E aʻo kākou e pili ana i ke ʻoki ʻana o ka valve puʻuwai (Surgical Mitral Commissurotomy) ma nā ʻōlelo maʻalahi.

E noʻonoʻo i kou puʻuwai e like me ka pamu wai e hana mau ana. I loko o kēia pamu, aia ʻehā mau ʻāpana liʻiliʻi e like me ka puka e kōkua ana i ke kahe ʻana o ke koko i hoʻokahi ala wale nō. Ma nā ʻōlelo lapaʻau, kapa mākou i kēia mau kiwikā puʻuwai. Inā ʻaʻole wehe pono kēia mau puka a pani pono, he pilikia nui ia, ʻeā? Pēlā nō, i kēia lā ke kamaʻilio nei mākou e pili ana i kahi ʻoki kūikawā i hana ʻia i ka wā e wehe pono ʻole ai ka kiwikā mitral, kekahi o nā kiwikā koʻikoʻi loa i loko o ko mākou puʻuwai, a lilo i mea haiki.

He aha ka commissurotomy?

I ka ʻōlelo maʻalahi, he hana ʻoki kino ka commissurotomy e hiki ai i ke koko ke kahe ma o kahi valve i loko o kou puʻuwai. Hana pinepine ʻia ia ma ka valve mitral . Aia ka valve mitral ma waena o ke keʻena hema o luna (atrium hema) a me ke keʻena hema haʻahaʻa (ventricle hema).

E noʻonoʻo ʻoe ʻaʻole e wehe pono ana kēia puka a ua paʻa a ua haiki. Kāhea mākou i kēia ʻano he mitral valve stenosis. ʻO ka mea e hana ʻia ana, ua ālai ʻia ke ala no ke kahe ʻana o ke koko mai ke keʻena luna a i ke keʻena lalo. Hoʻihoʻi kēia i ke koko a kau i ka nui o ke kaumaha ma ka puʻuwai a me nā māmā. I ka hala ʻana o ka manawa, hiki i kēia ke alakaʻi i nā kūlana koʻikoʻi e like me ka hāʻule ʻana o ka puʻuwai.

Hoʻohana ʻia kēia ʻoki commissurotomy ma ke ʻano he lāʻau lapaʻau no nā pae mua o ka mitral valve stenosis. Akā ʻo ka ʻoiaʻiʻo, ʻaʻole i hana pinepine ʻia i kēia mau lā. No ka mea, hana pinepine ʻia ia ma ke ʻano he ʻoki puʻuwai hāmama . Loaʻa iā ia kekahi mau pilikia. No laila, i ka wā e hiki ai, hoʻāʻo nā kauka e hoʻohana i nā ʻano maʻalahi a emi iki ka pilikia. ʻO kekahi o nā lāʻau lapaʻau nui i loaʻa i kēia manawa, ʻo ia ka balloon valvuloplasty . I loko o kēia, hoʻokomo ʻia kahi ʻōmole lahilahi a hoʻopiha ʻia kahi mea e like me ka balloon i loko o ka valve i haiki ʻia, e hoʻonui ana iā ia.

Eia nō naʻe, no kekahi poʻe, ʻaʻole hiki ke hana ʻia ke ʻano balloon ma muli o ke kūlana o ko lākou puʻuwai a i ʻole nā ​​​​kumu ʻē aʻe. I ia mau hihia, ʻo ke ʻoki commissurotomy ke koho maikaʻi loa.

ʻO wai ka mea e pono ai kēia ʻoki kino?

Inā loaʻa iā ʻoe ka mitral stenosis a pili kekahi o kēia mau mea, hiki i kāu kauka ke ʻōlelo i kēia ʻoki kino:

• Inā ʻaʻole ʻoe i ho'ōla ʻia e nā lāʻau ʻē aʻe.
• Inā ʻaʻole hiki iā ʻoe ke hana i ka valvuloplasty balloon.

Eia kekahi, inā ua loaʻa iā ʻoe nā ʻoki puʻuwai ʻē aʻe, hiki ke hana ʻia kēia ʻoki i ka manawa like.

Akā hoʻokahi mea nui e hoʻomanaʻo. ʻAʻole hiki i nā kānaka a pau me ka mitral valve stenosis ke hana i kēia ʻoki kino. Aia ia i ke kumu o kou valve stenosis.

ʻElua kumu nui:

1. Ka pōʻino i hana ʻia e ka maʻi puʻuwai Rheumatic:ʻO ka fiva rumatika, ka mea ma hope o ka maʻi ʻāʻī i ka wā kamaliʻi, hiki ke hōʻino i nā kiwikā o ka puʻuwai i nā makahiki ma hope.

