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02/11/2020
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Thành, B. M. ., Khánh, L. T. H. ., & Hòa, H. Q. . (2020). Phẫu thuật điều trị bệnh van hai lá trên bệnh nhân nhồi máu não. Tạp chí Phẫu thuật Tim mạch và Lồng ngực Việt Nam, 20, 10-20. https://doi.org/10.47972/vjcts.v20i.77
Phẫu thuật điều trị bệnh van hai lá trên bệnh nhân nhồi máu não
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Tóm tắt
Nghiên cứu hồi cứu 39 bệnh nhân mắc bệnh van hai lá đã có biến chứng nhồi máu não được phẫu thuật tại Khoa Phẫu Thuật Tim Bệnh viện Nhân Dân Gia Định từ tháng 4/2013 đến tháng 12/2017. Tuổi trung bình 50,3 ± 7,56, thời gian mắc nhồi máu não 8,2 ± 11,2 tháng, NYHA II và III-IV lần lượt là 38,5% và 10,3%. Yếu liệt chi chiếm 83,8%, liệt 0/5 chiếm 39,8%. Rung nhĩ gặp 88,2%, chỉ số tim-ngực là 0,58 ± 0,08, BNP 1989 ± 1156 pg/ml. Hẹp hai lá 94,8%, hở hai lá 48,7%, huyết khối buồng tim 28,2%, diện tích van 0,7 ± 0,19 cm², LA: 53,6 ± 7,9 mm, LVDd: 41,3 ± 3,6 mm, PAPs: 66,5 ± 17,8 mmHg. Tổn thương não bán cấp hay mãn (MSCT hoặc MRI) gặp 100%. Thời gian tuần hoàn ngoài cơ thể 83,18 ± 15,65 phút, thời gian cặp ĐMC 50,53 ± 11,15 phút, thời gian thông khí cơ học 11,52 ± 6,12 giờ, thời gian hồi sức sau mổ 69,74 ± 31,54 giờ. Tai biến thường gặp sau mổ là cơn nhịp nhanh thất (12,8%) và động kinh cục bộ gặp 15,4%, Không xuất hiện tai biến mạch máu não sau mổ, không có trường hợp nào tử vong.
Chi tiết bài viết
Từ khóa
Hẹp hở hai lá, Rung nhĩ, huyết khối trong tim, nhồi máu não, thay van hai lá, sữa van hai lá.
Tài liệu tham khảo
1. Kim JS, Lee SA, Park JB, Chee HK, Chung JW. Preoperative risk factor analysis of postoperative stroke after Cox-maze procedure with mitral valve repair. BMC Cardiovasc Disord. 2014 Sep 11;14:116.
2. Poungvarin N, Opartkiattikul N, Chaithiraphan S, Viriyavejakul A. A comparative study of coumadin and aspirin for primary cardioembolic stroke and thromboembolic preventions of chronic rheumatic mitral stenosis with atrial fibrillation. J Med Assoc Thai 1994;77:1-6.
3. Furie K, Khan M. Secondary Prevention of Cardioembolic Stroke: Pathophysiology, Diagnosis, and Management. 2016, Pages 1014–1029.
4. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke. Stroke. 2006;37:577-617.
5. Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, et al. The Harvard Cooperative Stroke registry: A prospective study. Neurology 1978;28:754-62.
6. Furie KL, Kasner SE, Adam JR et Alts. Guiline for prevention of stroke in patients with stroke or transient ischemic attack, AHA/ASA. Stroke 2011; 42:227.
7. Fleming HA, Bailey SM. Mitral valve disease, systemic embolism and anticoagulants. Postgrad Med J 1971;47:599-604.
8. Leung DY, Davidson PM, Cranney GB, Walsh WF. Thromboembolic risks of left atrial thrombus detected by TEE. Am J Cardiol .1997; 79:626.
9. Ghandehari K, Izadi-Mood Z. Etiology of young adult onset brain infarction in Iran. Arch Iran Med 1006;9:240-3.
10. Jordan B. King PharmD. MS, Peyman N. Azadani MD , Promporn Suksaranjit MD, MS, Adam P.Bress PharmD, MS, Daniel M.Witt PharmD, Frederick T.Han MD, Mihail G.Chelu MD, PhD, Michelle A.Silver MSPH , Joseph Biskupiak PhD, MBA, Brent D.Wilson MD, PhD, Alan K.Morris MS, Eugene G.Kholmovski PhD, Nassir Marrouche MD. Left Atrial Fibrosis and Risk of Cerebrovascular and Cardiovascular Events in Patients With Atrial Fibrillation. Journal of the American College of Cardiology, Volume 70, Issue 11, 2018, p:1311-1321
11. Carter AB. Prognosis of cerebral embolism. Lancet 1965;2:514-9.
12. Marc Gillinov MD, Adam E.Saltman MD, PhD. Ablation of Atrial Fibrillation with Concomitant Cardiac Surgery. Seminars in Thoracic and Cardiovascular Surgery, Vol 19, Issue 11, p:25-32
13. Al-Ahmad AM, Daudelin DH, Salem DN. Antithrombotic therapy for valve disease: Native and prosthetic valves. Curr Cardiol Rep 2000;2:56-60.
