Ungave wakambonzwa nezveAtrial Fibrillation (Afib), chirwere umo mwoyo wako unorova zvisina kurongeka uye nekukurumidza. Pamwe iwe kana mumwe munhu mumhuri yako ane chirwere ichi. Njodzi huru yeAfib injodzi yakawedzerwa yestroke. Semhinduro yeizvi, vanachiremba vanowanzo nyora mishonga inodzikisa ropa. Asi kutora mishonga iyi kwenguva refu hakusi nyore kune wese munhu. Kune vanhu vakadaro, tiri kutaura nezvenzira yakakosha yekurapa inogona kuderedza njodzi yestroke.
Zvichitaurwa zviri nyore, chii chinonzi Left Atrial Appendage Closure (LAA Closure)?
Kuti tinzwisise izvi, ngatitangei tadzidza nezvechikamu chidiki chemwoyo wedu. Mukamuri repamusoro rekuruboshwe remwoyo wedu, rinonzi Left Atrium, mune kaburi kadiki kakaita sehomwe. Izvi ndizvo zvatinodaidza kuti Left Atrial Appendage (LAA) .
Kazhinji, kana mwoyo uchirova zvine mutinhimira, ropa riri mukati meLAA iyi rinopombwa kuenda kumoyo wese. Zvisinei, mumunhu ane Atrial Fibrillation (Afib) , moyo unorova zvisina kurongeka, saka ropa riri mukati mebhegi iri rinonzi LAA haripombi zvakanaka uye rinotanga kuungana. Kuungana uku kweropa kunogona kupedzisira kwava kuumbwa .
Zvinosuwisa kuti, kana ropa rakagwamba rikabuda rikaramba riri mutsinga yeropa inoenda kuuropi, rinogona kukonzera sitiroko . Inenge 90% yesitiroko muvanhu vane Afib inokonzerwa nekugwamba kweropa kunoumbwa muLAA.
Saka, mukurapa uku kunonzi LAA Closure, bhegi rinodaidzwa kuti LAA apo ropa rinogwamba rinovharika, kungave kuburikidza nekuvhiyiwa kana kuburikidza nekucheka kudiki. Mushure mekunge izvi zvavharwa, kunyangwe ropa rigwamba, harigone kupinda muropa. Nokudaro, njodzi yekurohwa nestroke inodzikira zvakanyanya.
Chinhu chakakosha ndechekuti kurapwa uku hakurapi Afib, asi kunoderedza zvakanyanya njodzi yekurohwa nestroke kunokonzerwa nako.
Kurapa uku kwakanakira ani? Sei tisingashandise mishonga inobvisa ropa?
Kuvharwa kweLAA hakusi kurapwa kwevanhu vese vari panjodzi huru yekubatwa nechirwere cheAfib. Kunonyanya kufungwa nezvevanhu vane:
- Kune avo vasingade kutora mishonga inorwisa ropa kwenguva yakareba.
- Vanhu vanowa kakawanda uye nekudaro vari panjodzi yakakura yekubuda ropa (nekuti kunyangwe kukuvara kudiki kunogona kukonzera kubuda ropa kwakanyanya pavanotora mishonga inobvisa ropa).
- Kune avo vanowana mamwe matambudziko kubva mumishonga inobvisa ropa.
- Kune avo vasingakwanise kutenga mishonga inobvisa ropa yakawanda.
Vanhu vazhinji vanosangana nematambudziko akasiyana-siyana pavanotora mishonga yekare inoderedza ropa yakaita seWarfarin.
| Matambudziko ekutora mishonga yakaita seWarfarin |
|---|
| - Unofanira kuenda kuchipatara nguva dzose kuti unoongororwa ropa rako kuti uve nechokwadi chekuti mushonga wacho wakakodzera. |
| - Zvimwe zvekudya zvine vhitamini K (senge sipinachi) zvinofanira kuderedzwa. |
| - Njodzi yekubuda ropa yakanyanya. |
| - Miviri yevamwe vanhu haigone kutsungirira mushonga uyu. |
Kunyangwe paine mishonga mitsva yakaita seApixaban neRivaroxaban, kudhura kwayo kwakanyanya uye njodzi yekubuda ropa idambudziko kune vamwe vanhu. Unofanira kutaura nachiremba wemwoyo kuti asarudze kuti ndeipi mishonga yakakunakira.
Ndedzipi nzira dzinoshandiswa kuvhara LAA iyi?
Kune nzira dzakasiyana siyana dzekuita izvi. Funga nezvazvo sekuvhara muromo webhodhoro remvura, mudziyo uyu unoshandiswa kuvhara muromo webhegi iri unonzi LAA.
- Zvishandiso zvekuvhara mukati: Izvi zvakafanana neamburera diki. Zvinopinzwa mumoyo uchishandisa catheter uye zvinoshandiswa kuvhara mukana weLAA kubva mukati. WATCHMAN™ neAmulet™ zvishandiso zvakakurumbira zverudzi urwu.
- Midziyo yekuvhara kunze: Dzimwe nguva, panguva yekuvhiyiwa kwemoyo, LAA inogona kuvharwa kunze ne clip (`AtriClip™`) kana ne suture yakakosha (`Lariat™`).
