CASE LÂM SÀNG Bệnh nhân nam, 37 tuổi, đến khám lần đầu MEDIC 072022 vì huyết áp cao chưa kiểm soát được, huyết áp cao nhất 240 mmHg. Thỉnh thoảng ran ngực nhẹ khi gắng sức Tim: không âm thổi Các cơ quan khác: tổn thương vẩy nến
VAN ĐỘNG MẠCH CHỦ HAI MẢNH C ( BICUSPID AORTIC VALVE - BAV ) BS PHAN THỊ MINH NGA PHÒNG TĂNG HUYẾT ÁP Trung Tâm Chẩn Đoán Y Khoa CASE LÂM SÀNG - Bệnh nhân nam, 37 tuổi, đến khám lần đầu MEDIC 07/2022 huyết áp cao chưa kiểm soát được, huyết áp cao 240 mmHg - Thỉnh thoảng ran ngực nhẹ gắng sức - Tim: không âm thổi - Các quan khác: tổn thương vẩy nến CHẨN ĐOÁN VAN ĐỘNG MẠCH CHỦ HAI MẢNH- HỞ VAN ĐỘNG MẠCH CHỦ 2.5/4 DÃN ĐỘNG MẠCH CHỦ LÊN ( D: 40 MM- CTA 11/2022) TĂNG HUYẾT ÁP ĐỘ 3- DÀY NẶNG ĐỒNG TÂM THẤT TRÁI BỆNH MẠCH VÀNH CÓ TẮC NGHẼN ( OBS- CAD) VẨY NẾN TĂNG ACID URIC MÁU BICUSPID AORTIC VALVE EPIDEMIOLOGY • Approximately 1% to 2% of the population More prevalent in men, accounting for 70% to 80% of cases • In a subset of patients with BAV, familial clustering consistent with an autosomal dominant inheritance • In some families with BAV and associated congenital anomalies, a mutation in the NOTCH1 gene has been described 10 ECHOCARDIOGRAPHY 12 PATHOPHYSIOLOGY BAV • Bicuspid aortic valve disease is associated with an AORTOPATHY, with DILATION OF THE ASCENDING AORTA, related to accelerated degeneration of the aortic media • The risk of AORTIC DISSECTION in patients with BAV is five to nine times higher than the general population, but the absolute risk is still quite low 13 Pathophysiology 14 CLINICAL PRESENTATION • Patients with BAV may be diagnosed : • At any age on the basis of the presence of an aortic ejection sound or a systolic or diastolic murmur 15 DISEASE COURSE • Most bicuspid valves function normally until LATE IN LIFE, although a subset of patients present in childhood or adolescence with valve dysfunction • Risk factors for cardiac events were AGE GREATER THAN 30 YEARS, and moderate or severe AR or AS • However, most patients with BAV develop calcific valve stenosis later in life, typically resenting with severe AS after the age of 50 years • BAV disease accounts for greater than 50% of AVRs in the United States and is a common cause of calcific AS, even in older persons 16 17 MANAGEMENT • Currently, there are no effective medical therapies to prevent progressive valve deterioration when a bicuspid valve is diagnosed • The management of BAV disease is directed toward the hemodynamic consequences of valve dysfunction —AS or AR—as discussed earlier 18 Operative Procedures 19 20 21 22 23 BICUSPID AORTIC VALVE Arnold Schwarzenegger 1947 (age 75) − He opted in 1997 for a replacement aortic valve surgery − In 2020, 23 years after his first surgery, Schwarzenegger underwent a surgery for a new aortic valve 24 REFERENCES Braunwald ‘s Heart Disease 2022 Braunwald ‘s Heart Disease 2018 UptoDate 25 − THANK YOU 26 ... ĐOÁN VAN ĐỘNG MẠCH CHỦ HAI MẢNH- HỞ VAN ĐỘNG MẠCH CHỦ 2.5/4 DÃN ĐỘNG MẠCH CHỦ LÊN ( D: 40 MM- CTA 11/202 2) TĂNG HUYẾT ÁP ĐỘ 3- DÀY NẶNG ĐỒNG TÂM THẤT TRÁI BỆNH MẠCH VÀNH CÓ TẮC NGHẼN ( OBS- CAD)... earlier 18 Operative Procedures 19 20 21 22 23 BICUSPID AORTIC VALVE Arnold Schwarzenegger 1947 (age 7 5) − He opted in 1997 for a replacement aortic valve surgery − In 2020, 23 years after his first... therapies to prevent progressive valve deterioration when a bicuspid valve is diagnosed • The management of BAV disease is directed toward the hemodynamic consequences of valve dysfunction —AS or AR—as