14. Takashi Nitta MD, PhD. Surgery for Atrial Fibrillation: A Worldwide Review. Seminars in Thoracic and Cardiovascular Surgery, Vol 19, Issue 11, p:3-8 PHÌNH TIỂU NHĨ TRÁI - BÁO CÁO TRƯỜNG HỢP LÂM SÀNG 19
15. Matsumoto N, Whisnant J, Kurland L, Okazaki H. Natural history of stroke in Rochester, Minnesota 1955-1969. Stroke 1973;4:2-29.
16. Lee CH, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Left atrial appendage resection versus preservation during the surgical ablation of atrial fibrillation. Ann Thorac Surg 2014;97:124–32.
17. Caplan LR. Stroke: A clinical approach, 3 rd ed. Butterworth-Heinemann: Boston; 2000.
18. Park HC, Lee D, Shim J, Choi JI, Kim YH. The clinical efficacy of left atrial appendage isolation caused by extensive left atrial anterior wall ablation in patients with atrial fibrillation. J Interv Card Electrophysiol 2016;46:287–97.
19. Romanov A, Pokushalov E, Elesin D, et al. Effect of left atrial appendage excision on procedure outcome in patients with persistent atrial fibrillation undergoing surgical ablation. Heart Rhythm 2016;13:1803–9.
20. Cardiogenic brain embolism: The second report of the Cerebral Embolism Task Force. Arch Neurol 1989;46:727-43.
21. Lakkireddy D, Mahankali AS, Kanmanthareddy A, et al. Left atrial appendage ligation and ablation for persistent atrial fibrillation. The LAALA-AF registry. J Am Coll Cardiol EP 2015;1:153–60.
22. Constante Sotelo JL, Mendez Dominguez A. Rheumatic heart disease: Cause of cerebrovascular disease at the National Intstitute of Cardiology "Ignacio Chavez". Arch Cardiol Mex 2006;76:47-51.
23. Rillig A, Tilz RR, Lin T, et al. Unexpectedly high incidence of stroke and left atrial appendage thrombus formation after electrical isolation of the left atrial appendage for the treatment of atrial tachyarrhythmias. Circ Arrhythm Electrophysiol 2016;9:3461.
24. Stroke Prevention in Atrial Fibrillation Study Group Investigators: Preliminary report of the Stroke Prevention in Atrial Fibrillation Study. N Engl J Med 1990;322:863-8.
25. Yorgun H, Canpolat U, Kocyigit D, Coteli C, Evranos B, Aytemir K. Left atrial appendage isolation in addition to pulmonary vein isolation in persistent atrial fibrillation: oneyear clinical outcome after cryoballoon-based ablation. Europace 2017;19:758–68.
26. Chockalingam A, Gnanavelu G, Elangovan S, Chockalingam V. Clinical spectrum of chronic rheumatic heart disease in India. J Heart Valve Dis 2003;12:577-81.
27. Gillinov, A.M., Sirak, J., Blackstone, E.H., McCarthy, P.M., Rajeswaran, J., Pettersson, G. et al. The Cox maze procedure in mitral valve disease: predictors of recurrent atrial fibrillation. J Thorac Cardiovasc Surg. 2005; 130: 1653–1660
28. Stroke Prevention in Atrial Fibrillation Investigators: The stroke prevention in atrial fibrillation trial: Final results. Circulation 1991;84:527-39.
29. Lee, S.H., Kim, J.B., Cho, W.C., Chung, C.H., Jung, S.H., Choo, S.J. et al. The influence of age on atrial fibrillation recurrence after the maze procedure in patients with giant left atrium. J Thorac Cardiovasc Surg. 2011; 141: 1015–1019.
30. Deverall PB, Olley PM, Smith DR, Watson DA, Whitaker W. Incidence of systemic embolism before and after mitral valvotomy. Thorax 1968;23:530-6.
