So wo ba kumaa no koma mu mogya ntini titiriw no asiw? Momma yensua eyi ho ade (Coarctation of the Aorta)!

So woasusuw sɛnea yɛn koma nketewa no yɛ adwuma ma ɛyɛ nwonwa no ho pɛn? Nanso ɛtɔ mmere bi a, esiane ɔhaw ahorow bi a wonya fi awo mu nti, koma yi dwumadi betumi asɛe kakra. Koma tebea a ɛte saa biako a ebetumi aba nkokoaa binom mu no, wɔfrɛ no `(Coarctation of the Aorta)`. Ɛwom mpo sɛ ebia edin no bɛyɛ te sɛ nea ɛyɛ den kakra de, nanso mma ɛnhaw wo. Momma yɛnka eyi ho asɛm tiawa.

Dɛn ne `(Coarctation of the Aorta)`? Sɛ yɛbɛka no tiawa a...

Sɛ yɛbɛka no tiawa a, Coarctation of the Aorta yɛ aorta, mogya ntini titiriw a ɛde mogya a oxygen pii wom fi wo ba no koma mu kɔ nipadua no fã a aka no mu a ɛyɛ teateaa anaasɛ ɛyɛ teateaa . Eyi yɛ komayare a wɔde awo obi.

Fa no sɛ kar pii retu ntɛmntɛm paa wɔ ɔkwan kɛse bi so. Nanso sɛ wotew ɔkwan no so wɔ baabi na woma kwan ma kar kwan biako pɛ a, dɛn na ɛba? Kar akwan kyekyere, na karkafo fi ase tu, ɛnte saa? Saa na ɛba wɔ tebea yi mu nso. Ɛbɛyɛ den sɛ mogya bɛfa aorta a asiw kwan no mu yiye.

Mpɛn pii no, saa teateaa (coarctation) yi ba ansa na nkorabata a ɛde mogya fi aorta no mu kɔ nipadua no ase te sɛ nan no mu apaapae. Dɛn na ɛde eyi ba? Mogya mmoroso kɔ soro wɔ akokoaa no nipadua no atifi te sɛ nsateaa mu, nanso ɛso tew wɔ nipadua no fã a ɛwɔ fam te sɛ anan mu. Nsonsonoe kɛse a ɛwɔ mogya mmoroso mu wɔ nipadua no fã a ɛwɔ soro ne fam ntam yi yɛ ade titiriw a ɛde yare yi ba. Sɛ sɛnkyerɛnne foforo biara nni hɔ mpo a, ebia nnuruyɛfo adwenem yɛ wɔn naa bere a wohu mogya mmoroso mu nsonsonoe yi.

Sɛnea akontaabu a ɛwɔ United States kyerɛ no, nkokoaa a wɔwo wɔn afe biara no mu bɛyɛ 1,700 biara mu biako betumi anya saa yare yi (Aortic Coarctation). Nkokoaa binom nso betumi anya komayare afoforo a wɔde awo wɔn aka eyi ho.

Sɛ mmofra nya saa tebea yi a, sɛnkyerɛnne bɛn na wɔda no adi?

Saa sɛnkyerɛnne ahorow yi gyina sɛnea aorta no ayɛ ketewaa no so. Mpɛn pii no, sɛ ɛyɛ teateaa kakra a, sɛnkyerɛnne ahorow no befi ase ada adi wɔ awo akyi dapɛn biako anaa abien. Nanso, sɛ teateaa no mu nyɛ den pii a, ebia sɛnkyerɛnne ahorow no renna adi kosi sɛ akokoaa no benyin, anaasɛ ɛrenna adi koraa da.

Nkokoaa a wɔawo wɔn foforo ho sɛnkyerɛnne

Sɛ akokoaa a wɔawo no foforo wɔ saa tebea yi a, wobetumi anya yare no ho sɛnkyerɛnne te sɛ:

• Dae a ɔda bere nyinaa na ɔmpɛ sɛ ɔnom nufusu
• Koma a ɛbɔ ntɛmntɛm (a ɛbɔ ntɛmntɛm) .
• Fifiri a ɛboro so
• Abufuw a ɛkɔ so daa, su
• Wora a ɛyɛ mmerɛw anaasɛ ɛyɛ fitaa
• Ahome a wɔhome ntɛmntɛm anaasɛ ɛyɛ adwumaden
• Ɛyɛ den sɛ wobɛnom nufusu

Sɛ akokoaa bi aorta no mu ayɛ den kɛse a, sɛ wɔanhu na wɔansa no ntɛm a, ebetumi ayɛ basaa na ɛde ne nkwa ato asiane mu. Nanso, ebia nkokoaa binom renkyerɛ yare no ho sɛnkyerɛnne biara efisɛ nea asiw kwan no sua koraa.

