Dziwani zambiri za chithandizo cha LAA Closure (Left Atrial Appendage Closure) chomwe chimachepetsa chiopsezo cha sitiroko.

Mwina munamvapo za Atrial Fibrillation (Afib), vuto lomwe mtima wanu umagunda mosagwirizana komanso mwachangu. Mwina inuyo kapena wina m'banja mwanu ali ndi vutoli. Chiwopsezo chachikulu cha Afib ndi chiopsezo chowonjezeka cha sitiroko. Pofuna kuthetsa vutoli, madokotala nthawi zambiri amalemba mankhwala ochepetsa magazi. Koma kumwa mankhwala awa kwa nthawi yayitali sikophweka kwa aliyense. Kwa anthu otere, tikulankhula za njira yapadera yothandizira yomwe ingachepetse chiopsezo cha sitiroko.

Mwachidule, kodi kutsekeka kwa gawo la kumanzere la Atrial (LAA Closure) n'chiyani?

Kuti timvetse izi, choyamba tiyeni tiphunzire za gawo laling'ono la mtima wathu. Mu chipinda chakumtunda chakumanzere cha mtima wathu, chotchedwa Left Atrium, muli kachidutswa kakang'ono kooneka ngati thumba. Ichi ndi chomwe timachitcha Left Atrial Appendage (LAA) .

Kawirikawiri, mtima ukagunda motsatizana, magazi omwe ali mkati mwa LAA iyi amapopedwa kupita ku mtima wonse. Komabe, mwa munthu amene ali ndi Atrial Fibrillation (Afib) , mtima umagunda mosagwirizana, kotero magazi omwe ali mkati mwa thumba ili lotchedwa LAA sapopedwa bwino ndipo amayamba kusonkhana. Kusonkhana kumeneku kwa magazi kumatha kusintha kukhala magazi oundana .

Mwatsoka, ngati magazi oundanawa atuluka n’kukakamira mumtsempha wamagazi wopita ku ubongo, angayambitse sitiroko . Pafupifupi 90% ya magazi oundana mwa anthu omwe ali ndi Afib amayamba chifukwa cha magazi oundana omwe amapangika mu LAA.

Choncho, mu chithandizo ichi chotchedwa LAA Closure, thumba lotchedwa LAA komwe magazi amaundana amatsekedwa, kaya kudzera mu opaleshoni kapena kudzera mu kudula pang'ono kwambiri. Pambuyo potseka, ngakhale magazi ataundana, sangathe kulowa m'magazi. Chifukwa chake, chiopsezo cha sitiroko chimachepa kwambiri.

Kodi chithandizochi ndi chabwino kwa ndani? Bwanji osagwiritsa ntchito mankhwala ochepetsa magazi?

Kutsekedwa kwa LAA si chithandizo cha aliyense amene ali pachiwopsezo chachikulu cha sitiroko chifukwa cha Afib. Chimaganiziridwa makamaka kwa anthu omwe:

• Kwa iwo omwe sakufuna kumwa mankhwala oletsa magazi kuundana kwa nthawi yayitali.
• Anthu omwe amagwa pafupipafupi ndipo motero amakhala pachiwopsezo chachikulu cha kutuluka magazi (chifukwa ngakhale kuvulala pang'ono kungayambitse kutuluka magazi kwambiri akamamwa mankhwala ochepetsa magazi).
• Kwa iwo omwe amakumana ndi zotsatira zina zoyipa chifukwa cha mankhwala ochepetsa magazi.
• Kwa iwo omwe sangakwanitse kugula mankhwala ochepetsa magazi okwera mtengo.

Anthu ambiri amakumana ndi mavuto osiyanasiyana akamamwa mankhwala akale ochepetsa magazi monga Warfarin.

Ngakhale kuti pali mankhwala atsopano monga Apixaban ndi Rivaroxaban, mtengo wawo wokwera komanso chiopsezo chotuluka magazi nthawi zonse ndi mavuto kwa anthu ena. Muyenera kulankhula ndi dokotala wanu wa mtima kuti mudziwe chithandizo chomwe chili chabwino kwa inu.

Ndi njira ziti zomwe zimagwiritsidwa ntchito potseka LAA iyi?

Pali njira ndi zipangizo zosiyanasiyana zochitira izi. Taganizirani izi monga kutseka pakamwa pa botolo la madzi, chipangizochi chimagwiritsidwa ntchito kutseka pakamwa pa thumba ili lotchedwa LAA.

