So oduruyɛfo no ka kyerɛɛ wo sɛ ɛsɛ sɛ wɔyɛ wo koma oprehyɛn? Ɛyɛ ade a ɛfata sɛ wobɛte ehu nka kakra bere a ɔka saa no. Nanso ɛnnɛ, aduruyɛ anya nkɔanim paa. Oprehyɛn ahorow bi wɔ hɔ a wɔbɔ mmɔden sɛ wɔbɛbɔ wo nipadua no afã horow pii ho ban sɛnea wubetumi. Ɛnnɛ yɛrebɛka oprehyɛn titiriw biako a ɛte saa ho asɛm. Ɛne sɛ, koma no mu ntini a ɛyɛ oprehyɛn a ɛbɔ ntini no ho ban.
Sɛ yɛbɛka no tiawa a, dɛn ne Valve-Sparing oprehyɛn?
Okay, sɛ yɛbɛte eyi ase a, momma yenni kan nsua yɛn koma fã ketewaa bi ho ade. Yɛn koma no dan titiriw a wɔde pɔmpɔ gu mu (benkum so ahurututu) no ne mogya ntini kɛse a ɛwɔ yɛn nipadua mu, aorta, no di nkitaho. Yɛfrɛ saa nkitahodi yi `Aortic Root`. Ɛte sɛ dua ntini. Wɔ saa `Aortic Root` yi mu no, ɔpon bi a ɛho hia yiye, `Aortic Valve`.
Bere biara a koma no bɛbɔ no, saa `Aortic Valve` yi bue na ɛde mogya kɔ nipadua no mu, na afei ɛto mu. Saa ade a wɔto mu yi mma mogya no ntumi nsan nkɔ koma no mu.
Afei fa no sɛ, wɔ nnipa binom mu no, `Aortic Root`, kyerɛ sɛ, ɔpon no fã a ɛte sɛ ɔpon no, ayɛ mmerɛw, ahonhon, na ayɛ kɛse. Ɛte sɛ nea wɔde balloon rebɔ mu. Yɛfrɛ eyi `Aortic Root Aneurysm`. Sɛ saa apon yi yɛ kɛse a, ɔpon a ɛwɔ mu, kyerɛ sɛ, `Aortic Valve` no, nto mu yiye. Afei mogya no fi ase san kɔ koma no mu. Wɔfrɛ eyi `Aortic Regurgitation`.
Wɔ atetesɛm oprehyɛn (`Bentall nhyehyɛe`) mu no, oprehyɛn ho animdefo yi `Aortic Root` ne `Aortic Valve` a ayɛ kɛse no nyinaa na wɔde foforo abien a wɔayɛ no hyɛ nipadua mu.
Nanso wɔ Valve-Sparing oprehyɛn yi mu no, biribi titiriw bi si . Nea wɔyɛ wɔ ha ne sɛ woyi `Aortic Root` a ahonhon no nkutoo fi hɔ, wogyaw w'ankasa `Aortic Valve` a ɛwɔ apɔwmuden no sɛnea ɛte, na wɔde hyɛ `Aortic Root` foforo so. Sɛ yɛbɛka no tiawa a, ɛte sɛ nea woresakra ɔpon no ahaban nkutoo na woasiesie w’ankasa wo pon dedaw pa no.
Mfaso kɛse a ɛwɔ eyi so ne sɛ wubetumi de w’ankasa valve asie, enti enhia sɛ wonom nnuru a ekum mogya a ɛtwetwe wo nkwa nna nyinaa (te sɛ Coumadin) te sɛ nea wobɛyɛ wɔ mfiri valve ho no.
Tebea bɛn na oprehyɛn yi sa?
Wɔyɛ oprehyɛn yi titiriw wɔ nsɛm a edidi so yi mu:
- Aortic Root Aneurysm: Sɛnea madi kan aka no, eyi yɛ aorta ntini a ɛne koma no di nkitaho no mu a ɛyɛ kurukuruwa a ɛnyɛ ne kwan so. Sɛ eyi yɛ kɛse dodo a, ebetumi apae mpofirim (`Aortic Dissection` anaa Rupture). Ɛyɛ asiane kɛse ma nkwa.
