Cia peb kawm txog Aortic Root Replacement hauv cov lus yooj yim.

Koj yuav tsum tau hnov ​​txog lub aorta, lub hlab ntsha tseem ceeb uas tso ntshav thoob plaws peb lub cev. Xav txog, yuav ua li cas yog tias lub hlab ntsha tseem ceeb no, qhov chaw nws txuas rau lub plawv, ntawm "hauv paus," dhau los ua me ntsis tsis muaj zog thiab bulged tawm zoo li lub npas? Qhov ntawd yog qhov peb hu ua aneurysm hauv kev kho mob. Qhov no yog qhov txaus ntshai heev, vim tias txhua lub sijhawm no phab ntsa tsis muaj zog no tuaj yeem txiav lossis tawg. Yog tias qhov ntawd tshwm sim, tuaj yeem muaj ntshav ntau dhau hauv lub cev thiab txawm tias muaj kev phom sij rau lub neej. Yog li, Aortic Root Replacement yog ib qho kev phais mob tseem ceeb heev uas tau ua los tiv thaiv cov mob txaus ntshai no. Hnub no, peb yuav tham txog qhov no yooj yim, hauv txoj kev uas koj tuaj yeem nkag siab.

Qhov kev phais hloov cov hauv paus hniav Aorta no yog dab tsi?

Hais yooj yim xwb, qhov no yog ib qho kev phais mob los kho qhov aneurysm hauv cov hauv paus aortic, uas yog cov hlab ntsha tseem ceeb uas txuas koj lub plawv. Qee zaum, ob qho tib si hauv paus ntawm koj lub aorta thiab lub valve hauv nws raug hloov. Lwm lub sijhawm, tsuas yog hauv paus ntawm koj lub aorta raug hloov, ua rau koj lub valve ib txwm zoo li qub. Koj tus kws kho mob yuav txiav txim siab seb hom kev phais twg yog qhov zoo rau koj raws li ntau yam, suav nrog qhov xwm txheej ntawm koj lub valve.

Cov hom phais mob no yog dab tsi?

Muaj ob txoj kev phais mob no. Ib txoj yog hloov cov hauv paus ntawm lub aorta thiab lub valve. Qhov thib ob yog hloov cov hauv paus xwb, cia lub valve tseem zoo. Ob qho tib si muaj qhov zoo thiab qhov tsis zoo.

1. Kev Hloov Pauv Hauv Paus Aortic (ARR)

Cov txheej txheem no kuj hu ua Bentall txheej txheem . Nws yog ua rau cov neeg uas muaj aortic aneurysm thiab muaj teeb meem nrog lub valve. Piv txwv li, yog tias lub valve tsis kaw zoo thiab ntshav ntws rov qab (aortic valve regurgitation) lossis yog tias lub valve tau dhau los ua calcified (hardened).

• Qhov zoo tshaj plaws: Qhov zoo tshaj plaws ntawm qhov no yog tias koj tsis tas yuav phais cais kom kho lub valve dua tom qab phais. Ob qho tib si aneurysm thiab qhov teeb meem valve raug daws tib lub sijhawm.
• Kev Pheej Hmoo: Yog tias koj muaj lub qhov ntswg uas siv tau thaum lub sijhawm phais mob no, koj yuav tsum tau noj cov tshuaj ua kom cov ntshav nyias/tshuaj tiv thaiv kev coagulation ntshav mus tas koj lub neej. Muaj kev pheej hmoo me ntsis ntawm cov ntshav txhaws lossis los ntshav vim yog cov tshuaj no.

2. Kev Hloov Kho Cov Hauv Paus Uas Tsis Txhob Siv Lub Qhov (VSRR)

Qhov no yog qhov kev xaiv zoo tshaj plaws yog tias koj lub aortic valve ua haujlwm zoo yam tsis muaj teeb meem. Piv txwv li, yog tias tsis muaj ntshav ntws los yog tuab ntawm lub valve, txoj kev no yuav raug xaiv. Qhov no yog qhov kev daws teeb meem zoo tshaj plaws rau cov neeg uas muaj aneurysms thaum tseem hluas vim yog cov mob caj ces.