• Zipangizo zotsekera mkati: Izi zili ngati ambulera yaying'ono. Zimayikidwa mumtima pogwiritsa ntchito catheter ndipo zimagwiritsidwa ntchito kutseka kutsegula kwa LAA kuchokera mkati. WATCHMAN™ ndi Amulet™ ndi zida zodziwika bwino zamtunduwu.
• Zipangizo zotsekera zakunja: Nthawi zina, pa opaleshoni ina ya mtima, LAA ikhoza kutsekedwa kunja ndi clip (`AtriClip™`) kapena ndi suture yapadera (`Lariat™`).

Njira yoyenera kwa inu imasankhidwa pambuyo pokambirana pakati pa inu ndi dokotala wanu.

Kukonzekera chithandizo ndi momwe chithandizocho chimachitikira

Musanalandire chithandizo...

Musanayambe opaleshoniyi, dokotala wanu ayenera kuyeza kukula ndi mawonekedwe enieni a LAA yanu. LAA ya aliyense si yofanana. Ena amati imafanana ndi phiko la nkhuku, cactus, kapena kolifulawa. Izi zidzaphatikizapo Transesophageal Echocardiogram (TEE) (kujambula mtima kudzera mu chubu chotchedwa larynx) kapena Cardiac CT scan. Mudzalangizidwanso kuti musala kudya (musadye kapena kumwa) kwa maola angapo opaleshoni isanachitike.

Panthawi ya chithandizo...

Izi zitha kuchitika m'njira ziwiri zazikulu:

1. Ndi opaleshoni ina ya mtima:Ngati mukuchitidwa opaleshoni ina yaikulu ya mtima, monga opaleshoni ya bypass, dokotalayo angachotse kapena kusoka LAA yotsekedwa nthawi yomweyo.

2. Yosalowa m'thupi: Iyi ndi njira yomwe imagwiritsidwa ntchito kwambiri. Apa, chubu chopyapyala, chotchedwa catheter, chimalowetsedwa kudzera m'mimba mwanu kupita mumtsempha ndikutsogoleredwa mpaka kumtima kwanu. Kenako, chipangizo chosankhidwa kale chimayikidwa pa khomo la LAA ndikutsekedwa kuti magazi asatuluke. Njira yonseyi imachitika motsogozedwa ndi ukadaulo wapadera wa X-ray (Fluoroscopy) ndi scan (TEE/Intracardiac Ultrasound).

Pambuyo pa chithandizo...

• Kawirikawiri uyenera kukhala m'chipatala usiku wonse.
• Kujambula TEE kudzachitikanso patatha masiku pafupifupi 45 kuti muwone ngati chithandizocho chayenda bwino.
• Mudzapatsidwa mankhwala ochepetsa magazi ndi aspirin kuti mutenge mpaka minofu ya thupi itakula mozungulira chipangizochi, zomwe zimatenga pafupifupi mwezi umodzi ndi theka.
• Pambuyo pake, muyenera kusiya kumwa mankhwala ochepetsa magazi ndikumwa Clopidogrel ndi aspirin kwa miyezi pafupifupi 6. Mwina mungafunike kumwa aspirin moyo wanu wonse. Zonsezi zidzachitika mutalangizidwa ndi dokotala wanu.

Kodi ubwino ndi zoopsa za chithandizochi ndi ziti?

Monga chithandizo chilichonse chamankhwala, ichi chili ndi ubwino ndi zoopsa zake.

Mankhwalawa ndi othandiza kwambiri. Malinga ndi kafukufuku wina, njira iyi ingachepetse chiopsezo cha sitiroko ndi pafupifupi 80%. Koma kumbukirani, ndikofunikira kukambirana zonsezi ndi dokotala musanasankhe ngati izi ndi zoyenera kwa inu.

Ndiyenera kupita kwa dokotala liti?

Kuwonjezera pa kupita ku nthawi yanu yotsatira, dziwitsani dokotala wanu nthawi yomweyo ngati mukukumana ndi zizindikiro zotsatirazi:

• Zizindikiro za malungo kapena matenda ena
• Kugunda kwa mtima kosakhazikika
• Kupweteka pachifuwa
• Kuvuta kupuma

Ngati mukukumana ndi zizindikiro izi, pitani ku Dipatimenti Yothandiza Pangozi (ETU) ya chipatala chapafupi nthawi yomweyo.