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1.1.2. Giải phẫu van động mạch chủ
1.1.2.1. Van động mạch bình thường: ;!2E=-4E!‡r2-
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1.1.2.2. Bất thường về giải phẫu van động mạch chủ: AE09! 
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1.2.1. Bệnh lý gốc động mạch chủ
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D9:X‚=S7.D‰E=&.
D9:XŠS:6S7
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! H9:XE7ˆEM2J6-09! H
+ Điện tâm đồ: *?JZ'#Ž67-:4'>r0 :6<667-:2:\"
:567|=567-:4'6B-6Q!67*%6<667-:M7):=& `>L6qm#
7EMwG:E:0& "):=)Ž6<6J6\>K:->qS4p4E
2:VX4:U!9:6Q!! 
+ Siêu âm tim: :f>m0&-4'0*E7Ew0`>["6",6kJ
6\6{:5.:U"Q!e"E6'{&.:U"Q!e"E6{e"3
Đánh giá tình trạng tổn thương của lá van và gốc động chủ:
D*%6I=-4E9ZT#M6L<66*%6I€2<66*?:3:
>["=-4E
D)09! HMKL6*84p4E
Xác định mức độ hở van: Z{E67U.:U"Q!‰&>>=S7!'"M‰&>>=S7
6*?ZpG>|66N09! H4O6<667-:67&KP6Q!67*%


s
Đánh giá hình thái và chức năng thất trái:
Dr6-:HE6<667-:
Thể tích thất trái và chỉ số thể tích thất tráiG4E09! 
H! 6L='!6B6\6L6<667-:
Khối lượng cơ thất tráir0 :6<667-:K:g+•C•!G
E!4'••!GŒ
[kXB6Q!6"6<667-:0*16L6N-w.)‰4'
Chức năng co bóp của cơ tim:
Chức năng tâm thu thất trái: 
Qq"<66)!-"l‚ƒDS‘S6:&ˆ7E6:&nw.)6Q!6"6:,#M
0*1XZ|797j:<667&6:!! 
DkXB6Q!67*%6<667-: : H#V"0*10-:-e"E:U"
Q!M‰&>>=S7
+Thông tim:'#E#0*1w0`K:J:?4O6I6*%

"):6Q!67*%xb!!&0*?KL6<667-:"):6Q!6"bb!!n
•k*EJ67:5"X%BMXB6Q!6"6<667-:p
67&:8: 2r6*?l‚ƒ•b_n*2";6<667-:Zj
l0*?KL6<667-:"):6Q!67*%•xb!!&0*?KL6<667-:
"):6Q!6"•bb!!n
•5QT>["6",62aT"H4'M>["6",6G09
! H&-4E6:!K-
DA8:25QG4E09! H4NE*T>3:>["
6",609! H=U&T>3:>["6",62aT"09! 
H4'
1.4.2.3. Các phương pháp phẫu thuật hở van động mạch chủ.
* Tạo hình van:J*"0:\!W=56y4&.E">["6",66<>M
KFTZ6"))0FM6W=5.)=Q"Z':6)6"#:U0):
48:4E09! H6*?7<6KJ.yEUT>3:qS!qo6K3
B4Ep.yE0*1E#KF
f Thay van
+ Phẫu thuật thay van động mạch chủ:a62‡4E09! H
2`6I6*%M6E#4'&0J!964EQ6 &l%&.:nM
0*1={ET*6"#560):M6W=56y4&D_MJ6\6BE&
%K:J6*%6IG09! 4'
+ Thay van động mạch chủ qua da: e"E09! 0:M09
! Z*8:0p&e"E!‡!6:!MZ*8:.{*8Z[HE!'"P
e"E6B 4'.:U"Q!6:!e"E6{e"3
+ Ghép van: o>4E6{6Q&o>4E0;=&':+& :4E'#
J092OE&MU->e"E4E6<>.&48:-=& :4E.:K-

1.4.3. Các biến chứng sau phẫu thuật van ĐMC:
1.4.3.1. Các biến chứng chung trong phẫu thuật tim hở
f1r3WX2AR2]1P2Z12_Z='2<66*?K:4*16e"-b0V
!=•&:?0T"6:U&Db!=•.E"0J


