Ua lohe paha ʻoe i ka Atrial Fibrillation (Afib), kahi kūlana e paʻi pinepine ai kou puʻuwai a wikiwiki hoʻi. Loaʻa paha iā ʻoe a i ʻole kekahi o kou ʻohana kēia maʻi. ʻO ka pilikia nui o Afib ka piʻi ʻana o ka pilikia o ka hahau ʻana. Ma ke ʻano he hopena no kēia, kuhikuhi pinepine nā kauka i nā lāʻau hoʻokahe koko. Akā, ʻaʻole maʻalahi ka lawe ʻana i kēia mau lāʻau lapaʻau no nā mea āpau i ka wā lōʻihi. No kēlā poʻe, ke kamaʻilio nei mākou e pili ana i kahi ʻano lapaʻau kūikawā e hiki ke hōʻemi i ka pilikia o ka hahau ʻana.
I ka ʻōlelo maʻalahi, he aha ka Left Atrial Appendage Closing (LAA Closure)?
I mea e hoʻomaopopo ai i kēia, e aʻo mua kākou e pili ana i kahi ʻāpana liʻiliʻi o ko kākou puʻuwai. Ma ke keʻena hema o luna o ko kākou puʻuwai, i kapa ʻia ʻo ka Left Atrium, aia kahi ʻeke liʻiliʻi e like me ka ʻeke. ʻO kēia ka mea a kākou e kapa nei ʻo ka Left Atrial Appendage (LAA) .
ʻO ka maʻamau, ke kuʻi ka puʻuwai i kahi mele, ua hoʻokuʻu ʻia ke koko i loko o kēia LAA i ke koena o ka puʻuwai. Eia nō naʻe, i loko o ke kanaka me ka Atrial Fibrillation (Afib) , kuʻi ka puʻuwai i ke ʻano ʻē, no laila ʻaʻole e paʻi pono ke koko i loko o kēia ʻeke i kapa ʻia ʻo LAA a hoʻomaka e hōʻiliʻili. Hiki i kēia hōʻiliʻili ʻana o ke koko ke lilo i mau ʻūpā koko .
ʻO ka mea pōʻino, inā haki kēia ʻaʻa koko a paʻa i loko o kahi kīʻaha koko e alakaʻi ana i ka lolo, hiki iā ia ke hana i kahi hahau . Ma kahi o 90% o nā hahau i ka poʻe me Afib i hana ʻia e nā ʻaʻa koko e hana ana i loko o ka LAA.
No laila, ma kēia lāʻau i kapa ʻia ʻo LAA Closure, ua pani ʻia ka ʻeke i kapa ʻia ʻo LAA kahi e hana ai nā ʻōpū koko, ma o ke ʻoki ʻana a i ʻole ma o kahi ʻoki liʻiliʻi loa. Ma hope o ka pani ʻia ʻana o kēia, ʻoiai inā hana ʻia nā ʻōpū koko, ʻaʻole hiki iā lākou ke komo i ke kahe koko. No laila, ua emi nui ka pilikia o ka hahau ʻana.
ʻO ka mea nui, ʻaʻole e ho'ōla kēia lāʻau iā Afib, akā, hoʻemi nui ia i ka pilikia o ka hahau ʻana i hana ʻia e ia.
No wai kēia lāʻau lapaʻau maikaʻi loa? No ke aha e hoʻohana ʻole ai i nā lāʻau hoʻokahe koko?
ʻAʻole ʻo LAA Closure kahi lāʻau lapaʻau no nā mea āpau i loaʻa i ka pilikia nui o ka hahau ʻana ma muli o Afib. Ua noʻonoʻo nui ʻia no ka poʻe:
- No ka poʻe makemake ʻole e lawe i nā anticoagulants no ka manawa lōʻihi.
- ʻO ka poʻe e hāʻule pinepine ana a no laila ua nui ka pilikia o ke kahe ʻana o ke koko (no ka mea, ʻoiai kahi ʻeha liʻiliʻi hiki ke hoʻoulu i ke kahe nui ʻana i ka wā e lawe ana i nā lāʻau hoʻokahe koko).
- No ka poʻe i ʻike i nā hopena ʻē aʻe mai nā lāʻau hoʻokahe koko.
- No ka poʻe hiki ʻole ke uku i ke kumukūʻai kiʻekiʻe o nā lāʻau hoʻokahe koko.
