Umele ukuba ukhe weva nge-aorta, umthambo wegazi ophambili opompa igazi emzimbeni wethu. Khawuthelekelele, kuthekani ukuba lo mthambo uphambili, apho udibana khona nentliziyo, "engcanjini," uba buthathaka kancinci kwaye uqhume njengebhaluni? Yiloo nto siyibiza ngokuba yi-aneurysm kunyango. Oku kuyingozi kakhulu, kuba nangaliphi na ixesha olu donga lubuthathaka lunokuqhekeza okanye luqhekeke. Ukuba oko kuyenzeka, kunokubakho ukopha okugqithisileyo emzimbeni kwaye nemiphumo esongela ubomi. Ke ngoko, ukutshintshwa kweengcambu ze-Aortic lutyando olubaluleke kakhulu olwenziwayo ukunqanda ezo meko zisongela ubomi. Namhlanje, siza kuthetha ngale nto ngokulula, ngendlela onokuyiqonda.
Yintoni le ngcango yokutshintshwa kweengcambu ze-Aortic?
Ngamafutshane, olu lutyando lokulungisa i-aneurysm kwingcambu ye-aorta, umthambo oyintloko odibanisa intliziyo yakho. Ngamanye amaxesha, zombini ingcambu ye-aorta yakho kunye nevalvu ekuyo ziyatshintshwa. Ngamanye amaxesha, ingcambu ye-aorta yakho kuphela etshintshwayo, ishiya ivalvu yakho eqhelekileyo ingashukumi. Ugqirha wakho uya kugqiba ukuba loluphi uhlobo lotyando olufanelekileyo kuwe ngokusekelwe kwizinto ezininzi, kuquka imeko yevalvu yakho.
Ziziphi iintlobo eziphambili zolu tyando?
Zimbini iindlela eziphambili zolu tyando. Enye kukutshintsha ingcambu ye-aorta kunye nevalvu. Enye kukutshintsha ingcambu kuphela, kushiye ivalvu ingasebenzi. Zombini zinezibonelelo kunye neengxaki.
1. Ukutshintshwa kweengcambu ze-Aortic (ARR)
Le nkqubo ikwabizwa ngokuba yiBentall procedure . Yenzelwa abantu abane-aortic aneurysm kunye nengxaki yevalvu. Umzekelo, ukuba ivalvu ayivali kakuhle kwaye igazi livuza umva (i-aortic valve regurgitation) okanye ukuba ivalvu iye yaba yi-calcified (iqiniswe).
- Inzuzo ephambili: Eyona nzuzo inkulu yoku kukuba awudingi utyando olwahlukileyo ukuze ulungise ivalvu kwakhona emva kotyando. Zombini iingxaki ze-aneurysm kunye nevalvu zisonjululwa ngaxeshanye.
- Iingozi: Ukuba ufake ivalvu yomatshini ngexesha lotyando, kuya kufuneka uthathe amayeza okunciphisa igazi/alwa negazi ubomi bakho bonke. Kukho umngcipheko omncinci wokuqhekeka kwegazi okanye ukopha ngenxa yala mayeza.
2. Ukutshintshwa kweengcambu ezigcina iivalvu (VSRR)
Olu lolona khetho lufanelekileyo ukuba ivalvu yakho ye-aortic isebenza kakuhle ngaphandle kweengxaki. Umzekelo, ukuba akukho kuvuza kwegazi okanye ukuqina kwevalvu, le ndlela ingakhethwa. Esi sisisombululo esingcono kakhulu kubantu abafumana i-aneurysms besebancinci ngenxa yeemeko zemfuza.
Le nkqubo ibandakanya ukutshintsha ingcambu ye-aorta yakho kunye nokufaka kwakhona ivalvu yakho yendalo kuyo. Kukho iindlela ezimbini eziphambili, ezibizwa ngoogqirha abazifumeneyo.
- Inkqubo kaYacoub: Oku kubandakanya ukuhlaziya ivalvu ye-aorta. Oku kudla ngokufaneleka kubantu abadala abane-aneurysms ngenxa yezizathu ezingezizo ezemfuza.
- Inkqubo kaDavid: Oku kubandakanya ukufakelwa kwakhona kwevalvu ye-aortic. Le yinkqubo eqhelekileyo kodwa inzima kunekaJacob. Ilungele abantu abancinci abaneengxaki zemfuza okanye ivalvu ye-aortic ye-bicuspid .
