Makaʻu i ke ʻoki ʻana i ke aʻa aortic? E kamaʻilio maʻalahi kākou e pili ana i ia mea! (Aortic Root Replacement)

Ua haʻi aku anei ke kauka iā ʻoe ua nāwaliwali ke kīʻaha koko nui e lawe ana i ke koko mai kou puʻuwai a i kou kino holoʻokoʻa a he puʻupuʻu ma ke kumu? A i ʻole ua haʻi aku ʻo ia iā ʻoe e pono ʻoe i ke ʻoki kino? He mea maʻamau ke manaʻo iki i ka makaʻu ke lohe ʻoe i kekahi mea e like me ia. Akā, he ʻoki kino koʻikoʻi loa kēia e hiki ke hoʻopakele i kou ola. I kēia lā, e kamaʻilio mākou e pili ana i ke ʻano o kēia ʻoki kino Aortic Root Replacement, pehea e hana ʻia ai, a me nā mea āpau e pono ai ʻoe e ʻike e pili ana i ia mea.

I ka ʻōlelo maʻalahi, he aha ka Aortic Root Replacement?

ʻO ke kīʻaha koko nui loa a koʻikoʻi loa i loko o ke kino, ʻo ia ka aorta, ua pili ia i ko kākou puʻuwai. ʻO ka ʻāpana mua o kēia aorta kahi e pili ai i ka puʻuwai ua kapa ʻia ʻo ke aʻa aortic. I kekahi manawa ua nāwaliwali ka paia o kēia ʻāpana a hoʻomaka e puʻupuʻu e like me ka pōpō. Ua kapa ʻia kēia he aneurysm.

No laila, ʻo ke ʻoki ʻana i ke aʻa `Aortic Root Replacement` e pili ana i ka wehe ʻana i ke aʻa nāwaliwali a pehu o ka aorta a hoʻololi iā ia me kahi kahawai hana (graft). Hiki i kēia ke pale aku i nā kūlana weliweli aʻu i ʻōlelo ai a hoʻopakele i kou ola.

He aha nā ʻano nui o kēia ʻoki kino?

ʻElua mau ʻano hana nui no ka hana ʻana i kēia ʻoki kino. Na kāu kauka e koho i ke ʻano hana kūpono loa iā ʻoe ma muli o kou kūlana.

Nā ʻāpana liʻiliʻi o ke ʻoki kino VSRR

Ua māhele hou ʻia ke ʻoki VSRR i ʻelua mau ʻano hana: nā ʻano hana ʻo Yacoub lāua ʻo David.

• Ke kaʻina hana Yacoub: Pili kēia i ka hana hou ʻana i ka valve aortic. He kūpono kēia no ka poʻe ʻelemakule i loaʻa i kahi aneurysm ma muli o nā kumu ʻaʻole genetic.
• Ke kaʻina hana ʻo David: Pili kēia i ke kau hou ʻana o ka valve aortic. He ʻoi aku ka paʻakikī o kēia ma mua o ke kaʻina hana ʻo Yacoub, akā ʻoi aku ka hoʻohana pinepine ʻia. He kūpono loa ia no nā poʻe ʻōpio me nā maʻi genetic e like me ka `Marfan syndrome`.

ʻO wai ka mea e pono ai kēia ʻoki kino a i ka manawa hea?

ʻO kēlā me kēia mea i loaʻa kahi aʻa aortic pehu a i ka pilikia o ka haki ʻana a i ʻole ka haehae ʻana e pono paha i kēia ʻoki kino. I kekahi manawa hiki mai kēia ʻano ma muli o nā loli e kū mai ana me ka makahiki. Eia kekahi, ʻo nā maʻi genetic e like me ka Marfan syndrome a me Loeys-Dietz syndrome hiki ke hana i kēia aneurysm weliweli i ka wā ʻōpiopio.

Hoʻoikaika pinepine ʻia ke ʻoki ʻana ma muli o ka nui o ka aneurysm a me nā kumu pilikia ʻē aʻe.

• Inā ʻaʻohe maʻi hoʻoilina ʻē aʻe a i ʻole nā ​​​​kumu pilikia, ʻoi aku ke anawaena o ka aneurysm ma mua o 5.5 kenimika .
• Inā loaʻa iā ʻoe ka Marfan syndrome, ʻoi aku ke anawaena ma mua o 5.0 kenimika .
• Inā loaʻa iā ʻoe ka Marfan syndrome, kahi moʻolelo ʻohana o kēia ʻano aneurysm, ke hoʻolālā nei e hāpai, a inā e ulu wikiwiki ana ka aneurysm ma mua o 3 millimeters i kēlā me kēia makahiki, hiki ke ʻōlelo ʻia ke ʻoki ʻana inā he 4.5 kenimika ke anawaena.
• Inā he valve aortic bicuspid kou (ʻelua wale nō cusps) a me nā kumu pilikia ʻē aʻe, e like me ke koko kiʻekiʻe, hiki ke ʻōlelo ʻia ke hana ʻoki kino me ke anawaena o 5.0 kenimika .

Pehea ʻoe e hoʻomākaukau ai ma mua o ke ʻoki kino?

