Ingaba umthambo wegazi oyintloko wentliziyo yomntwana wakho uvalekile? Masifunde ngale nto ((Ukuhlanganiswa kwe-Aorta)!

Ngaba wakha wazibuza ukuba zisebenza njani ngokumangalisayo iintliziyo zethu ezincinci? Kodwa ngamanye amaxesha, ngenxa yeengxaki ezithile zokuzalwa, ukusebenza kwale ntliziyo kunokuphazamiseka kancinci. Enye imeko yentliziyo enokwenzeka kwezinye iintsana ibizwa ngokuba yi-`(Coarctation of the Aorta)`. Nangona igama lisenokuvakala liyinkimbinkimbi kancinci, ungakhathazeki. Masithethe ngale nto ngokulula.

Yintoni `(Ukudibanisa i-Aorta)`? Ngamafutshane...

Ngamafutshane, ukuxinana kwe-Aorta kukuxinana okanye ukuxinana kwe-aorta, umthambo wegazi oyintloko othwala igazi elineoksijini elisuka entliziyweni yomntwana wakho ukuya emzimbeni wonke. Esi sisiphene sentliziyo esizalwa naso.

Khawucinge nje, izithuthi ezininzi zihamba ngokukhawuleza kakhulu kwindlela enkulu. Kodwa kwenzeka ntoni ukuba unciphisa indlela kwindawo enye uze uvumele umzila omnye kuphela wezithuthi? Kuyenzeka ukuxinana kwezithuthi, kwaye abaqhubi baqale ukuhamba, akunjalo? Yiloo nto eyenzekayo nakule meko. Kuba nzima ukuba igazi lihambe kakuhle ngenxa yokuvaleka kwe-aorta.

Amaxesha amaninzi, oku kuncipha (ukuxinana) kwenzeka ngaphambi kokuba amasebe athwala igazi ukusuka kwi-aorta ukuya emzimbeni ongezantsi, njengemilenze, ahlukane. Yintoni ebangela oku? Uxinzelelo lwegazi luyanda kwinxalenye ephezulu yomzimba womntwana, njengeengalo, kodwa luyehla kwinxalenye esezantsi yomzimba, njengemilenze. Lo mahluko mkhulu kuxinzelelo lwegazi phakathi kwenxalenye ephezulu yomzimba kunye nesezantsi luphawu oluphambili lwesi sifo. Nokuba akukho zimpawu zimbi, oogqirha banokuba nomdla xa bebona lo mahluko kuxinzelelo lwegazi.

Ngokwezibalo eMelika, malunga nesinye kwi-1,700 yeentsana ezizalwa minyaka le sinokuba nale meko (i-Aortic Coarctation). Ezinye iintsana zinokuba nezinye izifo zentliziyo ezizalwa nazo kunye nesi.

Zeziphi iimpawu ezibonakaliswa ngabantwana xa befumana le meko?

Ezi mpawu zixhomekeke ekubeni i-aorta inciphile kangakanani. Ngokwesiqhelo, ukuba kukho ukuncipha okuncinci, iimpawu ziya kuqala ukubonakala kwiveki okanye ezimbini emva kokuzalwa. Nangona kunjalo, ukuba ukuncipha akunamandla kangako, iimpawu zisenokungabonakali de umntwana abe mdala, okanye zisenokungabonakali kwaphela.

Iimpawu zeentsana ezisandul' ukuzalwa

Ukuba umntwana osandul’ ukuzalwa unale meko, unokufumana iimpawu ezifana nezi:

• Ukozela rhoqo kunye nokungafuni ukusela ubisi
• Ukubetha kwentliziyo ngokukhawuleza (ukubetha kwentliziyo ngokukhawuleza)
• Ukubila okugqithisileyo
• Ukucaphuka rhoqo, ukukhala
• Ulusu olumhlophe okanye olungwevu
• Ukuphefumla okukhawulezayo okanye okunzima
• Ubunzima bokusela ubisi

Ukuba umntwana une -aorta exineneyo kakhulu, unokothuka aze abeke ubomi bakhe esichengeni ukuba akaqatshelwa aze anyangwe ngokukhawuleza. Nangona kunjalo, abanye abantwana basenokungabonakalisi zimpawu kuba ukuvaleka kuncinci kakhulu.

