Omusuwa omukulu ogw’omusaayi gw’omutima gw’omwana wo omuto guzibiddwa? Ka tuyige ku kino (Coarctation of the Aorta)!

Wali weebuuzizzaako engeri emitima gyaffe emitono gye gikolamu mu ngeri eyeewuunyisa? Naye oluusi, olw’ebizibu ebimu eby’obuzaale, enkola y’omutima guno eyinza okutaataaganyizibwa katono. Embeera emu ey’omutima ng’eno eyinza okubaawo mu baana abamu eyitibwa `(Coarctation of the Aorta)`. Wadde erinnya lino liyinza okuwulikika nga lizibu katono, tofaayo. Ka twogere ku nsonga eno mu ngeri ennyangu.

`(Okuzimba Omusuwa)` kye ki? Mu ngeri ennyangu ennyo...

Mu ngeri ennyangu, Coarctation of the Aorta kwe kufunda oba okufunda kw’omusuwa omunene ogutwala omusaayi ogulimu omukka gwa oxygen okuva ku mutima gw’omwana wo okutuuka ku mubiri gwonna. Kino kizibu ky’omutima ekizaalibwa.

Teebereza, mmotoka nnyingi nnyo zitambula ku sipiidi nnyo ku luguudo olunene. Naye kiki ekibaawo singa ofunza oluguudo mu kiseera ekimu n’okkiriza omulyango gumu gwokka ogw’ebidduka? Jaamu egwawo, baddereeva ne batandika okutambula, nedda? Ekyo kye kibaawo ne mu mbeera eno. Kifuuka kizibu omusaayi okutambula obulungi nga guyita mu kuzibikira mu aorta.

Ebiseera ebisinga, okufunda kuno (coarctation) kubaawo nga amatabi agatwala omusaayi okuva mu aorta okutuuka mu mubiri ogwa wansi, gamba ng’amagulu, tegannaba kwekutula. Kiki ekivaako kino? Puleesa yeeyongera mu kitundu eky’okungulu eky’omubiri gw’omwana, gamba ng’emikono, kyokka n’ekendeera mu kitundu ekya wansi eky’omubiri, gamba ng’amagulu. Enjawulo eno ennene mu puleesa wakati w’ebitundu by’omubiri ebya waggulu n’ebya wansi kye kikulu mu bulwadde buno. Ne bwe kiba nti tewali bubonero bulala, abasawo bayinza okwekengera nga balaba enjawulo eno eya puleesa.

Okusinziira ku bibalo ebiri mu Amerika, abaana nga omu ku buli 1,700 abazaalibwa buli mwaka ayinza okuba n’obulwadde buno (Aortic Coarctation). Abalongo abamu nabo bayinza okuba n’endwadde endala ez’omutima ze bazaalibwa wamu ne kino.

Bubonero ki abaana bwe balaga nga bafunye embeera eno?

Obubonero buno businziira ku ngeri omusuwa gw’omusaayi gye gufunda. Ebiseera ebisinga, singa wabaawo okufunda okutono, obubonero bujja kutandika okulabika mu wiiki emu oba bbiri oluvannyuma lw’okuzaalibwa. Kyokka singa okufunda tekuba kwa maanyi nnyo, obubonero buyinza obutalabika okutuusa ng’omwana akuze, oba obutalabika n’akatono.

Obubonero bw’abaana abaakazaalibwa

Singa omwana eyaakazaalibwa aba n’embeera eno, ayinza okufuna obubonero nga:

• Otulo buli kiseera n’obutayagala kunywa mata
• Omutima okukuba amangu (okukuba amangu) .
• Okutuuyana ekisusse
• Okunyiiga buli kiseera, okukaaba
• Olususu oluddugavu oba enzirugavu
• Okussa amangu oba mu ngeri enzibu
• Okukaluubirirwa okunywa amata

Singa omwana aba n’okuzimba ennyo omusuwa gw’omusaayi (aorta) , kiyinza okugwa mu nsisi n’okutta obulamu bwe singa tamanyibwa era n’ajjanjabibwa mangu. Wabula abalongo abamu bayinza obutalaga bubonero bwonna kubanga ekizibiti kibeera kitono nnyo.