Nsɛnkyerɛnne a ɛwɔ mmofra nkumaa ne mpanyimfo nkumaa mu

Mmofra a wɔn mfe akɔ anim ne mpanyimfo nkumaa a wɔwɔ Aortic Coarctation betumi anya sɛnkyerɛnne ahorow te sɛ:

• Ti a ɛtaa yɛ no yaw
• Mogya mmoroso
• Mogya a ɛtaa tu fi hwene mu
• Ɛyaw a ɛba nan mu bere a woreyɛ apɔw-mu-teɛteɛ, mmirikatu, anaa ahuruhuruw

Ebia mmofra binom renhu yare no ho sɛnkyerɛnne biara koraa. Mmom no, wodi kan hu ɔhaw no sɛ mogya mmoroso bere a wɔreyɛ nhwehwɛmu a wɔyɛ no yiye daa no.

Sɛ ɔpanyin bi nya saa sɛnkyerɛnne ahorow yi a, ɛtaa fi aorta a ɛsan yɛ ketewaa wɔ ayaresa a atwam akyi. Ɛntaa mma koraa sɛ tebea yi bɛkɔ so a wonhu kosi sɛ obi benyin.

Dɛn nti na tebea yi ba? Dɛn ne nea enti a ɛte saa?

Abenfo da so ara nnim nea ɛde CoA ba ankasa. Nanso, wogye di sɛ awosu mu ade bi wɔ hɔ. Ɛne sɛ, awosu mu nsakrae bi a ɛba bere a akokoaa no wɔ awotwaa mu no betumi ama akokoaa no aorta no nnyin yiye.

Ɛtɔ mmere bi a, wotumi de saa awosu mu nsakrae yi fa mmusua mu. Nhwehwɛmu ada no adi sɛ sɛ wowɔ CoA a, ɛda adi sɛ wo ba no benya CoA anaa komayare foforo sen obi a onni CoA.

Afei nso, asiane a ɛwɔ hɔ sɛ obi benya CoA no yɛ kɛse wɔ awosu mu tebea horow bi mu. Sɛ nhwɛso no, ɛnyɛ Coarctation of the Aorta nko na nkokoaa a wɔwo wɔn a wɔwɔ awosu mu tebea no mu no taa nya awo mu dɛmdi afoforo te sɛ bicuspid aortic valve, sintɔ bi a ɛwɔ koma no ntini mu nso.

Nea ɛde `(CoA)` nkutoo ba a komayare afoforo nni mu

Nea ɛde CoA a atew ne ho ba titiriw ne mogya ntini ketewaa bi a wɔfrɛ no ductus arteriosus a wɔto mu wɔ ɔkwan a ɛnteɛ so bere a awotwaa no nyin no. Ductus arteriosus yɛ mogya ntini ketewaa bi a ɛka awotwaa no aorta ne ahurututu mu ntini no bom. Ahurututu no ntumi nyɛ adwuma bere a akokoaa no wɔ awotwaa mu no, enti saa afiri yi boa akokoaa no ma onya mogya a oxygen pii wom a ohia.

Sɛ wɔwo akokoaa no wie a, ahurututu no fi ase yɛ adwuma. Afei, esiane sɛ saa `(ductus arteriosus)` yi ho nhia bio nti, efi ase to n’ankasa mu wɔ nna kakraa bi mu. Nanso, sɛ ɛto mu a, ntini a ɛwɔ saa ntini no mu no bi tumi ne `(Aorta)` ntini no bom. Sɛ ɛba saa a, sɛ wɔhyɛ `(ductus arteriosus)` no ma ɛto mu a, aorta no nso betumi ayɛ teateaa (coarctation)`.

Nsɛnnennen bɛn na ebetumi aba esiane tebea yi nti?

Sɛ wɔannya saa tebea yi (Coarctation of the Aorta) bere tenten a, nsɛnnennen te sɛ:

• Mogya mmoroso (hypertension) wɔ nipadua no nyinaa mu.
• Koma no ntini no yɛ kɛse sen sɛnea ɛte daa (benkum so ahurututu no mu ntini a ɛboro so).
• Plaque a ɛboaboa ano wɔ coronary arteries a ɛde mogya kɔ koma no mu no ba ntɛm sen sɛnea ɛte daa - wɔfrɛ eyi coronary artery disease.
• Aorta no mu a ɛyɛ kurukuruwa a ɛnyɛ ne kwan so (aneurysm) anaasɛ tetetew (twitwa).
• Amemene mu ntini a ɛma mogya tu (mogya ntini bi a ɛbɔ wɔ amemene no mu).
• Koma a entumi nyɛ adwuma yiye yɛ tebea a ɛma koma no ntumi mfa mogya nkɔ yiye.