He nui ka poʻe e kū nei i nā pilikia like ʻole i ka wā e lawe ai i nā lāʻau hoʻokahe koko kahiko e like me Warfarin.
| Nā pilikia me ka lawe ʻana i nā lāʻau lapaʻau e like me Warfarin |
|---|
| - Pono ʻoe e hele pinepine i ka haukapila e hoʻāʻo ʻia kou koko e hōʻoia i ka pololei o ka nui o ka lāʻau. |
| - Pono e kaupalena ʻia kekahi mau meaʻai i loaʻa ka wikamina K (e like me ka sipinaha). |
| - He kiʻekiʻe loa ka pilikia o ke kahe ʻana o ke koko. |
| - ʻAʻole hiki i ke kino o kekahi poʻe ke ʻae i kēia lāʻau lapaʻau. |
ʻOiai aia nā lāʻau lapaʻau hou e like me Apixaban lāua ʻo Rivaroxaban, ʻo ko lākou kumukūʻai kiʻekiʻe a me ka hoʻomau ʻana o ka pilikia o ke kahe ʻana he mau pilikia ia no kekahi poʻe. Pono ʻoe e kamaʻilio me kāu kauka puʻuwai e hoʻoholo i ka lāʻau lapaʻau kūpono loa iā ʻoe.
He aha nā ʻano hana i hoʻohana ʻia e pani ai i kēia LAA?
Aia nā ʻano hana a me nā mea hana like ʻole no kēia. E noʻonoʻo e like me ke pani ʻana i ka waha o kahi ʻōmole wai, hoʻohana ʻia kēia mea hana e pani i ka waha o kēia ʻeke i kapa ʻia ʻo LAA.
- Nā mea hana pani kūloko: Ua like kēia me kahi umbrella liʻiliʻi. Hoʻokomo ʻia lākou i loko o ka puʻuwai me ka hoʻohana ʻana i kahi catheter a hoʻohana ʻia e sila i ka puka o ka LAA mai loko mai. ʻO nā mea hana kaulana e komo pū ana me WATCHMAN™ a me Amulet™.
- Nā mea pani waho: I kekahi manawa, i ka wā o ke ʻoki puʻuwai ʻē aʻe, hiki ke pani ʻia ka LAA ma waho me kahi clip (`AtriClip™`) a i ʻole me kahi suture kūikawā (`Lariat™`).
Koho ʻia ke ʻano hana kūpono iā ʻoe ma hope o ke kūkākūkā ʻana ma waena ou a me kāu kauka.
Ka hoʻomākaukau ʻana no ka mālama ʻana a pehea e hana ʻia ai ka mālama ʻana
Ma mua o ka mālama ʻana...
Ma mua o kēia kaʻina hana, pono kāu kauka e ana i ka nui a me ke ʻano pololei o kāu LAA. ʻAʻole like ka LAA o kēlā me kēia kanaka. Wahi a kekahi ua like kona ʻano me ka ʻēheu moa, ka cactus, a i ʻole ka cauliflower. E pili ana kēia i kahi Transesophageal Echocardiogram (TEE) (kahi scan o ka puʻuwai i hana ʻia ma o kahi ʻōmole i kapa ʻia he larynx) a i ʻole kahi Cardiac CT scan. E aʻo ʻia hoʻi ʻoe e hoʻokē ʻai (ʻaʻole e ʻai a inu paha) no kekahi mau hola ma mua o ke kaʻina hana.
I ka wā o ka mālama ʻana...
Hiki ke hana i kēia ma nā ʻano nui ʻelua:
1. Me nā ʻoki puʻuwai ʻē aʻe:Inā ʻoe e hana nei i kekahi ʻoki puʻuwai nui ʻē aʻe, e like me ke ʻoki bypass, hiki i ke kauka lapaʻau ke wehe a humuhumu paha i ka LAA i pani ʻia i ka manawa like.
2. Minimally Invasive: ʻO kēia ke ʻano hana i hoʻohana pinepine ʻia. Maanei, ua hoʻokomo ʻia kahi ʻōmole lahilahi, i kapa ʻia he catheter, ma o kou ʻūhā i loko o kahi aa a alakaʻi ʻia a hiki i kou puʻuwai. A laila, ua kau ʻia kahi mea i koho mua ʻia ma ka puka o ka LAA a hoʻopaʻa ʻia e pale i ka puka ʻana o nā ʻōpū koko. Hana ʻia kēia kaʻina hana holoʻokoʻa ma lalo o ke alakaʻi ʻana o ka ʻenehana X-ray kūikawā (Fluoroscopy) a me ka scan (TEE/Intracardiac Ultrasound).