Iimpawu kubantwana abancinci nakubantu abadala abancinci

Abantwana abadala kunye nabantu abadala abancinci abane-Aortic Coarctation banokufumana iimpawu ezifana nezi:

• Intloko ebuhlungu rhoqo
• Igazi elonyukayo
• Ukopha rhoqo kwempumlo
• Intlungu emilenzeni xa uzilolonga, ubaleka, okanye utsiba

Abanye abantwana basenokungabi nazo naziphi na iimpawu kwaphela. Endaweni yoko, ingxaki iqalwa ngokuchongwa njengoxinzelelo lwegazi oluphezulu ngexesha lokuhlolwa rhoqo.

Xa umntu omdala efumana ezi mpawu, kudla ngokubakho ukuvela kwakhona kwe-aorta enciphayo emva konyango lwangaphambili. Kunqabile kakhulu ukuba le meko ingafunyaniswa de kube ngumntu omdala.

Kutheni le meko isenzeka? Zithini izizathu?

Iingcali azikayazi eyona nto ibangela i-CoA. Nangona kunjalo, kukholelwa ukuba kukho icandelo le-genetic . Oko kukuthi, utshintsho oluthile lwe-gene olwenzeka ngelixa umntwana esesibelekweni lunokubangela ukuba i-aorta yomntwana ingakhuli kakuhle.

Ngamanye amaxesha olu tshintsho lwemfuza lunokudluliselwa kwiintsapho. Uphando lubonise ukuba ukuba une-CoA, umntwana wakho unokuba nesifo se-CoA okanye esinye isifo sentliziyo kunomntu ongenayo i-CoA.

Kwakhona, umngcipheko wokuba ne-CoA uphezulu xa kukho iimeko ezithile zemfuza. Umzekelo, iintsana ezizelwe zine-genetic disorder ye-Turner syndrome zinamathuba amaninzi okuba ne-Coarctation ye-Aorta kuphela, kodwa nezinye iziphene zokuzalwa ezifana ne-bicuspid aortic valve, isiphene kwiivalvu zentliziyo.

Isizathu se-`(CoA)` sodwa ngaphandle kwezinye iziphene zentliziyo

Eyona nto ibangela i-CoA ehlukanisiweyo kukuvalwa okungaqhelekanga komthambo wegazi omncinci obizwa ngokuba yi-ductus arteriosus ngexesha lokukhula komntwana ongekazalwa. I-ductus arteriosus ngumthambo wegazi omncinci odibanisa i-fetal aorta kumthambo we-pulmonary. Imiphunga ayisebenzi ngelixa umntwana esesibelekweni, ngoko ke le tube inceda umntwana ukuba afumane igazi elineoksijini eninzi alifunayo.

Emva kokuba umntwana ezelwe, imiphunga iqala ukusebenza. Emva koko, ekubeni le `(ductus arteriosus)` ingasafuneki, iqala ukuvala yodwa kwiintsuku ezimbalwa. Nangona kunjalo, xa ivala, ezinye zezicwili ezikuloo mbhobho zinokudibana nezicwili ze`(Aorta)`. Kwimeko enjalo, xa `(ductus arteriosus)` inyanzelekile ukuba ivale, i-aorta nayo inokuncipha (i-coarctation)`.

Ziziphi iingxaki ezinokwenzeka ngenxa yale meko?