Obubonero mu baana abato n’abato abakulu

Abaana abakulu n‟abato abakulu abalina Aortic Coarctation bayinza okufuna obubonero nga:

• Okulumwa omutwe emirundi mingi
• Puleesa eri waggulu
• Okuvaamu omusaayi mu nnyindo emirundi mingi
• Obulumi mu magulu ng’okola dduyiro, ng’odduka oba ng’obuuka

Abaana abamu bayinza obutafuna bubonero bwonna n’akatono. Wabula ekizibu kino kisooka kuzuulibwa nga puleesa mu kiseera ky’okukebera obulungi buli kiseera.

Omuntu omukulu bw’afuna obubonero buno, kitera kuva ku kuddamu okufunda kw’omusuwa gw’omusaayi oluvannyuma lw’okujjanjabwa emabegako. Si kya bulijjo nnyo embeera eno obutazuulibwa okutuusa ng’omuntu omukulu.

Lwaki embeera eno ebaawo? Ensonga ze ziruwa?

Abakugu n’okutuusa kati tebamanyi kituufu ekivaako CoA. Kyokka, kirowoozebwa nti waliwo ekitundu ky’obuzaale . Kwe kugamba, enkyukakyuka ezimu ez’obuzaale ezibaawo ng’omwana ali mu lubuto ziyinza okuvaako omusuwa gw’omwana obutakula bulungi.

Oluusi enkyukakyuka zino mu buzaale zisobola okuyisibwa mu maka. Okunoonyereza kulaga nti bw’oba ​​olina CoA, omwana wo atera okufuna CoA oba obulwadde obulala obw’omutima okusinga omuntu atalina CoA.

Ate era, akabi k’okufuna CoA kali waggulu n’embeera z’obuzaale ezimu. Okugeza, abaana abazaalibwa n’embeera y’obuzaale eya Turner syndrome tebatera kuba na Coarctation of the Aorta yokka, wabula n’obulema obulala mu kuzaalibwa nga bicuspid aortic valve, ekikyamu mu valve z’omutima.

Ekivaako `(CoA)` yokka nga tewali bulema bulala ku mutima

Ekisinga okuvaako CoA eyawuddwamu kwe kuggalawo mu ngeri etaali ya bulijjo kw’omusuwa omutono oguyitibwa ductus arteriosus mu kiseera ky’okukula kw’omwana ali mu lubuto. Omusuwa omutono ogw’omusaayi ogugatta omusuwa gw’omu lubuto n’omusuwa gw’amawuggwe. Amawuggwe tegakola ng’omwana ali mu lubuto, n’olwekyo ttanka eno eyamba omwana okufuna omusaayi ogulimu omukka gwa oxygen gwe yeetaaga.

Omwana bw’amala okuzaalibwa, amawuggwe gatandika okukola. Olwo, okuva kino `(ductus arteriosus)` bwe kitakyetaagisa, kitandika okuggalawo ku bwakyo mu nnaku ntono. Naye bwe kiggalawo, ebimu ku bitundu ebiri mu mudumu ogwo bisobola okwegatta n’ebitundu by’omubiri ebya `(Aorta)`. Mu mbeera eyo, `(ductus arteriosus)` bwe ewalirizibwa okuggalawo, omusuwa gw’omusaayi nagwo gusobola okufunda (coarctation)`.

Bizibu ki ebiyinza okubaawo olw’embeera eno?

