Ke manaʻo nei ʻoe i kekahi manawa i ka pōkole o ka hanu a i ʻole ke kaumaha o kou umauma ke luhi iki ʻoe, a i ʻole ke piʻi ʻana i nā alapiʻi? Malia paha ua haʻi aku kāu kauka iā ʻoe e pili ana i kahi pilikia me kahi valve i loko o kou puʻuwai. Ke wehe pono ʻole kahi valve o ka puʻuwai a paʻa, kapa mākou ia he 'stenosis'. I kēia lā e kamaʻilio mākou e pili ana i kahi ʻoki kūikawā i hana ʻia ma ke ʻano he lāʻau lapaʻau no ia ʻano maʻi. ʻOiai he kumuhana koʻikoʻi loa kēia, e hoʻomaopopo maʻalahi kākou i nā mea āpau.
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I ka ʻōlelo maʻalahi, he aha kēia 'commissurotomy'?
ʻAe, e hoʻomaopopo mua kākou i kēia me ka maʻalahi. ʻEhā mau keʻena nui o kou puʻuwai. E noʻonoʻo iā lākou he ʻehā lumi. I mea e kahe ai ke koko mai kekahi keʻena a i kekahi, pono e wehe a pani pono nā puka ma waena o lākou. ʻO kēlā mau puka ka mea a mākou e kapa nei he mau valves puʻuwai .
ʻO ka commissurotomy kahi hana e pili ana i ka valve mitral i loko o kou puʻuwai. Aia ia ma waena o nā keʻena ʻelua o ka puʻuwai, ka atrium hema a me ka ventricle hema. ʻO kēia ka puka ma waena o nā keʻena ʻelua. He ʻelua mau ʻāpana o kēia puka.
Ma muli o kekahi mau kūlana olakino, ʻoiai ke kūlana i kapa ʻia ʻo 'Mitral Valve Stenosis' , ʻaʻole e wehe pono kēia mau puka ʻelua. Ua like ia me ka puka paʻa. He aha ka mea e hana ai? Hoʻemi ʻia ke kahe ʻana o ke koko mai ke keʻena luna a i ke keʻena lalo. Hoʻihoʻi kēia i ke koko, e kau ana 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 .
ʻO ke 'commissurotomy' kahi hana ʻoki e pili ana i ka hana ʻana i kahi ʻoki liʻiliʻi a me ka hoʻokaʻawale ʻana i nā wahi (commissures) kahi i hoʻopili ʻia ai nā lau o kahi valve i paʻa, e ʻae ana i ka valve e wehe pono hou. ʻAe kēia i ke koko e kahe maʻalahi hou ma o ka puʻuwai.
ʻO wai ka mea e pono ai kēia ʻoki kino?
ʻAʻole no nā kānaka a pau kēia ʻoki kino. Aia kekahi mau kumu nui e paipai ai kāu kauka i kēia ʻoki kino:
- Inā ʻaʻole i loaʻa kahi hopena maikaʻi i nā lāʻau ʻē aʻe (e like me ka lāʻau lapaʻau) i hāʻawi ʻia iā ʻoe.
- Inā ʻaʻole ʻoe kūpono no kahi kaʻina hana i kapa ʻia ʻo 'Balloon Valvuloplasty', ʻo ia hoʻi ka hoʻonui ʻana i ka valve me kahi pōpō.
- Inā loaʻa iā ʻoe kekahi ʻoki puʻuwai ʻē aʻe, hiki iā ʻoe ke hana i kēia ʻoki i ka manawa like.
