So oduruyɛfo no ka kyerɛɛ wo sɛ mogya ntini titiriw a ɛde mogya fi wo koma mu kɔ wo nipadua nyinaa mu no ayɛ mmerɛw na ayɛ kurukuruwa wɔ ase? Anaasɛ ɔka kyerɛɛ wo sɛ ɛsɛ sɛ wɔyɛ wo oprehyɛn? Ɛyɛ ade a ɛfata sɛ wobɛte ehu nka kakra bere a wote biribi a ɛte saa no. Nanso eyi yɛ oprehyɛn a ɛho hia paa a ebetumi agye wo nkwa. Ɛnnɛ, yɛbɛka nea saa Aortic Root Replacement oprehyɛn yi yɛ, sɛnea wɔyɛ, ne biribiara a ɛsɛ sɛ wuhu fa ho ho asɛm.
Sɛ yɛbɛka no tiawa a, dɛn ne Aortic Root Replacement?
Mogya ntini a ɛsõ na ɛho hia sen biara wɔ nipadua no mu, aorta, ne yɛn koma wɔ abusuabɔ. Wɔfrɛ saa aorta yi fã a edi kan a ɛne koma no di nkitaho no aortic root. Ɛtɔ mmere bi a, ɔfã yi fasu yɛ mmerɛw na efi ase bɔ te sɛ balloon. Wɔfrɛ eyi sɛ aneurysm.
Asiane a ɛwɔ mu sɛ obi benya aneurysm te sɛ eyi ne sɛ ebetumi "atwitwa" anaasɛ "apaapae" bere biara. Sɛ ɛba saa a, ebetumi ama mogya atu kɛse wɔ nipadua no mu na ɛde nkwa mpo ato asiane mu.
Enti, `Aortic Root Replacement` oprehyɛn no hwehwɛ sɛ woyi aorta no ntini a ayɛ mmerɛw na ahonhon no na wɔde afiri a wɔde ayɛ (graft) si ananmu. Eyi betumi asiw tebea horow a asiane wom a mekaa ho asɛm no ano na agye wo nkwa.
Dɛn ne oprehyɛn yi ahorow atitiriw?
Akwan atitiriw abien na wɔfa so yɛ oprehyɛn yi. Wo duruyɛfo no begyina wo tebea no so apaw ɔkwan a eye ma wo.
| Oprehyɛn ko a wɔyɛ | Nkyerɛmu |
|---|---|
| Aortic Root Replacement (ARR) anaa Bentall a wɔde yɛ adwuma | Wɔ saa adeyɛ yi mu no, woyi aortic ntini ne aortic valve a ɛbata ho no na wɔde foforo a wɔde ayɛ hyɛ mu. Saa adeyɛ yi ye sen biara sɛ wo aortic valve no yɛ mmerɛw (ɛretu) anaasɛ ayɛ den (calcification). Sɛ wɔde mfiri a wɔde yɛ valve hyɛ mu a, ɛho behia sɛ wonom nnuru a ekum mogya a ɛtwetwe mogya wo nkwa nna nyinaa. |
| Valve-Sparing Ntini a Wɔde Si ananmu (VSRR) . | Sɛnea edin no kyerɛ no, nea ɛka saa adeyɛ yi ho ne sɛ wobɛsesa wo aortic valve no fã a ayɛ mmerɛw no nkutoo a worensɛe no. Saa adeyɛ yi ye ma nnipa a wɔyɛ wɔn oprehyɛn wɔ wɔn mmofraase, titiriw sɛ wo valve no tebea ye a, titiriw wɔn a wɔwɔ awosu mu tebea horow (te sɛ Marfan syndrome). Mfaso titiriw a ɛwɔ so ne sɛ enhia sɛ wonom nnuru a ɛma mogya yɛ mmerɛw wo nkwa nna nyinaa. Saa kwan yi gu ahorow abien : Yacoub kwan ne David kwan. |
VSRR oprehyɛn no afã horow
Wɔakyekyɛ VSRR oprehyɛn mu bio ayɛ no akwan abien: Yacoub ne David akwan no.
- Yacoub adeyɛ: Eyi hwehwɛ sɛ wɔsan yɛ aortic valve no foforo. Eyi fata kɛse ma wɔn a wɔn mfe akɔ anim a wɔanya ntini mu yare esiane nneɛma a ɛnyɛ awosu mu nneɛma nti.
- David kwan: Eyi hwehwɛ sɛ wɔsan de aortic valve no hyɛ nipadua no mu. Eyi yɛ nea ɛyɛ den kakra sen Yacoub kwan no, nanso wɔtaa de di dwuma. Ɛfata titiriw ma mmerante ne mmabaa a wɔwɔ awosu mu nyarewa te sɛ `Marfan syndrome`.
