Kodi mwana wanu ali ndi vuto lopuma motere? Tiyeni tikambirane za "Double Aortic Arch"!

Kodi mwana wanu nthawi zina amamva ngati akuvutika kupuma? Kodi amatsamwitsidwa akamayamwitsa kapena akamayamwitsa? Kapena amapanga phokoso lachilendo akamapuma? Ngakhale kuti awa akhoza kukhala matenda ofala a ana, pakhoza kukhala vuto lina lalikulu, koma lochiritsika, kumbuyo kwa vutoli. Vuto limodzi losowa koma lofunika kulidziwa ndi lotchedwa "Double Aortic Arch." Tiyeni tikambirane za vutoli mwatsatanetsatane lero.

Mwachidule, mtsempha waukulu wamagazi womwe umanyamula magazi kuchokera mumtima wa mwana wanu kupita ku thupi lake lonse ndi aorta . Nthawi zambiri umakhala mtsempha umodzi waukulu. Gawo lopindika la mtsempha uwu pamwamba pa mtima limatchedwa aortic arch .

Komabe, mwa mwana amene ali ndi "Double Aortic Arch", "aortic arch" iyi imapangidwa m'magulu awiri. Izi zikutanthauza kuti, mtsempha wina wamagazi umalumikizidwa ndi "aortic arch" yayikulu iyi, ndikupanga arch yachiwiri. Ma arches awiriwa amalumikizana, ndikupanga mphete yozungulira payipi ya mwana (trachea) ndi payipi ya chakudya (esophagus) . Tangoganizirani, chimachitika ndi chiyani ngati mphete iyi yatsekedwa? Pamenepo ndi pomwe mwana amayamba kukhala ndi zizindikiro zoopsa monga kupuma movutikira, kupanga phokoso akamapuma, komanso kuvutika kumeza chakudya.

"Aortic arch" iyi imapangidwa kumayambiriro kwenikweni kwa mimba, pakati pa milungu iwiri ndi isanu ndi iwiri. Panthawiyi, mtima ndi mitsempha yamagazi zimakula m'njira yovuta kwambiri. Ziwalo zina zimapangidwa, ndipo pakapita nthawi sizimafunikanso ndipo zimasowa. "Double Aortic arch" imapangidwa chifukwa cha chinthu chonga ichi. Pafupifupi sabata yachisanu ya mimba, mitsempha yamagazi yomwe iyenera kuti inasowa, pazifukwa zina zosadziwika, siisowa ndipo "Double Aortic arch" iyi imapangidwa. Ichi ndi vuto la mtima lobadwa nalo , zomwe zikutanthauza kuti mwana amabadwa nalo.

Matendawa, otchedwa "double aortic arch," ndi a gulu la matenda a mtima obadwa nawo otchedwa "vascular rings." Izi zimapangitsa kuti mphuno ndi m'mero ​​wa mwana zipsinjike.

Kodi "mizere ya mitsempha" iyi ndi chiyani?

Chabwino, "Mitsempha ya Mitsempha", monga ndanenera kale, ndi matenda omwe "mtsempha wa m'mimba" umakula modabwitsa, zomwe zingayambitse kupindika kwa mtsempha wa m'mimba (trachea), chitoliro cha chakudya (m'mero), kapena zonse ziwiri. Izi ndi zolakwika za mtima zobadwa nazo kawirikawiri. Taganizirani izi, pafupifupi mwana m'modzi mwa 100 amabadwa ndi vuto la mtima lobadwa nalo. Koma "mtsempha wa m'mimba" umakhudza mwana m'modzi mwa 10,000 okha. Ndizosowa kwambiri.

Kodi mitundu ikuluikulu ya "Mitsempha ya Mitsempha" ndi iti?