Cov txheej txheem no tsuas yog hloov cov hauv paus ntawm koj lub aorta thiab rov txuas koj lub valve ntuj rau nws. Muaj ob txoj hauv kev tseem ceeb, muab lub npe raws li cov kws kho mob uas tau tshawb pom lawv.

• Kev kho mob Yacoub: Qhov no suav nrog kev kho dua tshiab ntawm lub plawv aortic. Qhov no feem ntau haum rau cov neeg laus uas muaj aneurysms vim yog cov laj thawj tsis yog caj ces.
• Kev kho mob David: Qhov no suav nrog kev rov cog dua lub plawv aortic valve. Qhov no yog ib qho kev kho mob uas siv ntau dua tab sis nyuaj dua li kev kho mob Jacob. Nws yog qhov zoo tshaj plaws rau cov neeg hluas uas muaj mob caj ces lossis lub plawv aortic valve bicuspid .

Peb puas yuav kawm me ntsis txog cov hauv paus aortic?

Lub hauv paus ntawm lub aorta yog thawj feem ntawm lub cev cov hlab ntsha loj tshaj plaws, lub aorta, qhov chaw nws txuas rau lub plawv. Nws zoo li lub hauv paus ntawm ib tsob ntoo. Lub aorta, uas tawm hauv lub plawv, nkhaus mus rau sab saud, zoo li ib txoj kab nkhaus. Txoj kab nkhaus ntawd pib qhov twg lub hauv paus ntawm lub aorta pib. Qhov no nyuaj heev.

• Aortic Valve: Qhov no yog qhov chaw uas lub valve ua haujlwm zoo li lub rooj vag tso cai rau cov ntshav ntws los ntawm lub plawv mus rau hauv aorta, tab sis tiv thaiv nws kom tsis txhob ntws rov qab.
• Cov hlab ntsha Coronary: Ob lub hlab ntsha tseem ceeb tshaj plaws uas muab ntshav rau lub plawv pib ntawm lub hauv paus ntawm lub aorta no.
• Sinuses ntawm Valsalva: Qhov no yog lub npe muab rau cov o me me uas tsim qhov chaw uas cov hlab ntsha hauv lub plawv pib.

Thaum peb tseem hluas, tag nrho cov feem no muaj qhov ywj pheej heev. Tab sis thaum peb laus zuj zus, qhov kev ywj pheej no txo ​​qis. Qhov no yog vim li cas qee qhov teeb meem tshwm sim. Vim tias qhov no nyuaj heev, kev phais mob rau nws kuj nyuaj heev. Txawm li cas los xij, nrog kev pab los ntawm cov kws phais mob uas muaj kev paub dhau los thiab cov kws tshaj lij, kev phais mob no tuaj yeem ua tiav thiab koj lub plawv tuaj yeem noj qab nyob zoo dua.

Leej twg xav tau qhov kev phais no tiag?

Qhov kev phais no yog qhov yuav tsum tau ua rau cov neeg uas muaj aneurysm hauv aorta uas muaj feem yuav tawg lossis tawg. Qee zaum cov no tshwm sim vim muaj kev hloov pauv hauv aorta thaum lawv laus. Tsis tas li ntawd, cov mob caj ces xws li Marfan syndrome thiab Loeys-Dietz syndrome tuaj yeem ua rau muaj aneurysms tuag taus thaum lawv tseem hluas.