Henanom na wohia oprehyɛn yi na bere bɛn?
Obiara a ɔwɔ aortic ntini a ahonhon na asiane wom sɛ ɔbɛpaapae anaasɛ ɔbɛtetew no betumi ahia oprehyɛn yi. Ɛtɔ mmere bi a, nsakrae a ɛba bere a obi nyin no na saa tebea yi ba. Afei nso, awosu mu nyarewa te sɛ Marfan syndrome ne Loeys-Dietz syndrome betumi ama mogya mu ntini a ɛyɛ hu yi aba wɔ ne mmofraase.
Mpɛn pii no, wogyina sɛnea ntini a ɛwɔ nipadua no mu no kɛse ne asiane afoforo so kamfo oprehyɛn kyerɛ.
- Sɛ awosu mu nyarewa anaa asiane foforo biara nni hɔ a, ntini a ɛma mogya tu no kɛse boro sɛntimita 5.5 .
- Sɛ wowɔ Marfan syndrome a, ne kɛse boro sɛntimita 5.0 .
- Sɛ wowɔ Marfan syndrome, abusua abakɔsɛm a ɛkyerɛ sɛ wowɔ saa ntini mu yare yi, woreyɛ nhyehyɛe sɛ wubenyinsɛn, anaasɛ sɛ ntini no nyin ntɛmntɛm sen milimita 3 afe biara a, wobetumi akamfo akyerɛ sɛ wɔnyɛ oprehyɛn sɛ ne kɛse yɛ sɛntimita 4.5 mpo a.
- Sɛ wowɔ bicuspid aortic valve (cusps abien pɛ) ne asiane afoforo te sɛ mogya mmoroso a, wobetumi akamfo akyerɛ sɛ wɔnyɛ oprehyɛn a ne kɛse yɛ sɛntimita 5.0 .
Nea ɛho hia ne sɛ, saa gyinaesi ahorow yi nyɛ pɛ mma obiara. Wo duruyɛfo begyina mfe a woadi, w’akwahosan nyinaa, ne ayaresa tebea afoforo so akyerɛ bere a eye sen biara a wobɛyɛ no oprehyɛn.
Ɔkwan bɛn so na wusiesie wo ho ansa na wɔayɛ wo oprehyɛn?
Esiane sɛ eyi yɛ oprehyɛn kɛse nti, ehia sɛ wosiesie wɔn ho yiye. Wo duruyɛfo bɛhwɛ wo yiye na wahyɛ sɛ wɔnyɛ nhwehwɛmu pii a ɛho hia.
- Mogya mu nhwehwɛmu: Hwɛ sɛnea asaabo no yɛ adwuma.
- CT anaa MRI mfonini a wɔde yɛ koma no: Hwɛ aorta no afã horow nyinaa.
- Coronary angiography: Hwɛ sɛnea coronary ntini a ɛde mogya kɔ koma no mu no te.
- Duplex ultrasound: Hwɛ sɛnea ntini a ɛwɔ kɔn no mu (carotid ntini ahorow) no akwahosan te.
Afei nso, akyinnye biara nni ho sɛ ɛsɛ sɛ wo ne wo duruyɛfo kasa fa nneɛma yi ho:
- Ɛfa nnuru a wonom nyinaa ho: Nea ɛka eyi ho ne vitamin ne nhabannuru mpo. Ebia nnuru bi bɛhwehwɛ sɛ wugyae nom ansa na wɔayɛ wo oprehyɛn.
- Ɛfa nyarewa afoforo a wowɔ ho: Ɛsɛ sɛ wodi nneɛma te sɛ mogya mmoroso so yiye ansa na wɔayɛ wo oprehyɛn.
- Sɛ wonom sigaret a: Anyɛ yiye koraa no, ɛsɛ sɛ wugyae sigaretnom koraa ɔsram biako ansa na wɔayɛ wo oprehyɛn. Bisa wo duruyɛfo no mmoa wɔ eyi ho.
Dɛn na ɛba bere a wɔreyɛ oprehyɛn no ne bere a wɔreyɛ no oprehyɛn no?
Bere a wɔreyɛ oprehyɛn no, wɔde wo bɛhyɛ aduru a wɔde kum nipadua no mu na woada koraa. Afei wɔde wo bɛka koma ne ahurututu afiri (cardiopulmonary bypass) ho . Saa afiri yi bɛyɛ wo koma ne w’ahurututu adwuma bere a wɔreyɛ oprehyɛn no.
Oduruyɛfo a ɔyɛ oprehyɛn no twa wo koko mfinimfini, kɔ wo koma mu, yi ntini no fã a ayɛ mmerɛw no, na ɔde ɔkwan foforo a wɔde nsa ayɛ (graft) si ananmu. Afei wɔde ntini a ɛma mogya kɔ koma no mu no bata ɔkwan foforo no ho na wɔpam nea wɔatwa no mu. Mpɛn pii no oprehyɛn yi gye nnɔnhwerew 4 kosi 6 .