31. Kim, J.B., Moon, S.J., Yun, S.C., Kim, K.W., Jung, S.H., Choo, S.J. et al. Long-term outcomes of mechanical valve replacement in patients with atrial fibrillation: impact of the maze procedure.Circulation. 2012; 125: 2071–2080.
32. Stroke Prevention in Atrial Fibrillation Investigators: Prospective identification of patients with nonvalvular atrial fibrillation at low risk during treatment with aspirin: Stroke prevention in Atrial Fibrillation III Study. Circulation 1997;96:1-28.
33. Kim, J.B., Bang, J.H., Jung, S.H., Choo, S.J., Chung, C.H., and Lee, J.W. Left atrial ablation versus biatrial ablation in the surgical treatment PHẪU THUẬT TIM MẠCH VÀ LỒNG NGỰC VIỆT NAM SỐ 20 - THÁNG 5/2018 20 of atrial fibrillation. (discussion 1404, 1395)Ann Thorac Surg.2011; 92: 1397–1404.
34. Levine HJ. Which atrial fibrillation patients should be on chronic anticoagulation? J Cardiovasc Med 1981;6:483-7.
35. Bando, K., Kasegawa, H., Okada, Y., Kobayashi, J., Kada, A., Shimokawa, T. et al. Impact of preoperative and postoperative atrial fibrillation on outcome after mitral valvuloplasty for nonischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2005; 129: 1032–1040
36. Coulshed N, Epstein EJ, McKendrick CS, Galloway RW, Walker E. Systemic embolism in mitral valve disease. Br Heart J 1970;32:26-34.
37. Bando, K., Kobayashi, J., Kosakai, Y., Hirata, M., Sasako, Y., Nakatani, S. et al. Impact of Cox maze procedure on outcome in patients with atrial fibrillation and mitral valve disease. J Thorac Cardiovasc Surg. 2002; 124: 575–583
38. Medi, C., Hankey, G.J., and Freedman, S.B. Stroke risk and antithrombotic strategies in atrial fibrillation. Stroke. 2010; 41: 2705–2713.
39. Karen L. Furie, MD, MPH; Mahesh V. Jayaraman, MD. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke. 2018;49:509-510.
40. Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: A statement for healthcare professionals from the American Heart Association/ American Stroke Association Council on Stroke: Cosponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke 2006;37:577-617.
41. Baek MJ, Na CY, Oh SS, Lee CH, Kim JH, Seo HJ, Park SW, Kim WS. Surgical treatment of chronic atrial fibrillation combined with rheumatic mitral valve disease: Effects of the cryo-maze procedure and predictors for late recurrence. Eur J Cardiothorac Surg. 2006 Nov;30(5):728-36.
42. Practice Guidelines AHA/ASA publish advisory on oral antithrombotics for stroke prevention in nonvalvular artial fibrillation. Am Fam Physician. 2013 May 15;87(10):732-3.
43. Akdemir I, Dagdelen S, Yuce M, Davutoglu V, Akcay M, Akdemir N, et al. Silent brain infarction in patients with rheumatic mitral stenosis. Jpn Heart J 2002;43:137-44.
44. Leary MC1, Saver JL. Annual incidence of first silent stroke in the United States: a preliminary estimate. Cerebrovasc Dis. 2003;16(3):280-5. Iung B, Leenhardt A, Extramiana F. Management of atrial fibrillation in patients with rheumatic mitral stenosis. Heart. 2018 Feb 16. pii: heartjnl. 2017: 311-425.
2. Poungvarin N, Opartkiattikul N, Chaithiraphan S, Viriyavejakul A. A comparative study of coumadin and aspirin for primary cardioembolic stroke and thromboembolic preventions of chronic rheumatic mitral stenosis with atrial fibrillation. J Med Assoc Thai 1994;77:1-6.
3. Furie K, Khan M. Secondary Prevention of Cardioembolic Stroke: Pathophysiology, Diagnosis, and Management. 2016, Pages 1014–1029.
4. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke. Stroke. 2006;37:577-617.
5. Mohr JP, Caplan LR, Melski JW, Goldstein RJ, Duncan GW, Kistler JP, et al. The Harvard Cooperative Stroke registry: A prospective study. Neurology 1978;28:754-62.
6. Furie KL, Kasner SE, Adam JR et Alts. Guiline for prevention of stroke in patients with stroke or transient ischemic attack, AHA/ASA. Stroke 2011; 42:227.