Xav txog seb, yog tias ib tug neeg uas muaj tus kab mob Marfan tsis tau txais kev kho mob, muaj feem yuav ua rau cov hlab ntsha tawg thiab tuag. Lub hnub nyoog nruab nrab ntawm kev tuag rau cov neeg hauv pawg ntawd yog li 32 xyoos. Tab sis, yog tias koj tau txais kev phais no, koj tuaj yeem ntev koj lub neej mus txog li ib tus neeg ib txwm.Yog li ntawd, yog tias muaj leej twg hauv koj tsev neeg muaj cov kab mob caj ces no, nws yog ib qho tseem ceeb uas yuav tsum nrog koj tus kws kho mob tham txog koj qhov kev pheej hmoo thiab txiav txim siab lub sijhawm zoo tshaj plaws rau kev phais.

Ua ntej, thaum lub sijhawm phais, thiab tom qab phais tas, muaj dab tsi tshwm sim?

Vim qhov no yog ib qho kev phais loj, nws yuav tsum tau npaj zoo.

Ua ntej phais

Koj tus kws kho mob yuav kuaj koj tag nrho. Nws kuj tseem yuav xa koj mus rau kws kho hniav kom kuaj hniav. Tsis tas li ntawd, lawv yuav ua ntau yam kev kuaj, xws li:

• Kev kuaj ntshav: Xyuas seb lub raum ua haujlwm li cas.
• Kev thaij duab CT lossis MRI ntawm lub plawv: Qhov no tuaj yeem kuaj xyuas txhua qhov ntawm aorta. Lwm yam teeb meem qee zaum tuaj yeem kho tau thaum lub sijhawm phais tib yam.
• Kev kuaj mob plawv (Coronary Angiography): Xyuas seb cov hlab ntsha hauv plawv uas muab ntshav mus rau lub plawv zoo li cas.
• Kev Siv Tshuab Ultrasound Ob Chav: Tshawb xyuas seb cov hlab ntsha carotid hauv caj dab zoo li cas. Cov teeb meem nrog cov no tuaj yeem ua rau muaj kev pheej hmoo ntawm kev tuag tes tuag taw thaum phais.

Tsis tas li ntawd xwb, koj tus kws kho mob yuav nug koj txog cov no:

• Cov Tshuaj Koj Noj: Koj yuav tsum qhia rau koj tus kws kho mob txog cov tshuaj lossis cov vitamins uas koj noj. Tej zaum yuav muaj qee cov tshuaj uas yuav kom koj tsum tsis txhob noj ua ntej phais.
• Lwm yam mob: Yog tias koj muaj tej yam mob xws li ntshav siab, yuav tsum tswj kom zoo ua ntej phais.
• Koj qhov mob tam sim no: Nco ntsoov qhia rau peb yog tias koj muaj mob, xws li mob khaub thuas lossis kub taub hau.
• Haus Luam Yeeb: Yuav tsum tsum tsis txhob haus luam yeeb kiag li tsawg kawg yog ib hlis ua ntej phais mob.

Thaum lub sijhawm phais

Koj yuav tau txais tshuaj loog kom koj tsaug zog tag nrho. Tom qab ntawd koj yuav raug txuas rau lub tshuab plawv-ntsws (cardiopulmonary bypass) . Lub tshuab no yuav ua haujlwm ntawm koj lub plawv thiab ntsws thaum lub sijhawm phais. Tus kws phais yuav ua raws li cov kauj ruam no:

1. Median Sternotomy: Yuav muaj ib qho kev phais hauv nruab nrab ntawm lub hauv siab kom cais lub hauv siab (sternum) thiab nkag mus rau hauv lub plawv.

2. Tshem tawm cov hlab ntsha aneurysm: Qhov tsis muaj zog thiab bulging ntawm lub aorta raug txiav tawm thiab tshem tawm.

3. Kev Ntxig Cov Hlwb: Ib txoj hlab ntsha cuav (graft) raug ntxig los hloov qhov uas raug tshem tawm.

4. Hloov lossis txuag lub valve: Koj hloov lub valve lossis rov nruab koj lub valve raws li txoj kev ARR lossis VSRR uas tau tham ua ntej.

