Puas yog koj tus me nyuam lub plawv cov hlab ntsha tseem ceeb raug thaiv? Cia peb kawm txog qhov '(Coarctation of the Aorta)' no!

Koj puas tau xav tias peb lub plawv me me ua haujlwm zoo kawg li cas? Tab sis qee zaum, vim muaj qee yam teeb meem uas yug los, kev ua haujlwm ntawm lub plawv no tuaj yeem raug cuam tshuam me ntsis. Ib qho mob plawv uas tuaj yeem tshwm sim rau qee tus menyuam yaus hu ua '(Coarctation of the Aorta)'. Txawm hais tias lub npe yuav zoo li nyuaj me ntsis, tsis txhob txhawj. Cia peb tham txog qhov no yooj yim.

"(Coarctation of the Aorta)" yog dab tsi? Hais yooj yim xwb...

Hais yooj yim xwb, Coarctation of the Aorta yog kev nqaim lossis nqaim ntawm aorta, lub hlab ntsha tseem ceeb uas nqa cov ntshav uas muaj oxygen ntau los ntawm koj tus menyuam lub plawv mus rau lwm qhov ntawm lub cev. Qhov no yog qhov teeb meem plawv uas yug los.

Xav txog seb, muaj ntau lub tsheb khiav ceev heev ntawm txoj kev loj. Tab sis yuav ua li cas yog tias koj ua kom txoj kev nqaim ntawm ib qho chaw thiab tsuas pub ib txoj kab tsheb xwb? Kev sib tsoo tsheb tshwm sim, thiab cov tsav tsheb pib txav mus, puas yog? Qhov ntawd yog qhov tshwm sim hauv qhov xwm txheej no thiab. Nws ua rau cov ntshav ntws tsis zoo los ntawm qhov txhaws hauv aorta.

Feem ntau, qhov kev nqaim no (coarctation) tshwm sim ua ntej cov ceg uas nqa cov ntshav los ntawm aorta mus rau lub cev qis, xws li ob txhais ceg, faib. Dab tsi ua rau qhov no? Cov ntshav siab nce ntxiv rau sab saud ntawm lub cev ntawm tus menyuam, xws li caj npab, tab sis txo qis rau sab qis ntawm lub cev, xws li ob txhais ceg. Qhov sib txawv loj ntawm cov ntshav siab ntawm sab saud thiab sab qis ntawm lub cev yog qhov tseem ceeb ntawm tus kab mob no. Txawm tias tsis muaj lwm yam tsos mob, cov kws kho mob yuav xav tsis thoob thaum lawv pom qhov sib txawv ntawm cov ntshav siab no.

Raws li cov ntaub ntawv hauv Tebchaws Meskas, kwv yees li ib tug ntawm 1,700 tus menyuam mos uas yug los txhua xyoo yuav muaj tus mob no (Aortic Coarctation). Ib txhia menyuam mos kuj tseem yuav muaj lwm yam kab mob plawv txij thaum yug los nrog rau qhov no.

Thaum cov menyuam yaus muaj tus mob no, lawv pom cov tsos mob li cas?

Cov tsos mob no nyob ntawm seb lub aorta nqaim npaum li cas. Feem ntau, yog tias nqaim me ntsis, cov tsos mob yuav pib tshwm sim hauv ib lossis ob lub lis piam tom qab yug los. Txawm li cas los xij, yog tias qhov nqaim tsis hnyav heev, cov tsos mob yuav tsis tshwm sim kom txog thaum tus menyuam loj hlob, lossis lawv yuav tsis tshwm sim li.

Cov tsos mob ntawm cov menyuam mos tshiab

Yog tias tus menyuam mos muaj tus mob no, lawv yuav muaj cov tsos mob xws li:

• Tsis tu ncua qaug zog thiab tsis kam haus mis nyuj
• Lub plawv dhia ceev (lub plawv dhia ceev)
• Tawm hws ntau dhau
• Kev chim siab tas li, quaj
• Tawv nqaij dawb los yog xim grey
• Ua pa sai lossis ua pa nyuaj
• Nyuaj haus mis nyuj

Yog tias tus menyuam mos muaj qhov txhaws ntawm lub aorta hnyav heev, nws tuaj yeem poob siab thiab ua rau tuag taus yog tias tsis paub thiab kho sai. Txawm li cas los xij, qee tus menyuam mos yuav tsis pom muaj tsos mob vim tias qhov txhaws me me heev.