Akā ʻo ka mea nui loa, ʻo ka holomua o kēia ʻoki kino e pili ana i ke kumu o kou mitral valve stenosis. E nānā kākou i nā kumu nui ʻelua.
| He aha ke kumu o ka prolapse o ka valve mitral? | Ka wehewehe ʻana a me ke kūpono o ke ʻoki kino 'commissarotomy' |
|---|---|
| Maʻi puʻuwai rumatika | ʻO ka hōʻino ʻana i nā kiwikā puʻuwai ma muli o ke kuni rumatika i ka wā kamaliʻi. Hana ʻia kēia hōʻino i nā makahiki ma hope. ʻO kēia kahi e hui pū ʻia ai nā lau kiwikā (fused commissures). ʻO ke ʻoki 'commissarotomy' ka mea holomua loa i kēia kūlana. |
| ʻO ka Stenosis Mitral Degenerative (ʻelemakule) | I ka wā e ʻelemakule ai nā kānaka, e hōʻino ana nā ʻāpana o ka valve. I kēia hihia, ua hōʻino ʻia nā ʻāpana ʻē aʻe o ka valve ma mua o nā lau valve e pipili pū ana. No laila, ʻaʻole kūpono ke ʻoki commissurotomy no kēia poʻe. Pono lākou i nā hoʻoponopono valve ʻē aʻe a i ʻole kahi hoʻololi piha o ka valve (Mitral Valve Replacement) . |
He aha ke ʻano o ka wā e pipili ai nā uhi valve?
He mea maʻalahi loa kēia e hoʻomaopopo. E noʻonoʻo ʻoe e minoʻaka ana i mua o ke aniani me kou mau lehelehe i pani ʻia. E nānā i nā kihi o kou mau lehelehe luna a me lalo. ʻO ia kahi e hui ai nā ʻaoʻao ʻelua o ka valve mitral (nā commissures). I kēia manawa e noʻonoʻo ʻoe e paʻa ana kekahi i nā kihi o kou mau lehelehe me nā manamana lima ʻelua. Hiki iā ʻoe ke wehe pono i kou waha? ʻAʻole, ʻaʻole hiki iā ʻoe? ʻO ia ka mea e hana ʻia ke ālai ʻia ka valve mitral. ʻO ka 'commissurotomy' kahi hana ʻoki e hoʻokuʻu i kēlā mau kihi ʻelua.
Pehea ʻoe e hoʻomākaukau ai ma mua o ke ʻoki kino?
ʻOiai he hana ʻoki kino nui kēia, hoʻomaka ka hoʻomākaukau ʻana i nā pule ma mua. E hana kāu hui lapaʻau (cardiologist, kauka puʻuwai) i kahi hoʻokolokolo piha iā ʻoe.
- He hoʻokolokolo kino piha
- Nā hoʻāʻo koko
- Ke kamaʻilio lōʻihi nei e pili ana i kāu mau hōʻailona a me ka mōʻaukala olakino
E hoʻāʻo ʻia hoʻi ʻoe e ʻike inā he mau poloka i loko o kāu valve mitral a me nā aʻa ʻē aʻe i loko o kou puʻuwai, e like me:
- Echocardiography - ʻO kēia ke nānā ʻana i ka puʻuwai.
- Nā scan CT
- ʻO ka Angiography Coronary
Inā he mau nīnau a hopohopo paha kāu e pili ana i ke ʻoki kino, e kamaʻilio me ke kauka a e hoʻomaha i kou manaʻo.Inā he mea puhi paka ʻoe, he mea nui e hoʻōki loa ma mua o ke ʻoki ʻana. Hiki i kēia ke hōʻemi nui i nā pilikia o ke ʻoki ʻana.
Pehea e hana ʻia ai ke ʻoki kino?
He ʻoki puʻuwai hāmama kēia. Eia ke kaʻina o nā hanana e hana ʻia ana ma ka lumi hana:
1. E hāʻawi ʻia ʻoe i ka lāʻau hoʻomaha e hoʻohiamoe loa iā ʻoe.
2. Hana ʻia kahi ʻoki ma waenakonu o ka iwi umauma (sternum).
3. E hoʻopili ʻia ʻoe i kahi mīkini bypass cardiopulmonary . ʻO kēia ke hāʻawi i kou kino i ke koko a me ka oxygen e pono ai ʻoiai e kū ana kou puʻuwai i ka wā o ke ʻoki ʻana.
4. Wehe ke kauka lapaʻau i ka atrium hema o ka puʻuwai a nānā i ka valve mitral.
5. Hana ʻia nā ʻoki liʻiliʻi ma nā commissures o ka valve e hoʻokuʻu iā lākou.
6. A laila e lawe ʻia aku ʻoe mai ka mīkini puʻuwai-māmā a e hoʻomaka hou ʻia kou puʻuwai.
7. ʻO ka hope loa, hana ʻia kahi echocardiogram transesophageal e hōʻoia i ka hana pono ʻana o ka valve.
