He ʻano ʻē anei kou puʻuwai? E kamaʻilio kākou e pili ana i ke Kaʻina Hana Maze, kahi hopena no ka Atrial Fibrillation!

Ua manaʻo paha ʻoe e like me ka pupule o kou puʻuwai, e kuʻi wikiwiki ana a ʻano ʻē, a manaʻo ʻoe he mea ʻē kou i loko o kou umauma? ʻO kēia ka mea a mākou e kapa nei he Atrial Fibrillation (AFib) i ka lāʻau lapaʻau. He maʻi puʻuwai maʻamau kēia. I ka hapa nui o ka manawa, hiki ke hoʻomalu ʻia kēia ʻano me ka lāʻau lapaʻau. Akā no kekahi poʻe, he paʻakikī ke kaohi iā ia me ka lāʻau lapaʻau wale nō. I kēlā mau manawa, i kēia lā e kamaʻilio mākou e pili ana i kahi ʻoki kino holomua loa a nā kauka e ʻōlelo nei. Ua kapa ʻia ʻo ia ʻo Maze Procedure . ʻOiai he ʻano ʻē iki ka inoa, ua hiki iā ia ke ho'ōla i ke ola o nā poʻe he nui me AFib.

I ka ʻōlelo maʻalahi, he aha kēia Maze Procedure?

E noʻonoʻo i kahi pāʻani maze. Hoʻokahi wale nō ala e komo ai, hoʻokahi ala e puka ai, a hoʻokahi wale nō ala pololei ma waena. Akā, he nui nō hoʻi nā ala hewa e alakaʻi ana i mua a i hope i loko. Pēlā nō ka mea e hana ʻia ma ke Kaʻina Hana Maze.

I ka ʻōlelo maʻalahi, ma kēia kaʻina hana, hana ke kauka ʻoki i kahi ʻano palupalu a hoʻolālā ʻia o nā ʻiʻo ʻeha ma luna o kou puʻuwai. Ua like ia me ka hana ʻana i kahi maze i loko o ka puʻuwai.

E nānā, ʻo ka mea e hana nei i loko o ka puʻuwai o kekahi me ka Atrial Fibrillation, ʻo ia ka hoʻomaka ʻana o nā hōʻailona uila e kaohi ana i ka puʻuwai ma ke ʻano haunaele, e hoʻomaka ana ma kahi hoʻokahi a laha aku i nā lima ʻehā. ʻO ia ke kumu e nalowale ai ka puʻuwai i kona mele a hoʻomaka koke e kuʻi.

ʻO ke ʻano o nā ʻiʻo ʻeha i hana ʻia ma ke Kaʻina Hana Maze e ālai i nā ala no nā hōʻailona uila kūpono ʻole a hewa e hele i mua a i hope . I ka manawa like, ua wehe ʻia ke ala wale nō no ka hōʻailona uila kūpono e kuʻi ai . E like me ke ala pololei i loko o kahi maze. Pale kēia i nā hōʻailona hewa a pau a ʻae wale i nā hōʻailona pololei e hele. I ka hopena, hoʻi ka helu o kou puʻuwai i kahi mele maʻamau a olakino.

Hoʻohana nā kauka i ʻelua mau ʻano e hoʻoponopono ai i kēia ʻiʻo ʻeha:

• Cryoablation: Hoʻohana i ke anu nui (hau) e hōʻino i nā ʻiʻo a hoʻoulu i ka ʻeha.
• Ikehu alapine lekiō: Hoʻohana ʻia ka ikehu alapine lekiō e hoʻomehana i nā ʻiʻo a hana i ka ʻeha.

Hiki ke hana ʻia kēia kaʻina hana i kekahi manawa i ka manawa like me nā ʻoki puʻuwai ʻē aʻe (e like me ke ʻoki bypass). A i ʻole, hiki ke hana hoʻokahi ʻia. I kēia lā, ʻo ke ʻano hou loa a me ka holomua loa o kēia ʻoki ʻana, ʻo ke kaʻina hana Cox-maze IV , ua manaʻo ʻia ʻo ia ke "kūlana gula" no ka atrial fibrillation.

I nā hihia hea e hana ʻia ai kēia ʻoki kino?