Pali mitundu ingapo ikuluikulu ya "mitsempha yamagazi" iyi. Tiyeni tiwone zomwe zili:

• Chipilala Chachiwiri cha Msewu: Mu ichi, "machipata awiri a msewu" (kumanzere ndi kumanja) amazungulira trachea ndi esophagus. Iyi ndiyo nkhani yaikulu yomwe tikukamba.
• Chipilala cha msempha chakumanja chokhala ndi mtsempha wamagazi wosagwirizana ndi mtsempha wamagazi wocheperako komanso ligamentum yakumanzere: Pali chipilala chimodzi cha msempha apa, koma chili kumbali yakumanja ya trachea (nthawi zambiri kumanzere). Pankhaniyi, mtsempha wamagazi wocheperako, womwe umapatsa magazi m'manja mwa mwana, umayamba pa aorta ndikudutsa kumbuyo kwa trachea ndi esophagus. Mzere wamagazi uwu umamalizidwa polumikizana ndi ligamentum arteriosus yakumanzere, yotsalira ya mtsempha wamagazi womwe unalipo panthawi ya moyo wa mwana wosabadwayo kenako umatha.
• Chipilala cha kumanzere cha mtsempha wamagazi chokhala ndi mtsempha wamagazi wamanja wa subclavian wosakhazikika: Apa, mtsempha wamagazi wamanja wa subclavian umadutsa kumbuyo kwa trachea ndi esophagus, ndikuzikanikiza.
• Kukanikiza kwa mitsempha ya innominate: Mitsempha ya innominate (brachiocephalic) ndi nthambi ya aorta. Pankhaniyi, imayambira kumanzere kwa trachea, kenako imadutsa patsogolo pa trachea kumanja. Izi zimaika mphamvu pa trachea.
• Kutsekereza mitsempha ya m'mapapo: Mitsempha ya m'mapapo yakumanzere imayambira kuchokera ku mitsempha ya m'mapapo yakumanja ndikudutsa pakati pa trachea ndi esophagus.

Chomwe chimachitika m'njira zonsezi ndi chakuti njira yopumira kapena ya m'mero ​​imakhudzidwa mwanjira ina.

Kodi pali mitundu ya "Double Aortic Arch"?

Inde, pali mitundu itatu ikuluikulu ya "double aortic arch." Izi zimasiyanitsidwa ndi arch yomwe ndi yayikulu, komanso ngati arch yayikuluyo ili kumanja kapena kumanzere kwa trachea.

• Chipilala chakumanja chachikulu chokhala ndi chipilala chaching'ono chakumanzere: Uwu ndi mtundu wofala kwambiri, womwe umapezeka pafupifupi 80 peresenti ya milandu.
• Chipilala chachikulu chakumanzere chokhala ndi chipilala chaching'ono chakumanja: Izi zimawoneka pafupifupi 10 peresenti ya milandu.
• Ma arches olinganizidwa: Izi zimawonekeranso pa milandu pafupifupi 10 peresenti.

Ndi mtundu wanji wa "mzere wa mitsempha" womwe umawoneka kwambiri?

Madokotala ankaganiza kuti "double aortic arch" ndiyo mtundu wofala kwambiri wa "vascular ring." Koma kafukufuku watsopano wapeza kuti "right aortic arch" kwenikweni ndi yofala kwambiri.

Koma palinso china. Makanda omwe ali ndi "right aortic arch" amakhala ndi vuto lina la mtima lobadwa nalo kuposa makanda omwe ali ndi "double aortic arch." Komabe, nthawi zambiri sapezeka akangobadwa. Izi zili choncho chifukwa "right aortic arch" siingayambitse zizindikiro kumayambiriro. Chifukwa chake, opaleshoni ya vutoli ingafunike pakati pa miyezi 6 ndi 18.

Matenda otchedwa ``Double Aortic Arch'' ndi mtundu wofala kwambiri wa mphete ya mitsempha yamagazi. Chifukwa chake, dokotala wa mwana wanu amatha kuzindikira vutoli msanga. Poyerekeza ndi makanda omwe ali ndi mitundu ina ya mphete ya mitsempha yamagazi, makanda omwe ali ndi ``Double Aortic Arch'' angafunike opaleshoni atangobadwa kumene.

Kodi zizindikiro za "Double Aortic Arch" ndi ziti?

Zizindikiro za "double aortic arch" nthawi zambiri zimachitika pamene mphuno ya mwana, m'mero, kapena zonse ziwiri zapanikizika. Kupsinjika kumeneku kungakhudze kupuma kwa mwana, kudya, kapena ntchito ya mtima.

Kawirikawiri, zizindikirozi zimawonekera ali ana aang'ono (makamaka ngati vutoli ndi lalikulu), koma nthawi zina zimatha kuonekera ali ndi zaka zitatu, kapena ngakhale ali achinyamata.

