Mogya a ɛbɛtɔ wɔ koma no mu ano aduru? (Left Atrial Appendage Closure) Momma yensua ho ade kɛkɛ!

So wo duruyɛfo aka akyerɛ wo sɛ wowɔ Atrial Fibrillation, koma a ɛbɔ ntɛmntɛm wɔ ɔkwan a ɛnteɛ so? Ebia wunim sɛ nnipa a wɔwɔ saa tebea yi betumi anya akisikuru mpɛn abiɛsa kosi anum sen afoforo. Ade titiriw nti a ɛte saa ne mogya a ɛtwetwe a ɛba koma no mu. Enti ɛnnɛ yɛreka ayaresa soronko bi a ɛde ahotɔ kɛse abrɛ nnipa pii na wɔde atew asiane a ɛyɛ hu yi so ho asɛm.

Sɛ yɛbɛka no tiawa a, dɛn ne Benkum Atrial Appendage Closure?

Okay, ebia eyi bɛyɛ te sɛ edin a ɛyɛ den, nanso asɛm no yɛ mmerɛw yiye. Susuw benkum atrium, yɛn koma no atifi dan no ho hwɛ. Ɔfã ketewaa bi wɔ hɔ a ɛte sɛ kotoku a ɛpuepue fi saa dan yi fasu ho. Ɛno ne nea nnuruyɛfo frɛ no Left Atrial Appendage (LAA) .

Mpɛn pii no, sɛ koma no bɔ yiye a, mogya sen kɔ saa kotoku yi mu na afei ɛsan fi adi bio. Nanso wɔ obi a ɔwɔ Atrial Fibrillation (Afib) mu no, koma no atifi adan no ntumi ntwitwiw no yiye, na mmom ɛwosow. Afei, mogya boaboa ano wɔ saa kotoku a wɔfrɛ no LAA no mu, na mogya tu fi ase sisi. Mogya a ɛtɔ a ɛma nnipa a wɔwɔ Afib nya akisikuru no mu 90% wɔ kotoku ketewa yi a wɔfrɛ no LAA mu.

Ade a eye sen biara ne sɛ, sɛ wɔto LAA no fã yi mu a, ɛnka koma no dwumadi a aka no. Koma no betumi ayɛ adwuma yiye bere a enni hɔ no.

Henanom na wohia saa ayaresa yi?

Wɔkamfo saa ayaresa yi kyerɛ nnipa a wɔwɔ Atrial Fibrillation (Afib) a asiane kɛse wom sɛ wobenya ɔyare a ɛma obi hwe ase no titiriw. Ɛyɛ ano aduru pa titiriw ma wɔn a wɔwɔ nnuru a ɛma mogya tu ho haw no.

Nnuruyɛfo taa kyerɛw nnuru a ɛma mogya yɛ mmerɛw te sɛ warfarin (Coumadin®) na ama asiane a ɛwɔ hɔ sɛ obi benya akisikuru no so atew. Nanso nnipa binom wɔ ɔhaw ahorow wɔ nnuru yi ho:

• Mogya mu nhwehwɛmu daa: Ɛsɛ sɛ woyɛ mogya mu nhwehwɛmu daa na ama woahu sɛ worenom nnuru dodow a ɛfata.
• Aduan a wodi so: Ebia ɛho behia sɛ wɔma nnuan bi te sɛ nhabannuru a vitamin K wom.
• Asiane a ɛwɔ hɔ sɛ mogya bɛtu: Saa aduru yi betumi ama mogya no ayɛ brɛoo esiane opira ketewaa bi mpo nti. Eyi yɛ asiane ma obi a ɔtaa hwe ase anaasɛ mogya betumi atu afi ne dwensɔtwaa mu.
• Saa aduru yi ntumi nyɛ adwuma mma nnipa binom.

Apixaban (Eliquis®), rivaroxaban (Xarelto®) a wɔmfa warfarin nni dwumaƐwom sɛ nnuru foforo te sɛ eyinom wɔ hɔ de, nanso ɛnyɛ adwuma mma obiara. Wɔn bo yɛ den ma nnipa binom, na ɛde asiane nso ba sɛ mogya bɛtu wɔn.

Enti, wɔ wɔn a ɛyɛ den ma wɔn sɛ wɔbɛkɔ so anom nnuru a ɛma mogya yɛ mmerɛw esiane nneɛma te sɛ eyinom nti no, wubetumi ne wo duruyɛfo akasa afa ayaresa bi a wɔfrɛ no LAA Closure ho.

Akwan bɛn na wɔfa so to LAA no mu?

Akwan ne mfiri ahorow wɔ hɔ a wɔfa so to LAA no fã yi mu. Eyinom bi ne:

Ahosiesie a wɔbɛyɛ ama ayaresa no na wɔayɛ

Ansa na wɔbɛsa no yare

Ansa na wobɛyɛ saa ayaresa yi no, wo duruyɛfo no de Transesophageal Echocardiogram (TEE) bɛhwehwɛ wo koma mu.Wɔyɛ scan a wɔfrɛ no TEE anaa koma CT scan. TEE hwehwɛ sɛ wɔde mfoninitwa afiri ketewaa bi hyɛ aduan no mu de susuw LAA a ɛwɔ koma no mu no nsusuwii ne ne kɛse pɔtee. Eyi te saa efisɛ ɛnyɛ obiara LAA na ɛyɛ pɛ. Nnipa binom LAA te sɛ akokɔ ntaban, bere a afoforo LAA te sɛ ntontom. Wɔde saa scan yi paw mfiri ne ne kɛse a ɛfata ma wo.