5. Kev phais plawv los ntawm kev phais plawv: Cov hlab ntsha hauv plawv uas muab ntshav rau lub plawv txuas nrog rau qhov tshiab.

6. Xaws qhov txiav: Thaum kawg, qhov txiav hauv siab raug xaws rov qab ua ke.

Feem ntau qhov kev phais no yuav siv sijhawm plaub thiab rau teev.

Tom qab phais mob

Tom qab phais lawm, koj yuav tsum tau nyob hauv chav saib xyuas mob hnyav (ICU) ob peb hnub. Tom qab ntawd koj yuav raug xa mus rau chav kho mob ib txwm. Tag nrho kev nyob hauv tsev kho mob yuav siv sijhawm li ib lub lim tiam. Thaum lub sijhawm no:

• Kuv mam muab tshuaj tua mob rau koj.
• Tej zaum koj yuav raug txuas nrog lub tshuab los pab koj ua pa.
• Cov thom khwm tshwj xeeb raug hnav kom tiv thaiv cov ntshav txhaws.
• Muaj ib txhia neeg tau txais tshuaj uas ua rau cov ntshav nyias.

Cov txiaj ntsig, kev pheej hmoo, thiab kev vam meej ntawm kev phais mob yog dab tsi?

Thaum twg koj yuav tsum mus ntsib kws kho mob?

Ua tib zoo saib xyuas koj lub cev thaum koj rov zoo. Yog tias koj pom ib qho ntawm cov hauv qab no , hu rau koj tus kws kho mob tam sim ntawd:

• Cov lus nug ntsig txog qhov txiav:
• Liab, mob, o, lossis sov so nyob ib puag ncig qhov txiav.
• Daim ntaub qhwv ntawd ntub heev ua rau ntshav lossis kua dej ntshiab tawm los.
• Cov kua qaub ntsuab los yog daj tawm.
• Cov npoo ntawm qhov txiav txav mus sib nrug.
• Lwm cov lus nug:
• Mob hauv siab los yog ua pa nyuaj txawm tias thaum so.
• Ob txhais ceg o los yog tsis muaj peev xwm txav ob txhais ceg.
• Kiv taub hau, tsaug zog tsis taus, lossis qaug zog heev.
• Hnoos ntshav los yog hnoos ntsuab/daj.
• Mob khaub thuas thiab kub taub hau.
• Ntshav hauv cov quav.

Thaum twg koj yuav tsum mus rau Chav Kho Mob Thaum Muaj Xwm Ceev (ETU)?

Yog tias koj muaj ib qho aneurysm uas tsis tau kho, mus rau chav kho mob ceev hauv tsev kho mob (ETU) ze tshaj plaws tam sim ntawd yog tias koj muaj cov tsos mob hauv qab no. Cov no yuav yog cov cim qhia ntawm ib qho aneurysm tawg:

• Mob sai sai hauv siab lossis sab nraub qaum. Tej zaum yuav zoo li muaj ib yam dab tsi raug rhuav tawm ntawm sab hauv lub cev.
• Tawm hws thiab xav tias ntub dej.
• Ua pa nyuaj.
• Kiv taub hau los yog lub taub hau me me.
• Lub plawv dhia nce ntxiv.
• Xeev siab thiab ntuav.

Nws yog ib qho ib txwm muaj kev ntshai thaum koj hnov ​​txog kev phais plawv. Tab sis nco ntsoov, qhov kev phais no yog ib yam dab tsi uas tuaj yeem cawm koj txoj sia thiab muab sijhawm rau koj kom muaj lub neej noj qab haus huv ntev. Koj tus kws kho mob thiab pab pawg kho mob muaj kev paub dhau los hauv kev ua cov kev phais no. Yog li ntawd, tham nrog lawv txog txhua lo lus nug lossis kev ntshai uas koj muaj.