ʻOiai he hana ʻoki nui kēia, pono ia e hoʻomākaukau pono. E nānā pono kāu kauka iā ʻoe a kauoha i kekahi mau hoʻokolohua e pono ai.

• Nā hoʻāʻo koko: E nānā i ka hana o nā puʻupaʻa.
• Nā kiʻi CT a i ʻole MRI o ka puʻuwai: E nānā i nā ʻāpana āpau o ka aorta.
• ʻO ka angiography coronary: E nānā i ke kūlana o nā aʻa coronary e hoʻolako koko i ka puʻuwai.
• ʻO ke ultrasound Duplex: E nānā i ke olakino o nā aʻa i ka ʻāʻī (nā aʻa carotid).

Eia kekahi, pono ʻoe e kamaʻilio me kāu kauka e pili ana i kēia mau mea:

• E pili ana i nā lāʻau lapaʻau āpau āu e lawe ai: Hoʻokomo pū kēia i nā huaora a me nā huahana lāʻau lapaʻau. Pono paha kekahi mau lāʻau lapaʻau iā ʻoe e hoʻōki i ka lawe ʻana iā lākou ma mua o ke ʻoki ʻana.
• E pili ana i nā maʻi ʻē aʻe āu i loaʻa ai: Pono e kaohi maikaʻi ʻia nā mea e like me ke koko kiʻekiʻe ma mua o ke ʻoki ʻana.
• Inā ʻoe e puhipaka: Pono ʻoe e hoʻōki loa i ka puhipaka ma ka liʻiliʻi hoʻokahi mahina ma mua o ke ʻoki kino. E noi i kāu kauka no ke kōkua me kēia.

He aha ka mea e hana ʻia i ka wā a ma hope o ke ʻoki kino?

I ka wā o ke ʻoki kino, e hoʻokomo ʻia ʻoe ma lalo o ka anesthesia a hiamoe loa. A laila e hoʻopili ʻia ʻoe i kahi mīkini puʻuwai-māmā (cardiopulmonary bypass) . E hana kēia mīkini i ka hana o kou puʻuwai a me kou māmā i ka wā o ke ʻoki kino.

Hana ke kauka lapaʻau i kahi ʻoki ma waenakonu o kou umauma, komo i kou puʻuwai, wehe i ka ʻāpana nāwaliwali o ke aʻa, a hoʻololi iā ia me kahi kahawai hana hou (graft). A laila hoʻopili ʻia nā aʻa coronary e hoʻolako ana i ke koko i ka puʻuwai i ke kahawai hou a humuhumu ʻia ka ʻoki. ʻO ka maʻamau, ma waena o 4 a me 6 mau hola kēia hana ʻoki.

Ma hope o ke ʻoki kino, pono ʻoe e noho ma ka ʻāpana mālama koʻikoʻi (ICU) no kekahi mau lā. A laila e hoʻoneʻe ʻia ʻoe i kahi keʻena maʻamau. ʻO ka noho ʻana ma ka haukapila holoʻokoʻa e hala paha ma kahi o hoʻokahi pule. I loko o kēia manawa, e hāʻawi ʻia ʻoe i nā ʻeha ʻeha, nā lāʻau hoʻokahe koko, a me nā lāʻau lapaʻau ʻē aʻe e pono ai.

ʻEhia ka lōʻihi e hoʻōla ai?

Hiki ke hala ma kahi o 6 a 12 mau pule , a i ʻole ʻelua a ʻekolu paha mahina, e hoʻōla piha ai mai kēia ʻoki kino. He ʻoki kino nui kēia, no laila pono ʻoe e hāʻawi i kou kino i ka manawa e ho'ōla ai.

• No 6 pule: Mai hoʻokele a hāpai paha i nā mea kaumaha.
• No kahi hana keʻena: E hiki iā ʻoe ke hoʻi mai i loko o kahi o 6-8 mau pule.
• No kahi hana koi kino: Pono ʻoe e kali lōʻihi.

ʻO ka hahai pono ʻana i nā ʻōlelo a kāu kauka a me ke komo ʻana i nā papahana hoʻoponopono puʻuwai e kōkua nui i ka ho'ōla wikiwiki ʻana.

I ka manawa e ʻike koke ai i ke kauka

Ma hope o ka hoʻi ʻana i ka home, inā loaʻa iā ʻoe kekahi o kēia mau hōʻailona , ​​e kāhea koke aku i kāu kauka.

Pehea e ʻike ai i kahi pilikia?

Inā loaʻa iā ʻoe kahi aneurysm i mālama ʻole ʻia, ʻo nā hōʻailona ma lalo nei he hōʻailona paha ia o ka haki ʻana a i ʻole ka haki ʻana. I kēlā hihia , e hele koke i ka haukapila kokoke loa i ka Emergency Department (ETU) a kāhea aku paha i ka lawelawe ambulance 1990.

• ʻEha koke a hiki ʻole ke hoʻomanawanui ma ka umauma a i ʻole ke kua o luna (me ka manaʻo e haehae ʻia ana kekahi mea mai loko mai o ke kino).
• Ke hou nei a me ka manaʻo palupalu.
• Paʻakikī ka hanu ʻana.
• Ka poniuniu a i ʻole ka māʻule ʻana.
• Ka wikiwiki o ka puʻuwai.