Ana ena angaganizidwe molakwika kuti ali ndi mphumu chifukwa zizindikiro zake ndi zofanana. Vutoli limapezeka pokhapokha ngati chithandizo cha mphumu chalephera ndipo mayeso ena achitika.

Zizindikiro za kupuma

Pafupifupi 91 peresenti ya makanda ndi ana omwe ali ndi "double aortic arch" amakhala ndi zizindikiro zokhudzana ndi kupuma. Izi ndi izi:

• Phokoso lachilendo popuma (phokoso lapamwamba lotchedwa `stridor` kapena phokoso lopumira lotchedwa `kupuma`) .
• Chifuwa chomwe chimamveka ngati "kukuwa kwa chisindikizo." Izi zikufanana ndi chifuwa chomwe chimachitika panthawi ya matenda otchedwa "croup."
• Matenda opatsirana pafupipafupi m'mapapo.

Zizindikiro za m'mimba

Pafupifupi 40 peresenti ya makanda ndi ana omwe ali ndi "double aortic arch" amakumana ndi zizindikiro izi za m'mimba.

• Kutsekeka pamene mukuyamwitsa kapena kudyetsa mwana.
• Kuvuta kumeza (dysphagia) . Izi nthawi zambiri zimawonekera mwana akayamba kudya zakudya zolimba.
• Kuvuta kunenepa .
• Chakudya chikubwerera mmwamba pakhosi (`Regurgitation/reflux`) .

Zizindikiro za mtima

Pafupifupi 30 peresenti ya makanda ndi ana omwe ali ndi "double aortic arch" amakhala ndi zizindikiro zokhudzana ndi mtima. Izi zikuphatikizapo:

• Kupweteka pachifuwa .
• Phokoso la mtima losazolowereka ('Kung'ung'udza kwa mtima') .
• Khungu labuluu (cyanosis) .

Kodi n’chiyani chimayambitsa “Double Aortic Arch”?

Choyambitsa chenicheni cha "double otic arch" sichinapezekebe . Ngakhale kuti vutoli limapezeka kawirikawiri mwa makanda omwe ali ndi pakati kudzera mu "in-vitro fertilization" (IVF) , chifukwa chenicheni sichikudziwika.

Chipilala cha msempha wawiri (double aortic arch) chingagwirizanenso ndi matenda ena. Pafupifupi 12 peresenti ya makanda omwe ali ndi chipilala cha msempha wawiri (double aortic arch) ali ndi vuto lina la mtima lobadwa nalo, monga ventricular septal defect (VSD) ndi tetralogy of Fallot . Kuphatikiza apo, pafupifupi 20 peresenti ya makanda omwe ali ndi chipilala cha msempha wawiri (double aortic arch) ali ndi matenda a majini monga chromosome 22q11 deletion ndi trisomy 21 (Down syndrome) .

Kodi mungazindikire bwanji "Double Aortic Arch"?

Chigoba cha mtsempha wamagazi (double aortic arch) chimapezeka mwangozi kapena zizindikiro zikayamba. Nthawi zina, chimapezeka mwangozi panthawi ya mimba, atabadwa, kapena panthawi yoyezetsa zithunzi pazifukwa zina. Kuyambira mu 2004, chiwerengero cha anthu omwe amapezeka ndi vutoli kudzera mu scans panthawi ya mimba chawonjezeka. Izi ndizothandiza kwambiri, chifukwa chithandizo chingakonzedwe mwana akangobadwa.

Kapena, zitha kuzindikirika zizindikiro zikaonekera mwana akabadwa. Dokotala wa mwana wanu adzakambirana nanu za zizindikirozo kenako n’kukuyesani zina.

Mayeso ozindikira matenda a "Double Aortic Arch"

Mayeso akuluakulu omwe amagwiritsidwa ntchito pozindikira vutoli ndi awa:

• X-ray ya pachifuwa: Iyi nthawi zambiri imakhala mayeso oyamba ochitidwa.
• Kujambula kwa CT.
• Kuyesa kwa Echocardiogram (Echo): Izi zimathandiza kwambiri kudziwa ngati pali matenda ena a mtima.
• Kuyesa kwa MRI (MRI).

Nthawi zina opaleshoni ya bronchoscopy ingachitike kuti ione mphuno ya mwana. Izi zitha kuchitika poyankha mavuto opuma asanapezeke ndi double aortic arch. Kapena, zitha kuchitika musanachite opaleshoni kuti dokotala amvetse bwino zomwe zikuchitika.