Sɛ wɔyɛ oprehyɛn no wie a, ɛho behia sɛ wotra baabi a wɔhwɛ wɔn a wɔyare denneennen (ICU) nna kakraa bi. Afei wɔbɛyi wo akɔ ward a wɔyɛ no daa. Ebia ayaresabea a wobɛtra no nyinaa begye bɛyɛ dapɛn biako. Saa bere yi mu no, wɔbɛma wo nnuru a wɔde kum ɛyaw, nnuru a ɛma mogya tu, ne ayaresa afoforo a ɛho hia.
Bere tenten ahe na egye na obi ho atɔ no?
Ebetumi agye bɛyɛ adapɛn 6 kosi 12 , anaa ebia asram abien kosi abiɛsa, ansa na ne ho atɔ no koraa afi oprehyɛn yi mu. Eyi yɛ oprehyɛn kɛse, enti ɛsɛ sɛ woma wo nipadua no bere ma ɛsa.
- Adapɛn 6: Nka kar anaa mma nneɛma a emu yɛ duru so.
- Sɛ wopɛ ɔfese adwuma a: Wubetumi asan aba wɔ bɛyɛ adapɛn 6-8 akyi.
- Sɛ wopɛ adwuma a egye honam fam de a: Ɛsɛ sɛ wotwɛn kyɛ.
Wo duruyɛfo akwankyerɛ a wubedi akyi pɛpɛɛpɛ na wode wo ho ahyɛ komayare ho nhyehyɛe ahorow mu no bɛboa kɛse ma wo ho atɔ wo ntɛmntɛm.
Bere a ɛsɛ sɛ wokɔ oduruyɛfo nkyɛn ntɛm ara
Sɛ wosan kɔ fie a, sɛ wunya sɛnkyerɛnne ahorow a edidi so yi bi a , frɛ wo duruyɛfo ntɛm ara.
| Nsɛnkyerɛnne a ɛsɛ sɛ yɛhwɛ yiye wɔ ho | |
|---|---|
| Ɔhaw ahorow a ɛfa oprehyɛn a wɔde twa nipadua no ho: | |
| |
| Nsɛm afoforo: | |
|
Ɔkwan bɛn so na wobehu tebea a egye ntɛmpɛ?
Sɛ wowɔ ntini mu yare a wɔansa a, sɛnkyerɛnne ahorow a edidi so yi betumi ayɛ sɛnkyerɛnne a ɛkyerɛ sɛ woapaapae anaasɛ woapaapae. Sɛ ɛba saa a , kɔ ayaresabea Emergency Department (ETU) a ɛbɛn wo no ntɛm ara anaa frɛ 1990 ambulance adwumayɛbea no.
- Ɛyaw a ɛba mpofirim a wontumi nnyina ano wɔ koko anaa akyi atifi (te sɛ nea wɔretetew biribi afi nipadua no mu).
- Fifiri ne te nka sɛ ɛyɛ mmerɛw.
- Ɔhome a ɛyɛ den.
- Adwene a ɛyɛ basaa anaasɛ obi a ɔtotɔ piti.
- Koma a ɛbɔ ntɛmntɛm.
Nkrasɛm a Wɔde Kɔ Fie
- Aortic Root Replacement yɛ oprehyɛn kɛse a ebetumi agye nkwa a wɔyɛ wɔ aorta ntini a ayɛ mmerɛw no so.
- Oprehyɛn yi ahorow atitiriw abien na ɛwɔ hɔ; biako nso si aortic valve (ARR) ananmu na biako nso a ɛmma valve no nkutoo nnye (VSRR). Wo duruyɛfo na obesi ɔkwan a eye ma wo ho gyinae.
- Ɛwom sɛ egye asram pii ansa na obi ho atɔ no koraa afi oprehyɛn yi mu de, nanso oprehyɛn no nkonimdi ne nkwa a wonya no dɔɔso yiye (bɛyɛ 98%-99%).
- Aduruyɛ ho akwankyerɛ a wobedi akyi yiye ansa na wɔayɛ oprehyɛn ne bere a wɔayɛ oprehyɛn akyi no ho hia na ama obi ho atɔ no ntɛmntɛm.
- Mfɛre sɛ wo ne wo duruyɛfo bɛbɔ dadwen anaa ehu biara a wowɔ ho nkɔmmɔ. Ɛwom sɛ oprehyɛn yi abu so wɔ nnuruyɛfo mu de, nanso ɛyɛ ade a ɛfata sɛ wubenya nsɛm bi a ɛhaw wo efisɛ ɛyɛ osuahu foforo.

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