Tiyeni tiphunzire za vuto losowa ili mumtima mwa mwana wanu? (Interrupted Aortic Arch)

Kubweretsa mwana wakhanda kunyumba ndi nthawi yosangalatsa kwa banja. Koma nthawi yomweyo, zingabweretsenso mantha kwa makolo. "Kodi mwana ali bwino?", "Kodi mwana akupuma bwino?", "N'chifukwa chiyani akulira kwambiri?" Mwina munali ndi mafunso ngati awa. Ngakhale nthawi zambiri izi ndi zinthu zachilendo, nthawi zina pamakhala zochitika zachilendo zomwe zimafuna kuti tikhale osamala pang'ono. Lero tikambirana za vuto la mtima lomwe silimachitika kawirikawiri lomwe lingachitike mwa makanda obadwa kumene, koma lomwe limafuna chithandizo chachangu. Imeneyo ndi Interrupted Aortic Arch, kapena IAA mwachidule.

Mwachidule, kodi Interrupted Aortic Arch (IAA) ndi chiyani?

Kuti timvetse izi, choyamba tiyeni tiwone momwe mtima wathu umagwirira ntchito. Tangoganizani kuti mtima wanu uli ngati pampu yayikulu yamadzi yokhala ndi zipinda zinayi.

• Zipinda ziwiri zapamwamba (Atria): Magazi abuluu omwe alibe mpweya wokwanira m'thupi amalowa m'chipinda chimodzi, ndipo magazi ofiira omwe ali ndi mpweya wokwanira m'mapapo amalowa m'chipinda china.
• Zipinda ziwiri zapansi (ventricles): Izi ndi zipinda zazikulu zopopera mpweya. Kumbali imodzi, zimatumiza magazi opanda mpweya m'mapapo kuti akatenge. Kumbali inayo, zimapopera magazi ofiira okhala ndi mpweya wambiri kuti agawidwe m'thupi lonse.

Mtsempha waukulu wamagazi womwe umanyamula magazi okhala ndi mpweya m'thupi lonse umatchedwa Aorta . Nthawi zambiri umakhala ngati ndodo, kapena chipilala.

Tsopano, pankhani ya Interrupted Aortic Arch (IAA) , mkombero wa mtsempha wamagazi suli wokwanira. Zili ngati chitoliro chachikulu chomwe chimanyamula madzi kuchokera mu thanki yamadzi kupita kunyumba yonse chasweka m'zigawo ziwiri . Chifukwa cha izi, ngakhale mtima utakakamira bwanji, sungatumize magazi okhala ndi mpweya wambiri m'zigawo zapansi pa thupi. Uwu ndi vuto lalikulu kwambiri, lomwe lingayambitse imfa . Chifukwa ngati ziwalo za thupi sizilandira magazi, ziwalozo zimatha kulephera ndikuika pachiwopsezo chachikulu kwa mwana.

Kodi mumadziwa bwanji ngati mwana wanu ali ndi vutoli? Kodi zizindikiro zake ndi ziti?

Mwana amene ali ndi IAA nthawi zambiri amasonyeza zizindikiro mkati mwa masiku oyamba kubadwa. Izi zili choncho chifukwa mwana asanabadwe, mtima wake umalandira mpweya kuchokera m'thupi la mayi ake, zomwe si vuto, koma mwana akangobadwa, mtima wake umayenera kugwira ntchito wokha. Apa ndi pamene vutoli limabuka.

Muyenera kusamala kwambiri ndi zizindikiro zotsatirazi.

Ngati muwona chimodzi mwa zizindikiro izi, pitani kwa dokotala nthawi yomweyo. Ngati kuli kofunikira, tengani mwana wanu ku chipatala chapafupi cha Emergency Treatment Unit (ETU).

Zovuta zina za mtima zomwe zingachitike ndi vutoli

Makanda omwe ali ndi IAA akhoza kukhala ndi zilema zina zingapo za mtima nthawi imodzi.

• Chilema cha Ventricular Septal (VSD): Ichi ndi dzenje lomwe lili pakati pa zipinda ziwiri zapansi zopopera (ventricles) za mtima. Chodabwitsa n'chakuti, kukhala ndi VSD nthawi zina kungakhale kothandiza kwakanthawi ngati munthu ali ndi IAA, chifukwa kumalola magazi ena okhala ndi mpweya kudutsa m'dzenjelo kupita ku thupi.
• Atrial Septal Defect (ASD): Iyi ndi dzenje lomwe lili pakati pa zipinda ziwiri zapamwamba za mtima.
• Truncus Arteriosus: Apa ndi pomwe mitsempha ikuluikulu iwiri yamagazi yotuluka mumtima (aorta ndi pulmonary artery) imalumikizana kuti ipange umodzi.

N’chifukwa chiyani izi zimachitikira makanda? Chifukwa chake n’chiyani?

Mukamva izi, funso loyamba lomwe limabwera m'maganizo mwanu monga makolo ndi lakuti, "Kodi ichi ndi chifukwa chathu?" Inde ayi.

Interrupted Aortic Arch (IAA) ndi vuto lomwe limayamba chifukwa cha vuto la majini . Mwachidule, ma chromosome athu ndi 'buku' lomwe lili ndi malangizo onse a momwe matupi athu amamangidwira. Pa vutoli, chidutswa chaching'ono kwambiri cha chromosome chomwe chili ndi malangizo a momwe mtima ndi mitsempha yamagazi zimamangidwira sichikupezeka. Izi zimapangitsa kuti aorta isapangidwe bwino.