Cov tsos mob ntawm cov menyuam yaus thiab cov tub ntxhais hluas

Cov menyuam yaus loj dua thiab cov tub ntxhais hluas uas muaj Aortic Coarctation yuav muaj cov tsos mob xws li:

• Mob taub hau ntau zaus
• Ntshav siab
• Ntsws ntshav ntau zaus
• Mob ceg thaum ua si, khiav, lossis dhia

Tej zaum yuav muaj ib txhia menyuam tsis muaj tsos mob dab tsi li. Tiam sis, qhov teeb meem no yuav raug txheeb xyuas thawj zaug tias yog ntshav siab thaum lub sijhawm kuaj xyuas lub cev.

Thaum ib tug neeg laus muaj cov tsos mob no, feem ntau nws yog vim rov qab muaj cov hlab ntsha aorta nqaim dua tom qab kev kho mob yav dhau los. Nws tsis tshua muaj mob no uas tsis raug kuaj mob kom txog thaum laus.

Vim li cas qhov xwm txheej no thiaj tshwm sim? Yog vim li cas?

Cov kws tshaj lij tseem tsis tau paub meej tias yog vim li cas CoA thiaj tshwm sim. Txawm li cas los xij, ntseeg tias muaj ib feem ntawm cov noob caj noob ces . Qhov ntawd yog, qee qhov kev hloov pauv ntawm cov noob caj noob ces uas tshwm sim thaum tus menyuam tseem nyob hauv plab tuaj yeem ua rau tus menyuam lub aorta tsis loj hlob zoo.

Qee zaum cov kev hloov pauv caj ces no tuaj yeem kis tau los ntawm tsev neeg. Kev tshawb fawb tau qhia tias yog tias koj muaj CoA, koj tus menyuam yuav muaj feem yuav mob CoA lossis lwm yam kab mob plawv ntau dua li ib tus neeg uas tsis muaj CoA.

Tsis tas li ntawd xwb, qhov kev pheej hmoo ntawm kev mob CoA yog siab dua nrog qee yam mob caj ces. Piv txwv li, cov menyuam mos uas yug los nrog tus mob caj ces Turner syndrome feem ntau yuav tsis yog tsuas yog muaj Coarctation ntawm Aorta xwb, tab sis kuj muaj lwm yam kev puas tsuaj thaum yug los xws li bicuspid aortic valve, qhov tsis zoo ntawm lub plawv lub plawv.

Ua rau muaj '(CoA)' ib leeg xwb yam tsis muaj lwm yam teeb meem plawv

Qhov ua rau muaj CoA cais tawm yog qhov kaw tsis zoo ntawm cov hlab ntsha me me hu ua ductus arteriosus thaum lub sijhawm cev xeeb tub. Lub ductus arteriosus yog cov hlab ntsha me me uas txuas lub fetal aorta mus rau lub pulmonary artery. Cov ntsws tsis ua haujlwm thaum tus menyuam tseem nyob hauv plab, yog li lub raj no pab tus menyuam tau txais cov ntshav uas muaj oxygen ntau uas nws xav tau.

Tom qab tus me nyuam yug los, lub ntsws pib ua haujlwm. Tom qab ntawd, vim tias qhov "ductus arteriosus" no tsis xav tau lawm, nws pib kaw nws tus kheej hauv ob peb hnub. Txawm li cas los xij, thaum nws kaw, qee cov nqaij hauv qhov "ductus arteriosus" ntawd tuaj yeem sib koom ua ke nrog cov nqaij ntawm "Aorta". Yog li ntawd, thaum "ductus arteriosus" raug yuam kom kaw, lub aorta kuj tuaj yeem nqaim (coarctation) tau.

Vim muaj tus mob no, yuav muaj teeb meem dab tsi tshwm sim?

Yog tias qhov mob no (Coarctation of the Aorta) tsis kho rau lub sijhawm ntev, cov teeb meem xws li:

• Ntshav siab (hypertension) thoob plaws lub cev.
• Cov leeg nqaij ntawm lub plawv yuav tuab dua li qub (lub plawv sab laug loj hlob sai).
• Qhov kev sib sau ua ke ntawm cov quav hniav hauv cov hlab ntsha coronary, uas muab ntshav mus rau lub plawv, tshwm sim ua ntej dua li qub - qhov no hu ua kab mob coronary artery.
• Muaj qhov o ntawm cov hlab ntsha (aneurysm) lossis qhov kua muag (dissection) hauv lub aorta uas tsis zoo li qub.
• Ib qho aneurysm ntawm lub hlwb (kev nthuav dav ntawm cov hlab ntsha hauv lub hlwb).
• Mob plawv tsis ua haujlwm yog ib qho mob uas lub plawv tsis tuaj yeem tso ntshav tau zoo.