Kuyezetsa majini kumathandiza kuzindikira matenda a majini.

Kodi mungachiritse bwanji "Double Aortic Arch"?

Opaleshoni imafunika kuti akonze vuto la "double aortic arch." Ngakhale kwa makanda omwe alibe zizindikiro, opaleshoniyi ndi yabwino kwambiri pakati pa miyezi 6 ndi 9. Makanda omwe ali ndi zizindikiro, makamaka ngati zizindikirozo ndi zazikulu, angafunike opaleshoni kale.

Tangoganizirani, vuto la "double aortic arch" linadziwika koyamba mu 1737. Opaleshoni yoyamba ya opaleshoniyi inachitika mu 1947. Kuyambira nthawi imeneyo, tafika pati! Makanda omwe ali ndi vuto lobadwa nalo akhala ndi moyo wautali komanso wathanzi chifukwa cha chithandizo cha opaleshoni.

Opaleshoni ya "Double Aortic Arch"

Opaleshoni ya "Double Aortic Arch" ndi yotetezeka kwambiri, ndipo zotsatira zake zimakhala zabwino kwambiri . Mwana wanu sadzafunika kulumikizidwa ndi "cardiopulmonary bypass" (makina a mtima ndi mapapo) .

Opaleshoniyi imachitika pogwiritsa ntchito njira yotchedwa "lateral thoracotomy." Izi zikutanthauza kuti dokotalayo amadula mbali imodzi ya chifuwa cha mwana, pakati pa nthiti ziwiri. Izi nthawi zambiri zimachitika kumanzere, chifukwa ndi komwe makanda ambiri amakhala ndi "nkhope" yaying'ono. Mayeso ojambulidwa omwe amachitidwa opaleshoni isanachitike amalola dokotalayo kuti ayang'ane bwino mkati mwa thupi la mwana ndikukonzekera opaleshoniyo moyenera.

Dokotala wa opaleshoni amagwiritsa ntchito njira ya "kulumikiza ndi kugawa" . Izi zikutanthauza kuti chingwe chaching'ono chimamangiriridwa kuti chilepheretse kutuluka magazi kudzera mmenemo. Kenako chimadulidwa ndi kusokedwa. Njirayi imabwerezedwanso mpaka chingwecho chitapatukana kwathunthu ndipo kupanikizika kwa paipi ya mphepo ndi m'mero ​​kuchotsedwa.

Mwana wanu adzakhala m'chipatala kwa pafupifupi sabata imodzi, kenako adzachira n'kubwera kunyumba.

Chithandizo cha "Kommerell diverticulum" (`Kommerell diverticulum - KD`)

Kawirikawiri, makanda ena omwe ali ndi "double aortic arch" angakhalenso ndi chinthu chotchedwa "Kommerell diverticulum (KD)." Izi zimachitika kwambiri mwa makanda omwe ali ndi "right aortic arch," komanso zimakhalanso zachilendo kwambiri ndi "double aortic arch."

`KD` iyi ndi `aneurysm`, mtsempha wamagazi womwe umakula mu `aorta` yotsika pafupi ndi `aortic arch`. Kutupa kumeneku kumatha kutenga malo ndikukankhira pa payipi ya mpweya ndi chitoliro cha chakudya cha mwana. Sikungayambitse mavuto nthawi yomweyo. Komabe, madokotala ochita opaleshoni amakonda kuchotsa izi popanga `double aortic arch` kuti apewe mavuto pambuyo pake.

Chithandizo cha zilema zina za mtima

Ngati mwana wanu ali ndi vuto lina la mtima lomwe limafuna opaleshoni, akhoza kuchiritsidwa nthawi yomweyo ndi double aortic arch. Izi zingafunike njira yotchedwa ``median sternotomy'' , yomwe imaphatikizapo kudula pakati pa chifuwa. Dokotala wa mwana wanu adzakambirana njira yabwino kwambiri kwa inu, kutengera mavuto omwe akufunika kuchiritsidwa.

Kodi ndi mavuto otani omwe angabwere chifukwa cha opaleshoni?