- Ascending Aortic Aneurysm with Dilated Aortic Sinuses: Nsɛm a abɔde mu mmeae nketenkete a ɛwɔ `Aortic Root` (`Aortic Sinuses`) no mu no yɛ kɛse kakra, na aorta no fã a ɛforo kɔ soro no yɛ kɛse.
Nnipa a wɔwɔ awosu mu ntini a ɛka bom yɛ nyarewa bi te sɛ Marfan syndrome no wɔ asiane kɛse mu sɛ wobenya aortic root aneurysm. Enti, nnuruyɛfo a wɔyɛ oprehyɛn hwehwɛ ɔyarefo no tebea mu yiye na wɔkari mfaso ne asiane a ɛwɔ oprehyɛn no so ansa na wɔasi gyinae sɛ ɛfata anaa.
So wofata ma oprehyɛn yi?
Sɛ wo aortic valve no wɔ saa su ahorow yi a, ebia wobɛyɛ obi a ɔpɛ sɛ wɔyɛ oprehyɛn yi:
- Sɛ calcium kakraa bi pɛ anaasɛ enni hɔ koraa (calcification) wɔ valve no mu a.
- Gye sɛ wɔasɛe valve no kɛse.
- Sɛ valve no reyɛ adwuma yiye anaasɛ wobetumi asiesie no denam nsiesie ketewaa bi so a.
Ɔkwan bɛn so na wusiesie wo ho ansa na wɔayɛ wo oprehyɛn?
Oduruyɛfo a ɔyɛ wo oprehyɛn no bɛkyerɛkyerɛ biribiara a ɛsɛ sɛ woyɛ ansa na woayɛ wo oprehyɛn no mu. Ɛho hia paa sɛ wubedi saa akwankyerɛ ahorow no akyi pɛpɛɛpɛ. Mpɛn pii no, eyi ne nea ebehia sɛ woyɛ.
| Ɔfã a ɛsɛ sɛ wosiesie | Nea ɛsɛ sɛ wɔyɛ |
|---|---|
| Nnuru a wɔde yɛ nnuru | Ka nnuru a wotaa nom ho asɛm kyerɛ wo duruyɛfo. Nnyae anaa nnsesa nnuru biara a n’afotu nka ho. |
| Aduan ne nsuo | Nni anaa nnom biribiara (nsu mpo) anadwo fã akyi anadwo a edi oprehyɛn no anim. |
| Sigaretnom | Anyɛ yiye koraa no, ɛsɛ sɛ wogyae sigaretnom ne tawanom koraa ɔsram biako ansa na wɔayɛ oprehyɛn. |
| Obi a ɔbɛboa | Yɛ nhyehyɛe ma obi bɛka wo ho akɔ ayaresabea ne fie. |
Nea ɛka ho no, oduruyɛfo no bɛyɛ nhwehwɛmu ahorow pii de ayɛ oprehyɛn no ho nhyehyɛe, te sɛ:
- Echocardiogram (koma mu nhwehwɛmu) .
- Mogya mu nhwehwɛmu
- `Koma ne koko EKG gated CT scan`
- Coronary Angiogram a Wɔde Yɛ Adwuma
- Awosu mu mogya mu nhwehwɛmu sɛ wosusuw sɛ awosu mu yare bi wɔ hɔ a
Dɛn na ɛba bere a wɔreyɛ oprehyɛn no?
Mpɛn pii no, oprehyɛn yi gye nnɔnhwerew 4 kosi 6. Sɛ oduruyɛfo a ne ho akokwaw yɛ oprehyɛn yi a, ɛsɛ sɛ wogyae koma no bɛyɛ dɔnhwerew biako. Mma ɛnhaw wo, saa bere no mu no, afiri bi bɛyɛ koma ne ahurututu adwuma.