Ukuba le meko (i-Coarctation of the Aorta) ayinyangwa ixesha elide, iingxaki ezifana nezi:

• Uxinzelelo lwegazi oluphezulu (uxinzelelo lwegazi oluphezulu) emzimbeni wonke.
• Imisipha yentliziyo iba nkulu kunesiqhelo (i-left ventricular hypertrophy).
• Ukwakheka kwe-plaque kwimithambo yentliziyo, ehambisa igazi entliziyweni, kwenzeka ngaphambi kwexesha eliqhelekileyo - oku kubizwa ngokuba sisifo semithambo yentliziyo.
• Ukudumba okungaqhelekanga (i-aneurysm) okanye ukukrazuka (ukuqhekeka) kwi-aorta.
• I-brain aneurysm (ukudumba komthambo wegazi engqondweni).
• Ukungaphumeleli kwentliziyo yimeko apho intliziyo ingakwazi ukupompa igazi ngokufanelekileyo.

Le meko `(CoA)` iyingozi kakhulu ukuba ayiqatshelwa kwaye ayinyangwa. Kungoko ke, kubaluleke kakhulu ukuyiqaphela ngokukhawuleza, kwasebuntwaneni, kwaye ufumane unyango olufunekayo kunye nokuhlolwa rhoqo (ukubeka esweni).

Oogqirha bayixilonga njani le nto? (Ukuxilongwa)

Iingcali zentliziyo zabantwana zihlala zixilonga esi sifo (i-Coarctation of the Aorta) besebancinci okanye besebancinci. Ukuba sixilonga ngokukhawuleza kangakanani kuxhomekeke ekubeni iimpawu zinzima kangakanani.

Iintsana ezineempawu ezingacacanga ziyabonwa kwiintsuku ezimbalwa emva kokuzalwa. Nangona kunjalo, iintsana ezineempawu ezingacacanga, okanye azibonakali kwaphela, zisenokungabonwa de zibe zikhulile kwaye zibe noxinzelelo lwegazi oluphezulu. Akuqhelekanga ukuba oku kubonwe xa sele zikhulile.

Le meko idla ngokufunyaniswa kwiintsana nabantwana abancinci ngenxa yeempawu ezithile ezikrokrisayo (iiflegi ezibomvu) ezibonwa ngexesha lovavanyo lomzimba. Ezi mpawu ziquka:

• Umntwana unoxinzelelo lwegazi oluphezulu ezingalweni nasemzimbeni ongasentla, kodwa uxinzelelo lwegazi oluphantsi emilenzeni nasemzimbeni ongezantsi.
• Kukho umahluko phakathi kwesantya sentliziyo entanyeni kunye nesantya sentliziyo emqolo.
• Xa ugqirha ebeka i-stethoscope emqolo womntwana aze amamele, kuvakala isandi esingaqhelekanga nesiqatha esivela entliziyweni ('ukugquma kwentliziyo okuqatha') .

Ezinye iintsana ezisandul’ ukuzalwa zifunyaniswa zinesifo ngaphambi kokuba zibonakalise iimpawu. Uyazi njani? Uvavanyo olubizwa ngokuba yi-``pulse oximetry`` olulinganisa amanqanaba eoksijini egazini lazo lubonisa ukuba amanqanaba eoksijini aphantsi. Amanqanaba eoksijini aphantsi anokuba luphawu lwesifo sentliziyo esinzulu sokuzalwa, ngoko ke ezi ntsana ziyavavanywa ukuze kufunyaniswe ukuba yintoni kanye kanye ingxaki.

Ukuqinisekisa le meko `(CoA)`, oogqirha badla ngokusebenzisa `(Echocardiogram)`, iskeni sentliziyo, okanye `(echo)`. Banokwenza novavanyo olufana `(CT scan)` okanye `(MRI scan)` ukuze bafunde ngakumbi malunga nokuma kunye nolwakhiwo lwe-aorta yomntwana.

Ngaba zikhona ezinye izifo zentliziyo ezinxulumene "nokudibanisa i-Aorta"?

Ewe, iintsana ezine-CoA zinokufunyaniswa zinezinye izifo zentliziyo. Umzekelo, phakathi kwama-45% nama-75% abantu abane-CoA nabo banesifo esibizwa ngokuba yi-bicuspid aortic valve. Oku kuthetha ukuba i-valve ethwala igazi ukusuka entliziyweni ukuya kwi-aorta ineencwadana ezimbini kuphela endaweni yezintathu ekufuneka zibe nazo ngokuqhelekileyo.

