Kunzima kangakanani ukuvaleka kwemithambo yegazi yentliziyo yakho? (Fractional Flow Reserve - FFR) Masifumanise ngovavanyo!

Ngaba ukrokrela ukuba unesifo sentliziyo? Okanye ngaba ugqirha wakho ukhankanye ukuvaleka kwemithambo yakho yentliziyo? Usenokuba ukhe weva ngolu vavanyo olubizwa ngokuba yiFractional Flow Reserve, okanye iFFR ngamafutshane. Nangona lusenokuvakala njengegama elinzima, luvavanyo olubaluleke kakhulu. Ngoko ke, masithethe ngalo namhlanje ngesiSinhala esilula nesiqondakalayo.

Yintoni iFractional Flow Reserve (FFR)?

Ngamafutshane, (FFR) yindlela yokulinganisa ngqo ukuba i-stenosis inzima kangakanani, oko kukuthi, ukuba ithintela kangakanani ukuhamba kwegazi, ukuba kukho ukuvaleka kwenye indawo kwimithambo yentliziyo ehambisa igazi entliziyweni yakho. Khawuthelekelele ukuba xa umbhobho wamanzi uvalekile, isantya kunye noxinzelelo lwamanzi luyehla, akunjalo? Ngendlela efanayo, xa umthambo wentliziyo uvalekile, uxinzelelo lwegazi oluhamba ngawo luyehla. Okwenziwa lolu vavanyo (FFR) kukulinganisa umahluko woxinzelelo kwaye ufumane ukuba ivalekile kangakanani.

Oogqirha badla ngokwenza olu vavanyo (FFR) ngexesha lokuhlolwa kwentliziyo okanye i-coronary angiogram. Iziphumo zolu vavanyo zinceda ekumiseleni uhlobo lonyango omele ulufumane (umzekelo, nokuba kufuneka usebenzise amayeza wedwa okanye i-angioplasty kunye ne-stent). Olu luvavanyo olubaluleke kakhulu olunokukunceda wenze izigqibo ezibalulekileyo.

Lufuneka nini uvavanyo lwe-FFR?

Akuyena wonke umntu oya kufuneka enze olu vavanyo. Ugqirha uya kugqiba ekubeni enze olu vavanyo (FFR) kwiimeko ezimbalwa ezikhethekileyo.

• Ukuba imifanekiso yemithambo yakho yentliziyo ibonisa ukuba phakathi kwe-50% kunye ne-70% yobubanzi bomthambo ivaliwe (stenosis), olu vavanyo (FFR) lunokubonisa ukuba loo mvalelo uthintela kangakanani ukuhamba kwegazi.
• Ngamanye amaxesha, nokuba kukho ukuvaleka okukhulu kwe-90% yomthambo, olu vavanyo lwenziwa ukuze kuvavanywe ngokuchanekileyo ubukhali bawo.

Nangona kunjalo, ukuba ukuvaleka kwemithambo yakho yegazi kungaphantsi kwama-30% okanye ngaphezulu kakhulu kwama-70%, olu vavanyo (FFR) alusoloko luyimfuneko. Kuba ukuba ukuvaleka kuncinci kakhulu (ngaphantsi kwama-30%), unyango (njengotyando lwe-angioplasty) alunakwenzeka ukuba luyimfuneko. Ukuba ukuvaleka kukhulu kakhulu (ngaphezu kwama-70%), unyango ngokuqinisekileyo luyafuneka. Oko kwenziwa yi-(FFR) kukunceda wenze isigqibo esifanelekileyo kwiimeko eziphakathi.

Kubalulekile: Ukuba ukhe wayenza i-angioplasty kwaye wafakwa i-stent kumthambo wakho wemithambo yegazi, olu vavanyo (FFR) lunokunceda ekuqikeleleni amathuba okuba uhlaselwe yintliziyo enkulu kwixesha elizayo.

Ngaba kukho naziphi na iingxaki kolu vavanyo (FFR)?

Njengalo lonke uvavanyo lwezonyango, kukho izinto ezincinci ekufuneka ziqwalaselwe.

• Ngamanye amaxesha, iziphumo eziqhelekileyo ezingezizo ezinokwenzeka zinokwenzeka. Oku kuthetha ukuba kukho ingxaki, kodwa uvavanyo lusenokungayifumani. Esinye isizathu sokuba oku kwenzeke kukuba imithambo yegazi yakho emincinci kakhulu (ii-coronary arterioles) ayiphenduli kakuhle kumayeza anikwe ngexesha lovavanyo ukuze kwandiswe imithambo yegazi yakho.
• Kwakhona, ubude bendawo enciphileyo emthanjeni buchaphazela ixabiso le-FFR.