2. Degenerative Mitral Stenosis: I ka hala ʻana o ka manawa, nāwaliwali mālie ka valve, lilo i mea haiki, a uhi ʻia me nā waihona calcium.

He mea kōkua nui ke ʻoki ʻana o ka commissurotomy no ka poʻe me ka maʻi puʻuwai rheumatic . I kēia kūlana, ʻo nā kihi ʻelua o ka valve kahi e hui ai nā lau ʻelua, i kapa ʻia ʻo commissures , e mānoanoa a i kekahi manawa e pili pū ana.

I ke ʻoki ʻana o ka commissurotomy, hana ʻia nā ʻoki liʻiliʻi ma nā kihi ʻelua o ka valve a hoʻokuʻu ʻia lākou. A laila hoʻomaka hou ka valve e wehe pono. Eia nō naʻe, i ka poʻe i pau nā valves ma muli o ka ʻelemakule, ʻaʻole i hōʻino ʻia nā commissures. Akā, pono e hoʻoponopono ʻia nā ʻāpana ʻē aʻe o ka valve. No laila, ʻaʻole kūpono kēia ʻoki no lākou. Pono lākou e hana i kahi ʻano hoʻoponopono valve ʻokoʻa a i ʻole kahi pani valve piha (mitral valve replacement).

He aha ka mea e hana ʻia ma mua o ke ʻoki kino?

Hoʻomaka nā hoʻomākaukau i nā pule, i kekahi manawa he mau mahina, ma mua o ka lā o kou ʻoki kino. E hui pū kāu hui lapaʻau (kou kauka ʻohana, kauka puʻuwai, a me ke kauka hana puʻuwai) e hāʻawi iā ʻoe i kahi hoʻokolokolo lapaʻau piha.

Inā he mau nīnau kāu, makaʻu, a kānalua paha e pili ana i ke ʻoki kino, e kamaʻilio me kāu kauka e pili ana iā lākou. Mai hūnā i kekahi mea iā ʻoe iho. He mea nui loa ka ʻike i nā mea āpau a komo i ke ʻoki kino me ka noʻonoʻo hoʻomaha.

E hāʻawi aku kāu kauka iā ʻoe i nā ʻōlelo aʻoaʻo no ke ʻano o ka hoʻomākaukau ʻana no ke ʻoki ʻana, me ka wā e hoʻōki ai i ka ʻai ʻana a me ka inu ʻana ma mua o ke ʻoki ʻana, a me nā hoʻololi i kāu mau lāʻau lapaʻau.

Pehea e hana ʻia ai ke ʻoki kino?

Ma ka lumi hana, hahai ke kime lapaʻau i kēia mau hana:

1. ʻO ka mea mua, e hāʻawi ʻia ʻoe i ka anesthesia a e hoʻomoe ʻia a hiki i ka pau ʻana o ke ʻoki ʻana. ʻAʻole ʻoe e ʻeha.

2. A laila, hana ke kauka lapaʻau i kahi ʻoki ma waenakonu o kou umauma, i lalo o ka iwi umauma (sternum). Ua kapa ʻia kēia he median sternotomy .

3. E hoʻopili ʻia ʻoe i kahi mīkini bypass cardiopulmonary . Lawe kēia mīkini i ka hana o kou puʻuwai a me kou māmā i ka wā o ke ʻoki ʻana. Hiki i ke kauka ke hana i ke ʻoki ʻana ʻoiai ʻoe e noho mālie ana, me ka ʻole o ka paʻi ʻana o kou puʻuwai.

4. Ua wehe ʻia ka atrium hema o ka puʻuwai a ua nānā ʻia ka valve mitral.

5. A laila, hana ʻia nā ʻoki liʻiliʻi loa ma nā kihi ʻelua (commissures) o ka valve i paʻa a mānoanoa, e hoʻokaʻawale ana iā lākou mai kekahi i kekahi a hoʻokuʻu iā lākou.

6. Ma hope o ka pau ʻana o ka hana, e hoʻokaʻawale ʻia ʻoe mai ka mīkini puʻuwai-māmā a e hoʻomaka hou ʻia kou puʻuwai a me kou mau māmā e hana.

7. ʻO ka hope loa, he echocardiogram transesophagealHana ʻia kahi scan kūikawā e hōʻoia inā e hana pono ana ka valve a inā e hana pono ana nā mea āpau.

I kekahi manawa, hiki ke hana ʻia nā ʻoki puʻuwai ʻē aʻe, e like me ka hoʻoponopono ʻana i nā valves puʻuwai ʻē aʻe (aortic valve a i ʻole tricuspid valve), i ka manawa like me kēia ʻoki. Inā pono kēia, e wehewehe mua ke kime lapaʻau i kēia iā ʻoe.

