E aʻo kākou e pili ana i ka mālama ʻana i ka mitral valve (TMVR) me ke ʻoki ʻole ʻana

Ua haʻi ʻia anei ʻoe a i ʻole kekahi āu i ʻike ai a i ʻole he hoaaloha pili paha e ke kauka he pilikia kou me ka 'Mitral Valve' o kou puʻuwai a pono ʻoe i ke ʻoki kino? Ke lohe mākou i ka huaʻōlelo "ʻoki kino," nui ka poʻe o mākou e makaʻu iki, ʻeā? He mea maʻamau kēlā. No ka mea, ua lohe mākou e pili ana i nā ʻoki kino e pili ana i ka wehe ʻana i ka umauma a me ka hana ʻana i nā ʻoki kino nui. Akā, ua ʻike anei ʻoe, ua holomua nui ka ʻepekema lapaʻau i kēia manawa. No laila, aia kekahi ʻano hana hou e hiki ke pani i kēia valve me ka ʻole o ka wehe ʻana i ka umauma a ma o kahi ʻoki liʻiliʻi loa. I kēia lā, e kamaʻilio mākou e pili ana i kahi ʻano lapaʻau i lilo i mea hōʻoluʻolu nui no nā poʻe he nui, i kapa ʻia ʻo 'Transcatheter Mitral Valve Replacement' a i ʻole TMVR no ka pōkole.

I ka ʻōlelo maʻalahi, he aha ka TMVR?

ʻAe, e wehewehe maʻalahi kākou. He hana kaʻina hana ʻo TMVR e pani ana i ka valve mitral i loko o kou puʻuwai. Akā, ʻo ka mea kūikawā e pili ana i ia mea, ʻaʻole ia e hana ʻia ma ka wehe piha ʻana i kou umauma e like me ke ʻoki puʻuwai hāmama. Akā, ua hoʻokomo ʻia kahi ʻōmole lahilahi (catheter) ma o kahi ʻoki liʻiliʻi loa, a laila hoʻokomo ʻia ka valve hou i loko o kou puʻuwai.

E noʻonoʻo ʻoe ma kahi o ka wehe ʻana i kahi kiwikā nui a hoʻololi iā ia me kahi mea hou, lawe ʻoe i nā ʻāpana o ka kiwikā hou ma o kahi lua liʻiliʻi a hoʻopaʻa iā lākou i loko. He hana invasive iki kēia ma mua o ke ʻoki kino nui. Hiki ke hana ʻia ka kiwikā hou i hoʻokomo ʻia ma kēia ʻano. A i ʻole he kiwikā olaola i hana ʻia mai ka bipi wahine, puaʻa, a i ʻole ka ʻiʻo puʻuwai kanaka. Ma hope o ke komo ʻana o ka kiwikā hou, hoʻomaka ia e hana i ka mea like me kāu kiwikā kahiko a maʻi.

ʻO wai ka mea e pono ai kēia lāʻau TMVR?

No ka hoʻomaopopo ʻana i kēia, e nānā mua kākou i ke ʻano o kēia 'mitral valve' a me ka mea e hana ʻia iā ia.

ʻEhā keʻena nui o ko kākou puʻuwai. ʻElua ma luna a ʻelua ma lalo. Aia ka valve mitral ma waena o ka atrium hema a me ka ventricle hema. Ua like ia me ka puka ma waena o nā lumi ʻelua. ʻElua mau ʻāpana (leaflet) o kēia puka. I kēlā me kēia manawa e paʻi ai ka puʻuwai, wehe a pani kēia mau ʻāpana. ʻAe kēia i ke koko e kahe i hoʻokahi wale nō ʻaoʻao, mai ke keʻena luna a i ke keʻena lalo. ʻO ka hana nui o kēia valve, ʻo ia ke pale i ke koko mai ke kahe ʻana i hope.

Akā i kekahi manawa, mai ka hānau ʻana a ma hope paha, hiki ke loaʻa nā pilikia like ʻole me kēia kiwikā. ʻElua ʻano pilikia nui.

Ke koʻikoʻi kēia mau kūlana, hiki iā lākou ke hana i nā hōʻailona e like me ka pōkole o ka hanu, ka luhi, a me ka ʻeha o ka umauma. Hiki iā lākou ke alakaʻi i nā kūlana koʻikoʻi e like me ka atrial fibrillation (ka puʻuwai kūpono ʻole), ka hypertension pulmonary (ke koko kiʻekiʻe i loko o nā māmā), a i ʻole ka hāʻule ʻana o ka puʻuwai.

He like anei ʻo TMVR lāua ʻo MitraClip?

ʻAʻole. ʻOiai ʻo nā mea ʻelua he mau lāʻau lapaʻau invasive ʻole no nā pilikia valve mitral, aia kahi ʻokoʻa ma waena o nā mea ʻelua.