1Lp56DT•K&€&&
DTGTB;ZL•56561;45?‚2
;!25Q 6*%6IG4E09! H0*1m
0&-4'0:O"67`6 :K&E>["6",6:!! D+;{M254:5
A:56DX
2.1.1. Tiêu chuẩn lựa chọn bệnh nhân và bệnh án nghiên cứu.
;!6<63Œ25QKF>Q2:566"I::8:M0*1m
0&-='G4E09! HJw0`>["6",6
•*1!I=T0T"6:U
•km0&-G4E09! H0*10*E7E
+Q!.'7:5"XG4E09! H
:V6I:6Q!67*%GK&E=:U.*?DA X67-:
:U"Q!
*%6I=-4E=-4EZ'#M&7f6&Kh!6S&4F:JE
X09G4E6S&K"#V-&HE9:6:!! A:56E!
s:E='!C!X09Gi€4NE€4NED:O"4':O"lCn
•gF=& :67N-67*?1>G4EJKh!6S&i>iM4NE
*67:5"XGH='L4'25QJKh!25=R6&'
6QM25! 4'
DTDT&1Lp56]1X]561;45?‚2
2.2.1. Phương pháp nghiên cứu: WwZritWA756?ƒZ56R56!Z1„9O…;
OS?!Z;†5?‚2T
?::E:U X"  6N•c0V •  k- 25Q
:UX"0*16:V>,6S&!96e"#67r.E"
2.2.1.1. Bệnh nhân trước phẫu thuậtZ{E6S&-w.)
•#1XWitWA75680:\!"8
D"I:€:8:
Dk-67:5"X=Q!.'
7:5"X%BM6&'6QM6{6\

•:U"Q!.E">["6",6.:U"Q!K:\!67E4'&'#6Xx.E"!I
D-:-6r67 4EQ6 &4'-2:VXHE4E
DkXB6<667-:4'.{;:>|HE6<667-:.E">["6",6
X516;XQ†ZŒ2rAR2Q1;zRm;V58?::EK:\!67E.E">["
6",66-Mc6-MB!MB!MbB!
D+Q!.'0E"{MKJ6GM"#V6->M6r67 HE6:!
•:VX3#!-"M6a! MKi64EM."#6:!
y4&l"#UQ6y4&n
D:U"Q!6:!

r67 & 609HE4EQ6 &4'-2:VX
{>|;:HEXB6<667-:
DW=5!I= :l=RZ&!I>3:!I= :M-6X!In
DT`T•ŽivABi;V2T
IKV6-ZŒ=:5"6"0*10\7f67E-00:\!HEG4E
09! H
Yy=R.)=:5"6S&>*%>->6)KU#‚Dƒ•
1Lp56`T#$%
N•cD•f6F:>["6",6cx67*?1>G4E
09! H
`TGTU?n;•W?1256T
2y;7&cx25Q:UX"6"I:=8<6='xM6"I:‡
<6='c6"I:€"I:67"2rCbMs–Ms
;N;CuE!:V!6W=5xM_€Œs:V!cMu_
`TDTU?n;•WitWA756Zy5Z1Lp56mR5ns56W:?1?1hZzLN?WyT
3.2.1. Các triệu chứng lâm sàng
Triệu chứng cơ năng thường gặp:  KJ6GK:a.X:V!
sMu_M0E"{:V!MC_M
Huyết áp: "#V6->6Q!6"sMC–!!. "#V6->
6Q!67*%buM–M!!€kU=5"#V6->6):0E4'6):

1_5“”Z8kw.)g+E&%GJ!G4E0%6"Tl.{
K-2:56JRŽE48:>„Mbn
+ Chức năng thất trái: Q.)6)!-" ‚ƒl_n67"2r
bMC–uMx! >Q.)6)!-"•CbbuMx_Mx67*?1>J‚ƒ„
:V!MCb_
`T`T1_5“”ZZz956WyT
3.3.1 Th¬ng tæn van, ®éng m¹ch chñ trong phÉu thuËt.
Bảng 3.16. Nguyên nhân gây tổn thương hở van động mạch chủ
BiL•56iXmR5
V5151t5
•5–CE—
˜iV
•™—
<66*?:3:>["
AEk=- s MuC
AEkC=-  MCu
I6*%=-4E
?4EZT# bu ssMc
o>4E&7f6 b xcM
AF:JE=-4E b bMC
E=-4E b xMCc
H=-4E  CMCs
I6*%)k
AF:JE4p4E b xMCc
:j09! H=U b xMCc
*%6IKh!6S& i>09! 4' b xMCc
1_5“”Z84EkJ=-4E>bs67*?1>:V!scMbx_M4E
09! H=-4EMuC_M=-4E2`&7f6"9= :xcM_
3.3.2. Các phương pháp phẫu thuật  E#4Ecx67*?1>M:V!
_7&0J4E%b67*?1>lxuM_nM4E.:

lsMuc_n
C
lbMux_n

lMuu_n
y4&K:z!4:5

lMCu_n

lMCu_n

1_5“”Z8 67*?1>3#!-">3:!I= :0\T!!-"€x
67*?1>3#Z`G4V6!I:V!MCb_
kJ67*?1>.E"6E#4EM."#6:!M6y4&:V!MCu_
`THT`#†ZŒ2rŠV5151t5Q1;zRm;V5
3.4.3.1.Thăm khám lâm sàng và siêu âm tim khi ra viện
Bảng 3.28. Kết quả lâm sàng ngày thứ 7 sau phẫu thuật
tWA756