Singa embeera eno (Coarctation of the Aorta) erekebwa okumala ebbanga ddene nga tejjanjabiddwa, ebizibu nga:

• Puleesa (hypertension) mu mubiri gwonna.
• Ebinywa by’omutima bifuuka ebinene okusinga ebya bulijjo (left ventricular hypertrophy).
• Okukuŋŋaanyizibwa kw’ebikuta mu misuwa gy’omusaayi, egigabira omutima, kubaawo nga bukyali okusinga ku bulijjo - kino kiyitibwa obulwadde bw’emisuwa.
• Okubumbulukuka okutali kwa bulijjo (aneurysm) oba okukutuka (okusalako) mu aorta.
• A brain aneurysm (okubumbulukuka kw’omusuwa mu bwongo).
• Omutima okulemererwa embeera omutima mwe gulemererwa okusiba omusaayi obulungi.

Embeera eno eya `(CoA)` esinga kuba ya bulabe singa temanyiddwa era tejjanjabibwa. N’olwekyo, kikulu nnyo okukitegeera amangu ddala, ng’okyali muto, n’okufuna obujjanjabi obwetaagisa n’okukeberebwa buli kiseera (okulondoola).

Abasawo kino bakizuula batya? (Okuzuula obulwadde)

Abasawo b’omutima mu baana batera okuzuula embeera eno (Coarctation of the Aorta) mu baana abawere oba abato. Engeri gye kizuulibwamu amangu kisinziira ku bubonero bwe buli obw’amaanyi.

Abalongo abalina obubonero obutono bazuulibwa mu nnaku ntono nga bamaze okuzaalibwa. Kyokka abalongo abalina obubonero obutono, oba abatalina n’akatono, bayinza obutamanyibwa okutuusa nga bakuze ne bafuna puleesa. Tekitera kubaawo nnyo kino okumanyibwa mu bukulu.

Embeera eno etera okuzuulibwa mu baana abawere n’abaana abato olw’ebintu ebimu ebiteeberezebwa (bendera emmyufu) ezirabibwa nga bakeberebwa omubiri. Ebintu ng’ebyo mulimu:

• Omwana alina puleesa mu mikono ne mu mubiri ogwa waggulu, kyokka puleesa ntono mu magulu ne mu mubiri ogwa wansi.
• Waliwo enjawulo wakati w’okukuba mu bulago n’okukuba mu kisambi.
• Omusawo bw’ateeka ekyuma ekiwuliriza ku mugongo gw’omwana n’awuliriza, eddoboozi ery’enjawulo, ery’obukambwe eriva ku mutima (‘okwemulugunya kw’omutima omukambwe’) liwulirwa.

Abalongo abamu bazuulibwa n’obulwadde buno nga tebannaba na kulaga bubonero. Omanyi otya? Okukebera okuyitibwa ``pulse oximetry`` okupima oxygen mu musaayi gwabwe kulaga nti oxygen mutono. Omukka gwa oxygen omutono guyinza okuba akabonero k’obulwadde bw’omutima obw’amaanyi obuzaalibwa, n’olwekyo abalongo bano bakeberebwa okuzuula ddala ekikyamu.

Okukakasa embeera eno eya `(CoA)`, abasawo batera okukozesa `(Echocardiogram)`, okukebera omutima, oba `(echo)`. Bayinza n'okukola ebigezo nga `(CT scan)` oba `(MRI scan)` okumanya ebisingawo ku nkula n'ensengeka y'omusuwa gw'omwana.

Waliwo endwadde z'omutima endala ezikwatagana ne ``Coarctation of the Aorta''?

Yee, abalongo abalina CoA basobola okuzuulibwa nga balina embeera endala ez’omutima. Okugeza, wakati wa 45% ne 75% ku bantu abalina CoA nabo balina embeera eyitibwa bicuspid aortic valve. Kino kitegeeza nti vvaalu etambuza omusaayi okuva ku mutima okutuuka mu aorta erina obupapula bubiri bwokka mu kifo ky’obusatu bwe yandibadde nabwo mu budde obwa bulijjo.