Ayipheleli apho, kodwa `(CoA)` inokukhatshwa zezi meko zilandelayo:

• Ukuba nomngxuma entliziyweni - oko kubizwa ngokuba yi-`(atrial septal defect)` okanye `(ventricular septal defect)`.
• Umthambo wegazi owawukho ngexesha lobomi bomntwana ongekazalwa (`ductus arteriosus`) uhlala uvuliwe ixesha elide kunokuba bekulindelwe - oku kubizwa ngokuba yi-`patent ductus arteriosus``.
• I-Aortic arch hypoplasia okanye i-hypoplastic left heart syndrome.
• Ukuqina kwevalvu yentliziyo - oko kukuthi, i-aortic valve stenosis okanye i-mitral valve stenosis.

Oogqirha bentliziyo bajonga zonke ezi zinto entliziyweni yomntwana wakho baze benze isicwangciso sonyango esikhethekileyo kubo. Oku kuthetha ukuba ukunyanga umntwana oneziphene ezininzi zentliziyo kunokuba nzima ngakumbi kunokunyanga umntwana one-CoA enye kuphela.

Zithini iindlela zonyango zoku?

Iindlela zonyango zixhomekeke kwiminyaka yomntwana wakho, ubungakanani bokuncitshiswa kwe-aorta, kunye nokuba unezinye iziphene zentliziyo. Utyando yeyona ndlela ilungileyo yokunyanga i-coagulopathy kwiintsana nabantwana abancinci. Kubantwana abadala, ukuba ukuncitshiswa akukubi kakhulu, i-catheterization yentliziyo, inkqubo engangenisi kakhulu kunotyando, inokufaneleka. Ikwasetyenziswa kubantwana nakubantu abadala abaye baphinda bancitshiswa emva konyango lwangaphambili.

Utyando

Kukho iintlobo ezininzi eziphambili zotyando olwenziwayo ukulungisa le meko `(CoA)`:

• Ukususwa kwesisu nge-anastomosis ukusuka ekuqaleni ukuya ekupheleni: Ukuba i-coarctation incinci, ugqirha unokususa inxalenye evalekileyo ye-aorta yomntwana aze aphinde ahlangane nezinye iziphelo.
• Ukususwa kwakhona kwesisu nge-anastomosis ende ukusuka ekuqaleni ukuya ekupheleni:Ukuba i-aorta arch yomntwana nayo ivaliwe, ugqirha angasika inxalenye evaliweyo ye-aorta aze adibanise inxalenye engezantsi ye-aorta ehlayo kwi-incision ende kwi-aorta arch. Olu lolona khetho lufanelekileyo xa umntwana ene-aortic arch hypoplasia enqamlezileyo kunye ne-aortic coarctation.

Iintsana ezibonisa iimpawu ezinzima emva kokuzalwa nazo zisenokufuna ukufumana amayeza ngaphambi kotyando. Umzekelo:

• Iyeza elibizwa ngokuba yi-`(Prostaglandin (PGE-1))` linganikwa ukugcina i-`(ductus arteriosus)` yomntwana ivulekile. Oku kuya kuvumela umntwana ukuba afumane ioksijini ayidingayo aze ayigcine izinzile de alungele utyando.
• Ungamnika nomntwana amayeza okunceda intliziyo yakhe ipompe igazi.

Ukufakwa kwe-catheter kwintliziyo

Ukuba umntwana wakho unciphile ukuncitshiswa kwe-aorta, okanye ukuba ukuncitshiswa kuphinde kwavela emva kotyando, ugqirha angacebisa unyango olufana nolu:

• I-angioplasty yebhaluni: Ugqirha usebenzisa ibhaluni encinci ukwandisa inxalenye encinci ye-aorta yomntwana.
• I-angioplasty yebhaluni ene-stent placement: Ngelixa ugqirha otyandayo ekhulisa i-aorta yomntwana, ufaka nombhobho omncinci, obizwa ngokuba yi-stent, ukuze ungavaleki kwakhona.