• He pani piha ʻo TMVR no ka valve.
• He hana hoʻoponopono valve ʻo MitraClip™ . Ua like ia me ke kau ʻana i kahi ʻūmiʻi liʻiliʻi ma waena o nā ʻāpana ʻelua o kahi valve e liki ana, e hoʻōki ana i ka liki ʻana.

E hoʻoholo kāu cardiologist i ke ʻano o ka lāʻau lapaʻau kūpono loa iā ʻoe.

He aha ka mea e hana ʻia ma mua o ka mālama ʻana iā TMVR?

Ma mua o kēia lāʻau lapaʻau, e nānā pono kāu hui lapaʻau iā ʻoe. E komo pū ana kēia me kēia mau hoʻokolohua:

• Echocardiogram: He scan ultrasound kēia o ka puʻuwai. Hiki iā ia ke ʻike maopopo i ke ʻano o ka hana ʻana o nā keʻena a me nā valves o ka puʻuwai.
• CT Scan: Lawe kēia i nā kiʻi ʻekolu-dimensional (3D) o ka puʻuwai a me nā kīʻaha koko a kōkua i ka hoʻolālā ʻana i ka mālama ʻana.

Ma ka hoʻohana ʻana i ka ʻike mai kēia mau hoʻokolohua, hoʻolālā ke kime lapaʻau i ka nui o ka valve maikaʻi loa a me ke ʻano lapaʻau nāu.

Eia kekahi, e kamaʻilio kekahi kauka anesthesiologist me ʻoe a hoʻoholo i ke ʻano anesthesia maikaʻi loa e pale aku iā ʻoe mai ka ʻeha i ka wā o ke kaʻina hana. Hiki ke hoʻomoe loa ʻia ʻoe (anesthesia laulā), a i ʻole e hoʻomoe ʻia ʻoe a ʻaʻole ʻoe e ʻeha (hoʻomoe ʻike).

I kekahi mau lā ma mua o kāu lāʻau lapaʻau, e hāʻawi kāu kauka iā ʻoe i nā kuhikuhi maopopo no ka hoʻomākaukau ʻana. Hiki i kēia mau mea ke komo pū me:

• ʻO kekahi mau lāʻau lapaʻau, e like me nā lāʻau hoʻokahe koko, pono e hoʻopau ʻia no kekahi mau lā.
• I ka lā o ka mālama ʻana, e noi ʻia ʻoe e hoʻokē ʻai (me ka ʻai ʻole a me ka inu ʻole) no kekahi mau hola.
• Ma hope o ka mālama ʻana, noi lākou e hoʻonohonoho i kahi kaʻa e lawe iā ʻoe i ka home mai ka haukapila.

He aha ka mea e hana ʻia i ka wā o ka mālama ʻana iā TMVR?

ʻO ka maʻamau, ʻelua a ʻekolu hola ka lōʻihi o ke kaʻina hana holoʻokoʻa a hana ʻia e kahi hui nui o nā kauka, me nā kauka ʻoki puʻuwai, nā cardiologists interventional, nā loea kiʻi, a me nā anesthesiologists.

Eia kahi wehewehe maʻalahi o nā mea e hana ʻia i ka wā o ka mālama ʻana:

1. ʻO ka mea mua, e hoʻomaʻemaʻe ʻia ka wahi e ʻoki ʻia ai (pinepine ka ʻūhā a i ʻole kahi liʻiliʻi ma ka umauma) a wehe ʻia ka lauoho inā pono.

2. A laila, e kau ʻia kahi cannula (laina IV) i loko o kahi aa koko ma kou lima, kahi e hāʻawi ʻia ai iā ʻoe nā lāʻau lapaʻau a me nā wai e pono ai.

3. A laila, hoʻopili ʻia ka valve hou i ka hopena o kahi ʻōmole lahilahi a palupalu i kapa ʻia he catheter .

4. I kēia manawa, hana ʻia kahi ʻoki liʻiliʻi loa ma kahi i hoʻoholo mua ʻia ma ka ʻūhā a i ʻole ka umauma, a ma o ia mea, hoʻokomo ʻia kēia catheter i loko o kahi kīʻaha koko.

5. Me ka hoʻohana ʻana i ka ʻenehana kiʻi kūikawā, e like me nā kukuna X, alakaʻi pono nā kauka i kēia catheter ma o nā kīʻaha koko a i ka valve mitral i loko o ka puʻuwai.

6. Ke kau ʻia, e kau ʻia ka valve hou i loko o ka valve kahiko i maʻi ʻia.

7. Ke kau pono ʻia ka valve hou, e wehe pono ʻia ke catheter a pani ʻia ka ʻoki liʻiliʻi.

I loko o kēia manawa, e hoʻomau ka hui lapaʻau i ka nānā ʻana i nā mea āpau mai kou koko a me nā pae oxygen koko a hiki i ka hana ʻana o kou puʻuwai me ka hoʻohana ʻana i kahi echocardiogram.