•5–CC—
˜iV™
@~
  CbMCb
  Ms
  cMcx
A C cMc
"#V6->6Q!6"l!!n Mb DD
"#V6->6Q!67*%l!!n xsMC DD
E"{ b xMbs
:V"!-"%6:!  M

AV6!I
+:O6)6 c ubMCb
:$!674V6!I  M
:56Q!0;
O"q&E b sM
+& `>  sMs
1_5“”Z8puMu_.)25QKJ6G:O"
Bảng 3.34. Đánh giá hoạt động của van trên siêu âm tim sau 1 tháng
x
V5151t5
5–CC
p1S?
•5–cc—
;511S?
•5–GG—
)6 bu b
luMu_n
u
lbMs_n
G 4E  lMcC_n 
G67"6Q!  lMs_n lMbC_n
kU->6):
0Ee"E4E
l!!n
k% b Ms–bMs MbC
:  Mc–sMC
1_5“”ZJb67*?1>pG4E.E"!IkU->6):0E
e"E4EQ6 &67"2rMc–cM!!
Bảng 3.35. Kết quả 1 số thông số trên siêu âm tim sau 1 tháng
X??1ˆAB 5 #†ZŒ2r ]

b
CxMcu
CMs
xMcu
y4&  MbC
1_5“”Z8E"!Ic6-uMxx_@~MkJ67*?1>6y
4&.E"!IC6-:V!MbC_
s
•r67 & 609HE4EQ6 &
Bảng 3.37. Hoạt động của van nhân tạo và chức năng thất
R551t5Z:9 ˜cb W=5l_n
& 609HE4E6)6 c uM
G 4E  Ms
kU->e"E4E
l!!n
k" cb Mu–bM
k% b M–bM
:  Mx–CMs
7"2r‚ƒl_n cb cM–xMC
kw.)g+l•!n cb uMb–uMc
1_5“”Z8U->67"2re"E4EG3=& :4EMs!!
3.4.4.3. Sau mổ 1 năm:
Lâm sàng: y4&67*?1>McC_
Bảng 3.41. Kết quả sau mổ 1 năm
)
1256 R5A;511S? R5?p1S?
#1;&
•5–CE—
R2&G
5šW•5–cc—

MC–x!!€kw.)K):=*1%6<667-:l•!

nuM–bMC€‚ƒ
l_nc–bMC
u
3.4.4.5. Sau mổ >3 năm
Bảng3.49. Kết quả sau mổ trên 3 năm
X?Z1w56AB 5–DF #†ZŒ2r
7:5"X
E"{  _
:!=& `> c _
@~
 c s_
 C C_
  
A  
& 609
HE4E
Q6 &
& 6096)6 u ub_
G 4E  b_
kU->6):0Ee"E4El!!n M–MC
kXB
6<667-:
7"2r‚ƒl_n cCMx–CM
kw.)g+l•!n
sM–
M
1Lp56HT"
HTGTU?n;•WitWA756!?_5itWA756T

;42tWZ;W8
*%6I=-4E*%6I&7f6=-4Ef6F:>b
67*?1>:V!xcM_0Q#0*1&='6*%6I0:5"Z&6<>
7&6*%6I4E6:!Z&6<>J:"4'4EkJ:7:UL6
K:0%09!'6*?>):1>:O"4ElE#>='4EE:=-n :
4E2`6I6*%™L6K:J!96r6-:6I6*%0%6"T
!'6*?>):1>4NEG4NEi>ME#i>='L&G='LM
f6F:>67*?1>6*%6IG4EJi>4EKh!6S&
X09G4EsuMbb_25QG4EG!X096N4NE0V
67G=UM67&0J25QJ!X09G4E6N4NEv:V!
bsM_M25QG4E:V!MC_ubMb_J@~
67G=UxMCc_25QJGH:O"*J!X09@~
kf6F:,6<#:ŒE!X09G4E48:6r67 ."#6:!67*8
!IJ.{6*%e"E4NE>3:l48:Š6*%e"EMsvMCun

Hình thái và chức năng thất trái:
7&:UX"HEf6F:>Q.)6)!-"6<667-:HET"
V625Q:3!48:scMbx_MJ‚ƒ„bb_S& ;95;A8W=56y
4&G25QJXB6<667-::3!.E"6E#4EE&M6N
Dx_MKV6e"367" 6*%0):6)6MXBHET"V6-25
Q3:6:5.E"K:>["6",6‰&0JMK:‚ƒq")6<>„b_
KF>3:='!96)w0`6E#4E
kf6F:&7z25QGH4'‚ƒ:3!:O"T0*1
qS!='J"#%E&M>3:0-:-m6,4'V">1>UE
6:5>>["6",6'.8!'6)6kf6F:Jx67*?1>:V!
MCb_J>Q."<66)!-"„_4[0*1>["6",6M6y4&
67*?1>
1g]W:?1m7518 kJb67*?1>l:V!xMCc_n6*%6I
i>09! 4'U&':6E#4E0*1>["6",62aT"H
4'S&:SE=M6W=5J6*%6I09! 4'Kh!6S&