ʻAʻole ʻōlelo ʻia ke Kaʻina Hana Maze no nā maʻi AFib āpau. E kūkākūkā pinepine kāu kauka i kēia kaʻina hana me ʻoe inā:

• Ua kauoha ʻia nouInā ʻaʻole hiki i nā lāʻau lapaʻau ke hoʻomalu i kou puʻuwai, a inā ʻaʻole hiki iā ʻoe ke hoʻohana i kekahi mau lāʻau lapaʻau ma muli o nā hopena ʻaoʻao.
• Inā loaʻa iā ʻoe ka fibrillation atrial, ka mea i hoʻoulu ai i nā ʻōpū koko i loko o kou kino a hoʻoulu i nā kūlana weliweli e like me ka hahau ʻana .
• Inā ua hoʻonohonoho ʻia ʻoe e hana i ke ʻoki kino no kekahi maʻi puʻuwai ʻē aʻe (e laʻa, ka hoʻoponopono ʻana i ka valve puʻuwai, ke ʻoki bypass) , hiki ke hoʻohana ʻia kēia ʻano hana e mālama i kāu fibrillation atrial i ka manawa like me ke ʻoki kino.
• Inā ua hana mua ʻia ʻoe i kahi lāʻau i kapa ʻia ʻo Catheter Ablation a ʻaʻole i holomua.

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

ʻAʻole hiki iā ʻoe ke hele i kahi ʻoki kino e like me kēia i ka manawa hoʻokahi. Ma mua o kēlā, pono ʻoe e nānā pono i ke kūlana o kou kino. Pili ia i kekahi mau hoʻokolohua a me nā kipa ʻana i ke kauka.

• ʻO ka Echocardiogram Transthoracic: Ua like kēia me ka scan ultrasound o ka puʻuwai. Nānā ia i ka nui o kou atrium hema a inā he mau pilikia valve puʻuwai.
• ʻO ke kiʻi CT (Computed Tomography) o ka umauma: Hana ʻia kahi kiʻi CT o ka umauma. I kekahi manawa, inā e hana ʻoe i ke ʻoki kino minimally invasive, pono paha ʻoe e hana i kahi kiʻi CT o ka ʻōpū a me ke pelvis.
• Hālāwai me nā kauka: E hālāwai kāu kauka puʻuwai, kauka ʻoki kino, a me ka anesthesiologist me ʻoe e wehewehe i ke ʻoki kino, kona mau pilikia, a pehea e lawelawe ʻia ai ka anesthesia. E nīnau i nā nīnau āu e loaʻa ai i kēia manawa.
• Ke hāʻawi nei i nā kuhikuhi: E hāʻawi ʻia ʻoe i nā kuhikuhi maopopo e pili ana i ka mea e ʻai ai, inu ai, hoʻōki i ka lawe ʻana, a me nā lāʻau lapaʻau e lawe ai i nā lā ma mua o ke ʻoki ʻana.

Pehea e hana ʻia ai ke ʻoki kino?

Hiki ke hana ʻia ke Kaʻina Hana Maze ma nā ʻano nui ʻelua. Na kāu kauka lapaʻau e hoʻoholo i ke ʻano hana kūpono loa no kou kūlana.

Ma muli o ka hana ʻia ʻana o ke ʻoki puka kī (Thoracoscopic) me nā ʻoki liʻiliʻi loa, ua emi nā pilikia a me ka noho pōkole ʻana i ka haukapila.

He aha ka mea e hana ʻia ai i ka Left Atrial Appendage?

He ʻāpana koʻikoʻi loa kēia o ke Kaʻina Hana Maze. ʻO ka Left Atrial Appendage kahi ʻeke liʻiliʻi o nā ʻiʻo i hoʻopili ʻia i ka atrium hema o ka puʻuwai. ʻO kēia ke kahua nui o ka hoʻokumu ʻia ʻana o ke koko i nā poʻe me ka atrial fibrillation.

Ke hoʻopilikia ʻia ke kani o ka puʻuwai, kū ke koko e komo ana i loko o kēia ʻāpana ma laila, e ʻoi aku ka maʻalahi o ke kūkulu ʻia ʻana o nā ʻūpā koko. Inā haki kahi ʻūpā koko e hana ʻia ma kēia ʻano a hele ma nā kīʻaha koko a paʻa i loko o kahi aa koko i loko o ka lolo, hiki iā ia ke hana i ka hahau.