Saa `(CoA)` tebea yi yɛ asiane kɛse sɛ wɔanhu na wɔansa a. Enti, ɛho hia yiye sɛ wohu no ntɛm ara, wɔ mmofraase, na wɔyɛ ayaresa a ɛho hia ne nhwehwɛmu a wɔyɛ no daa (hwɛ a wɔhwɛ so).

Ɔkwan bɛn so na nnuruyɛfo hu eyi? (Nyare a Wɔahu) .

Mmofra komayare ho animdefo taa hu saa tebea yi (Coarctation of the Aorta) wɔ nkokoaa anaa mmofraase. Sɛnea wohu no ntɛmntɛm no gyina sɛnea sɛnkyerɛnne ahorow no mu yɛ den no so.

Wohu nkokoaa a wɔn yare no ho sɛnkyerɛnne nyɛ den no wɔ nna kakraa bi mu wɔ awo akyi. Nanso, ebia wɔrenhu nkokoaa a wɔn yare no ho sɛnkyerɛnne nyɛ den, anaasɛ wonni bi koraa no kosi sɛ wobenyin na wɔanya mogya mmoroso. Ɛntaa mma koraa sɛ wobehu eyi wɔ mpanyin afe so.

Wɔtaa hu saa tebea yi wɔ nkokoaa ne mmofra nkumaa mu esiane nneɛma bi a ɛyɛ adwenem naayɛ (frankaa kɔkɔɔ) a wohu bere a wɔreyɛ nipadua mu nhwehwɛmu nti. Nneɛma a ɛtete saa no bi ne:

• Akokoaa no mogya mmoroso wɔ ne nsa ne ne nipadua atifi, nanso mogya mmoroso a ɛba fam wɔ ne nan ne ne nipadua ase.
• Nsonsonoe wɔ sɛnea ɛbɔ wɔ kɔn no mu ne sɛnea ɛbɔ wɔ asen mu no ntam.
• Sɛ oduruyɛfo no de afiri a wɔde tie asɛm no si akokoaa no akyi na otie a, wɔte nnyigyei soronko bi a emu yɛ den a efi koma no mu (‘koma mu nwiinwii a emu yɛ den’) .

Wohu sɛ mmofra a wɔawo wɔn foforo no bi anya yare no ansa na wɔada yare no ho sɛnkyerɛnne mpo adi. Wobɛyɛ dɛn ahu? Sɔhwɛ bi a wɔfrɛ no ``pulse oximetry`` a ɛkyerɛ oxygen dodow a ɛwɔ wɔn mogya mu no kyerɛ sɛ oxygen dodow no sua. Oxygen dodow a ɛba fam betumi ayɛ komayare a emu yɛ den a wɔde awo wɔn ho sɛnkyerɛnne, enti wɔyɛ saa nkokoaa yi mu nhwehwɛmu de hu nea enye ankasa.

Sɛnea ɛbɛyɛ a wobesi `(CoA)` tebea yi so dua no, nnuruyɛfo taa de `(Echocardiogram)`, koma mu nhwehwɛmu, anaa `(echo)` di dwuma. Wobetumi nso ayɛ nhwehwɛmu te sɛ `(CT scan)` anaa `(MRI scan)` de asua pii afa akokoaa no aorta no nsusuwii ne ne nhyehyɛe ho.

So komayare afoforo bi wɔ hɔ a ɛne ``Coarctation of the Aorta'' wɔ abusuabɔ?

Yiw, wobetumi ahu sɛ nkokoaa a wɔwɔ CoA no wɔ komayare afoforo. Sɛ nhwɛso no, nnipa a wɔwɔ CoA no mu 45% kosi 75% nso wɔ tebea bi a wɔfrɛ no bicuspid aortic valve. Eyi kyerɛ sɛ valve a ɛde mogya fi koma no mu kɔ aorta no mu no wɔ nkrataa abien pɛ sen abiɛsa a ɛsɛ sɛ ɛtaa nya no.