Ekubeni ugqirha wakho ezazi kakuhle zonke ezi zinto, uza kwenza izigqibo emva kokuqwalasela zonke ezi zinto.

Yintoni i-(iFR) kunye ne-(FFR)? Yintoni umahluko phakathi kwezi zimbini?

Usenokuba ukhe weva ngento ebizwa ngokuba yi-(iFR). (iFR) imele i-(instant wave-free ratio). Zombini i-(FFR) kunye ne-(iFR) ziimvavanyo ezilinganisa ukuba ukuvaleka kwemithambo yentliziyo kukhulu kangakanani. Kodwa kukho umahluko omncinci.

• Ngexesha lovavanyo (i-FFR): Kunikwa iyeza elikhethekileyo, elifana ne-adenosine (i-Adenocard® okanye i-Adenoscan®), ukuze kwandiswe imithambo yegazi kwaye kwandiswe ukuhamba kwegazi.
• Kuvavanyo (iFR): Ngaphandle kokusebenzisa iyeza elinjalo, uxinzelelo lulinganiswa ngexesha elithile kumjikelo wentliziyo.

Nangona injongo yazo zombini ifana, kukho umahluko omncinci kwindlela ezenziwa ngayo. Ugqirha wakho uya kugqiba ukuba yeyiphi efanelekileyo kuwe.

Ngubani owenza uvavanyo (i-FFR)?

Olu luvavanyo lwezonyango olukhethekileyo. Uvavanyo (FFR) lwenziwa yingcali yentliziyo , eqeqeshwe ngokukhethekileyo koku.

Lusebenza njani uvavanyo (lwe-FFR)?

Oku kungabonakala ngathi yinkqubo elula, kodwa kubandakanya indlela entsonkothileyo. Uxinzelelo lwegazi lulinganiswa kokubini ukusuka ekuvalekeni kwemithambo yakho yentliziyo kunye nokukufutshane nayo . Oko kukuthi, uxinzelelo lulinganiswa ngaphambi nasemva kokuvaleka. Umlinganiselo phakathi kwezi xabiso zimbini zoxinzelelo ubizwa ngokuba yi-fractional fraction (FFR). Oku kusinika umbono wokuba kungakanani na ukuhamba kwegazi okuthintelweyo.

Ndingazilungiselela njani uvavanyo (lwe-FFR)?

Oku kufana nokulungiselela utyando oluncinci. Ugqirha wakho uza kukuchazela iinkcukacha, kodwa nazi izinto eziqhelekileyo ekufuneka uzenze:

• Ugqirha wakho angakucela ukuba uyeke ukusebenzisa amayeza athile, ingakumbi amayeza okunciphisa igazi , kwiintsuku ezimbalwa ngaphambi kovavanyo.
• Musa ukutya okanye ukusela nantoni na emva kweentsuku ezinzulwini zobusuku ngaphambi kovavanyo (i-NPO - akukho nto ithethwa ngomlomo).
• Ngenxa yokuba uza kunikwa i-anesthesia okanye i-sedative encinci ngexesha lovavanyo, uza kufuna umntu oza kukuyisa ekhaya emva kovavanyo. Awuyi kukwazi ukuqhuba ngokwakho.

Yintoni onokuyilindela ngomhla wovavanyo (i-FFR)?

Uvavanyo ngokwalo ludla ngokuthatha ngaphantsi kweyure . Nangona kunjalo, ukuba ugqirha ujonga i-FFR yakho ngoko nangoko aze agqibe ekubeni enze i-angioplasty okanye i-stent, kuya kuthatha ixesha elongezelelweyo. Ke ngoko, licebo elihle ukubuza ugqirha wakho kwangaphambili ukuba uza kuhlala ixesha elingakanani esibhedlele, kuquka nexesha lokulungiselela nokuphumla emva kovavanyo.

Kwenzeka ntoni ngexesha lovavanyo (i-FFR)?

Kulungile, ngoku masibone ukuba kwenzeka ntoni ngaphakathi kovavanyo. Nangona la manyathelo esenokubonakala eyinkimbinkimbi kancinci, iqela lezonyango liza kukunyamekela kakuhle.

1. Ukuba ndindisholo:Okokuqala, indawo encinci yolusu lwakho (engalweni yakho, entanyeni, okanye emqolo) ivalwe yi-anesthetic yendawo.