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

Pono ʻoe e noho ma ka haukapila no hoʻokahi pule ma hope o ke ʻoki kino. No ka lā mua a ʻelua paha, e mālama ʻia ʻoe i loko o ka ʻāpana mālama koʻikoʻi (ICU) a e nānā pono ʻia. ʻO kēia ke kōkua i ka ʻike ʻana i nā pilikia e kū mai ana ma hope o ke ʻoki kino i ka hikiwawe loa.

Ma mua o kou hoʻi ʻana i ka home mai ka haukapila, e hāʻawi aku kāu kauka iā ʻoe i ka ʻike e pili ana i:

• Hoʻōla Puʻuwai: He mea maikaʻi loa kēia no ka poʻe e hoʻōla ana mai ke ʻoki puʻuwai. Kōkua ia iā ʻoe e hoʻihoʻi i kou ikaika a hoʻomaka e hana i nā hana maʻamau.
• Pehea e mālama ai i ka ʻoki: He mea nui loa e mālama i ka maʻemaʻe o ka ʻoki i mea e pale ai i ka maʻi a ho'ōla koke i ka ʻeha.
• Nā Palena: ʻŌlelo aʻoaʻo no ka lōʻihi o ke kali ʻana ma mua o kou hiki ke hoʻomaka hou i nā hana e like me ka hoʻokele kaʻa ʻana a i ʻole ka hana ʻana i nā hana kaumaha.

Ma mua o kou hoʻi ʻana i ka home, mai poina e hoʻonohonoho i kahi e kiʻi iā ʻoe.

He aha nā pōmaikaʻi a me nā pilikia o kēia ʻoki kino?

Nā Pōmaikaʻi

Hiki i kēia ʻoki kino ke hōʻoluʻolu i nā hōʻailona e like me ka pōkole o ka hanu a me ka luhi i hoʻokumu ʻia e ka haiki ʻana o ka valve mitral. Hiki iā ia ke pale iā ʻoe mai nā pilikia koʻikoʻi e hiki mai ana i ka wā e hiki mai ana. He lāʻau lapaʻau maikaʻi loa kēia no ka poʻe ʻaʻole i koʻikoʻi ko lākou kūlana e pani piha i ka valve a ʻaʻole i holomua me nā lāʻau lapaʻau ʻē aʻe.

Nā Pōʻino a i ʻole nā ​​​​Pilikia

E like me nā ʻoki kino āpau, aia nā pilikia. ʻO ka pilikia maʻamau ka mitral valve regurgitation .

Hiki ke hoʻēmi ʻia ka nui o kēia mau pilikia ma ka loaʻa ʻana o ka lāʻau lapaʻau ma kahi haukapila nui me nā pono hana a me nā kauka ʻoki puʻuwai akamai.

He aha ke kūlana ma hope o ke ʻoki kino?

He kiʻekiʻe loa ka holomua o ka commissurotomy hāmama. Hoʻoponopono pinepine kēia ʻoki kino i ka haiki o ka valve a hoʻihoʻi i ke kahe koko.

Hiki i kāu kauka ke haʻi maikaʻi loa iā ʻoe e pili ana i kou olakino i ka wā e hiki mai ana. Hoʻōla like ʻole kēlā me kēia kanaka. Nui nā mea e hoʻopilikia i kēia, me kou makahiki, ke olakino holoʻokoʻa, a me ka nui o ka pōʻino i kāu valve ma mua o ke ʻoki ʻana.

Āhea ʻoe e pono ai e ʻike i ke kauka?

Inā loaʻa iā ʻoe kekahi mau hōʻailona o ka maʻi i kou wā e hoʻōla ana ma ka home ma hope o ke ʻoki ʻana, e kāhea koke aku i kāu kauka.

• ʻEha ka umauma, paʻa, a i ʻole ka ʻoluʻolu ʻole.
• Kuni.
• ʻUlaʻula a wai paha e like me ka pus e kahe ana mai ka wahi i ʻoki ʻia.

Inā ʻike ʻoe i kekahi o nā hōʻailona koʻikoʻi ma lalo nei, e kelepona koke i kāu helu ulia pōpilikia kūloko a i ʻole e hele i ka haukapila kokoke loa ʻo Emergency Department (ETU):

• Nā hōʻailona o ka hōʻeha puʻuwai (ʻeha nui o ka umauma, pilikia ka hanu ʻana, luaʻi ʻana, hou ʻana).
• Nā hōʻailona o ka maʻi lolo (ka paʻakikī o ka ʻōlelo ʻana, ke kūlou ʻana o kekahi ʻaoʻao o ka maka, ka nalowale o ka manaʻo ma ka lima a i ʻole ka wāwae).