7. Fleming HA, Bailey SM. Mitral valve disease, systemic embolism and anticoagulants. Postgrad Med J 1971;47:599-604.
8. Leung DY, Davidson PM, Cranney GB, Walsh WF. Thromboembolic risks of left atrial thrombus detected by TEE. Am J Cardiol .1997; 79:626.
9. Ghandehari K, Izadi-Mood Z. Etiology of young adult onset brain infarction in Iran. Arch Iran Med 1006;9:240-3.
10. Jordan B. King PharmD. MS, Peyman N. Azadani MD , Promporn Suksaranjit MD, MS, Adam P.Bress PharmD, MS, Daniel M.Witt PharmD, Frederick T.Han MD, Mihail G.Chelu MD, PhD, Michelle A.Silver MSPH , Joseph Biskupiak PhD, MBA, Brent D.Wilson MD, PhD, Alan K.Morris MS, Eugene G.Kholmovski PhD, Nassir Marrouche MD. Left Atrial Fibrosis and Risk of Cerebrovascular and Cardiovascular Events in Patients With Atrial Fibrillation. Journal of the American College of Cardiology, Volume 70, Issue 11, 2018, p:1311-1321
11. Carter AB. Prognosis of cerebral embolism. Lancet 1965;2:514-9.
12. Marc Gillinov MD, Adam E.Saltman MD, PhD. Ablation of Atrial Fibrillation with Concomitant Cardiac Surgery. Seminars in Thoracic and Cardiovascular Surgery, Vol 19, Issue 11, p:25-32
13. Al-Ahmad AM, Daudelin DH, Salem DN. Antithrombotic therapy for valve disease: Native and prosthetic valves. Curr Cardiol Rep 2000;2:56-60.
14. Takashi Nitta MD, PhD. Surgery for Atrial Fibrillation: A Worldwide Review. Seminars in Thoracic and Cardiovascular Surgery, Vol 19, Issue 11, p:3-8 PHÌNH TIỂU NHĨ TRÁI - BÁO CÁO TRƯỜNG HỢP LÂM SÀNG 19
15. Matsumoto N, Whisnant J, Kurland L, Okazaki H. Natural history of stroke in Rochester, Minnesota 1955-1969. Stroke 1973;4:2-29.
16. Lee CH, Kim JB, Jung SH, Choo SJ, Chung CH, Lee JW. Left atrial appendage resection versus preservation during the surgical ablation of atrial fibrillation. Ann Thorac Surg 2014;97:124–32.
17. Caplan LR. Stroke: A clinical approach, 3 rd ed. Butterworth-Heinemann: Boston; 2000.
18. Park HC, Lee D, Shim J, Choi JI, Kim YH. The clinical efficacy of left atrial appendage isolation caused by extensive left atrial anterior wall ablation in patients with atrial fibrillation. J Interv Card Electrophysiol 2016;46:287–97.
19. Romanov A, Pokushalov E, Elesin D, et al. Effect of left atrial appendage excision on procedure outcome in patients with persistent atrial fibrillation undergoing surgical ablation. Heart Rhythm 2016;13:1803–9.
20. Cardiogenic brain embolism: The second report of the Cerebral Embolism Task Force. Arch Neurol 1989;46:727-43.
21. Lakkireddy D, Mahankali AS, Kanmanthareddy A, et al. Left atrial appendage ligation and ablation for persistent atrial fibrillation. The LAALA-AF registry. J Am Coll Cardiol EP 2015;1:153–60.
22. Constante Sotelo JL, Mendez Dominguez A. Rheumatic heart disease: Cause of cerebrovascular disease at the National Intstitute of Cardiology "Ignacio Chavez". Arch Cardiol Mex 2006;76:47-51.
23. Rillig A, Tilz RR, Lin T, et al. Unexpectedly high incidence of stroke and left atrial appendage thrombus formation after electrical isolation of the left atrial appendage for the treatment of atrial tachyarrhythmias. Circ Arrhythm Electrophysiol 2016;9:3461.
24. Stroke Prevention in Atrial Fibrillation Study Group Investigators: Preliminary report of the Stroke Prevention in Atrial Fibrillation Study. N Engl J Med 1990;322:863-8.
25. Yorgun H, Canpolat U, Kocyigit D, Coteli C, Evranos B, Aytemir K. Left atrial appendage isolation in addition to pulmonary vein isolation in persistent atrial fibrillation: oneyear clinical outcome after cryoballoon-based ablation. Europace 2017;19:758–68.
26. Chockalingam A, Gnanavelu G, Elangovan S, Chockalingam V. Clinical spectrum of chronic rheumatic heart disease in India. J Heart Valve Dis 2003;12:577-81.