Nea ɛkɔ so anammɔn biara ni:
1. Anesthesia: Nea edi kan no, wɔde wo bɛda koraa. Enti worente ɛyaw biara nka.
2. Koko a wobue: Oduruyɛfo a ɔyɛ oprehyɛn no twa koko no mfinimfini (a `median sternotomy`) de du koma no mu.
3. Bata Koma-Ahurututu Mfiri no ho: Wɔde wo bɛka `Cardiopulmonary Bypass` afiri ho. Saa afiri yi begye wo koma ne w’ahurututu dwumadi bere a wɔreyɛ oprehyɛn no. Saa bere yi, wɔde aduru bi a wɔfrɛ no `cardioplegia solution` bɛma wo de asiw wo koma ano bere tiaa bi.
4. Valve no a Wobɛgyae: Oduruyɛfo a ɔyɛ oprehyɛn no de ahwɛyiye yi wo aortic valve no fi ntini a atwa ho ahyia no mu.
5. Afã horow a asɛe a woyi fi hɔ: Wɔtwa `Aortic Root` a ahonhon ne afã afoforo a asɛe no na woyi fi hɔ.
6. Graft: Wɔde afiri a wɔde ayɛ (a `graft`) ahyɛ ɔfã a wɔayi afi hɔ no ananmu. Wɔde ntama soronko bi (`polyester`) na ɛyɛ eyi.
7. Valve re-implantation: Wɔfa w’ankasa aortic valve, wɔde graft foforo hyɛ mu, na wɔde suture gu mu.
8. Valve no a wobɛhwɛ: Sɛnea ɛbɛyɛ a biribiara yɛ yie no, wɔde nsuo bi fa `Graft` no mu hwɛ sɛ valve no reyɛ adwuma yie, abue na ɛreto mu anaa.
9. Anamɔn a etwa to: Koma no mu ntini a ɛma mogya tu no bata `Graft` foforo no ho. Afei woyi wo fi `Heart-Lung Machine` no mu na wɔma wo koma kwan ma ɛsan yɛ adwuma bio. Afei wɔto baabi a wɔatwa koko no mu.
Nnɛyi akwan a wɔfa so yɛ oprehyɛn (Modified Reiplantation) .
Bere kɔ so no, nnuruyɛfo a wɔyɛ oprehyɛn de akwan foforo aka ho na ama oprehyɛn yi ayɛ yiye. Nhwɛsoɔ:
- Aortic Sinus Foforo a Wɔbɔ (`Neosinuses`): Mpɛn pii no, `Graft` yɛ tube a ɛyɛ tẽẽ. Nanso abɔde mu `Aortic Root` no wɔ mmeae nketenkete (`sinus`). Wɔ ɔkwan foforo no mu no, wɔbɔ mmeae a ɛte saa no wɔ ɔkwan a wɔayɛ so wɔ `Graft` no mu. Eyi ma mogya no sen sɛnea ɛte wɔ awosu mu, na nea ɛsɛe valve no so tew.
- Aortic Annulus Sizing: Wɔayɛ nsakrae wɔ ɔfã a ɛte sɛ ring a valve no gyina so (`aortic annulus`) no kɛse ma ɛne wo nipadua kɛse hyia. Eyi ma asiane a ɛwɔ hɔ sɛ mogya bɛtu afi valve no mu daakye no so tew.
Dɛn na ɛba wɔ oprehyɛn no akyi? Na bere tenten ahe na egye na obi ho atɔ no?
Sɛ wɔyɛ oprehyɛn no wie a, wɔde wo bɛto baabi a wɔhwɛ wɔn a wɔyare denneennen (ICU) da koro anaa nnanu, na afei wɔde wo akɔ ayaresabea a wɔhwɛ wɔn daa. Mpɛn pii no wubetumi akɔ fie wɔ nnafua 4 kosi 7 mu.
Egye bɛyɛ adapɛn 6 ansa na ne ho atɔ no koraa. Mfa ahopere nyɛ nneɛma saa bere yi. Ɛsɛ sɛ woma w’ani da hɔ na wosan kɔ wo tebea a na wodi kan no mu.
Sɛ wowɔ karka tumi krataa mpo a, nka kar kosi sɛ wo duruyɛfo bɛma wo kwan. Anyɛ yiye koraa no, ɛho behia sɛ wotwɛn adapɛn 6 ansa na woayɛ biribiara te sɛ nneɛma a emu yɛ duru a wobɛma so anaasɛ woakɔ adwuma.