Tus mob '(CoA)' no yog qhov txaus ntshai tshaj plaws yog tias tsis paub thiab kho nws. Yog li ntawd, nws yog ib qho tseem ceeb heev uas yuav tsum paub nws sai li sai tau, thaum tseem hluas, thiab kom tau txais kev kho mob tsim nyog thiab kev kuaj xyuas tsis tu ncua (saib xyuas).

Cov kws kho mob kuaj qhov no li cas? (Kev kuaj mob)

Feem ntau cov kws kho mob plawv rau menyuam yaus kuaj mob no (Coarctation of the Aorta) thaum lawv tseem yog menyuam yaus lossis thaum lawv tseem yog menyuam yaus. Yuav kuaj mob sai npaum li cas nyob ntawm seb cov tsos mob hnyav npaum li cas.

Cov menyuam mos uas muaj cov tsos mob tsis hnyav heev yuav pom tau hauv ob peb hnub tom qab yug los. Txawm li cas los xij, cov menyuam mos uas muaj cov tsos mob tsis hnyav heev, lossis tsis muaj li, yuav tsis pom tau kom txog thaum lawv loj hlob thiab muaj ntshav siab. Nws tsis tshua muaj neeg pom qhov no thaum lawv laus lawm.

Feem ntau cov menyuam mos thiab cov menyuam yaus raug kuaj pom tus mob no vim muaj qee yam tsis meej pem (cov cim liab) pom thaum kuaj lub cev. Cov yam ntxwv no suav nrog:

• Tus me nyuam muaj ntshav siab hauv caj npab thiab lub cev sab saud, tab sis ntshav qis hauv ob txhais ceg thiab lub cev sab hauv qab.
• Muaj qhov sib txawv ntawm lub plawv dhia hauv caj dab thiab lub plawv dhia hauv qhov chaw mos.
• Thaum tus kws kho mob muab lub stethoscope tso rau ntawm tus menyuam nraub qaum thiab mloog, lub suab tshwj xeeb, hnyav los ntawm lub plawv (lub suab 'lub plawv nrov nrov') .

Muaj ib txhia menyuam mos uas raug kuaj pom tias muaj tus kab mob ua ntej lawv txawm muaj tsos mob. Koj paub li cas? Ib qho kev kuaj hu ua "pulse oximetry" uas ntsuas cov pa oxygen hauv lawv cov ntshav qhia tau tias cov pa oxygen qis. Cov pa oxygen qis tuaj yeem yog ib qho cim qhia txog kab mob plawv loj heev uas yug los, yog li cov menyuam mos no raug kuaj kom paub tseeb tias muaj teeb meem dab tsi.

Yuav kom paub meej tias tus mob "(CoA)" no zoo li cas, cov kws kho mob feem ntau siv "(Echocardiogram), kev ntsuas lub plawv, lossis "(echo)". Lawv kuj tseem yuav ua cov kev kuaj xws li "(CT scan)" lossis "(MRI scan)" kom paub ntau ntxiv txog cov duab thiab cov qauv ntawm tus menyuam lub plawv aorta.

Puas muaj lwm yam kab mob plawv uas cuam tshuam nrog "Coarctation of the Aorta"?

Yog, cov menyuam mos uas muaj CoA tuaj yeem kuaj pom tias muaj lwm yam mob plawv. Piv txwv li, ntawm 45% thiab 75% ntawm cov neeg uas muaj CoA kuj muaj ib qho mob hu ua bicuspid aortic valve. Qhov no txhais tau tias lub valve uas nqa cov ntshav los ntawm lub plawv mus rau aorta tsuas muaj ob daim nplooj xwb es tsis yog peb daim uas nws yuav tsum muaj.