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

Ma hope o ka pau ʻana o ka lāʻau lapaʻau, e lawe ʻia ʻoe i kahi lumi hoʻōla. E mālama pono ke kime lapaʻau iā ʻoe a hiki i kou hoʻōla ʻana mai ka anesthesia. Pono paha kekahi poʻe e noho i loko o ka ʻāpana mālama koʻikoʻi (ICU) no kekahi manawa. ʻO ka maʻamau, pono ʻoe e noho i ka haukapila no kekahi mau lā.

Ma mua o kou hoʻi ʻana i ka home, e wehewehe pono nā kauka i kāu mea e hana ai.

• Hoʻoponopono hou ʻana i ka puʻuwai: Nā ʻōlelo aʻoaʻo no nā hoʻomaʻamaʻa kino a me nā loli o ke ʻano o ka nohona e kōkua ai i ka hoʻoikaika hou ʻana i ka puʻuwai.
• Nā manawa hoʻopaʻa: Nā lā e pono ai ʻoe e ʻike hou i ke kauka.
• Nā lāʻau lapaʻau: Nā ʻōlelo aʻoaʻo no nā lāʻau lapaʻau hou e hoʻomaka ai a i ʻole nā ​​​​lāʻau lapaʻau kahiko e hoʻomaka hou.
• Hana maʻamau: Āhea ʻoe e hoʻi ai i ka hana a hoʻomau i nā hana maʻamau?

He aha nā pono o ka mālama ʻana me TMVR?

Ke hoʻohālikelike ʻia me ke ʻoki puʻuwai hāmama, he nui nā pono o kēia ʻano catheter.

• Hiki ke hoʻoponopono ʻia ka maʻi valve mitral.
• Ka hōʻemi ʻana o nā hōʻailona i hoʻokumu ʻia e ka maʻi, e like me ka pōkole o ka hanu a me ka luhi.
• Hoʻemi ʻia ka pilikia o nā pilikia olakino koʻikoʻi.
• Hiki ke ho'ōla wikiwiki ma mua o ke ʻoki kino hāmama.
• Hoʻemi ʻia ka hopena o ke kino a me ka ʻeha.

Aia kekahi mau pilikia a i ʻole nā ​​​​pilikia me kēia lāʻau lapaʻau?

ʻAe. ʻOiai ʻoi aku ka haʻahaʻa o nā pilikia ma mua o ke ʻoki puʻuwai hāmama, e like me nā kaʻina hana lapaʻau āpau, hiki i ka TMVR ke loaʻa kekahi mau pilikia a me nā pilikia. Eia nō naʻe, he mea kakaikahi loa kēia.

Eia kekahi o nā pilikia nui e hiki ke hana:

• Nā ʻūpā koko: Inā hele kēia mau ʻūpā koko i ka lolo, hiki ke loaʻa kahi hahau.
• Ka hōʻino ʻana o nā ʻiʻo: Hiki ke hōʻeha ʻia kahi paia o ka puʻuwai (perforation ventricular hema) a i ʻole kahi kīʻaha koko e hoʻolako ana i ke koko i ka puʻuwai (coronary artery).
• Ka ālai ʻana o ke kahe ʻana o ke koko i waho o ka ventricle hema: Ke ālai nei ka valve hou i ke ala o ke koko e kahe ana mai loko mai o ke keʻena haʻahaʻa hema.
• Ka neʻe ʻana o ka valve: Ka neʻe ʻana o ka valve mai kona kūlana paʻa.

Pono paha kekahi mau pilikia i ka mālama hou ʻana a i ʻole ke ʻoki ʻana.

ʻEhia ka lōʻihi e hoʻōla ai?

Hiki i ka hapa nui o ka poʻe ke hoʻi i kā lākou mau hana maʻamau a hana i loko o kekahi mau pule. Eia nō naʻe, hiki ke hala i ʻelua a ʻekolu mahina e hoʻōla piha ai . ʻO ka mea nui loa, ʻo ia ke hahai pono i nā ʻōlelo a kāu kauka. Mai wikiwiki i ka hana kaumaha a i ʻole ka hana hoʻoikaika kino.

I nā hihia hea e pono ai ʻoe e ʻimi i ke kōkua lapaʻau ma hope o ka mālama ʻana?

He ʻāpana koʻikoʻi loa kēia. Ke hoʻi ʻoe i ka home ma hope o ka mālama ʻana, pono ʻoe e makaʻala i nā loli i kou kino. Aia kekahi mau hōʻailona, ​​​​inā ʻike ʻia lākou, pono ʻoe e ʻimi koke i ke kōkua lapaʻau .

He koho lapaʻau waiwai nui ka TMVR no ka poʻe me ka maʻi valve mitral ʻaʻole hiki ke hana i ke ʻoki puʻuwai hāmama. Inā he mau nīnau hou aku kāu e pili ana i kēia, e ʻoluʻolu e kamaʻilio me kāu kauka. E hiki iā ia ke wehewehe i ke koho lapaʻau maikaʻi loa nāu.