Eyona nzuzo inkulu yotyando lwe-VSRR kukuba akukho mfuneko yokuthatha amayeza okunciphisa igazi ubomi bakho bonke. Kwakhona kunciphisa umngcipheko wesifo sohlangothi okanye usulelo olufana ne-endocarditis.
Ngaba singayifunda kancinci ngengcambu ye-aorta?
Ingcambu ye-aorta yinxalenye yokuqala yomthambo wegazi omkhulu emzimbeni, i-aorta, apho idibana khona nentliziyo. Ifana nengcambu yomthi. I-aorta, ephuma entliziyweni, igoba iye phezulu, njengegophe. Elo gophe liqala apho ingcambu ye-aorta iqala khona. Le nxalenye iyinkimbinkimbi kakhulu.
- I-Aortic Valve: Kulapho i-valve esebenza njengesango ivumela igazi ukuba liphume entliziyweni liye kwi-aorta, kodwa lithintele ukuba lingabuyeli.
- Imithambo yegazi emibini ebalulekileyo ehambisa igazi entliziyweni iqala kwisiseko sale aorta.
- IiSinuses zeValsalva: Eli ligama elinikwa ukudumba okuncinci ekuqaleni kwemithambo yentliziyo.
Xa sisebancinci, zonke ezi ndawo ziguquguquka kakhulu. Kodwa njengoko sikhula, oku kuguquguquka kuncipha. Yiyo loo nto kuvela ezinye iingxaki. Ekubeni le ndawo inzima kakhulu, utyando olwenziwa kuyo nalo lunzima. Nangona kunjalo, ngoncedo loogqirha abanamava nabanobuchule, olu tyando lunokwenziwa ngempumelelo kwaye intliziyo yakho inokuba sempilweni kwakhona.
Ngubani ngokwenene odinga olu tyando?
Olu tyando luyimfuneko kubantu abane-aneurysm kwi-aorta esengozini yokuqhuma okanye ukuqhekeka. Ngamanye amaxesha oku kuvela ngenxa yotshintsho kwi-aorta njengoko iminyaka ikhula. Kwakhona, iimeko zemfuza ezifana ne -Marfan syndrome kunye ne-Loeys-Dietz syndrome zinokubangela ii-aneurysms ezibulalayo besebancinci.
Khawucinge nje, ukuba umntu one-Marfan syndrome akafumani unyango, kukho umngcipheko omkhulu wokuqhuma kwe-aneurysm nokufa. Ubudala obuqhelekileyo bokufa kubantu abakwelo qela bumalunga neminyaka engama-32 ubudala. Kodwa, ukuba ufumana olu tyando, ungandisa ubomi bakho bube bobomntu oqhelekileyo.Ngoko ke, ukuba kukho umntu kusapho lwakho onezi zifo zemfuza, kubalulekile ukuthetha nogqirha wakho malunga nomngcipheko wakho kwaye umisele ixesha elifanelekileyo lotyando.
| Imeko yezonyango/umngcipheko | Ububanzi be-aneurysm efuna utyando |
|---|---|
| Ngaphandle kokuba kukho imeko ethile yemfuza okanye ezinye izinto ezinobungozi | Iisentimitha ezi-5.5 |
| Ukuba une-Marfan syndrome | Iisentimitha ezi-5.0 |
| Ukuba unezinye iingozi ezifana neMarfan syndrome kunye nembali yosapho, ukukhula ngokukhawuleza, okanye uceba ukukhulelwa | Iisentimitha eziyi-4.5 |
| Ukuba unezinye iingozi, ezifana ne-bicuspid aortic valve kunye noxinzelelo lwegazi oluphezulu | Iisentimitha ezi-5.0 |
Into ebalulekileyo kukuba la manani awafani kuwo wonke umntu. Esi sigqibo sinokuhluka ngokuxhomekeke kwiminyaka yakho, impilo yakho iyonke, kunye nezinto ezifana noxinzelelo lwegazi oluphezulu olungalawulekiyo kunye nokutshaya. Ngoko ke, thetha nogqirha wakho malunga nemingcipheko yakho ethile kunye nexesha elifanelekileyo lotyando.
Kwenzeka ntoni ngaphambi, ngexesha nasemva kotyando?
