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Di tat con ong dong mach co nguy hiem?

Con ong dong mach la di tat kha pho bien o tre em (chiem 18% - 20% tong so tim bam sinh), benh co the ton tai duoi dang con ong dong mach don thuan hoac ket hop voi cac benh khac. Truoc day can benh nay it co co may dieu tri nhung voi cac phuong phap dieu tri tien tien hien nay, di tat con ong dong mach da khong con qua nguy hiem.

                                            Dat catheter xu tri con ong dong mach o tre em.

Vi sao lai co di tat nay?

Trong thoi ky bao thai, tim cung co dong mach chu va dong mach phoi nhung luc bay gio phoi chua tho nen he tieu tuan hoan chua hoat dong. Dong mach chu va dong mach phoi duoc noi lien voi nhau boi mot ong dong mach. Mau o tam that phai cung di vao dong mach phoi nhung roi qua ong dong mach do thang sang dong mach chu. Khi tre ra doi phoi bat dau hoat dong, he tieu tuan hoan hoat dong, mau tu tam that phai len dong mach phoi roi toi phoi trao doi oxy va carbonic chu khong qua ong dong mach nua, nen ong dong mach dan dan teo, tac lai vao tuan thu 6 den tuan thu 11.

Di tat tim thuong phat sinh do loi trong thoi ky thai nhi hinh thanh tim, nhung chung thuong khong co nguyen nhan ro rang. Neu trong co the ton tai tinh trang con ong dong mach se xay ra hien tuong: ap suat o dong mach chu lon hon o dong mach phoi trong ca hai thi tam thu va tam truong, nen co mot luong mau tu dong mach chu qua dong mach phoi tao thanh mot shunt trai - phai va gay ra tieng thoi lien tuc. Do luong mau di tu dong mach chu vao dong mach phoi manh hon lam cho luu luong mau qua phoi tang len.

Neu ong dong mach nho anh huong it,   con ong dong mach lon se lam cho luong mau kha lon do vao dong mach phoi, ap luc tieu tuan hoan tang len dan lam ton thuong va xo cung cac dong mach nho. Neu ap luc dong mach phoi tang cao hon dong mach chu, luong mau se doi chieu, mau tu dong mach phoi vao dong mach chu gay tim phan duoi co the (sau cho noi ong  dong mach).

Dau hieu cua benh

Dau hieu cua benh con ong dong mach co bieu hien khac nhau tuy thuoc vao kich thuoc cua lo thong. Lo thong nho co the khong gay trieu chung gi nen co the khong duoc phat hien. Kich thuoc lo thong lon co the gay nen cac dau hieu suy tim som sau khi sinh.

Khi lo thong lon thuong co cac bieu hien: kho tho nhe khi gang suc, tho hon hen, tho nhanh keo dai; nhip tim nhanh, cham phat trien the chat, an uong kem, ra mo hoi khi khoc hoac khi choi de bi nhiem khuan o phoi. Neu benh o the nang va muon thi phan duoi co the bi tim lai.

Yeu to nguy co

Benh co the xuat hien mang tinh chat gia dinh va doi khi xay ra voi van de gen khac nhu hoi chung Down. Neu trong gia dinh co mot dua tre bi benh tim bam sinh thi nen nho chuyen gia tu van di truyen de biet duoc kha nang mac benh cua nhung dua tre duoc sinh ra sau.

 Kinh nghiem cho thay nhung ba me trong thoi ky mang thai, nguy co co tre mac benh tim bam sinh tang len khi:

Bi nhiem Rubella: Nhiem Rubella trong khi mang thai co the tang nguy co mac benh tim bam sinh. Virut Rubella xam nhap qua nhau thai va vao he thong tuan hoan cua thai lam ton thuong mach mau, cac co quan bao gom ca tim, khong kiem soat tot duong huyet o nhung ba me mang thai bi dai thao duong, lam dung thuoc hoac ruou, cac chat hoa hoc, tia xa trong qua trinh mang thai co the lam ton hai den thai nhi trong do co tim va mach mau.

Bien chung thuong gap: Mot lo thong nho co the khong gay nen trieu chung, lo thong lon neu khong dieu tri co the la nguyen nhan gay tang ap dong mach phoi, hay bi viem phoi hoac suy tim. Mot nguoi khong that ong dong mach nguy co nhiem khuan mach mau tang len, vi ly do nay khi tre em hoac nguoi lon con ong dong mach phai dung khang sinh truoc khi nho rang. Viem phoi tai phat keo dai thuong gap o tre duoi 2 tuoi; tinh trang suy  tim rat hay gap; luong mau doi chieu gay tim thuong xuyen o nua duoi co the; viem noi tam mac nhiem khuan (Osler)...

Dieu tri benh bang nhung bien phap nao?

Cac bien phap noi khoa duoc ap dung nhu cac thuoc chong viem khong steroid: ibuprofen hoac indomethacin... de giup dong lai lo thong o tre de non. Thuoc chong viem khong steroid ngan can hoa chat giong hormon trong co the ma cac chat do giu cho ong dong mach mo.

Can thiep tim mach: Dung mot ong nho (catheter) duoc choc vao mach mau o hang va luon len tim. Qua catheter, mot bong nho duoc bom len bit kin lo thong.

Phau thuat: Ong dong mach thuong duoc dong lai bang mot cai kep bang kim loai. Cat, that ong dong mach cho ket qua rat tot, nen tien hanh phau thuat som truoc 5-7 tuoi.

Nen phong va phat hien benh som

Cac bac cha me can dua tre di kham  benh khi: Tre nhanh met khi choi hoac chan an; khong tang can; tro nen kho tho hoac tim tai khi an hoac khoc; luon tho nhanh hoac tho nong.

Dieu quan trong de phong benh tim bam sinh la ba me khi mang thai can:

- Bo thuoc la, giam cac stress, hoi y kien bac si ve nhung loai thuoc duoc dung

 - Dinh duong day du hop ly, bao gom cung cap cac vitamin, cac thuc an co chua acid folic, han che cac chat kich thich nhu caffein.   Nen tiem phong day du cac vaccin truoc khi mang thai.

- Neu gia dinh co tien su ve benh tim bam sinh hoac cac roi loan ve di truyen khac thi ban nen den gap cac chuyen gia tu van ve di truyen de duoc tu van truoc khi mang thai.

BS. Nguyen Le Phuong