Si ekyo kyokka, naye `(CoA)` era esobola okuwerekerwako embeera zino wammanga:

• Okubeera n'ekituli mu mutima - ekyo kiyitibwa `(atrial septal defect)` oba `(ventricular septal defect)`.
• Omusuwa ogwaliwo mu bulamu bw’omwana ali mu lubuto (`ductus arteriosus`) gusigala nga guggule okumala ekiseera ekiwanvu okusinga bwe kisuubirwa - kino kiyitibwa ``patent ductus arteriosus``.
• Aortic arch hypoplasia oba obulwadde bw’omutima ogwa kkono obutazimba.
• Okukaluba kwa vvaalu y’omutima - kwe kugamba, okusannyalala kw’ensuwa y’omusuwa oba okusannyalala kw’ensuwa y’omutima.

Abasawo abalongoosa omutima batunuulira ebintu bino byonna mu mutima gw’omwana wo ne bakola enteekateeka y’obujjanjabi ekwata ku bo. Kino kitegeeza nti okujjanjaba omwana alina obuzibu ku mutima ebingi kiyinza okuba ekizibu katono okusinga okujjanjaba omwana alina CoA emu yokka.

Bujjanjabi ki obukolebwa ku kino?

Obujjanjabi bw’oyinza okukozesa kusinziira ku myaka gy’omwana wo, obuwanvu bw’omusuwa gw’omusaayi (aorta) we gufunda, n’okumanya oba alina obulemu obulala ku mutima. Okulongoosa y’engeri esinga okujjanjaba obulwadde bw’okuzimba omusaayi mu baana abawere n’abaana abato. Ku baana abakulu, singa okufunda tekuba kwa maanyi nnyo, okuteekebwamu emisuwa gy’omutima, enkola etali ya kuyingirira nnyo okusinga okulongoosa, kiyinza okuba ekituufu. Era ekozesebwa mu baana n’abantu abakulu abazze baddamu okufunza oluvannyuma lw’okujjanjabibwa emabegako.

Okuloongoosa

Waliwo ebika by’okulongoosa ebikulu ebiwerako ebikolebwa okutereeza embeera eno eya `(CoA)`:

• Okusalako nga bakozesa enkola ya anastomosis okuva ku nkomerero okutuuka ku nkomerero: Singa ekizimba kiba kitono, omusawo ayinza okusalako ekitundu ky’omusuwa gw’omwana ekizibiddwa n’addamu okwegatta ku nkomerero ezisigadde.
• Okusalako nga bakozesa enkola ya anastomosis eyagaziyizibwa okuva ku nkomerero okutuuka ku nkomerero:Singa n’omusuwa gw’omwana guzibikira, omusawo asobola okusala ekitundu ky’omusuwa oguzibiddwa n’agatta ekitundu ekya wansi eky’omusuwa ogukka ku kifo ekiwanvu ekisaliddwa mu kisenge ky’omusuwa. Kino kye kisinga obulungi ng’omwana alina obulwadde bwa transverse aortic arch hypoplasia ne aortic coarctation.

Abalongo abalaga obubonero obw’amaanyi nga bamaze okuzaalibwa nabo bayinza okwetaaga okuweebwa eddagala nga tebannalongoosebwa. Okugeza nga:

• Eddagala eriyitibwa `(Prostaglandin (PGE-1))` liyinza okuweebwa okukuuma `(ductus arteriosus)` y'omwana nga nzigule. Kino kijja kusobozesa omwana okufuna omukka gwa oxygen gwe yeetaaga n’okumukuuma nga banywevu okutuusa lw’anaaba nga yeetegese okulongoosebwa.
• Omwana osobola n’okumuwa eddagala eriyamba omutima gwe okukuba omusaayi.

Okussa eddagala eriyitibwa catheter mu mutima

Singa omwana wo akendedde ku kufunda kw’omusuwa gw’omusaayi, oba singa okufunda kuzzeemu oluvannyuma lw’okulongoosebwa, omusawo ayinza okukuwa amagezi ku bujjanjabi nga:

• Balloon angioplasty: Omusawo alongoosa akozesa akapiira akatono okugaziya ekitundu ekifunda eky’omusuwa gw’omwana.
• Balloon angioplasty with stent placement: Omusawo alongoosa bw’aba agaziya omusuwa gw’omwana, era ayingizaamu akatuli akatono akayitibwa stent, okugukuuma obutaddamu kuzibikira.