Z|•Z:56L2O!6%6\HE25Q='„Ms
HT`T#†ZŒ2rAR2Wy
4.3.1. Giai đoạn hậu phẫu:
z45itWA756,.E"6E#4Ef6F:,6<#-67:5"X
%BHE25Q2a60T"J.{3:6:5T=825Q6 :
6?:0:\!67*8>["6",60O"JKJ6G48:-!X09K-E"
67&0J@~67G=UCuM_M.E"!IMx_pKJ6G48:
@~MA
kf6F:J67*?1>lMuu_n3#!-">3:!I= :!96
67*?1>3#!-"QwKQ"Ž>3:M!9667*?1>3#!-"
.E"q*%XW=53#!-".E"!IHEf6F:KFE&%.&
48:-:UX"K-‚=E:S='M_MŠE‘E~K6E7='MC_M‰E4:Z
E='cMu_4'6S&‰E4:Z‰@"M6W=53#!-".E"!I0):48:
6E#4EkZ*8:b_
7&:UX"f6F:Jx67*?1>:V!MCb_:$!
674V6!IMKF>67*?1>:$!67q*%X'&&48:
!96.)6-:3K-6r6W=5:$!67HEf6F:E&%

˜iVZŽm9568f6F:J25Q6y4&.E"!I:V!
MCu_Q#='67*?1>J."#6:!67*8!I@~AMJ
>Q."<66)!-"„_.E"!I6E#4E6r67 ."#6:!KF3:
6:5:O"'#>1>48:,0`HE‰E4:Z‰@MŠ&2S76›G4E
09! HJ7):=& XB6<667-::U!67‚ƒ„b_.E"
!IXB6<667-:;:>|7<6Ko!M6W=56y4&=U68:_*
V"KF!I!'0:O"67`9:K&E6W=56y4&=U68:_
z45A;42tWZ;W8kf6F:,6<#7zXB6<667-:
.E"K:6E#4ET"**EJ.{3:6:5:O"6,!Lw.)'#
p:3!%.&48:67*8K:>["6",6l‚ƒbMC–uMxn.E"!I
‚ƒbMc–sMS&K"#V-&HE9::!! A:56E!4'
:5>9::!! ]67&4':6"T0T"6:U.E">["6",6MX

67*?1>G 4EQ6 &='Œ67*?1>67&!I
J6*%6I4F:&-0V6,4p4E& 48:‰E4:Z‰@_M
Š&2S76“‚_M6W=5HEf6F:E&%
kXB6Q!6"6<667-:0*?KL6<667-:"):6Q!67*%
.E"!IxM–xMc!!M.&48:67*8!IxCM–CM!!M>Q."<66)
!-"J.{3:6:5M67"2r='bbM–uMc_kw.)K):=*16<6
67-:6 :6?:0:\!.E"7E4:56-CbMx–CsMc.&48:=f7E4:5
lxsMu–Mbn
4.3.3. Kết quả sau ra viện 6 tháng
Về lâm sàng,0 :29>,25Q67& "6-.E"!IV6
67:5"XKJ6G48:@~M6"#:U4[pb67*?1>25
QpKJ6G48:@~
r67 ."#6:!HE25Q3:6:50-K\.&48:67*8
K:>["6",648:xb_25QG@~&A67*8K:>["
6",6MsM_0 6!X@~M.E">["6",6
25Q6y4&.E"K:7E4:5C6-:V!MbC_
b
Trên siêu âm tim: 
kXB6:!f6F:6<#MXB6Q!6"6<667-:L66E#
0I:kw.)g+M:3!! <66 :6?:0:\!67*8K:7E4:5
luMu–Mb.&48:67*8!ICMC–cuMnM6-6X<6.E"!I
bbMx–CsMcMK:0V6-6Xc6rw.)'#4O!X2r6*?
luMb–uMcn
AEQ6 &kU->e"E4EQ6 &6<>%GŒ25
Q0*16E#4E.:M*.{K-2:56*EJRŽE6)KU
kJ67*?1>G 4E:V!Ms_MKV6e"3'#E&%
.&48:6-:3K-HE‰E4:ZE='M_4'‰E4:Z‰@"M6W=5
G 4E48:4Ek%='D_kJ67*?1>G4E
6B=UM2:\":52&4EQ6 &>3:>["6",66E#= :4E
4.3.4. Kết quả sau mổ 6 tháng - 1 năm