Kia ako tātou mō te pokanga hou e whakaora ana i te takirere o te ngākau (Valve-Sparing Aortic Root Replacement).

I kī atu te tākuta me pokanga koe ki te ngākau? He mea noa te mataku i a ia e kī ana i tēnā. Engari i ēnei rā, kua tino matatau te rongoā. He maha ngā pokanga e ngana ana ki te tiaki i ngā wāhanga maha o tō tinana. I tēnei rā ka kōrero tātou mō tētahi pokanga tino motuhake. Arā, ko te takirere ngākau, he pokanga e tiaki ana i te takirere.

He aha te tikanga o te pokanga tiaki-takirua?

Āe, kia mārama ai tātou ki tēnei, me ako tātou mō tētahi wāhanga iti o tō tātou ngākau. Ko te rūma papu matua o tō tātou ngākau (te ventricle maui) e hono ana ki te oko toto nui rawa atu o tō tātou tinana, te aorta. Ka kiia tēnei hononga ko te 'Aortic Root'. He rite ki te pakiaka o te rākau. Kei roto i tēnei 'Aortic Root' tētahi kuaha tino nui, ko te 'Aortic Valve'.

Ia wā e pā ai te ngākau, ka huaki tēnei 'Aortic Valve' ka pupuhi i te toto ki roto i te tinana, kātahi ka kati. Mā tēnei kati ka aukati i te rere o te toto ki roto i te ngākau.

Whakaarohia i roto i ētahi tāngata, kua ngoikore te 'Pūtake Aorta', arā, te wāhanga o te kēti e rite ana ki te kēti, kua pupuhi, kua nui. He rite ki te poihau e pupuhihia ana. Ka kiia tēnei ko te 'Aortic Root Aneurysm'. Ina nui haere tēnei kēti, kāore te tatau o roto, arā, te 'Aortic Valve', e kati tika. Kātahi ka tīmata te toto ki te turuturu ki roto i te ngākau. Ka kiia tēnei ko te 'Aortic Regurgitation'.

I roto i te pokanga tuku iho (te 'tikanga Bentall'), ka tangohia e ngā taote pokanga te 'Aortic Root' me te 'Aortic Valve' e pupuhi ana, kātahi ka whakatōkia kia rua ngā mea horihori hou.

Ko te painga nui o tēnei ko te taea e koe te pupuri i tō ake takirere, nō reira kāore koe e hiahia ki te tango i te rongoā whakaheke toto mō te wā katoa (pēnei i te Coumadin) pērā i tāu e mahi ai me te takirere ā-ringa.

He aha ngā āhuatanga ka rongoatia e tēnei pokanga?

Ko te nuinga o te wā ka mahia tēnei mahi pokanga i roto i ngā take e whai ake nei:

• Te Aneurysm o te Pūtake Aorta: E ai ki taku kōrero i mua ake nei, he pupuhi rerekē tēnei i te pūtake o te aorta e hono ana ki te ngākau. Mēnā ka nui rawa, ka pāhū ohorere ('Aortic Dissection', te Rupture rānei). He tino morearea mō te ora.
• Te Aneurysm Aortic Piki me ngā Sinuses Aortic Whānui: Ngā take ka paku whakanuia ngā āputa iti o te 'Pūtake Aortic' ('Aortic Sinuses'), me te pupuhi i te wāhanga piki o te aorta.

Ko te hunga whai mate hononga ira tuku iho, pērā i te Marfan syndrome, he nui ake te tūponotanga ki te whakawhanake i te aneurysm pakiaka aorta. Nō reira, ka āta arotakehia e ngā taote pokanga te āhua o te tūroro, ā, ka paunatia ngā painga me ngā mōrearea o te pokanga i mua i te whakatau mēnā he tika.

He pai koe mō tēnei pokanga?

Mena kei roto i tō takirere aorta ēnei āhuatanga, tera pea he kaitono koe mō tēnei pokanga:

• Mena he iti noa iho, he kore rānei he putunga konupūmā (whakapūpū) i roto i te takirere.
• Ki te kore te takirere i tino pakaru.
• Mena kei te pai te mahi a te takirere, ki te taea rānei te whakatika mā te whakatikatika iti noa iho.

Me pēhea te whakarite i mua i te pokanga?

Mā tō taote pokanga e whakamārama ngā mea katoa me mahi e koe i mua i te pokanga. He mea tino nui kia whai tika koe i aua tohutohu. Ko te tikanga, koinei te mea me mahi e koe.

Hei tāpiritanga, ka whakahaerehia e te tākuta ētahi whakamātautau hei whakarite i te pokanga, pēnei i:

• Echocardiogram (matawai ngākau)
• Ngā whakamātautau toto
• `Matawai CT kua āraia e te EKG o te ngākau me te uma`
• Angiogram Coronary
• He whakamātautau toto ira mēnā kei te whakapaetia he mate tuku iho

He aha ngā mea ka tupu i te wā o te pokanga?

E 4 ki te 6 hāora te roa o tēnei pokanga. Ina mahia tēnei pokanga e te taote pokanga mātau, me whakamutu te ngākau mō te haora pea. Kaua e manukanuka, i taua wā, ka mahia e te mīhini te mahi a te ngākau me ngā pukahukahu.