Sɛ wode wo ho hyɛ koma mu ahosiesie nhyehyɛe (`cardiac rehab`) mu a, ɛbɛboa wo ma wo ho atɔ wo ntɛmntɛm. Afei nso, hwɛ hu sɛ wobɛkɔ bere a wo ne wo duruyɛfo no bɛkɔ akɔhwɛ wo. Wɔbɛkɔ so ahwɛ sɛnea wo koma te.
Asiane ne mfaso bɛn na ɛwɔ oprehyɛn yi so?
Te sɛ oprehyɛn kɛse biara no, asiane ahorow bi wɔ mu. Nanso, sɛ oduruyɛfo a ne ho akokwaw yɛ oprehyɛn wɔ ayaresabea a ɛwɔ mmeae pa a, asiane ahorow yi sua koraa .
Mfaso atitiriw a ɛwɔ so:
- Ɛho nhia sɛ wonom nnuru a ɛma mogya yɛ mmerɛw wo nkwa nna nyinaa.
- Asiane a ɛwɔ hɔ sɛ mogya bɛtɔ, akisikuru, ne valve infection (endocarditis) no so tew.
- Sɛnea ɛbɛyɛ yiye sɛ ɛsɛ sɛ wɔyɛ oprehyɛn de sesa valve no bio daakye no sua koraa.
Nhwehwɛmu ada no adi sɛ oprehyɛn yi nkonimdi boro 99%. Mfeɛ 10 akyi mpo no, nnipa a wɔayɛ saa oprehyɛn yi bɛyɛ 95% renhia oprehyɛn foforɔ.
| Bere a ɛsɛ sɛ wɔfrɛ oduruyɛfo no bere a wɔayɛ no oprehyɛn awie no | |
|---|---|
| Nsakrae a ɛba wɔ ɔkwan a wɔfa so twa no mu | Kɔkɔɔ, ɛyaw, ɔfe, akisikuru anaa nsu foforo a ɛretu fi baabi a wɔatwa no. |
| Koko mu yaw anaasɛ ɛyɛ den sɛ wobɛhome | Koko mu yaw mpofirim anaasɛ ɛyɛ den sɛ ɔbɛhome. |
| Nipadua mu nneɛma afoforo | Nan a ɛho ahonhon, ɔbrɛ a ɛtra so, akisikuru, atiridiinini, mogya a ɛwɔ nsu mu. |
| Ɛwa | Ɔfe a ɛyɛ kɔkɔɔ anaa ahabammono anaa ɔfe a ɛde mogya ba. |
Sɛ wowɔ saa sɛnkyerɛnne yi bi a, frɛ wo duruyɛfo ntɛm ara anaa kɔ ayaresabea a ɛbɛn wo no Dwumadibea a Ɛhwɛ Ntɛmntɛm (ETU).
Nkrasɛm a Wɔde Kɔ Fie
- Valve-Sparing Aortic Root Replacement yɛ oprehyɛn a ɛkɔ akyiri a wɔde si aortic ntini a asɛe no nkutoo ananmu, na ɛkora w’ankasa aortic valve a ɛte apɔw so.
- Mfaso kɛse a ɛwɔ eyi so ne sɛ ɛnsɛ sɛ wonom nnuru a ɛma mogya yɛ mmerɛw wo nkwa nna nyinaa na asiane a ɛwɔ hɔ sɛ wobɛyɛ oprehyɛn foforo daakye no so tew.
- Oprehyɛn yi mfata obiara. Wo duruyɛfo a ɔyɛ wo oprehyɛn no besi gyinae sɛ ebia ɛfata wo tebea no anaa.
- Egye bɛyɛ adapɛn 6 ansa na obi ho atɔ no koraa wɔ oprehyɛn no mu. Saa bere yi mu no, di oduruyɛfo no akwankyerɛ akyi pɛpɛɛpɛ.
- Sɛ wowɔ nsɛmmisa bi a, nsuro sɛ wubebisa wo duruyɛfo. Mmoa a w’abusua de ma nso som bo paa wɔ saa bere yi mu.
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