Ɛnyɛ ɛno nko, na mmom `(CoA)` nso betumi de tebea horow a edidi so yi aka ho:

• Sɛ wowɔ tokuru wɔ koma mu - ɛno na wɔfrɛ no `(atrial septal defect)` anaa `(ventricular septal defect)`.
• Mogya ntini bi a na ɛwɔ hɔ wɔ awotwaa mu nkwa nna mu (`ductus arteriosus`) da so ara bue kyɛ sen sɛnea wɔhwɛɛ kwan - wɔfrɛ eyi ``patent ductus arteriosus``.
• Aortic arch hypoplasia anaa koma benkum mu yare a ɛma mogya tu.
• Koma mu ntini a ɛyɛ den - kyerɛ sɛ, aortic valve stenosis anaa mitral valve stenosis.

Koma ho oprehyɛn ho animdefo hwɛ saa nneɛma yi nyinaa wɔ wo ba koma mu na wɔyɛ ayaresa nhyehyɛe a ɛfa wɔn pɔtee ho. Eyi kyerɛ sɛ akokoaa a ɔwɔ komayare pii a wɔbɛsa no betumi ayɛ den kakra sen sɛ wɔbɛsa akokoaa a ɔwɔ CoA biako pɛ.

Dɛn ne ayaresa ahorow a wɔde sa eyi?

Ayaresa a wubetumi apaw no gyina mfe a wo ba no adi, baabi a aorta no ayɛ teateaa, ne sɛ ebia ɔwɔ komayare afoforo so. Oprehyɛn ne ɔkwan a eye sen biara a wɔfa so sa coagulopathy wɔ nkokoaa ne mmofra nkumaa mu. Wɔ mmofra a wɔanyinyin fam no, sɛ teateaa no mu nyɛ den pii a, ebia ɛbɛyɛ nea ɛfata sɛ wɔde koma mu catheter, adeyɛ a ɛnyɛ den pii sen oprehyɛn. Wɔde di dwuma nso wɔ mmofra ne mpanyimfo a wɔasan ayɛ teateaa no wɔ ayaresa a atwam akyi no mu.

Sɛɛgyiri

Oprehyɛn ahorow atitiriw pii wɔ hɔ a wɔyɛ de siesie saa `(CoA)` tebea yi:

• Resection with end-to-end anastomosis: Sɛ coarctation no sua koraa a, oduruyɛfo a ɔyɛ oprehyɛn no betumi atwa akokoaa no aorta no fã a asiw no na wasan akɔka n’awiei a aka no ho.
• Resection a wɔde anastomosis a ɛtrɛw fi awiei kosi awiei:Sɛ akokoaa no aortic arch nso siw a, oduruyɛfo a ɔyɛ oprehyɛn no betumi atwitwa aorta no fã a asiw no na ɔde aorta a ɛresiane no fã a ɛwɔ fam no abɔ ntwitwiridii tenten bi a ɛwɔ aortic arch no mu. Eyi ne ɔkwan a eye sen biara bere a akokoaa no wɔ transverse aortic arch hypoplasia ne aortic coarctation no.

Ebia ɛho behia nso sɛ wɔma nkokoaa a wɔda sɛnkyerɛnne a emu yɛ den adi wɔ awo akyi no nnuru ansa na wɔayɛ wɔn oprehyɛn. Nhwɛsoɔ:

• Wobetumi ama aduru bi a wɔfrɛ no `(Prostaglandin (PGE-1))` na ama akokoaa no `(ductus arteriosus)` abue. Eyi bɛma akokoaa no anya mframa pa a ohia na ama wakɔ so agyina kosi sɛ wɔbɛyɛ krado ama oprehyɛn.
• Wubetumi nso ama akokoaa no aduru a ɛbɛboa ne koma ma watumi abɔ mogya.

Koma mu catheter a wɔde hyɛ nipadua no mu

Sɛ wo ba no aortic a ɛyɛ teateaa no so atew, anaasɛ sɛ ɛyɛ teateaa no san ba bio wɔ oprehyɛn akyi a, oduruyɛfo no betumi akyerɛ ayaresa ahorow te sɛ:

• Balloon angioplasty: Oduruyɛfo a ɔyɛ oprehyɛn no de balloon ketewaa bi trɛw abofra no aorta no fã a ayɛ teateaa no mu.
• Balloon angioplasty a wɔde stent si hɔ: Bere a oduruyɛfo a ɔyɛ oprehyɛn no retrɛw abofra no aorta mu no, ɔde afiri ketewaa bi a wɔfrɛ no stent nso hyɛ mu na amma ansiw bio.

Bere bɛn na ɛsɛ sɛ mede me ba no kɔ oduruyɛfo nkyɛn? (Nsɔhwɛ a wɔsan yɛ) .

