He ʻōkana kupaianaha ko kākou puʻuwai e hana mau ana. I loko o kēia puʻuwai, aia he ʻehā mau kiwikā e hana ana e like me nā puka ʻehā e kāohi pono i ke kahe ʻana o ke koko. ʻAe kēia i ke koko e kahe i hoʻokahi wale nō ʻaoʻao. ʻO kekahi o kēia mau kiwikā ua kapa ʻia ʻo 'Mitral valve'. Aia kēia ma ka ʻaoʻao hema o ka puʻuwai ma waena o ke keʻena luna (atrium hema) a me ke keʻena haʻahaʻa (ventricle hema). Akā i kekahi manawa hiki i kēia kiwikā mitral ke lilo i maʻi. ʻO ia hoʻi, hiki i ke koko ke kahe i hope me ka ʻole o ka pani pono ʻana, a i ʻole hiki ke ālai ʻia me ka ʻole o ka wehe pono ʻana. No laila i kēia hihia, pono e hoʻololi ʻia kēlā kiwikā.
No laila he aha ka TMVR?
I ka ʻōlelo maʻalahi, ʻo TMVR (Transcatheter Mitral Valve Replacement) kahi ʻano lapaʻau hou e pani ana i ka valve mitral i hōʻino ʻia me kahi valve hou me ka ʻole o ka hana ʻana i ke ʻoki puʻuwai nui.
E noʻonoʻo, ma kahi o kahi ʻoki kino nui e pili ana i ka wehe ʻana i ka umauma a me ke kāohi ʻana i ka puʻuwai, ua hoʻokomo ʻia kahi ʻōmole lahilahi (catheter) ma o kahi ʻoki liʻiliʻi loa ma ka ʻūhā a i ʻole ka umauma, ma ke aʻa koko, i loko o ka puʻuwai, a ua hoʻokomo ʻia kahi valve hou ma o ka ʻōmole a hoʻopaʻa ʻia ma kahi o ka valve kahiko, maʻi. Hiki i kēia valve hou ke lilo i valve i hana ʻia e ke kanaka, a i ʻole hiki ke hana ʻia mai nā ʻiʻo holoholona (pipi, puaʻa). Ma kēia ʻano hana, ʻaʻole i wehe ʻia ka valve kahiko, akā ua kau ʻia ka mea hou i loko a hoʻopaʻa ʻia.
ʻO wai ka mea e pono maoli ai kēia lāʻau lapaʻau?
ʻElua mau ʻano nui o ka maʻi valve mitral:
1. Ka luaʻi ʻana o ka valve mitral: ʻO kēia ka wā e pani pono ʻole ai nā ʻāpana ʻelua o ka valve, e hoʻokahe ana i hope kekahi o ke koko i pamu ʻia e ka puʻuwai. Ua like ia me ka wai e kahe ana mai kahi faucet i haki.
2. ʻO ka stenosis o ka valve mitral: ʻO kēia ka wā e haiki ai ka valve a ʻaʻole e wehe pono. Hoʻopaʻa kēia i ka nui o ke koko e hiki ke kahe i mua. E like me ka wā e ālai ʻia ai kahi paipu, emi iho ke kahe o ka wai.
Ke koʻikoʻi kēia mau kūlana ʻelua, hiki ke loaʻa nā hōʻailona koʻikoʻi e like me ka pōkole o ka hanu, ka atrial fibrillation, ke koko kiʻekiʻe pulmonary, a me ka hāʻule ʻana o ka puʻuwai.
ʻO ka maʻamau, hana ʻia ke ʻoki puʻuwai hāmama i nā hihia e like me kēia. Eia nō naʻe, he koho maikaʻi loa ʻo TMVR no ka poʻe ʻelemakule, loaʻa nā pilikia olakino ʻē aʻe, a ʻaʻole hiki ke uku i nā pilikia o ia ʻoki nui.
He like anei ʻo TMVR lāua ʻo MitraClip?
ʻAʻole. ʻOiai ʻo kēia mau mea ʻelua he mau lāʻau lapaʻau i hana ʻia me ka wehe ʻole ʻana i ka puʻuwai, he ʻelua mau ʻano hana like ʻole lāua.
- MitraClip™: Pili kēia i ka hoʻoponopono ʻana i kahi kiwikā e liki ana. Pili kēia i ke kau ʻana i kahi mea liʻiliʻi e like me ke clip ma waena o nā ʻāpana ʻelua o ka kiwikā e pale ai i ke kahe ʻana o ke koko.
