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HÀNH CHÍNH

Họ và tên (viết tắt tên)..................................................................................

Số hồ sơ:

Số nhập viện:

Địa chỉ (tỉnh, thành phố) ..............................................................................

Ngày tháng năm sinh: Giới: Nam  Nữ  Ngày nhập viện:

TRƯỚC PHẪU THUẬT

Cân nặng ………………kg Diện tích cơ thể………. m2

Tiền căn: ......................................................................................................

Stent PDA  Stent RVOT 

BT shunt 

Bất thường di truyền(Down, Di Georgre...) Cơn tím: 

SpO2:

Hct ………….% Hb.................

Siêu âm tim:

Thông liên thất: số lượng...........phần màng  phần phễu 

Đường kính …………….mm ĐMC cưỡi ngựa……………%

Vòng van ĐMP………….mm, Z score vòng van ĐMP......

Thân ĐMP ………. Z score............ĐMP P ………. ĐMP T ………… Vị trí hẹp: dưới van  tại van  trên van ĐMP  nhánh..................... Van ĐMP: số mảnh....hình dạng các lá van

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