Tiyeni tiphunzire za opaleshoni yaposachedwa yomwe imapulumutsa valavu ya mtima (Valve-Sparing Aortic Root Replacement).

Kodi dokotala anakuuzani kuti mukufunika opaleshoni ya mtima? Ndizachilendo kumva mantha pang'ono akanena zimenezo. Koma masiku ano, mankhwala ndi apamwamba kwambiri. Pali opaleshoni zina zomwe zimayesa kuteteza ziwalo zambiri za thupi lanu momwe zingathere. Lero tikambirana za opaleshoni imodzi yapadera kwambiri. Ndiko kuti, valavu ya mtima, yomwe ndi opaleshoni yomwe imateteza valavu.

Mwachidule, kodi opaleshoni yoteteza ma valve ndi chiyani?

Chabwino, kuti timvetse izi, choyamba tiyeni tiphunzire za gawo laling'ono la mtima wathu. Chipinda chachikulu chopopera cha mtima wathu (ventricle yakumanzere) chimalumikizana ndi mtsempha waukulu kwambiri wamagazi m'thupi lathu, aorta. Timatcha kulumikizanaku kuti `Muzu wa Aortic`. Uli ngati muzu wa mtengo. Mkati mwa `Muzu wa Aortic` uwu muli chipata chofunikira kwambiri, `Valuvu ya Aortic`.

Nthawi iliyonse mtima ukagunda, 'Aortic Valve' iyi imatsegula ndikupopera magazi m'thupi, kenako nkutseka. Kutseka kumeneku kumaletsa magazi kuti asabwererenso mumtima.

Tsopano taganizirani, mwa anthu ena, 'Muzu wa Mtsempha wa Aortic', kutanthauza kuti, gawo la chipata chomwe chimawoneka ngati chipata, chafooka, chatupa, ndipo chakhala chachikulu. Chili ngati baluni yomwe ikufufumitsidwa. Timachitcha 'Aneurysm ya Muzu wa Mtsempha wa Aortic'. Chipata ichi chikakula, chitseko chomwe chili mkati mwake, ndiko kuti, 'Valuvu ya Mtsempha wa Aortic', sichitseka bwino. Kenako magazi amayamba kutuluka mumtima. Izi zimatchedwa 'Aortic Regurgitation'.

Mu opaleshoni yachikhalidwe (njira ya `Bentall`), madokotala opaleshoni amachotsa `Aortic Root` yotupa ndi `Aortic Valve` ndikuyika awiri atsopano opangidwa.

Ubwino waukulu wa izi ndikuti mutha kusunga valavu yanu, kotero simuyenera kumwa mankhwala oletsa magazi kutuluka magazi kwa moyo wanu wonse (monga Coumadin) monga momwe mungachitire ndi valavu yamakina.

Kodi opaleshoniyi imachiza matenda otani?

Opaleshoni iyi imachitika makamaka pazochitika zotsatirazi:

• Aneurysm ya Mizu ya Mtsempha wa Mtsempha: Monga ndanenera kale, uku ndi kutupa kosazolowereka muzu wa mtsempha wa mtsempha komwe kumalumikizana ndi mtima. Ngati izi zitakula kwambiri, zimatha kuphulika mwadzidzidzi (`Aortic Dissection` kapena Kuphulika). Ndi koopsa kwambiri pa moyo.
• Kukwera kwa Aortic Aneurysm ndi Dilated Aortic Sinuses: Milandu yomwe malo ang'onoang'ono achilengedwe mu `Aortic Root` (`Aortic Sinuses`) amakula pang'ono, ndi kutupa m'gawo lokwera la aorta.

Anthu omwe ali ndi matenda enaake obadwa nawo monga Marfan syndrome, ali pachiwopsezo chachikulu chotenga matenda a aortic root aneurysm. Chifukwa chake, madokotala opaleshoni amawunika mosamala momwe wodwalayo alili ndikuyesa ubwino ndi zoopsa za opaleshoniyo asanasankhe ngati ndi koyenera.

Kodi ndinu woyenera opaleshoni iyi?

Ngati valve yanu ya aorta ili ndi makhalidwe awa, mukhoza kukhala woyenera opaleshoni iyi:

• Ngati pali calcium yochepa kwambiri kapena palibe calcium mu valavu.
• Pokhapokha ngati valavu yawonongeka kwambiri.
• Ngati valavu ikugwira ntchito bwino kapena ingakonzedwe ndi kukonzanso pang'ono.

Kodi mumakonzekera bwanji musanachite opaleshoni?

Dokotala wanu adzakufotokozerani zonse zomwe muyenera kuchita musanachite opaleshoni. Ndikofunikira kwambiri kutsatira malangizo amenewo molondola. Nthawi zambiri, izi ndi zomwe muyenera kuchita.

Kuphatikiza apo, dokotalayo adzachita mayeso angapo kuti akonzekere opaleshoniyo, monga:

• Echocardiogram (kujambula mtima)
• Kuyezetsa magazi
• `Kujambula kwa mtima ndi chifuwa cha EKG`
• Angiogram ya Mitsempha ya Mtima
• Kuyezetsa magazi m'majini ngati mukukayikira kuti muli ndi matenda obadwa nawo

Kodi chimachitika ndi chiyani panthawi ya opaleshoni?

Opaleshoni imeneyi nthawi zambiri imatenga pakati pa maola 4 ndi 6. Dokotala wodziwa bwino ntchito akachita opaleshoniyi, mtima uyenera kuyimitsidwa kwa ola limodzi. Musadandaule, panthawiyi, makina adzachita ntchito ya mtima ndi mapapo.