- TMVR:ʻAʻole kēia he hoʻoponopono, akā ua hoʻokomo ʻia kahi kiwikā hou loa.
He aha ka mea e hana ʻia ma mua o ka mālama ʻana iā TMVR?
Ma hope o ka hoʻoholo ʻana e hāʻawi iā ʻoe i kēia lāʻau lapaʻau, e nānā pono ke kime lapaʻau iā ʻoe.
- Nā Hoʻāʻo: Hana ʻia kekahi mau hoʻāʻo, e like me ka "Echocardiogram" e nānā i ka hana o ka puʻuwai a me ka "CT scan" e nānā i ke ʻano o ka puʻuwai. Hoʻohana ʻia kēia mau mea e hoʻolālā i ka lāʻau lapaʻau.
- Ke kamaʻilio ʻana e pili ana i ka anesthesia: E kamaʻilio kekahi loea me ʻoe e pili ana i ke ʻano o ka anesthesia e hāʻawi ʻia iā ʻoe e pale aku i ka ʻeha i ka wā o ka mālama ʻana. E hoʻoholo ʻia ma muli o kou kūlana, inā e hāʻawi ʻia ʻoe i ka anesthesia laulā a i ʻole ka hoʻomaha hoʻomaopopo.
- Nā Kuhikuhi: E hāʻawi ke kauka iā ʻoe i kekahi mau kuhikuhi kūikawā.
- Pono e hoʻopau ʻia kekahi mau lāʻau lapaʻau (ʻoiai nā lāʻau hoʻokahe koko) no kekahi mau lā.
- E noi ʻia ʻoe e hoʻokē ʻai no kekahi mau hola i ka lā o ka mālama ʻana.
- E hoʻomaopopo ʻia ʻoe e lawe mai i kekahi me ʻoe i ka home ma hope o ka mālama ʻana.
He aha ka mea e hana ʻia i ka wā o ka mālama ʻana?
ʻO ka maʻamau, ʻelua a ʻekolu hola ka lōʻihi o kēia lapaʻau. Aia kahi hui o nā loea, me nā kauka ʻoki puʻuwai, nā kauka cardiologist, a me nā anesthesiologist, i loko o kēia.
I ka pōkole, eia nā mea e hana ʻia.
1. Ua hoʻomaʻemaʻe ʻia a hoʻomākaukau ʻia ka wahi ʻoki (ʻūhā a umauma paha).
2. Hoʻokomo ʻia kahi cannula (laina IV) i loko o kahi aa koko ma ka lima, kahi e lawelawe ʻia ai nā lāʻau lapaʻau a me nā wai e pono ai.
3. Hoʻopili ʻia ka valve hou i ka hopena o kahi ʻōmole lahilahi (catheter).
4. Hoʻokomo ʻia kēia ʻōmole i loko o kahi kīʻaha koko ma o kahi ʻoki liʻiliʻi i hana ʻia ma ka ʻāʻī a i ʻole ka umauma.
5. Me ka hoʻohana ʻana i ka ʻenehana kiʻi kūikawā, alakaʻi ʻia kēia ʻōmole i ka valve mitral i loko o ka puʻuwai.
6. Hoʻokomo ʻia ka valve hou i loko o ka valve kahiko i maʻi ʻia, kau pololei ʻia, a hoʻokomo ʻia.
7. A laila wehe ʻia ka ʻōmole a pani ʻia ka ʻoki.
Ke nānā nei ke kime lapaʻau i nā mea āpau, me kou koko a me nā pae oxygen, i loko o kēia manawa holoʻokoʻa.
He aha ka mea e hana ma hope o ka TMVR?
Ma hope o ka lāʻau lapaʻau, e lawe ʻia ʻoe i kahi lumi hoʻōla. E nānā pono ʻia ʻoe a hiki i kou hoʻōla ʻana mai ka anesthesia. Pono paha kekahi poʻe e noho ma ka ʻāpana mālama koʻikoʻi (ICU) no hoʻokahi a ʻelua paha lā. ʻO ka maʻamau, pono ʻoe e noho ma ka haukapila no kekahi mau lā.
Ke hoʻi ʻoe i ka home, e aʻo aku kāu kauka iā ʻoe ma kēia mau mea:
- Pehea e komo ai i nā papahana hoʻoponopono puʻuwai.