Tsis yog li ntawd xwb, tab sis `(CoA)` kuj tseem tuaj yeem nrog cov xwm txheej hauv qab no:

• Muaj ib lub qhov hauv lub plawv - qhov ntawd hu ua '(atrial septal defect)' lossis '(ventricular septal defect)'.
• Ib txoj hlab ntsha uas nyob thaum lub sijhawm cev xeeb tub ('ductus arteriosus') tseem qhib ntev dua li qhov xav tau - qhov no hu ua "patent ductus arteriosus"
• Aortic arch hypoplasia lossis hypoplastic left heart syndrome.
• Kev tawv ntawm lub plawv valve - uas yog, aortic valve stenosis lossis mitral valve stenosis.

Cov kws phais plawv saib xyuas txhua yam no hauv koj tus menyuam lub plawv thiab tsim ib txoj kev npaj kho mob uas tshwj xeeb rau lawv. Qhov no txhais tau tias kev kho tus menyuam uas muaj ntau yam teeb meem plawv tuaj yeem nyuaj me ntsis dua li kev kho tus menyuam nrog ib qho CoA xwb.

Cov kev kho mob rau qhov no yog dab tsi?

Cov kev xaiv kho mob nyob ntawm koj tus menyuam lub hnub nyoog, qhov dav ntawm qhov nqaim ntawm aorta, thiab seb nws puas muaj lwm yam teeb meem plawv. Kev phais yog txoj hauv kev zoo tshaj plaws los kho cov coagulopathy rau cov menyuam mos thiab cov menyuam yaus. Rau cov menyuam loj dua, yog tias qhov nqaim tsis hnyav heev, kev siv catheterization plawv, uas yog ib qho txheej txheem uas tsis mob hnyav dua li kev phais, yuav tsim nyog. Nws kuj tseem siv rau cov menyuam yaus thiab cov neeg laus uas tau rov qab muaj qhov nqaim tom qab kev kho mob yav dhau los.

Kev phais mob

Muaj ntau hom kev phais mob tseem ceeb uas tau ua los kho qhov mob '(CoA)' no:

• Kev txiav tawm nrog qhov kawg-rau-kawg anastomosis: Yog tias qhov coarctation me me, tus kws phais yuav txiav qhov thaiv ntawm tus menyuam lub aorta thiab rov koom nrog cov kawg seem.
• Kev txiav tawm nrog kev ncua ntev ntawm qhov kawg mus rau qhov kawg anastomosis:Yog tias tus menyuam lub aortic arch kuj raug thaiv, tus kws phais tuaj yeem txiav qhov aorta uas raug thaiv tawm thiab txuas qhov qis ntawm descending aorta rau ib qho kev phais ntev hauv aortic arch. Qhov no yog qhov kev xaiv zoo tshaj plaws thaum tus menyuam muaj transverse aortic arch hypoplasia thiab aortic coarctation.

Cov menyuam mos uas muaj cov tsos mob hnyav tom qab yug los kuj yuav tsum tau noj tshuaj ua ntej phais. Piv txwv li:

• Muaj tshuaj hu ua '(Prostaglandin (PGE-1))' muab tau kom tus menyuam lub '(ductus arteriosus)' qhib. Qhov no yuav ua rau tus menyuam tau txais cov pa oxygen uas lawv xav tau thiab ua kom lawv ruaj khov kom txog thaum lawv npaj txhij rau kev phais.
• Koj tuaj yeem muab tshuaj rau tus menyuam kom pab nws lub plawv nqus ntshav.

Kev siv catheter rau lub plawv

Yog tias koj tus menyuam lub plawv aortic nqaim dua, lossis yog tias qhov nqaim rov qab los tom qab phais, tus kws kho mob yuav qhia cov kev kho mob xws li:

• Kev phais plawv siv lub npas loj (balloon angioplasty): Tus kws phais siv lub npas me me los ua kom qhov nqaim ntawm tus menyuam lub aorta dav dua.
• Kev phais plawv nrog lub raj xa ntshav (balloon angioplasty) nrog rau kev tso stent: Thaum tus kws phais mob tab tom nthuav dav lub aorta ntawm tus menyuam, nws kuj tseem ntxig ib lub raj me me, hu ua stent, kom nws tsis txhob raug thaiv dua.