No laila, i ka wā o ke Kaʻina Hana Maze, pani ke kauka lapaʻau i kēia Left Atrial Appendage me ka hoʻohana ʻana i nā humuhumu, nā staples, a i ʻole kahi mea kūikawā, a ʻoki loa paha iā ia. Hiki i kēia ke hōʻemi nui i kou pilikia o ka loaʻa ʻana o ka hahau i ka wā e hiki mai ana.

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

Ma hope o ke ʻoki kino, e mālama ʻia ʻoe i loko o ka ʻāpana mālama koʻikoʻi (ICU) no ka nānā ʻana no hoʻokahi a ʻelua paha lā, a laila e hoʻoneʻe ʻia i kahi keʻena maʻamau. Inā ua loaʻa iā ʻoe nā ʻoki kino ʻē aʻe, ʻoi aku ka lōʻihi o kou noho ʻana ma ka haukapila. ʻO ka maʻamau, hiki i kahi mea i loaʻa i ke ʻoki kino kī ke hoʻi i ka home ma kahi o ʻehā mau lā. Inā ua loaʻa iā ʻoe ke ʻoki kino hāmama, pono paha ʻoe e noho no kahi o hoʻokahi pule.

ʻOiai ma hope o kou hoʻi ʻana i ka home, pono ʻoe e lawe i kekahi mau lāʻau lapaʻau no kekahi mau mahina.

• Nā lāʻau hoʻokahe koko (nā lāʻau hoʻomāmā koko): Pono ʻoe e lawe i kēia mau lāʻau lapaʻau (e.g., warfarin, apixaban) no ʻekolu mahina ma ka liʻiliʻi e pale aku ai i nā ʻūpā koko. Ma hope o kēlā, e hoʻoholo kāu kauka inā pono ʻoe e hoʻomau i ka lawe ʻana i kēia mau lāʻau lapaʻau.
• Nā lāʻau lapaʻau kaohi o ka puʻuwai: Pono paha kēia mau mea e kaohi i nā puʻuwai kū ʻole i hiki ke hana i nā wā mua o ka hoʻōla ʻana o ka puʻuwai.
• Diuretics: Hāʻawi ʻia kēia mau lāʻau lapaʻau e hōʻemi i ka hōʻiliʻili pono ʻole o ka wai i loko o ke kino.

I kekahi manawa, ʻaʻole i hoʻopau loa ʻia ka AFib ma hope o ke Kaʻina Hana Maze. I ia mau hihia, pono paha kahi ablation catheter hou aʻe. No laila, he mea nui loa e hoʻomau i ka launa pū me kāu cardiologist ma hope o ke kaʻina hana.

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

ʻEhia ka lōʻihi e ho'ōla ai?

ʻO ka maʻamau, he ʻekolu a ʻeono pule e hoʻi ai i kāu mau hana maʻamau o kēlā me kēia lā. Inā ua hana ʻia ʻoe i ke ʻoki puka kī, e wikiwiki loa kou manawa hoʻōla no ka mea ʻaʻohe ʻoki nui ma kou umauma.

Āhea ʻoe e pono ai e ʻike hou i kāu kauka?

Inā ʻike hou ʻoe i nā hōʻailona AFib ma hope o ke ʻoki ʻana, e hoʻomaopopo koke i kāu kauka cardiologist. Eia kekahi, pono ʻoe e mālama i kahi papa kuhikuhi kikoʻī o nā hoʻokolohua a me nā manawa i koho ʻia.

• Ua hoʻi au i ka home mai ka haukapila i hoʻokahi pule.
• E ʻike i kahi cardiologist i loko o hoʻokahi mahina.
• Hoʻāʻo ʻia ka Electrocardiogram (EKG) ma 3, 6, a me 12 mau mahina ma hope o ke ʻoki ʻana, a laila hoʻokahi manawa i ka makahiki.
• Hoʻāʻo ʻia kahi monitor Holter (kahi mea e nānā ai i ka hana o ka puʻuwai no 24 mau hola) ma 6 a me 12 mau mahina ma hope o ke ʻoki ʻana.

He mea nui loa e hana pololei ʻia kēia mau hoʻokolohua a pau e hōʻoia i kou olakino.