Kawirikawiri, makanda omwe ali ndi IAA amakhala ndi vuto lina la majini lotchedwa DiGeorge syndrome . Izi zimachitikanso chifukwa cha kusowa kwa gawo la chromosome yomweyo. Ana omwe ali ndi DiGeorge syndrome amatha kukhala ndi matenda pafupipafupi komanso kusintha kwina kwa nkhope (monga milomo yosweka).

Kodi madokotala amapeza bwanji izi molondola?

Mukapita ndi mwana wanu kuchipatala, ngati madokotala amufufuza mwanayo ndikukayikira kuti ali ndi vuto la mtima ngati ili, mayeso akuluakulu otsimikizira kuti ali ndi vuto la mtima ndi echocardiogram .

Nthawi zina, vuto la mtima ngati limeneli limapezeka panthawi ya kusanthula kwachilendo (ultrasound scan) komwe kumachitika mwana akadali m'mimba.

Kodi mankhwala a izi ndi otani? Kodi mwana angachiritsidwe?

Inde, ndithudi. Ngakhale kuti vutoli ndi lalikulu, lingathe kuchiritsidwa kwathunthu ndi opaleshoni . Njira yothandizira ikhoza kugawidwa m'magawo awiri akuluakulu.

1. Zoyenera kuchita musanachite opaleshoni

Mwanayo akapezeka ndi matendawa, nthawi yomweyo amalowetsedwa m'chipinda chosamalira odwala omwe ali ndi matenda a shuga (NICU). Cholinga chachikulu ndi kusunga magazi m'thupi mpaka mwanayo atakonzeka kuchitidwa opaleshoni.

Madokotala amagwiritsa ntchito njira yanzeru pochita izi. Mwana aliyense asanabadwe, pamakhala kulumikizana kwakanthawi (ductus arteriosus) pakati pa msempha wamagazi ndi mtsempha wamagazi womwe umanyamula magazi kupita ku mapapo. Izi zimatseka zokha mkati mwa maola ochepa kapena masiku angapo atabadwa.

Koma pankhani ya IAA, madokotala salola kuti kulumikizana kwakanthawiku kutseke. Kuli ngati 'njira yodutsa' yomwe imagwiritsidwa ntchito msewu waukulu ukatsekedwa. Sungani njira yodutsa iyi yotseguka.Mankhwala otchedwa Prostaglandin E1 amaperekedwa kwa mwana mu saline. Izi zimathandiza kuti thupi la mwana lilandire magazi mpaka opaleshoni itachitika.

2. Opaleshoni yopulumutsa moyo

Mwana akakhazikika bwino, opaleshoniyo imachitidwa ndi madokotala a ana odziwa za mtima.

• Chinthu chachikulu: Zigawo ziwiri za mtsempha wamagazi zomwe zadulidwa ndikulekanitsidwa zimalumikizidwanso, zomwe zimapangitsa kuti pakhale mkombero wathunthu.
• Zinthu zina: Nthawi yomweyo, ngati mwana ali ndi VSD (dzenje mumtima), lidzatsekedwanso panthawi ya opaleshoniyi. Chotsekera (PDA) chomwe chinatsegulidwa ndi mankhwala kale chidzatsekedwanso, chifukwa tsopano popeza njira yayikulu yatha, palibe chifukwa chochitira zimenezo.

Opaleshoni iyi ndi yovuta kwambiri, koma madokotala aluso ku Sri Lanka amachita opaleshoni yotereyi bwino.

Kodi tsogolo la mwana lidzakhala bwanji pambuyo pa opaleshoni?

Ichi ndiye chinthu chofunikira kwambiri. Pambuyo pa opaleshoni yopambana, ana ambiri amatha kukhala ndi moyo wabwinobwino komanso wathanzi . Malinga ndi ziwerengero, ngakhale patatha zaka 10 kuchokera pamene opaleshoni inachitika, anthu opitilira 81% amakhalabe ndi moyo.

Koma chofunika kwambiri kukumbukira ndichakuti ngakhale mutachita opaleshoni, muyenera kutsatiridwa ndi dokotala wa mtima moyo wanu wonse . Muyenera kupita kuzipatala panthawi yomwe yakonzedwa ndikuyesedwa ngati echocardiogram kuti muwone ngati mtima wanu ukugwira ntchito bwino. Nthawi zina, mukakula, mungafunikenso chithandizo. Chifukwa chake, ndikofunikira kutsatira malangizo a dokotala wanu.

Ndizachibadwa kumva ngati dziko lanu lonse lawonongeka mukazindikira kuti mwana wanu ali ndi vutoli. Koma kumbukirani kuti sayansi ya zamankhwala yapita patsogolo kwambiri masiku ano. Ngati matendawa apezeka msanga ndikuchiritsidwa bwino, mwana wanu ali ndi mwayi wokhala wosangalala ngati mwana wina aliyense.

Kusokonezeka kwa Aortic Arch, IAA, vuto la mtima wobadwa nalo, mavuto a mtima wa mwana, matenda a mtima wa mwana, zilema za mtima wobadwa nawo, opaleshoni, VSD, echocardiogram, DiGeorge syndrome