Kua rongo pea koe i te Atrial Fibrillation (Afib), he mate e tere ana te pao o tō ngākau, kāore i te auau, ā, kāore hoki i te tere. Tērā pea kei a koe, kei tētahi rānei o tō whānau tēnei mate. Ko te mōrearea nui rawa atu o te Afib ko te pikinga ake o te mōrearea o te whiu. Hei otinga mō tēnei, he maha ngā wā ka tohua e ngā tākuta he rongoā whakangawari toto. Engari, ehara i te mea ngāwari te tango i ēnei rongoā mō te wā roa mō te katoa. Mō ēnei tāngata, kei te kōrero tātou mō tētahi tikanga maimoatanga motuhake ka taea te whakaiti i te mōrearea o te whiu.
He aha te Katinga o te Āpitihanga o te Atrium Mauī (Katinga o te LAA)?
Hei mārama ki tēnei, me ako tuatahi tātou mō tētahi wāhanga iti o tō tātou ngākau. I te rūma maui o runga o tō tātou ngākau, e kiia nei ko te Atrium Mauī, he pūwero iti e rite ana ki te pēke. Koinei te mea e kiia nei e tātou ko te Tāpiri Atrial Mauī (LAA) .
I te nuinga o te wā, ina pā te manawa i roto i te manawa, ka tukuna te toto i roto i tēnei LAA ki te toenga o te manawa. Heoi, i roto i te tangata e pāngia ana e te Atrial Fibrillation (Afib) , ka pā te manawa i runga i te koretake, nō reira, kāore te toto i roto i tēnei pēke e kiia nei ko te LAA e pā tika ana, ā, ka tīmata te pupū. Ka taea e tēnei pupū toto te huri hei toto toto .
Engari, ki te pakaru tēnei toto totoka ka mau ki roto i tētahi oko toto e anga atu ana ki te roro, ka pā mai he whiu . Tata ki te 90% o ngā whiu i roto i te hunga whai Afib ka puta mai i ngā toto totoka e hanga ana i roto i te LAA.
Nō reira, i roto i tēnei maimoatanga e kiia nei ko te LAA Closure, ka katihia te putea e kiia nei ko te LAA te wāhi e puta ai ngā toto totoka, mā te pokanga, mā te tapahi iti rānei. I muri i te kati i tēnei, ahakoa ka puta ngā toto totoka, kāore e taea te uru ki te toto. Nō reira, ka tino whakaitihia te mōrearea o te whiu.
Ko te mea nui, kāore tēnei maimoatanga e whakaora i a Afib, engari ka tino whakaiti i te mōrearea o te whiu i puta mai i tēnei.
Mā wai tēnei maimoatanga e pai ai? He aha e kore ai e whakamahi noa i ngā rongoā whakaiti toto?
Ehara te LAA Closure i te rongoā mō te hunga katoa e tino mōrearea ana ki te whiu nā te Afib. He mea tino whai whakaaro ki te hunga e:
- Mō te hunga kāore e hiahia ki te tango i ngā rongoā anticoagulant mō te wā roa.
- Ko te hunga e hinga pinepine ana, ā, nō reira ka nui ake te mōrearea o te toto (nā te mea ahakoa he whara iti noa iho ka taea te whakaheke toto nui ina tango ana i ngā rongoā whakaiti toto).
- Mō te hunga e pāngia ana e ētahi atu pānga taha mai i ngā rongoā whakaiti toto.
- Mō te hunga kāore e taea te utu i te utu nui o ngā rongoā whakaiti toto.
He maha ngā tāngata e pāngia ana e ngā uauatanga maha ina tango ana i ngā rongoā tawhito hei whakaiti toto pērā i te Warfarin.
| Ngā raruraru ki te tango i ngā rongoā pēnei i te Warfarin |
|---|
| - Me haere tonu koe ki te hōhipera kia whakamātauria tō toto kia tika ai te horopeta o te rongoā. |
| - Me whakawhāiti te kai i ētahi kai kei roto te huaora K (pērā i te pīnihi). |
| - He tino tiketike te mōrearea o te toto. |
| Kāore e taea e te tinana o ētahi tāngata te aro atu ki tēnei rongoā. |
Ahakoa kei reira ngā rongoā hou pēnei i a Apixaban me Rivaroxaban, he raruraru nui mō ētahi tāngata te utu nui me te mōrearea tonu o te toto. Me kōrero koe ki tō tākuta ngakau kia whakatauhia ai ko tēhea maimoatanga te mea pai mōu.
He aha ngā tikanga e whakamahia ana hei kati i tēnei LAA?
He maha ngā tikanga me ngā taputapu hei mahi i tēnei. Whakaarohia he rite ki te katinga o te waha o te pounamu wai, ka whakamahia tēnei taputapu hei katinga i te waha o tēnei putea e kiia nei ko te LAA.
- Ngā taputapu ārai ā-roto: He rite ēnei ki tētahi maru iti. Ka whakauruhia ki roto i te ngākau mā te whakamahi i tētahi catheter, ā, ka whakamahia hei hiri i te whakatuwheratanga o te LAA mai i roto. He taputapu rongonui a WATCHMAN™ me Amulet™ o tēnei momo.
- Ngā taputapu kati o waho: I ētahi wā, i roto i ētahi atu pokanga ngākau, ka taea te kati i te LAA ki waho mā te topenga (`AtriClip™`) mā te tuitui motuhake rānei (`Lariat™`).