2. Ukufaka inaliti: Okulandelayo, kufakwa inaliti encinci emthanjeni kwindawo ebhobokileyo.

3. Ukufakwa kwe-catheter: Ngale ndlela yokusikwa, isixhobo esincinci kakhulu, esifana netyhubhu (i-catheter) sidluliselwa kwimithambo yegazi yakho ukuya kwimithambo yentliziyo yakho.

4. Ukujonga indlela: Indlela ekhethekileyo efana ne-X-ray ebizwa ngokuba yi-fluoroscopy isetyenziswa ukujonga kwisikrini ukuze kubonwe ukuba i-catheter iya kwindawo efanelekileyo na.

5. Ulwelo lokwahlulahlula: Emva koko, kufakwa idayi ekhethekileyo (i-contrast media) ngale catheter kwimithambo yentliziyo yakho. Emva koko imithambo ivele ngokucacileyo kwi-X-ray.

6. Uvavanyo lokuvaleka kwemithambo: Olu vavanyo lusetyenziselwa ukujonga ukuba kukho naziphi na izithintelo kwimithambo yentliziyo yakho.

7. Ukujonga ukuhamba kwegazi: Ngamanye amaxesha, isixhobo esincinci se-ultrasound esiqhotyoshelwe esiphelweni sale catheter sinokusetyenziswa ukujonga ukuhamba kwegazi ngaphakathi kwemithambo yegazi.

8. Ukunika amayeza: Ngaphambi kokuba kufakwe ucingo loxinzelelo kwindawo evalekileyo, kunikwa amayeza afana ne-heparin (ukuthintela ukujiya kwegazi) kunye ne-nitroglycerin (ukwandisa imithambo yegazi) (iNitronal® okanye iTridil®).

9. Ukulinganisa uxinzelelo: Ngoku kuza umsebenzi wokwenyani. Intambo ekhethekileyo (intambo yoxinzelelo) idlula kwindawo evalekileyo, kwaye iisensa ezikuyo zilinganisa uxinzelelo lwegazi ngaphambi nasemva kokuba umthambo uvalekile. Ukulinganisa oku ngokuchanekileyo, ukuhamba kwegazi kulinganiswa ngexesha lokuhamba kwegazi okuphezulu. Ngenxa yoko, kunikwa iyeza (i-adenosine) okanye (i-papaverine) ukuze kwandiswe ukuhamba kwegazi okwethutyana.

10. Unyango (ukuba kuyimfuneko): Ukuba ukuvaleka kubonwa njengokunzima ngokusekelwe kwixabiso le-FFR, i-angioplasty (ukwandisa umthambo ngebhaluni) inokwenziwa ngoko nangoko, kwaye i-stent (ityhubhu encinci efana ne-mesh) inokubekwa ukuthintela ukuvaleka okungakumbi.

11. Ukuvavanywa kwakhona: Emva kokuba i-stent ifakiwe, ixabiso le-FFR liyajongwa kwakhona ukuqinisekisa ukuba unyango luphumelele na.

12. Ukugqitywa: Ekugqibeleni, i-catheter kunye nocingo ziyasuswa, indawo yokubhoboza ibanjwa okwethutyana, emva koko kufakwa iplasta.

Yintoni onokuyilindela emva kovavanyo (lwe-FFR)?

Uninzi lwabantu alufumani ntlungu ingako emva kolu vavanyo (FFR), kwaye iingxaki azifumaneki rhoqo.

• Ukuba uvavanyiwe kuphela, ungagoduka emva kweeyure ezimbalwa.
• Nangona kunjalo, ukuba une-angioplasty kwaye ufake i-stent emva kwe-FFR, kunokufuneka uhlale esibhedlele ngobo busuku phantsi kweliso likagqirha.

Zithini iziphumo ebezingalindelekanga zovavanyo (i-FFR)?

Njengakwinkqubo nganye yezonyango, abanye abantu banokuziva bengakhululekanga kangako.

• Usenokuba neentlungu esifubeni okanye ubunzima bokuphefumla malunga nomzuzu emva kokuba unikwe iyeza le-adenosine (nokuba nge-IV okanye ngqo emthanjeni osentliziyweni yakho).Oku kuqhelekile, ungakhathazeki. Kuthetha ukuba ukuhamba kwegazi lakho kuphezulu, oko kuthetha ukuba lixesha lokulinganisa i-FFR yakho. Oku kungakhululeki kuza kuphela kungekudala.
• (iPapaverine) ayisoloko ibangela isigqi sentliziyo esingaqhelekanga (malunga ne-1% yabantu), kodwa oku kudla ngokuphela emva kwexesha elithile.
• Kubalulekile ukukhumbula ukuba ekubeni olu vavanyo (FFR) lwenziwa nge-catheterization yentliziyo, kukho iingozi ezithile ezinxulumene nalo (umz. ukopha, usulelo, ukunganyamezelani ne-contrast medium). Nangona kunjalo, ezi azixhaphakanga kakhulu.

