He hopena no nā ʻūpā koko i loko o ka puʻuwai? (Paʻa ʻana o ka Atrial Appendage Hema) E aʻo maʻalahi kākou e pili ana i ia mea!

Ua haʻi ʻia anei ʻoe e kāu kauka he Atrial Fibrillation kou, he puʻuwai wikiwiki loa? Ua ʻike paha ʻoe he ʻekolu a ʻelima paha manawa ka nui o ka loaʻa ʻana o ka hahau ʻana i ka poʻe me kēia maʻi ma mua o nā poʻe ʻē aʻe. ʻO ke kumu nui o kēia, ʻo ia nā ʻōpū koko e hana ʻia ana i loko o ka puʻuwai. No laila, i kēia lā, ke kamaʻilio nei mākou e pili ana i kahi lāʻau lapaʻau kūikawā i lawe mai i ka hōʻoluʻolu nui i nā poʻe he nui a hoʻohana ʻia e hōʻemi i kēia pilikia weliweli.

I ka ʻōlelo maʻalahi, he aha ka pani ʻana o ka Left Atrial Appendage?

ʻAe, he inoa paʻakikī paha kēia, akā he maʻalahi loa ka moʻolelo. E noʻonoʻo i ka atrium hema, ke keʻena luna o ko kākou puʻuwai. Aia kahi ʻāpana liʻiliʻi e like me ka ʻeke e puka mai ana mai ka paia o kēia keʻena. ʻO ia ka mea a nā kauka e kapa nei ʻo Left Atrial Appendage (LAA) .

ʻO ka maʻamau, ke paʻi pono ka puʻuwai, kahe ke koko i loko o kēia ʻeke a laila puka hou i waho. Akā i loko o ke kanaka me ka Atrial Fibrillation (Afib), ʻaʻole e ʻūlū pono nā keʻena o luna o ka puʻuwai, akā e haʻalulu. A laila, hōʻiliʻili ke koko i loko o kēlā ʻeke i kapa ʻia ʻo LAA, a hoʻomaka ke koko e hana. 90% o nā koko e hoʻoulu ai i nā hahau i ka poʻe me Afib e hana ʻia i loko o kēia ʻeke liʻiliʻi i kapa ʻia ʻo LAA.

ʻO ka mea maikaʻi loa, ʻo ka pani ʻana i kēia ʻāpana o ka LAA ʻaʻole ia e hoʻopilikia i ke koena o ka hana o ka puʻuwai. Hiki i ka puʻuwai ke hana maikaʻi me ka ʻole o ia.

ʻO wai ka mea e pono ai kēia lāʻau lapaʻau?

ʻOi aku ka maikaʻi o kēia lāʻau lapaʻau no ka poʻe me ka Atrial Fibrillation (Afib) i loaʻa i ka pilikia nui o ka hahau ʻana. He hopena maikaʻi loa ia no ka poʻe i loaʻa nā pilikia me nā lāʻau hoʻokahe koko.

Hoʻomaʻamaʻa pinepine nā kauka i nā lāʻau hoʻokahe koko e like me warfarin (Coumadin®) e hōʻemi i ka pilikia o ka hahau ʻana. Akā, pilikia kekahi poʻe me kēia mau lāʻau:

• Nā hoʻāʻo koko maʻamau: Pono ʻoe e loaʻa i nā hoʻāʻo koko maʻamau e hōʻoia i ka lawe ʻana i ka nui kūpono o ka lāʻau lapaʻau.
• Kaohi ʻana i ka ʻai: Pono paha e kaupalena ʻia kekahi mau meaʻai, e like me nā mea kanu i loaʻa ka wikamina K.
• Ka pilikia o ke kahe ʻana o ke koko: Hiki i kēia lāʻau lapaʻau ke hoʻolohi i ke kaʻina hana kahe ʻana o ke koko mai kahi ʻeha liʻiliʻi. He mea weliweli kēia no ka mea e hāʻule pinepine ana a i ʻole e pilikia ana i ke kahe ʻana o ke koko mai nā ʻōpū.
• ʻAʻole hana kēia lāʻau lapaʻau no kekahi poʻe.

ʻO Apixaban (Eliquis®), rivaroxaban (Xarelto®) me ka ʻole o warfarinʻOiai aia nā lāʻau lapaʻau hou e like me kēia, ʻaʻole lākou e hana no nā mea āpau. He pipiʻi lākou no kekahi poʻe, a loaʻa pū kekahi iā lākou ka pilikia o ke kahe ʻana o ke koko.

No laila, no ka poʻe i paʻakikī ke hoʻomau i ka lawe ʻana i nā lāʻau hoʻokahe koko no nā kumu e like me kēia, hiki iā ʻoe ke kamaʻilio me kāu kauka e pili ana i kahi lāʻau i kapa ʻia ʻo LAA Closure.

He aha nā ʻano hana i hoʻohana ʻia e pani ai i ka LAA?