Ka whiriwhiria te tikanga e tika ana māu i muri i te kōrerorero i waenganui i a kōrua ko tō tākuta.
Te whakarite mō te maimoatanga me te āhua o te maimoatanga
I mua i te maimoatanga...
I mua i tēnei tikanga, me ine tō tākuta i te rahi me te āhua tuturu o tō LAA. Kāore e rite te LAA o te katoa. E kī ana ētahi he rite tōna āhua ki te parirau heihei, ki te kākati, ki te kūmara rānei. Ka uru atu ki tēnei he Transesophageal Echocardiogram (TEE) (he matawai i te ngākau mā roto i te ngongo e kiia nei ko te larynx) he matawai CT Cardiac rānei. Ka tohutohuhia hoki koe kia nohopuku (kaua e kai, kaua e inu) mō ētahi haora i mua i te tikanga.
I te wā e rongoatia ana...
E rua ngā huarahi matua e taea ai tēnei:
1. Me ētahi atu pokanga ngākau:Mena kei te whakahaerehia he pokanga ngākau nui atu anō, pērā i te pokanga bypass, ka tangohia, ka tuitui rānei e te taote pokanga te LAA i taua wā anō.
2. Te Whakatōtō Iti: Koinei te tikanga e whakamahia whānuitia ana. I konei, ka whakauruhia he ngongo angiangi, e kiia nei ko te catheter, mā roto i tō hope ki roto i te uaua ka arahina ki tō ngākau. Kātahi ka whakanohoia he taputapu kua tohua i mua ki te whakatuwheratanga o te LAA ka hiritia kia kore ai e puta ngā toto totoka. Ka mahia tēnei tikanga katoa i raro i te arataki a te hangarau X-ray motuhake (Fluoroscopy) me te matawai (TEE/Intracardiac Ultrasound).
I muri i te maimoatanga...
- I te nuinga o te wā me noho koe ki te hōhipera mō te pō.
- Ka whakahaerehia anō he matawai TEE i roto i te 45 rā pea hei tirotiro mēnā i angitu te maimoatanga.
- Ka hoatu he rongoā whakaiti toto me te aspirin hei tango māu kia tupu rā anō te kiko o te tinana huri noa i tēnei taputapu, ā, e tata ana ki te marama me te hawhe te roa.
- Ā muri iho, me mutu te tango i te rongoā whakaiti toto, ka tango i te Clopidogrel me te aspirin mō te ono marama pea. Tērā pea me tango e koe te aspirin mō te toenga o tō oranga. Ka mahia ēnei katoa i runga i te tohutohu a tō tākuta.
He aha ngā painga me ngā mōrearea o tēnei maimoatanga?
Pērā i ngā maimoatanga hauora katoa, he painga, he mōrearea hoki tō tēnei.
| Ngā Painga | Ngā Tūponotanga/Ngā Raruraru |
|---|---|
| Kua tino whakaitihia te mōrearea o te whiu. | He raruraru kei te taputapu whakairi. |
| Te āheinga ki te noho kore e tango i ngā rongoā whakangawari toto mō te wā roa (ngā rongoā anticoagulant). | He tauhohenga kino ki te rongoā whakamoe. |
| He tere te ora nā te mea ka mahia mā roto i tētahi tapahi iti. | Te toto. |
| Te whakapai ake i te kounga o te oranga. | Mamae o te uma, mate pāwera. |
| Te kohikohinga o te wai e karapoti ana i te ngākau (te rerenga wai i roto i te ngākau). | |
| He mate tino onge, he rite ki te whiu. |
He tino whai hua tēnei maimoatanga. E ai ki ētahi rangahau, ka taea e tēnei tikanga te whakaiti i te mōrearea o te whiu mā te 80%. Engari kia maumahara, he mea nui kia kōrerohia ēnei mea katoa ki tō tākuta i mua i te whakatau mēnā he tika tēnei māu.
Āhea ahau me kite i te tākuta?
Haunga te haere ki ō wā tirotiro kua whakaritea, me whakamōhio tonu atu ki tō tākuta mēnā ka pāngia koe e ēnei tohu:
- Ngā tohu o te kirika, o tētahi atu mate rānei
- Te manawa pāpaku koretake
- Mamae o te uma
- Te uaua ki te manawa
Ki te pāngia koe e tētahi o ēnei tohu, haere tonu ki te Tari Ohotata (ETU) o te hōhipera tata rawa atu.
Karere Tangohia ki te Kāinga
- He maimoatanga te LAA Closure mā te hunga whai Atrial Fibrillation (Afib) hei whakaiti i te mōrearea o te whiu.
- Mā te kati i tētahi pēke iti i roto i te ngākau e kiia nei ko te LAA, ka ārai i ngā toto totoka e puta mai ana i reira kei uru ki te tinana.
- He huarahi pai tēnei hei rongoā mā te hunga e uaua ana ki te tango i ngā rongoā whakaheke toto mō te wā roa.
- E kore tēnei e whakaora i a Afib, engari ka taea te ārai i te mōrearea nui rawa atu, arā, ko te whiu.
- Whai muri i te kōrero ki tō tākuta ngakau, me whakatau koe mēnā he tika tēnei maimoatanga māu, me ōna painga me ōna mōrearea.
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