Nzira yakakunakira inosarudzwa mushure mekukurukurirana pakati pako nachiremba wako.
Kugadzirira kurapwa uye kuti kurapwa kwacho kunoitika sei
Usati warapwa...
Usati waita izvi, chiremba wako anofanira kuyera saizi chaiyo uye chimiro cheLAA yako. LAA yemunhu wese haisi yakafanana. Vamwe vanoti yakaumbwa sebapiro rehuku, cactus, kana cauliflower. Izvi zvinosanganisira Transesophageal Echocardiogram (TEE) (kuongororwa kwemoyo kunoitwa kuburikidza nechubhu inonzi larynx) kana Cardiac CT scan. Ucharayirwawo kutsanya (kusadya kana kunwa) kwemaawa mashoma usati waita izvi.
Panguva yekurapwa...
Izvi zvinogona kuitwa nenzira mbiri huru:
1. Nekumwe kuvhiyiwa kwemoyo:Kana uri kuvhiyiwa kwemoyo kwakasiyana-siyana, kwakadai sekuvhiyiwa kwe bypass, chiremba anogona kubvisa kana kusona LAA yakavharwa panguva imwe chete.
2. Kusapindira zvakanyanya: Iyi ndiyo nzira inonyanya kushandiswa. Pano, chubhu tete, inonzi catheter, inopinzwa nepaburi remudumbu mako ichipinda mutsinga yoendeswa kumoyo wako. Zvadaro, mudziyo wakasarudzwa unoiswa paburi reLAA wovharwa kudzivirira mavharo eropa kuti asabude. Maitiro ese aya anoitwa pasi pekutungamirirwa kwetekinoroji yeX-ray (Fluoroscopy) uye scan (TEE/Intracardiac Ultrasound).
Mushure mekurapwa...
- Kazhinji unofanira kugara muchipatara kwehusiku hwese.
- Kuongororwa kweTEE kuchaitwa zvakare mumazuva angangoita makumi mana nemashanu kuti vaone kana kurapwa kwacho kwakabudirira.
- Uchapihwa mushonga wekuderedza ropa neaspirin kuti unwe kusvika nyama yemuviri yakura yakakomberedza mudziyo uyu, izvo zvinotora mwedzi nehafu.
- Mushure meizvozvo, uchafanira kurega kutora mushonga wekuderedza ropa wotora Clopidogrel neaspirin kwemwedzi inosvika mitanhatu. Ungatofanira kutora aspirin kweupenyu hwako hwese. Zvese izvi zvichaitwa nekurairwa nachiremba wako.
Ndezvipi zvakanakira uye njodzi dzekurapa uku?
Kufanana nechero nzira yekurapa, iyi ine zvakanakira uye njodzi.
| Mabhenefiti | Njodzi/Matambudziko |
|---|---|
| Njodzi yekurohwa nestroke yakaderedzwa zvakanyanya. | Dambudziko nemudziyo wekuisa. |
| Kukwanisa kusununguka kubva pakutora mishonga inopedza ropa kwenguva refu (anticoagulants). | Kukanganisa kwakashata kune anesthesia. |
| Kupora nekukurumidza nekuti kunoitika kuburikidza nekucheka kudiki. | Kubuda ropa. |
| Kuvandudza hupenyu. | Kurwadziwa pachipfuva, hutachiona. |
| Kuungana kwemvura yakakomberedza mwoyo (pericardial effusion). | |
| Chirwere chakafanana nestroke chisingawanzoitiki. |
Kurapa uku kunoshanda zvikuru. Sekureva kwezvimwe zvidzidzo, nzira iyi inogona kuderedza njodzi yekurohwa ne80%. Asi yeuka, zvakakosha kukurukura zvese izvi nachiremba wako usati wasarudza kana izvi zvakakunakira.
Ndinofanira kuona chiremba rini?
Pamusoro pekuenda kumisangano yako yekutevera yakarongwa, zivisa chiremba wako nekukasika kana ukaona zviratidzo zvinotevera:
- Zviratidzo zvefivha kana chimwe chirwere
- Kurova kwemoyo kusina kurongeka
- Kurwadziwa kwechipfuva
- Kuoma kufema
Kana ukaona chimwe chezviratidzo izvi, enda kuchipatara chiri pedyo neEmergency Department (ETU) nekukasika.
Mharidzo Yekuenda Nayo Kumba
- LAA Closure inzira yekurapa vanhu vane Atrial Fibrillation (Afib) kuderedza njodzi yekurohwa nesitiroko.
- Izvi zvinoshanda nekuvhara kabhegi kadiki mumoyo kanonzi LAA, zvichidzivirira magwamba eropa anoumbwa imomo kuti asapinde mumuviri.
- Kurapa uku inzira yakanaka kune avo vasingakwanise kutora mishonga inobvisa ropa kwenguva refu.
- Izvi hazvizorape Afib, asi zvinogona kudzivirira njodzi huru, iyo sitiroko.
- Sarudza mushure mekutaura nachiremba wemwoyo wako kuti mushonga uyu wakakunakira here uye kuti zvakanakira uye njodzi dzawo ndedzipi.
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