Thaum twg kuv yuav tsum coj kuv tus menyuam mus ntsib kws kho mob? (Xyuas dua)

Pab neeg kho mob ntawm koj tus menyuam yuav qhia rau koj thaum twg yuav tsum coj koj tus menyuam tuaj. Thoob plaws hauv koj tus menyuam lub neej, lawv yuav tsum tau mus ntsib kws kho mob tshwj xeeb txog kab mob plawv txij thaum yug los. Tus kws kho mob tshwj xeeb no yuav:

• Saib xyuas tus menyuam cov ntshav siab tsis tu ncua.
• Ua kev soj ntsuam (kev kuaj duab) tsis tu ncua kom paub tseeb tias tus menyuam lub plawv ua haujlwm li cas thiab nrhiav cov cim qhia tias muaj teeb meem.
• Muab cov lus qhia txog kev noj zaub mov zoo rau lub plawv thiab kev tawm dag zog.
• Sau tshuaj thiab hloov lawv cov koob tshuaj raws li qhov xav tau.

Ib tug neeg uas muaj tus mob no yuav muaj sia nyob tau ntev npaum li cas?

Nrog cov kev kuaj mob thiab kev kho mob siab heev, cov neeg uas muaj Coarctation of the Aorta tam sim no tuaj yeem nyob tau tsawg kawg yog 60 xyoo. Yav dhau los, lub neej nruab nrab rau cov neeg uas muaj tus mob no yog li 35 xyoo. Yog li qhov no yog xov xwm zoo tiag tiag.

Yog tias koj tus menyuam muaj Coarctation of the Aorta, tej zaum koj yuav xav tsis thoob tias yog vim li cas nws thiaj tshwm sim. Peb tsis tuaj yeem txheeb xyuas qhov tseeb ua rau muaj kab mob plawv txij thaum yug los. Tab sis peb paub tias kev kuaj pom thiab kho thaum ntxov tuaj yeem txo qhov cuam tshuam ntawm tus mob no rau lub neej ntawm tus menyuam.

Cov kws kho mob yeej ib txwm nyob ntawd los pab koj tus menyuam. Lawv npaj txhij los teb cov lus nug uas koj muaj thiab los pab koj nkag siab tias qhov kev kuaj mob '(CoA)' no yuav cuam tshuam li cas rau koj tus menyuam. Tej zaum koj yuav pom tias nws yuav pab tau yog tham nrog lwm cov niam txiv ntawm cov menyuam uas muaj hom mob plawv no.

Tej yam tseem ceeb uas yuav tsum nco ntsoov (Cov Lus Qhia Coj Mus Tsev)

Vam tias koj tam sim no nkag siab txog qhov mob uas peb tau tham txog hu ua "Coarctation of the Aorta". Nov yog qee yam tseem ceeb tshaj plaws uas yuav tsum nco ntsoov:

• Qhov no yog ib qho teeb meem plawv uas muaj txij thaum yug los ; kev txhaws hauv cov hlab ntsha tseem ceeb uas nqa ntshav los ntawm lub plawv mus rau lub cev.
• Tej yam tsos mob yuav tshwm sim thaum tseem yog menyuam yaus lossis tej zaum yuav tshwm sim tom qab. Yog tias koj pom tias koj tus menyuam tsaug zog ntau dhau, ua pa nyuaj, lossis tsis kam pub niam mis, nrhiav kev pab kho mob tam sim ntawd.
• Kev kuaj mob thiab kho tus kab mob thaum ntxov ua rau tus menyuam muaj lub sijhawm ntau dua los ua neej nyob zoo li qub.
• Tus mob no tuaj yeem tswj tau zoo nrog kev phais thiab lwm yam kev kho mob.
• Kev saib xyuas kws kho mob tshwj xeeb tas mus li yog qhov tseem ceeb txawm tias tom qab kho mob lawm los xij.

Tsis txhob ntshai. Kev tshawb fawb txog kev kho mob niaj hnub no zoo heev. Muaj cov kws kho mob txawj ntse uas tuaj yeem muab kev kho mob zoo tshaj plaws rau koj tus menyuam. Qhov tseem ceeb tshaj plaws yog koj paub txog qhov no, ua tib zoo saib xyuas koj tus menyuam qhov kev hloov pauv, thiab nrhiav kev pab kho mob raws sijhawm.

Kev Coarctation ntawm Aorta, Kab Mob Plawv, Kev Kho Mob Me Nyuam, Kab Mob Plawv Txij Thaum Yug Los, Aortic Stenosis, Kev Noj Qab Haus Huv Me Nyuam, Ntshav Siab