuật thay van động mạch chủ bằng van sinh học không gọng Freedom Solo. Tạp Chí Nghiên Cứu Y Học 2023; 168 (7). https://doi.org/10.52852/tcncyh.v168i7.1721.
3.N Pham, H Zaitoun, T Lucien Mohammed, E DeLaPena-Almaguer, F Martinez, GM. Novaro, J Kirsch. Complications of Aortic Valve Surgery: Manifestations at CT and MR Imaging. RadioGraphics 2012; 32:1873–1892 Published online 10.1148/rg.327115735.
4. K. Prenger, F. Pieters, and E. Cheriex. Aortic Dissection After Aortic Valve Replacement: Incidence and Consequences for Strategy. J Cardiac Surg 1994;9: 495-499. https://doi.org/10.1111/j.1540-8191.1994.tb00882.x
5. P Y. von Kodolitsch, R. Loose, J. Ostermeyer, A. Aydin, DH. Koschyk, A. Haverich, and CA. Nienaber. Proximal Aortic Dissection Late After Aortic Valve Surgery: 119 Cases of a Distinct Clinical Entity. Thorac Cardiov Surg 2000; 48: 342 – 346. DOI: 10.1055/s-2000-8346
6. HJ Koo , HN Lee, Xuan Anh Tran Thi, J-W Kang, DH Yang, J-K Song et al.Postoperative Complications after Surgical Aortic Valve Replacement. Cardiovasc Imaging Asia. 2017 Oct;1(4):222-230. https://doi.org/10.22468/cvia.2017.00115
7. International Team for the Revision of the International Criteria for Behcet’s Disease (ITR-ICBD): F. Davatchi, S. Assaad-Khalil, K.T. Calamia, J.E. Crook, B. Sadeghi-Abdollahi, M. Schirmer, et al. The International Criteria for Behcet’s Disease (ICBD): a collaborative study of 27 countries on the sensitivity and specificity of the new criteria. Journal of the European Academy of Dermatology and Venereology 2014; 28: 338–347. DOI: 10.1111/jdv.12107.
8. Y.Tamagawa, M. Kawamura, K.Shibata, et al. Risk factor analysis for aortic dissection after aortic valve replacement in patients with tricuspid aortic valve. Gen Thorac Cardiovasc Surg 2024; 72: 305–310. https://doi.org/10.1007/s11748-023-01970-3
9.AA. Behranwala, SR. Handa and NP. Mehta. Aortic dissection one year after aortic valve replacement. Asian Cardiovascular & Thoracic Annals 2014, Vol. 22(9) 1099–1102. DOI: 10.1177/0218492313493793.
10.W. Derkac, H. Laks, LH. Cohn, JJ. Collins. Dissecting Aneurysm After Aortic Valve Replacement. Arch Surg 1974; 109: 388-390. DOI: 10.1001/archsurg.1974.01360030040010.
11. M. Chenier, KK. Patel, LG. Svensson, J. Navia, JF. Sabik III, LL. Rodriguez et al. Characteristics and outcomes of patients with postoperative cardiovascular pseudoaneurysms. J Thorac Cardiovasc Surg 2017;153:43-50. DOI: 10.1016/j.jtcvs.2016.08.065.
12. PG Manvindi, A Cappai et al. Analysis of Postsurgical Aortic False Aneurysm in 27 Patients. Texas Heart Inst J 2013;40(3):274-80) . PMID: 23914017.
13. A. Luk, TE. David, J. Butany. Complications of Bioglue postsurgery for aortic dissections and aortic valve replacement. J Clinical Pathol 2012; 65(11): 1008-12. DOI: 10.1136/jclinpath-2012-200809.
14. TE. David. False aneurysms after heart valve surgery. J Thorac Cardiovasc Surg 2017;153:51-2. DOI: 10.1016/j.jtcvs.2016.09.019
15. M Agarwal, M Ray, M Pallavi, S Sen, D Ganguly, P Josh et al. Device occlusion of pseudoaneurysm of ascending aorta. Annals of Pediatric Cardiology 2011 Vol 4 Issue 2: 195-199. PMID: 21976887
16. Graham R. McClure MD, MSc1,2 | Geemitha Ratnayake BSc3 | Albert Chan MD, MSc4,5 | Joel Gagnon. Percutaneous closure of a post-surgical ascending aortic pseudoaneurysm with an amplatzer septal occluder device and steerable guiding sheath. Catheter Cardiovasc Interv. 2021;98:E985–E989. DOI: 10.1002/ccd.29951.
17. M Randal, O Betageri , S Hanayneh and R. David Anderson. Paravalvular Leak: A Systemic Review. Current Cardiology Reviws, 2022, 18, e110522204571. DOI: 10.2174/1573403X18666220511113310.
18. Hung Dung Van, Chi Linh Chau, Minh Chau Van Nguyen. Technique for repair of recurrent aortic valve dehiscence. J Surg Case Report 2025; 2: 1-3. PMID: 40007566.
19. T. Azuma, K.Yamazaki, S. Saito, et al. Aortic valve replacement in Behcet’s disease: surgical modification to prevent valve detachment. Euro J Cardiothorac Surg 2009; 36: 771–2. Doi:10.1016/ j.ejcts.2009.05.031.
20. GK. Mani, JR. Kanwar, PK. Sharma, et al. Fourth recurrence of aortic annular dehiscence following AVR for aortic regurgitation. Apollo Med 2011; 8:238–42. Doi:10.1177/ 0976001620110314.
21. Elaine M.C. Chau, K-L Cheung, K-H Fub, Jan W.T. Lee. Recurrent aortic valve prosthesis dehiscence secondary to aortoarteritis: three case reports and literature review. International Journal of Cardiology 56 (1996) 113-118. https://doi.org/10.1016/0167-5273(96)02754-4.