Ndifanele ndimse nini umntwana wam kugqirha? (Ukuhlolwa kwakhona)

Iqela lezonyango lomntwana wakho liza kukuxelela ukuba umzise nini umntwana wakho. Kubo bonke ubomi bomntwana wakho, kuya kufuneka ukuba alandelelwe yingcali yezifo zentliziyo yokuzalwa. Le ngcali iza:

• Jonga uxinzelelo lwegazi lomntwana rhoqo.
• Ukwenza iiskeni (uvavanyo lwemifanekiso) rhoqo ukujonga ukusebenza kwentliziyo yomntwana kunye neempawu zeengxaki.
• Ukubonelela ngeengcebiso malunga neendlela zokutya ezinempilo kunye nokuzilolonga.
• Ukunika amayeza kunye nokutshintsha idosi yawo njengoko kufuneka.

Umntu onesi sifo angaphila ixesha elingakanani?

Ngeendlela eziphambili zokuxilonga kunye nonyango, abantu abane-Coarctation of the Aorta ngoku banokuphila ubuncinane iminyaka engama-60 ubudala. Ngaphambili, umyinge wobomi babantu abanale meko wawumalunga neminyaka engama-35. Ngoko ke ezi ziindaba ezimnandi ngokwenene.

Ukuba umntwana wakho une-Coarctation ye-Aorta, usenokuba uzibuza ukuba kutheni kwenzeke oku. Asinakusoloko sichaza unobangela wesifo sentliziyo esizalwa naso. Kodwa siyazi ukuba ukufunyaniswa kwangethuba kunye nonyango kunokunciphisa kakhulu impembelelo yale meko kubomi bomntwana.

Iqela lezonyango lihlala likhona ukunceda umntwana wakho. Bakulungele ukuphendula nayiphi na imibuzo onokuba nayo kwaye bakuncede uqonde indlela olu xilongo (CoA) oluya kumchaphazela ngayo umntwana wakho. Ungafumana kuluncedo ukuthetha nabanye abazali babantwana abanesifo sentliziyo esinjalo.

Izinto ezibalulekileyo ekufuneka uzikhumbule (Umyalezo Wokuya Ekhaya)

Ndiyathemba ukuba ngoku uyaqonda imeko ebesithetha ngayo ebizwa ngokuba yi-"Coarctation of the Aorta". Nazi ezinye zezinto ezibalulekileyo ekufuneka uzikhumbule:

• Esi sisifo sentliziyo esizalwa naso ; ukuvaleka komthambo ophambili othwala igazi lisuka entliziyweni liye emzimbeni.
• Iimpawu zisenokuba khona ebuntwaneni okanye zivele kamva. Ukuba ubona ukozela kakhulu, ubunzima bokuphefumla, okanye ukungafuni ukuncancisa umntwana wakho, funa ingcebiso kagqirha ngokukhawuleza.
• Ukuxilongwa kwangethuba kunye nonyango lwesi sifo kunika umntwana ithuba elikhulu lokuphila ubomi obuqhelekileyo nobusempilweni.
• Le meko inokulawulwa ngempumelelo ngotyando kunye nolunye unyango.
• Ukuhlolwa ngugqirha okhethekileyo ubomi bonke kubalulekile nokuba emva konyango.

Musa ukoyika. Isayensi yezonyango iphucuke kakhulu namhlanje. Kukho oogqirha abanezakhono abanokubonelela ngonyango olungcono kumntwana wakho. Eyona nto ibalulekileyo kukuba uyazi oku, uqaphele utshintsho lomntwana wakho, kwaye ufune iingcebiso zonyango ngexesha.

Ukudibana kwe-Aorta, Isifo sentliziyo, iiPediatrics, Isifo sentliziyo esizalwa naso, i-Aortic Stenosis, Impilo yomntwana, Uxinzelelo lwegazi