27. Gillinov, A.M., Sirak, J., Blackstone, E.H., McCarthy, P.M., Rajeswaran, J., Pettersson, G. et al. The Cox maze procedure in mitral valve disease: predictors of recurrent atrial fibrillation. J Thorac Cardiovasc Surg. 2005; 130: 1653–1660
28. Stroke Prevention in Atrial Fibrillation Investigators: The stroke prevention in atrial fibrillation trial: Final results. Circulation 1991;84:527-39.
29. Lee, S.H., Kim, J.B., Cho, W.C., Chung, C.H., Jung, S.H., Choo, S.J. et al. The influence of age on atrial fibrillation recurrence after the maze procedure in patients with giant left atrium. J Thorac Cardiovasc Surg. 2011; 141: 1015–1019.
30. Deverall PB, Olley PM, Smith DR, Watson DA, Whitaker W. Incidence of systemic embolism before and after mitral valvotomy. Thorax 1968;23:530-6.
31. Kim, J.B., Moon, S.J., Yun, S.C., Kim, K.W., Jung, S.H., Choo, S.J. et al. Long-term outcomes of mechanical valve replacement in patients with atrial fibrillation: impact of the maze procedure.Circulation. 2012; 125: 2071–2080.
32. Stroke Prevention in Atrial Fibrillation Investigators: Prospective identification of patients with nonvalvular atrial fibrillation at low risk during treatment with aspirin: Stroke prevention in Atrial Fibrillation III Study. Circulation 1997;96:1-28.
33. Kim, J.B., Bang, J.H., Jung, S.H., Choo, S.J., Chung, C.H., and Lee, J.W. Left atrial ablation versus biatrial ablation in the surgical treatment PHẪU THUẬT TIM MẠCH VÀ LỒNG NGỰC VIỆT NAM SỐ 20 - THÁNG 5/2018 20 of atrial fibrillation. (discussion 1404, 1395)Ann Thorac Surg.2011; 92: 1397–1404.
34. Levine HJ. Which atrial fibrillation patients should be on chronic anticoagulation? J Cardiovasc Med 1981;6:483-7.
35. Bando, K., Kasegawa, H., Okada, Y., Kobayashi, J., Kada, A., Shimokawa, T. et al. Impact of preoperative and postoperative atrial fibrillation on outcome after mitral valvuloplasty for nonischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2005; 129: 1032–1040
36. Coulshed N, Epstein EJ, McKendrick CS, Galloway RW, Walker E. Systemic embolism in mitral valve disease. Br Heart J 1970;32:26-34.
37. Bando, K., Kobayashi, J., Kosakai, Y., Hirata, M., Sasako, Y., Nakatani, S. et al. Impact of Cox maze procedure on outcome in patients with atrial fibrillation and mitral valve disease. J Thorac Cardiovasc Surg. 2002; 124: 575–583
38. Medi, C., Hankey, G.J., and Freedman, S.B. Stroke risk and antithrombotic strategies in atrial fibrillation. Stroke. 2010; 41: 2705–2713.
39. Karen L. Furie, MD, MPH; Mahesh V. Jayaraman, MD. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke. Stroke. 2018;49:509-510.
40. Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: A statement for healthcare professionals from the American Heart Association/ American Stroke Association Council on Stroke: Cosponsored by the Council on Cardiovascular Radiology and Intervention: The American Academy of Neurology affirms the value of this guideline. Stroke 2006;37:577-617.
41. Baek MJ, Na CY, Oh SS, Lee CH, Kim JH, Seo HJ, Park SW, Kim WS. Surgical treatment of chronic atrial fibrillation combined with rheumatic mitral valve disease: Effects of the cryo-maze procedure and predictors for late recurrence. Eur J Cardiothorac Surg. 2006 Nov;30(5):728-36.
42. Practice Guidelines AHA/ASA publish advisory on oral antithrombotics for stroke prevention in nonvalvular artial fibrillation. Am Fam Physician. 2013 May 15;87(10):732-3.
43. Akdemir I, Dagdelen S, Yuce M, Davutoglu V, Akcay M, Akdemir N, et al. Silent brain infarction in patients with rheumatic mitral stenosis. Jpn Heart J 2002;43:137-44.
44. Leary MC1, Saver JL. Annual incidence of first silent stroke in the United States: a preliminary estimate. Cerebrovasc Dis. 2003;16(3):280-5. Iung B, Leenhardt A, Extramiana F. Management of atrial fibrillation in patients with rheumatic mitral stenosis. Heart. 2018 Feb 16. pii: heartjnl. 2017: 311-425.