- Nā hoʻonohonoho hoʻomau.
- E pili ana i nā lāʻau lapaʻau e hoʻomaka hou ai a me nā lāʻau lapaʻau hou e lawe ai.
- Āhea e hiki ai iaʻu ke hoʻi i nā hana maʻamau a me ka hana?
Nā pono a me nā pilikia o ka mālama ʻana iā TMVR
E like me nā lāʻau lapaʻau āpau, aia nā pono a me nā pilikia. E nānā kākou iā lākou.
| Nā Pōmaikaʻi | Nā Pōʻino a me nā Pilikia |
|---|---|
| Hoʻoponopono ʻia ka maʻi valve mitral. | Aia kahi pilikia o ka hoʻokumu ʻana o nā ʻūpā koko a hele i ka lolo, e hana ana i ka hahau ʻana. |
| ʻO ka emi ʻana o nā hōʻailona (e like me ka pōkole o ka hanu). | Ka hōʻino ʻana i nā ʻiʻo puʻuwai. No ka laʻana: Ka perforation ventricular hema. |
| Ke ho'ōla wikiwiki nei ma mua o ke ʻoki puʻuwai hāmama. | Ka ālai ʻana o ke kahe ʻana o ke kahe o ka ventricle hema. |
| ʻAʻohe ʻeha nui a emi ka ʻeha. | Hiki ke neʻe a neʻe paha ka valve i hoʻokomo ʻia mai kona wahi. |
ʻO ka mea nui, he mea kakaikahi loa kēia mau pilikia, a inā kū mai kekahi mau pilikia, ua mākaukau ka hui lapaʻau e hoʻololi koke i ke ʻoki kino wehe a i ʻole e hana i nā hana kūpono ʻē aʻe.
Āhea ʻoe e ʻimi ai i ke aʻo lapaʻau pilikia?
Ke hoʻi ʻoe i ka home ma hope o ka mālama ʻana, pono ʻoe e makaʻala loa e pili ana i kekahi mau hōʻailona. Inā ʻike ʻoe i kēia mau hōʻailona , e hele koke i ka ʻOihana Pilikia (ETU) o ka haukapila.
| E hele koke i ETU! | |
|---|---|
| Nā hōʻailona o ka hahau ʻana |
|
| Nā hōʻailona o ka hōʻeha puʻuwai | |
| Inā loaʻa iā ʻoe kēia mau hōʻailona, e hoʻomaopopo i kāu kauka. | |
| Nā pilikia e pili ana i ka ʻoki ʻana | Ke hemo nei nā humuhumu, ke kahe nei ke koko mai ka ʻeha. |
| Nā hōʻailona o ka maʻi | ʻEha, ʻulaʻula, pus a kahe wai paha, kuni ma kahi o ka ʻeha. |
| Nā hōʻailona o ke koko koko | ʻEha, pehu, a me ke kala ʻole o ke kala ma nā wahi e like me ka ʻūhā, ke kuli, a i ʻole ka kuʻekuʻe wāwae. |
| Nā hōʻailona ʻē aʻe o ka hōʻeha puʻuwai | Piʻi koke ke kaumaha, pehu o nā wāwae a me nā kuʻekuʻe wāwae. |
Leka Lawe-Home
- He ʻano lapaʻau hou ka TMVR e pani ana i ka valve mitral me ka wehe ʻole ʻana i ka puʻuwai, me ka pilikia haʻahaʻa a me ka ho'ōla koke ʻana.
- He koho maikaʻi loa kēia, ʻoi aku hoʻi no ka poʻe ʻelemakule a i ʻole nā maʻi ʻē aʻe e paʻakikī ai iā lākou ke hana i ke ʻoki kino nui.
- Inā loaʻa iā ʻoe a i ʻole kekahi mea kokoke iā ʻoe ka maʻi valve mitral, e kamaʻilio me kāu kauka cardiologist e pili ana i kēia koho lapaʻau. Na ia e hoʻoholo i ka lāʻau lapaʻau kūpono loa iā ʻoe.
- Ma hope o ka lāʻau lapaʻau, he mea nui ka hahai pololei ʻana i nā ʻōlelo a kāu kauka no ka hoʻōla wikiwiki ʻana. E makaʻala mau i nā hōʻailona makaʻala.
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