Anei te mea e tupu ana i ia taahiraa:

1. Whakamoe: Tuatahi, ka whakamoea rawatia koe. Nō reira, kāore koe e mamae.

2. Te whakatuwhera i te uma: Ka tapahia e te taote pokanga te waenganui o te uma (he 'median sternotomy') hei toro atu ki te ngākau.

3. Te Hononga ki te Mīhini Manawa-Pūkahukahu: Ka honoa koe ki te mīhini 'Cardiopulmonary Bypass'. Ka tangohia e tēnei mīhini te mahi a tō manawa me ō pūkahukahu i te wā o te pokanga. I tēnei wā, ka hoatu he rongoā e kīia nei ko te 'cardioplegia solution' hei whakamutu i tō manawa mō tētahi wā poto.

4. Te Tuku i te Takirere: Ka āta wehea e te taote tō takirere aorta mai i te kiko e karapoti ana.

5. Te tango i ngā wāhanga pakaru: Ka tapahia te 'Aortic Root' pupuhi me ētahi atu wāhanga pakaru, ā, ka tangohia.

6. Tāruarua: Ka whakatōkia he ngongo horihori (he 'tāruarua') ki te wāhi o te wāhanga kua tangohia. He mea hanga tēnei ki tētahi momo papanga motuhake ('polyester').

7. Te whakaurunga anō i te takirere: Ka tangohia tō ake takirere aorta, ka whakauruhia he hononga hou, kātahi ka tuia ki te wāhi.

8. Te Tirotiro i te Takirere: Hei whakarite kei te pai ngā mea katoa, ka tukuna he wai mā roto i te `Graft` hei tirotiro mēnā kei te mahi tika te takirere, e tuwhera ana, e kati ana rānei.

9. Te taahiraa whakamutunga: Ka honoa ngā uaua o te ngākau ki te `Graft` hou. Kātahi ka tangohia koe i te `Heart-Lung Machine` ka tukuna tō ngākau kia mahi anō. Kātahi ka katihia te tapahi o te uma.

Ngā tikanga pokanga hou (Whakatōnga anō kua whakarerekētia)

I roto i ngā wā, kua tāpirihia e ngā taote pokanga he tikanga hou hei whakapai ake i te angitu o tēnei mahi. Hei tauira:

• Te Waihanga i ngā Sinuse Aorta Hou (`Neosinuses`): I te nuinga o te wā, he ngongo tika te `Graft`. Engari he iti ngā āputa (`sinuses`) o te `Aortic Root` tūturu. I roto i te tikanga hou, ka hangaia aua āputa mā te hangai i roto i te `Graft`. Mā tēnei ka pai ake te rere o te toto, ā, ka whakaitihia te kino o te takirere.
• Te Rahi o te Aorta: Ka whakarerekētia te rahi o te wāhanga porowhita e tau ana te takirere (te 'aorta') kia rite ki te rahi o tō tinana. Mā tēnei ka whakaiti i te tūponotanga o te turuturu toto mai i te takirere ā muri ake nei.

He aha ngā mea ka tupu i muri i te pokanga? Ā, kia pēhea te roa o te wā e ora ai?

I muri i te pokanga, ka puritia koe ki te wāhanga tiaki nui (ICU) mō te rā kotahi, e rua rānei, kātahi ka whakawhitia ki te wāhanga noa. I te nuinga o te wā ka taea e koe te hoki ki te kāinga i roto i ngā rā e 4 ki te 7.

Ahakoa he raihana taraiwa tāu, kaua e taraiwa kia whakaaetia rā anō koe e tō tākuta. Me tatari koe mō te iti rawa o te 6 wiki i mua i te mahi i tētahi mea pēnei i te hiki taumaha, te haere rānei ki te mahi.

Mā te whai wāhi atu ki tētahi kaupapa whakaora ngākau ('cardiac rehab') ka tere ai tō ora. Me whakarite hoki kia haere koe ki ngā wā tirotiro whai muri me tō tākuta. Ka aroturuki tonu rātou i te āhua o tō ngākau.

He aha ngā mōrearea me ngā painga o tēnei pokanga?

Pērā i ngā pokanga nui katoa, he iti noa iho ngā mōrearea kei roto. Heoi, ina mahia e te taote pokanga mātau i roto i te hōhipera he pai ngā whare hauora, he iti noa iho ēnei mōrearea .

Ngā painga matua:

• Kāore koe e hiahia ki te tango i ngā rongoā whakaiti toto mō te toenga o tō oranga.
• Ka whakaitihia te mōrearea o te toto totoka, te whiu, me te mate takirere (endocarditis).
• He tino iti te tūponotanga kia pokangahia anō te takirere a muri ake nei.

E whakaatu ana ngā rangahau ko te angitu o tēnei pokanga neke atu i te 99%. Ahakoa kua 10 tau te roa, tata ki te 95% o te hunga kua pokangahia, kāore e hiahiatia he pokanga anō.

Mena kei a koe tētahi o ēnei tohu, waea atu ki tō tākuta tonu atu, haere rānei ki te Tari Whawhati Tata (ETU) o te hōhipera tata ki a koe.