Izi ndi zomwe zimachitika pang'onopang'ono:

1. Kuletsa kupweteka: Choyamba, mudzagonedwa mokwanira. Choncho simudzamva kupweteka kulikonse.

2. Kutsegula chifuwa: Dokotala wa opaleshoni amadula pakati pa chifuwa ('median sternotomy') kuti afike pamtima.

3. Kulumikiza ku Makina Othandizira Mtima ndi Mapapo: Mudzalumikizidwa ku makina otchedwa `Cardiopulmonary Bypass`. Makinawa adzagwira ntchito ya mtima ndi mapapo anu panthawi ya opaleshoni. Panthawiyi, mankhwala otchedwa `cardioplegia solution` adzaperekedwa kuti ayimitse mtima wanu kwakanthawi.

4. Kutulutsa Vavu: Dokotala wa opaleshoni adzalekanitsa mosamala vavu yanu ya aorta ndi minofu yozungulira.

5. Kuchotsa ziwalo zoonongeka: `Muzu wa Aortic` wotupa ndi ziwalo zina zoonongeka zimadulidwa ndikuchotsedwa.

6. Kulumikiza: Chubu chopangira ('kulumikiza') chimayikidwa m'malo mwa gawo lochotsedwa. Ichi chimapangidwa ndi nsalu yapadera ('polyester').

7. Kuikanso ma valavu: Valavu yanu ya aorta imatengedwa, kuyikapo graft yatsopano, ndikuyiyika pamalo pake.

8. Kuyang'ana Vavu: Kuti muwonetsetse kuti zonse zili bwino, madzi amadutsa mu `Graft` kuti awone ngati vavu ikugwira ntchito bwino, kutsegula ndi kutseka.

9. Gawo lomaliza: Mitsempha ya mtima imalumikizidwa ndi `Graft` yatsopano. Kenako mumachotsedwa mu `Mtima-Makina a Mapapo` ndipo mtima wanu umaloledwa kugwiranso ntchito. Kenako kudula pachifuwa kumatsekedwa.

Njira zamakono zopangira opaleshoni (Kubwezeretsa kwatsopano)

Pakapita nthawi, madokotala opanga opaleshoni awonjezera njira zatsopano kuti opaleshoniyi ipambane. Mwachitsanzo:

• Kupanga Ma Sinuses Atsopano a Aortic (`Neosinuses`): Kawirikawiri, `Graft` ndi chubu cholunjika. Koma `Muzu wa Aortic` wachilengedwe uli ndi malo ang'onoang'ono (`sinuses`). Mu njira yatsopanoyi, malo oterewa amapangidwa mwaluso mu `Graft`. Izi zimapangitsa kuti magazi aziyenda mwachibadwa, ndipo kuwonongeka kwa valavu kumachepa.
• Kukula kwa Aortic Annulus: Kukula kwa gawo longa mphete lomwe valavu imakhalapo ('aortic annulus') kumakonzedwa kuti kugwirizane ndi kukula kwa thupi lanu. Izi zimachepetsa chiopsezo cha kutuluka kwa magazi kuchokera ku valavu mtsogolo.

Kodi chimachitika ndi chiyani pambuyo pa opaleshoni? Ndipo zimatenga nthawi yayitali bwanji kuti munthu achire?

Pambuyo pa opaleshoni, mudzasungidwa m'chipinda chosamalira odwala kwambiri (ICU) kwa tsiku limodzi kapena awiri, kenako mudzasamutsidwira ku chipinda chogona. Nthawi zambiri mumatha kupita kunyumba pakatha masiku 4 mpaka 7.

Ngakhale mutakhala ndi laisensi yoyendetsa galimoto, musayendetse galimoto mpaka dokotala wanu atakupatsani chilolezo. Muyenera kudikira milungu isanu ndi umodzi musanachite chilichonse monga kunyamula zolemera kapena kupita kuntchito.

Kutenga nawo mbali mu pulogalamu yothandiza anthu odwala matenda a mtima (`cardiac rehab`) kudzakuthandizani kuchira msanga. Komanso, onetsetsani kuti mwapita kukaonana ndi dokotala wanu nthawi ina. Adzapitiriza kuyang'anira momwe mtima wanu ulili.

Kodi zoopsa ndi ubwino wa opaleshoniyi ndi ziti?

Monga opaleshoni yaikulu iliyonse, pali zoopsa zina zomwe zingachitike. Komabe, akachitidwa ndi dokotala wodziwa bwino ntchito yake kuchipatala chomwe chili ndi zipangizo zabwino, zoopsa zimenezi zimakhala zochepa .

Ubwino waukulu:

• Simuyenera kumwa mankhwala ochepetsa magazi kwa moyo wanu wonse.
• Chiwopsezo cha magazi kuundana, sitiroko, ndi matenda a valavu (endocarditis) chimachepa.
• Mwayi woti achite opaleshoni kuti asinthe valavu mtsogolo ndi wochepa kwambiri.

Kafukufuku wasonyeza kuti kupambana kwa opaleshoniyi kuli pa 99%. Ngakhale patatha zaka 10, pafupifupi 95% ya anthu omwe adachita opaleshoniyi sadzafunika opaleshoni ina.

Ngati muli ndi zizindikiro izi, imbani dokotala wanu nthawi yomweyo kapena pitani ku Dipatimenti Yodzidzimutsa (ETU) ya chipatala chapafupi.