Ma hope o ka mālama ʻana...
- ʻO ka maʻamau, pono ʻoe e noho i ka haukapila i ka pō.
- E hana hou ʻia kahi scan TEE i loko o 45 mau lā e ʻike ai inā ua holomua ka lāʻau lapaʻau.
- E hāʻawi ʻia ʻoe i kahi lāʻau hoʻokahe koko a me ka aspirin e lawe a hiki i ka ulu ʻana o nā ʻiʻo o ke kino a puni kēia hāmeʻa, ʻo ia hoʻi ka manawa e mau ai ma kahi o hoʻokahi mahina a me ka hapa.
- Ma hope o kēlā, pono ʻoe e hoʻōki i ka lawe ʻana i ka lāʻau hoʻokahe koko a lawe iā Clopidogrel a me ka aspirin no kahi o 6 mau mahina. Pono paha ʻoe e lawe i ka aspirin no ke koena o kou ola. E hana ʻia kēia mau mea a pau ma ke ʻōlelo aʻo a kāu kauka.
He aha nā pōmaikaʻi a me nā pilikia o kēia lāʻau lapaʻau?
E like me nā lāʻau lapaʻau āpau, loaʻa i kēia lāʻau nā pono a me nā pilikia.
| Nā Pōmaikaʻi | Nā Pōʻino/Nā Pilikia |
|---|---|
| Ua hoʻemi nui ʻia ka pilikia o ka hahau ʻana. | He pilikia me ka hāmeʻa kau ʻana. |
| ʻO ka hiki ke kūʻokoʻa mai ka lawe ʻana i nā lāʻau hoʻokahe koko lōʻihi (anticoagulants). | He hopena maikaʻi ʻole i ka anesthesia. |
| Hoʻōla wikiwiki no ka mea hana ʻia ma o kahi ʻoki liʻiliʻi. | Ke kahe ʻana o ke koko. |
| Ka hoʻomaikaʻi ʻana i ke ʻano o ke ola. | ʻEha umauma, maʻi. |
| Ka hōʻiliʻili ʻana o ka wai a puni ka puʻuwai (pericardial effusion). | |
| He ʻano maʻi e like me ka hahau ʻana kakaikahi loa. |
He kūpono loa kēia lāʻau lapaʻau. Wahi a kekahi mau noiʻi, hiki i kēia ʻano hana ke hōʻemi i ka pilikia o ka hahau ʻana ma kahi o 80%. Akā e hoʻomanaʻo, he mea nui e kūkākūkā i kēia mau mea āpau me kāu kauka ma mua o ka hoʻoholo ʻana inā kūpono kēia iā ʻoe.
Āhea wau e ʻike ai i ke kauka?
Ma waho aʻe o ka hele ʻana i kāu mau manawa hoʻopaʻa i hoʻonohonoho ʻia, e hoʻomaopopo koke i kāu kauka inā ʻike ʻoe i nā hōʻailona penei:
- Nā hōʻailona o ke kuni a i ʻole ka maʻi ʻē aʻe
- Puʻuwai puʻuwai kūpono ʻole
- ʻEha umauma
- Paʻakikī ka hanu ʻana
Inā ʻike ʻoe i kekahi o kēia mau hōʻailona, e hele koke i ka ʻOihana Pilikia (ETU) o ka haukapila kokoke loa.
Leka Lawe-Home
- ʻO ka LAA Closure kahi lāʻau lapaʻau no ka poʻe me Atrial Fibrillation (Afib) e hōʻemi i ka pilikia o ka hahau ʻana.
- Hana kēia ma ka pani ʻana i kahi ʻeke liʻiliʻi i loko o ka puʻuwai i kapa ʻia ʻo LAA, e pale ana i nā ʻūpā koko e hana ʻia ma laila mai ke komo ʻana i ke kino.
- He koho maikaʻi kēia lāʻau lapaʻau no ka poʻe i pilikia i ka lawe ʻana i nā lāʻau hoʻokahe koko i ka wā lōʻihi.
- ʻAʻole kēia e ho'ōla iā Afib, akā hiki iā ia ke pale aku i ka pilikia nui loa, ʻo ia hoʻi ka hahau ʻana.
- E hoʻoholo ma hope o ke kamaʻilio ʻana me kāu kauka cardiologist inā kūpono kēia lāʻau lapaʻau iā ʻoe a me kona mau pono a me nā pilikia.
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