Aia kekahi mau ʻano hana a me nā mea hana e pani ai i kēia ʻāpana o ka LAA. ʻO kekahi o kēia mau mea:

Ke hoʻomākaukau ʻana a me ka hana ʻana i ka lāʻau lapaʻau

Ma mua o ka mālama ʻana

Ma mua o kou hana ʻana i kēia lāʻau lapaʻau, e nānā kāu kauka i kou puʻuwai me kahi Transesophageal Echocardiogram (TEE).Hana ʻia kahi scan i kapa ʻia ʻo TEE a i ʻole ka cardiac CT scan. ʻO ka TEE ke komo ʻana i kahi kāmela liʻiliʻi i lalo o ka esophagus e ana i ke ʻano a me ka nui o ka LAA i loko o ka puʻuwai. ʻO kēia no ka mea ʻaʻole like ka LAA o kēlā me kēia kanaka. ʻO ke ʻano o nā LAA o kekahi poʻe he ʻēheu moa, aʻo nā LAA o kekahi poʻe he ʻano pulelehua. Hoʻohana ʻia kēia scan e koho i ka hāmeʻa kūpono a me ka nui nāu.

Eia kekahi, e aʻo ʻia ʻoe e hoʻōki i ka ʻai ʻana a me ka inu ʻana (hoʻokē ʻai) no kekahi mau hola ma mua o ka mālama ʻana.

I ka wā o ka mālama ʻana

ʻElua ala nui e hana ai i kēia.

1. Ke hana ʻana i ka manawa like me nā ʻoki puʻuwai ʻē aʻe: Inā ʻoe e hana nei i kahi ʻoki puʻuwai nui ʻē aʻe, e like me ke ʻoki bypass, hiki i ke kauka ke ʻoki a wehe i kēia ʻāpana o ka LAA i ka manawa like, a i ʻole e humuhumu iā ia a pani ʻia.

2. Minimally Invasive: ʻO kēia ke ʻano hana maʻamau. ʻAʻohe ʻoki nui ma ʻaneʻi. Eia ka mea e hana ʻia:

• Hana ʻia kahi ʻoki liʻiliʻi ma ka ʻili kokoke i ka ʻūhā, a hoʻokomo ʻia kahi ʻōmole lahilahi i kapa ʻia he catheter ma waena o kahi kīʻaha koko ma laila a i ka puʻuwai.
• Hoʻokomo ʻia kēia ʻōmole mai ka atrium ʻākau o ka puʻuwai a i ka atrium hema, ma o kahi lua liʻiliʻi ma ka paia ma waena o nā keʻena ʻelua. (Mai hopohopo, pani pinepine kēia lua iā ia iho i loko o 6 mau mahina).
• A laila hoʻokuʻu ʻia ka ʻōmole i ka LAA, a ua koi ʻia ka mea i koho mua ʻia e pani i ka waha o ka LAA.
• Hana ʻia kēia mau mea a pau ma ka nānā ʻana i loko me nā scan e like me Fluoroscopy (wikiō X-ray) a me TEE .
• A pau ka hana, e lawe ʻia ka catheter.

He aha ka mea e hana ʻia ma hope o ka lāʻau lapaʻau?

Inā hana ʻia kēia lāʻau lapaʻau ma kahi ʻoki liʻiliʻi, hoʻokahi wale nō pō āu e noho ai ma ka haukapila a hiki iā ʻoe ke hoʻi i ka home i ka lā aʻe.

E loli iki ka hoʻolālā lāʻau lapaʻau ma hope o kou hoʻi ʻana i ka home.

• ʻO ka maʻamau, no nā lā 45 mua , e haʻi ʻia iā ʻoe e lawe i kahi anticoagulant a me ka aspirin. I loko o ia manawa, e hana ʻia ka ʻiʻo ʻili a puni ka hāmeʻa, e hoʻopaʻa pono ana iā ia.
• Ke hōʻoia ka nānā ʻana o ka TEE ma hope o 45 mau lā ua pani loa ʻia ka LAA, hiki iā ʻoe ke hoʻōki i ka lawe ʻana i nā lāʻau hoʻokahe koko. A laila e hāʻawi ʻia ʻoe i ka clopidogrel (Plavix®) a me ka aspirin no 6 mau mahina .
• I kekahi manawa, ʻōlelo ke kauka e lawe i ka aspirin i ka wā lōʻihi.

He aha nā pono a me nā pilikia?

E like me nā lāʻau lapaʻau āpau, aia nā pono a me nā pilikia liʻiliʻi. E wehewehe kāu kauka i kēia mau mea āpau iā ʻoe.

Āhea ʻoe e pono ai e kamaʻilio me ke kauka?

Inā ʻike ʻoe i kekahi o kēia mau hōʻailona ma hope o ka hoʻi ʻana i ka home ma hope o ka lāʻau lapaʻau, e hoʻomaopopo koke i kāu kauka.

• Ke kuni a i ʻole nā ​​hōʻailona ʻē aʻe o ka maʻi (pehu ʻana, ʻulaʻula o ka ʻoki ʻia).
• He puʻuwai kūpono ʻole, he manaʻo e lele ana i loko o ka umauma.
• ʻEha nui o ka umauma.
• Paʻakikī ka hanu ʻana.

Hiki ke kaumaha ka noho ʻana me Afib, ʻoiai inā he pilikia kou me kāu mau lāʻau hoʻokahe koko. ʻAʻole no nā kānaka āpau ka LAA Closure, akā he koho paha ia nou. No laila e wehe e pili ana i ia mea me kāu kauka cardiologist, e nīnau i kāu mau nīnau, a e hoʻoholo i ka mea maikaʻi loa iā ʻoe.