Chiwopsezo cha mavuto omwe amabwera chifukwa cha opaleshoni ya double aortic arch ndi chochepa kwambiri . Nthawi zambiri, mwana angakhale ndi vuto la kudya kapena kupuma kosalekeza. Ngati pali mavuto aliwonse opuma osalekeza, nthawi zambiri amatha mkati mwa chaka chimodzi kuchokera pamene opaleshoniyo yachitika.

Mavuto omwe amabuka chifukwa cha opaleshoni yokonza double aortic arch ndi zolakwika zina za mtima zimatha kusiyana. Kambiranani zoopsa ndi mavuto onsewa ndi dokotala wa mwana wanu.

Kodi "Double Aortic Arch" ingapewedwe?

Ayi, vuto lotchedwa "double aortic arch" silingathe kupewedwa . Ndi vuto lomwe limayamba msanga mimba ikayamba ndipo limapezeka pobadwa.

Kodi tsogolo la anthu omwe ali ndi "Double Aortic Arch" ndi lotani?

Makanda ndi ana omwe adachitidwa opaleshoni ya "Double Aortic Arch" ali ndi tsogolo labwino kwambiri . Akhoza kukhala ndi kuchita zinthu zachizolowezi popanda zoletsa zilizonse.

Pambuyo pa opaleshoni, mwana wanu angapitirize kupuma mopanda phokoso kwa chaka chimodzi. Izi zili choncho chifukwa chakuti payipi ya mwana siinakule bwino chifukwa cha "double aortic arch." Choncho, zimatenga nthawi kuti payipi ya mpweya ikhale yolimba.

Kawirikawiri, makanda ndi ana angakhalebe ndi zizindikiro za kupuma patatha chaka chimodzi kuchokera pamene opaleshoni yachitika.

Chofunika kwambiri ndikutenga mwana wanu kuti akamupime nthawi zonse ndikuuza dokotala wanu ngati muli ndi zizindikiro zilizonse zomwe zikupitirira. Chisamaliro chotsatiridwa kwa nthawi yayitali n'chofunika kwambiri kwa mwana aliyense amene wachitidwa opaleshoni ya mtima.

Kodi ndiyenera kuyimbira dokotala wa mwana wanga liti?

Ngati muwona zizindikiro zatsopano, kapena ngati zizindikiro zomwe zilipo zikuipiraipira, lankhulani ndi dokotala wa mwana wanu nthawi yomweyo. Makanda ndi ana aang'ono amasintha kwambiri kotero kuti nthawi zina zimakhala zovuta kudziwa zomwe zili bwino komanso zomwe sizili bwino. Koma ngati mwana wanu ali ndi chifuwa "chofanana ndi chisindikizo" kapena phokoso lopuma , dziwitsani dokotala wanu nthawi yomweyo. Ikhoza kukhala matenda wamba a ubwana. Koma nthawi zambiri, ikhoza kukhala chizindikiro cha vuto la mtima lomwe likukhudza mphamvu ya mwana wanu yopumira.

Kodi muyenera kuyimba 911 (nambala yadzidzidzi) liti?

"Double aortic arch" ingayambitse kupanikizika pa mphuno ya mwana wanu. Ngati khungu la mwana wanu likuwoneka labuluu (cyanosis) , kapena ngati mwana wanu akuvutika kupuma , imbani 911 nthawi yomweyo.

Ndi mafunso ati omwe ndiyenera kufunsa dokotala wa mwana wanga?

Ngati mwana wanu wapezeka ndi "double aortic arch," ndi zachilendo kuti mukhale ndi mafunso ambiri. Ndikofunikira kudziwa momwe mwana wanu alili, kuphatikizapo nthawi yomwe opaleshoni ikufunika, komanso ngati mwana wanu ali ndi mavuto ena azaumoyo. Mungafune kufunsa mafunso monga:

• Kodi mwana wanga ayenera kuchitidwa opaleshoni liti?
• Kodi opaleshoniyi imachitikira kuti? Ndani akuchita opaleshoniyi?
• Ndi zizindikiro ziti zomwe ndiyenera kuzisamala kunyumba?
• Kodi ndingachite chiyani kuti mwana wanga azikhala panyumba mosavuta?
• Kodi mwana wanga ali ndi vuto lina la mtima?
• Kodi ndiyenera kuyezetsa majini a mwana wanga kapena a banja langa lonse?
• Kodi tsogolo la mwana wanga lidzakhala bwanji?