He aha ka mea e hana ʻia ma hope o ke ʻoki kino?
Ma hope o ke ʻoki kino, pono ʻoe e noho ma ka haukapila no hoʻokahi pule. No ka lā mua a ʻelua paha, e mālama ʻia ʻoe i loko o ka keʻena mālama koʻikoʻi (ICU) a e nānā pono ʻia.
Ma mua o kou haʻalele ʻana i ka haukapila, e aʻo aku kāu kauka iā ʻoe ma kēia mau mea:
- Hoʻōla Puʻuwai: He mea kōkua nui kēia i ka loaʻa hou ʻana o ka ikaika a me ka maʻa ʻana i ke ola maʻamau ma hope o ke ʻoki ʻana.
- Pehea e mālama ai i ka ʻoki: He mea nui loa kēia e pale ai i ka maʻi a ho'ōla koke i ka ʻeha.
- Ma kahi o ka wā e hiki ai iā ʻoe ke hoʻomaka e hoʻokele a hana hou .
Nā hopena, nā pilikia, a me ka wā e ʻike ai i ke kauka
He kiʻekiʻe loa ka holomua o ka open mitral commissurotomy. Hoʻomaikaʻi ia i ke kahe koko a hōʻemi nui i nā hōʻailona. Eia naʻe, ʻaʻole ia he hopena mau loa. Nui ka poʻe i loaʻa i kēia kaʻina hana e pono ai ke ʻoki pani valve i kekahi manawa i ka wā e hiki mai ana.
E like me nā ʻoki kino a pau, aia kekahi mau pilikia.
- ʻO ka Mitral Regurgitation
- Kahe nui ʻana o ke koko
- Nā maʻi
- Nā hewa o ka puʻuwai (Arrhythmia)
- Hahau
Eia nō naʻe, ua hoʻemi ʻia kēia mau pilikia ma kahi haukapila nui me nā kauka ʻokiʻoki akamai. Inā loaʻa iā ʻoe nā maʻi e like me ka maʻi diabetes, ka maʻi puʻupaʻa, a i ʻole ka momona, hiki ke kiʻekiʻe iki aʻe ka pilikia. E kamaʻilio me kāu kauka e pili ana i kēia.
Inā ʻike ʻoe i kēia mau hōʻailona, e haʻi koke aku i kāu kauka:
- kuni
- ʻUlaʻula, pehu, a pus paha kokoke i ka ʻoki ʻia
- ʻEha a kaomi paha o ka umauma
Inā ʻike ʻoe i nā hōʻailona o ka hōʻeha puʻuwai koke (ʻeha nui o ka umauma, paʻakikī ka hanu ʻana) a i ʻole nā hōʻailona o ka hahau ʻana (ʻōlelo hū, kūlou o kekahi ʻaoʻao o ka maka), e kelepona koke iā 1990 a hele i ka Emergency Treatment Unit (ETU) o ka haukapila.
Leka Lawe-Home
- ʻO ka 'commissarotomy' kahi ʻoki puʻuwai hāmama i hana ʻia e hoʻihoʻi i ka hana kūpono i kahi valve mitral i ālai ʻia.
- ʻO ke kumu nui o kēia ʻano, ʻo ia ka hōʻino ʻia ʻana o nā kiwikā o ka puʻuwai ma muli o ke kuni rumatika i ka wā kamaliʻi.
- ʻOiai he hana ʻoki kino holomua loa kēia, he hopena manawa pōkole ia a pono paha e hoʻololi ʻia ka valve i ka wā e hiki mai ana.
- He mea nui loa nā papahana hoʻoponopono puʻuwai no ka ho'ōla piha ʻana ma hope o ke ʻoki kino.
- He mea nui loa e nīnau i kāu kauka i nā nīnau āu e pili ana i kou kūlana, ke ʻoki kino, a me kona mau pilikia.
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