Nea ɛka ho no, wɔbɛtu wo fo sɛ gyae adidi ne anonne (mmuadadi) nnɔnhwerew kakraa bi ansa na wɔayɛ ayaresa.

Bere a wɔreyɛ ayaresa no

Akwan titiriw abien na ɛwɔ hɔ a yebetumi afa so ayɛ eyi.

1. Bere koro no ara a wobɛyɛ ne koma oprehyɛn afoforo: Sɛ woreyɛ koma oprehyɛn kɛse foforo, te sɛ oprehyɛn a wɔde twa kwan a, oduruyɛfo a ɔyɛ oprehyɛn no betumi atwitwa na ayi LAA no fã yi bere koro no ara mu, anaasɛ ɔbɛpam no ato mu.

2. Minimally Invasive: Eyi ne ɔkwan a wɔtaa fa so. Ntwitwiridii kɛse biara nni ha. Eyi ne nea ɛba:

• Wɔtwa ketewaa bi wɔ honam ani a ɛbɛn asen no mu, na wɔde afiri teateaa bi a wɔfrɛ no catheter fa mogya ntini bi a ɛwɔ hɔ mu kɔ koma no mu.
• Wɔde saa afiri yi fi koma no nifa so kɔ benkum so, fa tokuru ketewaa bi a ɛwɔ ɔfasu a ɛda adan abien no ntam no mu. (Mma ɛnhaw wo, saa tokuru yi taa to n’ankasa mu wɔ asram 6 ntam).
• Afei wɔde afiri no kɔ anim kɔ LAA no mu, na wɔhyɛ afiri a wɔadi kan apaw no ma ɛto LAA no ano.
• Wɔnam mfoninitwa mfiri te sɛ Fluoroscopy (X-ray video) ne TEE a wɔde hwɛ mu no so na ɛyɛ eyi nyinaa.
• Sɛ wɔyɛ adwuma no wie a, woyi catheter no fi mu.

Dɛn na ɛba wɔ ayaresa akyi?

Sɛ wɔfa ntwitwiridii ketewaa bi so na ɛyɛ saa ayaresa yi a, ebia ɛsɛ sɛ wotra ayaresabea hɔ anadwo biako pɛ na ade kyee no wubetumi akɔ fie.

Nnuru ho nhyehyɛe no bɛsakra kakra bere a woakɔ fie akyi.

• Mpɛn pii no, nnafua 45 a edi kan no , wɔbɛka akyerɛ wo sɛ fa aduru a ekum mogya a ɛtwetwe mogya ne aspirin. Saa bere no mu no, honam ani ntini bɛba atwa afiri no ho ahyia, na ɛbɛkata so denneennen.
• Sɛ TEE scan wɔ nnafua 45 akyi si so dua sɛ wɔato LAA no mu koraa pɛ a, wubetumi agyae nnuru a ɛma mogya tu no nom. Afei wɔbɛma wo clopidogrel (Plavix®) ne aspirin asram 6 .
• Ɛtɔ mmere bi a oduruyɛfo no tu fo sɛ wɔmfa aspirin nkyɛ.

Mfaso ne asiane bɛn na ɛwɔ so?

Sɛnea ɛte wɔ aduruyɛ biara ho no, mfaso ne asiane nketenkete wɔ so. Wo duruyɛfo bɛkyerɛkyerɛ eyinom nyinaa mu akyerɛ wo.

Bere bɛn na ɛsɛ sɛ wo ne oduruyɛfo no kasa?

Sɛ wuhu sɛnkyerɛnne ahorow a edidi so yi mu biara bere a woakɔ fie bere a woasa wo yare awie no a, bɔ wo duruyɛfo amanneɛ ntɛm ara.

• Atiridii anaa sɛnkyerɛnne afoforo a ɛkyerɛ sɛ obi anya ɔyare no (ɔhohoro, baabi a wɔatwa no yɛ kɔkɔɔ).
• Koma a ɛbɔ a ɛnyɛ ne kwan so, atenka a ɛte sɛ nea ɛrehuruhuruw wɔ koko mu.
• Koko mu yaw a emu yɛ den.
• Ɔhome a ɛyɛ den.

Afib a wo ne wo bɛtra no betumi ayɛ adwennwen, titiriw sɛ wowɔ ɔhaw ahorow wɔ wo mogya a ɛma wo mogya yɛ mmerɛw no ho a. LAA Closure nyɛ obiara dea, nanso ebia ɛbɛyɛ ɔkwan a wobɛfa so. Enti ka ho asɛm pefee kyerɛ wo koma ho ɔyaresafo, bisa wo nsɛm, na si gyinae a eye ma wo.