Wo ba no aduruyɛ kuw no bɛkyerɛ wo bere a ɛsɛ sɛ wode wo ba no ba mu Wɔ wo ba no asetra nyinaa mu no, ɛho behia sɛ wo ne komayare ho ɔbenfo bi di akyi. Saa ɔbenfo yi bɛyɛ:

• Hwɛ abofra no mogya mmoroso daa.
• Scan (mfonini nhwehwɛmu) a wɔbɛyɛ daa de ahwɛ sɛnea abofra no koma yɛ adwuma na sɛ ebia nsɛnnennen bi wɔ ho sɛnkyerɛnne bi anaa.
• Afotu a wɔde bɛma wɔ adidi a ɛma koma nya ahoɔden ne apɔw-mu-teɛteɛ ho.
• Nnuru a wɔkyerɛw ma ne dodow a wɔsakra no sɛnea ɛho hia.

Obi a ɔwɔ saa tebea yi betumi atra ase bere tenten ahe?

Esiane akwan a ɛkɔ akyiri a wɔfa so hu yare ne ayaresa nti, mprempren nnipa a wɔwɔ Coarctation of the Aorta no betumi atra ase anyɛ yiye koraa no mfe 60. Bere bi a atwam no, sɛ wɔkyekyem pɛpɛɛpɛ a, na nnipa a wɔwɔ saa tebea yi nkwa nna bɛyɛ mfe 35. Enti eyi yɛ asɛmpa ankasa.

Sɛ wo ba no wɔ Coarctation of the Aorta a, ebia woresusuw nea enti a ɛbaa saa no ho. Ɛnyɛ bere nyinaa na yentumi nkyerɛ nea ɛde komayare a wɔde awo obi ba ankasa. Nanso yenim sɛ sɛ wohu abofra ntɛm na wɔsa no a, ebetumi atew nkɛntɛnso a tebea yi nya wɔ abofra asetra so no so kɛse.

Aduruyɛ kuw no wɔ hɔ bere nyinaa sɛ wɔbɛboa wo ba no. Wɔasiesie wɔn ho sɛ wobebua nsɛmmisa biara a ebia wowɔ na wɔaboa wo ma woate sɛnea saa `(CoA)` nhwehwɛmu yi bɛka wo ba no ase. Ebia wubehu nso sɛ ɛbɛboa wo sɛ wo ne mmofra a wɔwɔ komayare a ɛte sɛɛ awofo afoforo bɛkasa.

Nneɛma a ɛho hia a ɛsɛ sɛ wode sie w’adwenem (Take-Home Message) .

Mewɔ anidaso sɛ seesei woanya ntease bi wɔ tebea a yɛaka ho asɛm a wɔfrɛ no ``Coarctation of the Aorta'' no ho. Nneɛma a ɛho hia paa a ɛsɛ sɛ wokae ni:

• Eyi yɛ komayare a wɔde awo obi ; ntini kɛse a ɛde mogya fi koma no mu kɔ nipadua no mu a esiw ano.
• Ebia yare no ho sɛnkyerɛnne bɛba wɔ nkokoaabere mu anaasɛ ebetumi aba akyiri yi. Sɛ wuhu sɛ wo ba no da dodo, ɛyɛ den sɛ wobɛhome, anaasɛ ɔmpɛ sɛ ɔbɛma wo ba nufu a, hwehwɛ aduruyɛfo afotu ntɛm ara.
• Sɛ wohu yare no ntɛm na wɔsa no a, ɛma abofra no nya hokwan kɛse sɛ ɔbɛtra ase sɛnea ɛsɛ na apɔwmuden wom.
• Wobetumi de oprehyɛn ne ayaresa afoforo adi tebea yi ho dwuma yiye.
• Nkwa nna nyinaa mu aduruyɛ mu ɔbenfo hwɛ ho hia wɔ ayaresa akyi mpo.

Nsuro. Aduruyɛ ho nyansahu akɔ anim yiye nnɛ. Nnuruyɛfo a wɔn ho akokwaw wɔ hɔ a wobetumi de ayaresa a eye sen biara ama wo ba. Nea ɛho hia sen biara ne sɛ wubehu eyi, wobɛhwɛ nsakrae a wo ba no ayɛ no yiye, na woahwehwɛ aduruyɛ mu afotu wɔ bere ano.

` Coarctation of the Aorta, Koma Yare, Mmofra, Koma Yare a Wɔde Awo Wɔn, Aortic Stenosis, Mmofra Akwahosan, Mogya Nhyɛso