Ixabiso (le-FFR) libalwa njani?

Oku kufana nefomula yezibalo. Ugqirha wahlula uxinzelelo olukwimithambo yakho yentliziyo ecaleni kwento evalekileyo (distal - Pd) ngoxinzelelo olukwicala lento evalekileyo (proximal - Pa).

Kalula nje, i-FFR = Pd / Pa .

Ezi ndlela zokulinganisa uxinzelelo zithathwa ngugqirha esebenzisa izixhobo ezikhethekileyo ngexesha lokufaka i-catheter kwintliziyo.

Zinjani iziphumo? Zisixelela ntoni?

Uza kufumana inombolo eneendawo zedesimali.

• Ixabiso eliqhelekileyo le-FFR liphakathi kwe-0.94 kunye ne-1.0. Ukuba eli xabiso lifikelelwe, oko kuthetha ukuba akukho thintelo libalulekileyo ekuhambeni kwegazi ngemithambo yegazi.
• Ukuba ixabiso le-FFR lihlala lingaphantsi kwe-0.80, oko kuthetha ukuba ukuvaleka kubangela ukuvaleka okukhulu kwegazi, ngoko ke kufuneka unyango (oludla ngokuba yi-angioplasty kunye ne-stenting).
• Umzekelo, ukuba i-FFR yakho yi-0.75, oko kuthetha ukuba uxinzelelo lwakho lwegazi luye lwehla ngama-25% ngenxa yokuncitshiswa kwemithambo yakho yentliziyo (1.00 - 0.75 = 0.25, okanye 25%).
• Ukuba ixabiso le-FFR libonisa ukuba ukuvaleka akukubi kangako, ngoko ke i-angioplasty kunye ne-stenting azikho mfuneko. Inganyangwa ngamayeza kuphela. Oku kunokunceda ukuthintela utyando olungeyomfuneko.

Ndiza kuzazi nini iziphumo zovavanyo (lwe-FFR)?

Le yeyona nto ilungileyo. Ugqirha uza kukubonisa ixabiso le-FFR kwisixhobo sakhe kwangoko nje ukuba ahlole uxinzeleko lwakho lwegazi. Ngoko ke, nokuba kusemva kokuba uvavanyo lugqityiwe okanye lugqityiwe, ugqirha uza kukuxelela iziphumo kunye nento omawuyenze ngokulandelayo.

Ufanele uthethe nini nogqirha? (Emva kovavanyo)

Xa ubuyela ekhaya emva kovavanyo, kufuneka wazise ugqirha wakho okanye isibhedlele esikufutshane ukuba unenye okanye ngaphezulu kwezi mpawu:

• Intlungu yesifuba (ingakumbi intlungu entsha, enzima, okanye engapheliyo xa uphumle)
• Ubunzima bokuphefumla
• Umkhuhlane (ubushushu bomzimba obuphezulu)
• Intlungu, ukudumba, ukuba bomvu, okanye ubomvu kwindawo yokungena
• Ukuziva unesizungu okanye ubuthathaka
• Ukubetha kwentliziyo okungaqhelekanga okanye i-palpitations

Musa ukuzityeshela ezi mpawu.

Okokugqibela, khumbula

Olu vavanyo (lweFractional Flow Reserve - FFR) luvavanyo lwesifo sakho semithambo yegazi yentliziyo.Indlela yanamhlanje nechanekileyo eya kunceda kakhulu ugqirha ukuba agqibe ukuba loluphi unyango olufanelekileyo. Abasebenzi bezonyango baya kuqinisekisa ukuba ukhululekile kangangoko ngexesha lovavanyo. Ukuba kukho into ongayiqondiyo okanye ukuba uyoyika, qiniseka ukuba ubuza ugqirha okanye umongikazi. Lilungelo lakho.

Kulungile ukuba ulungele loo nto engqondweni, kuba unokufuna ukufakwa i-angioplasty okanye i-stent emva nje kokuhlolwa kwe-FFR yakho. Khumbula, yonke into yenziwa ukukhusela impilo yentliziyo yakho.

Ndikunqwenelela ukuchacha ngokukhawuleza!

Isifo sentliziyo, isifo semithambo yegazi yentliziyo, uvavanyo lwe-FFR, i-Fractional Flow Reserve, i-cardiac catheterization, i-coronary angiogram, i-angioplasty, i-stent, uhlaselo lwentliziyo, iimpawu zesifo sentliziyo