Omwana wange mmutwale ddi ew’omusawo? (Okuddamu ebigezo)

Ttiimu y’abasawo b’omwana wo ejja kukubuulira ddi lw’olina okuleeta omwana wo Mu bulamu bw’omwana wo bwonna, ajja kwetaaga okugoberera n’omukugu mu ndwadde z’omutima ezizaalibwa. Omukugu ono ajja:

• Londoola puleesa y’omwana buli kiseera.
• Okukola sikaani (okukebera ebifaananyi) buli luvannyuma lwa kiseera okukebera enkola y’omutima gw’omwana n’obubonero bw’ebizibu.
• Okuwa amagezi ku ngeri y’okulya ennungi eri omutima n’okukola dduyiro.
• Okuwandiika eddagala n’okukyusa mu ddoozi yaalyo nga bwe kyetaagisa.

Omuntu alina embeera eno asobola okuwangaala ebbanga ki?

Olw’enkola ez’omulembe ez’okuzuula n’okujjanjaba, abantu abalina Coarctation of the Aorta kati basobola okuwangaala okutuuka ku myaka egitakka wansi wa 60. Edda abantu abalina embeera eno bawangaala emyaka nga 35. Kale gano ddala mawulire malungi.

Omwana wo bw’aba alina obulwadde bwa Coarctation of the Aorta, oyinza okuba nga weebuuza lwaki kyabaddewo. Bulijjo tetusobola kuzuula kituufu ekivaako obulwadde bw’omutima obuzaalibwa. Naye tukimanyi nti okuzuula amangu n’okujjanjaba kiyinza okukendeeza ennyo ku ngeri embeera eno gy’ekwata ku bulamu bw’omwana.

Ttiimu y’abasawo bulijjo ebeerawo okuyamba omwana wo. Beetegefu okuddamu ebibuuzo byonna by’oyinza okuba nabyo n’okukuyamba okutegeera engeri okuzuula kuno (CoA) gye kunaakwata ku mwana wo. Oyinza n’okukisanga nga kya muganyulo okwogera n’abazadde abalala ab’abaana abalina obulwadde bw’omutima obw’ekika kino.

Ebintu ebikulu by'olina okukuuma mu birowoozo (Take-Home Message)

Nsuubira kati olina okutegeera ku mbeera gye tubadde twogerako eyitibwa ``Coarctation of the Aorta''. Bino bye bimu ku bintu ebikulu by’olina okujjukira:

• Kino kizibu ky'omutima ekizaalibwa ; okuzibikira mu musuwa omukulu ogutwala omusaayi okuva ku mutima okutuuka mu mubiri.
• Obubonero buyinza okubaawo mu buwere oba buyinza okulabika oluvannyuma. Bw’olaba ng’omwana asusse okwebaka, okukaluubirirwa okussa oba nga tayagala kuyonsa, genda mangu omusawo amagezi.
• Okuzuula obulwadde buno nga bukyali n’okubujjanjaba kiwa omwana omukisa omunene okubeera mu bulamu obwa bulijjo era obulungi.
• Embeera eno esobola okuddukanyizibwa obulungi nga balongoosebwa n’obujjanjabi obulala.
• Okulabirirwa kw’abasawo omukugu obulamu bwonna kyetaagisa nnyo ne bwe baba bamaze okujjanjabibwa.

Totya. Sayansi w’obusawo akulaakulana nnyo leero. Waliwo abasawo abakugu abasobola okuwa omwana wo obujjanjabi obusinga obulungi. Ekisinga obukulu kwe kuba nti kino okimanyi, ofaayo ku nkyukakyuka z’omwana wo, era ofune amagezi g’abasawo mu budde.

` Coarctation of the Aorta, Obulwadde bw’omutima, Obujjanjabi bw’abaana, Obulwadde bw’omutima obuzaalibwa, Aortic Stenosis, Obulamu bw’abaana, Puleesa