Kodi "Aortic Arch Syndrome" ndi chiyani? Kodi ndi yosiyana ndi "Double Aortic Arch"?

Inde, musasokoneze awiriwa. "Aortic Arch Syndrome" ndi mtundu wosowa kwambiri wa "Vasculitis" . Umadziwikanso kuti "Takayasu's arteritis" .

"Vasculitis" ndi kutupa kwa makoma a mitsempha yanu yamagazi. Kungachitike mu mitsempha iliyonse yamagazi, ngakhale mitsempha yaying'ono kwambiri yamagazi, ma capillaries. "Takayasu's arteritis" ndi kutupa kwa mitsempha yamagazi yapakatikati ndi yayikulu. Kawirikawiri imapezeka mu "aortic arch" ndi nthambi zake zazikulu. Ichi ndichifukwa chake imatchedwanso "aortic arch syndrome."

Matenda a Takayasu's arteritis (omwe amadziwikanso kuti "aortic arch syndrome") amapezeka mwa achinyamata ndi achinyamata . Vutoli ndi losiyana kwambiri ndi "double aortic arch" yobadwa nayo yomwe tidakambirana kale, ndipo chithandizo chofunikira ndi chosiyana.

Kubadwa kwa mwana nthawi zambiri kumakhala nthawi yosangalatsa komanso yosangalatsa. Komabe, mukazindikira kuti mwana wanu ali ndi vuto la mtima, kaya panthawi ya mimba kapena atabadwa, chisangalalo chimenecho chimalowedwa m'malo ndi nkhawa komanso kusatsimikizika. Ngati mwangopeza kumene kuti mwana wanu ali ndi "double aortic arch," mwina mukudabwa kuti chidzachitike ndi chiyani.

Musadandaule. Gulu lanu lachipatala lidzakuthandizani pa zonsezi. Mwatenga kale gawo loyamba, lomwe ndi kuphunzira zambiri za matenda a mwana wanu. Nkhani yabwino ndi yakuti opaleshoni ya double aortic arch ndi yotetezeka kwambiri komanso yopambana. Ngati mwana wanu ali ndi vuto lina la mtima kapena matenda ena a majini, chithandizo chingakhale chovuta pang'ono. Komabe, ndi kupita patsogolo kwa chisamaliro cha makanda, mutha kuthandiza mwana wanu kupeza chisamaliro choyenera chomwe akufunikira, kuchira, ndikukhala ndi ubwana wosangalala.

Ndiye, ndi zinthu ziti zofunika kwambiri zomwe muyenera kukumbukira kuchokera pa zomwe takambiranazi? (Uthenga Wopita Nawo Kunyumba)

Chabwino, tiyeni tifotokoze mwachidule zina mwa zinthu zomwe muyenera kukumbukira kuchokera pa zomwe takambirana zokhudza "Double Aortic Arch" iyi:

• "Double aortic arch" ndi vuto la mtima lobadwa nalo . Mtsempha wa mwana umagawidwa m'magawo awiri, zomwe zimapangitsa kuti trachea ndi esophagus zitsekerezeke.
• Zizindikiro zazikulu ndi kuvutika kupuma, kupuma movutikira, kuvutika kumeza, komanso matenda opatsirana pafupipafupi .
• Matendawa amapezeka kudzera mu mayeso monga `CT scan`, `MRI`, `Echocardiogram` . Nthawi zina amatha kupezeka ngakhale panthawi ya mimba.
• Chithandizo chake ndi opaleshoni . Opaleshoni iyi ndi yotetezeka kwambiri komanso yopambana.
• Kwa mwana pambuyo pa opaleshoniMungathe kukhala ndi moyo wabwinobwino komanso wathanzi.
• Ngati mwana wanu ali ndi zizindikiro monga kuvutika kupuma kapena kusanza, funsani thandizo la dokotala nthawi yomweyo .
• Musadandaule . Chifukwa cha kupita patsogolo kwa mankhwala amakono, vutoli lingathe kuchiritsidwa bwino. Gulu lanu lachipatala lidzakupatsani chithandizo chomwe mukufuna.

` Double Aortic Arch, Matenda a Mtima Obadwa Nawo, Mphete za Mitsempha, Kusowa Mphamvu kwa Ana, Thanzi la Ana, Opaleshoni ya Mtima