Ekubeni olu lutyando olukhulu, lufuna ukulungiswa kakuhle.
Ngaphambi kotyando
Ugqirha wakho uza kukunika uhlolo olupheleleyo. Uza kukuthumela kugqirha wamazinyo ukuze ahlolwe amazinyo. Ukongeza, baza kwenza uvavanyo oluninzi, olufana nolu:
- Uvavanyo lwegazi: Jonga ukusebenza kwezintso.
- I-CT okanye i-MRI scan yentliziyo: Oku kungahlola zonke iindawo ze-aorta. Ezinye iingxaki ngamanye amaxesha zinokulungiswa ngexesha lotyando olufanayo.
- I-Coronary Angiography: Jonga imeko yemithambo yegazi yentliziyo ehambisa igazi entliziyweni.
- I-Duplex Ultrasound: Ijonga imeko yemithambo ye-carotid entanyeni. Iingxaki ngezi zinto zinokunyusa umngcipheko wokukhubazeka ngexesha lotyando.
Kwakhona, ugqirha wakho uza kukubuza ngezi zinto:
- Amayeza owasebenzisayo: Ufanele uxelele ugqirha wakho malunga namayeza okanye iivithamini ozisebenzisayo. Amanye amayeza anokufuna ukuba uyeke ukuwasebenzisa ngaphambi kotyando.
- Ezinye iimeko zempilo: Ukuba uneengxaki zempilo ezifana noxinzelelo lwegazi oluphezulu, kufuneka zilawulwe kakuhle ngaphambi kotyando.
- Imeko yakho yangoku: Qiniseka ukuba uyasixelela ukuba unayo nayiphi na isifo, njengomkhuhlane okanye umkhuhlane.
- Ukutshaya: Ukutshaya kufuneka kuyekwe ngokupheleleyo ubuncinane inyanga enye ngaphambi kotyando.
Ngexesha lotyando
Uza kunikwa i-anesthesia ukuze ulale ngokupheleleyo. Emva koko uza kuqhagamshelwa kumatshini wentliziyo nemiphunga (cardiopulmonary bypass) . Lo matshini uza kwenza umsebenzi wentliziyo nemiphunga yakho ngexesha lotyando. Emva koko ugqirha uza kulandela la manyathelo:
1. I-Median Sternotomy: Kusikwa inxeba embindini wesifuba ukuze kwahlulwe ithambo lesifuba (sternum) kwaye kufikelelwe entliziyweni.
2. Ukususwa kwe-Aneurysm: Inxalenye ebuthathaka nevuthulukileyo ye-aorta iyasikwa ize isuswe.
3. Ukufakwa kwe-Graft: Kufakwa umthambo wegazi owenziweyo (i-graft) ukuze kuthathelwe indawo inxalenye esusiweyo.
4. Ukutshintsha okanye ukugcina ivalvu: Utshintsha ivalvu okanye ufake kwakhona ivalvu yakho ngokwendlela ye-ARR okanye ye-VSRR ekuthethwe ngayo ngaphambili.
5. Ukufakelwa kwemithambo yegazi ejikeleza imithambo yegazi: Imithambo yegazi ehambisa igazi entliziyweni iqhagamshelwe kwi-graft entsha.
6. Ukuthunga isilonda: Ekugqibeleni, isilonda sesifuba sithungwa ndawonye.
Olu tyando ludla ngokuthatha iiyure ezine ukuya kwezintandathu.
Emva kotyando
Emva kotyando, kuya kufuneka uhlale kwigumbi labagula kakhulu (ICU) kangangeentsuku ezimbalwa. Emva koko uya kudluliselwa kwigumbi eliqhelekileyo. Ukuhlala esibhedlele lonke kungathatha malunga neveki. Ngeli xesha:
- Ndiza kukunika amayeza okudambisa iintlungu.
- Usenokuqhagamshelwa kumatshini ukuze akuncede uphefumle.
- Iisokisi ezikhethekileyo zinxitywa ukuthintela ukuqhekeka kwegazi.
- Abanye abantu banikwa amayeza okunciphisa igazi.
Emva kokuba ubuyele ekhaya uvela esibhedlele, landela imiyalelo kagqirha ngokuchanekileyo. Musa ukungxama izinto. Phila ngokukhawuleza. Awunakuqhuba imoto ude uphile.
Zithini iingenelo, iingozi, kunye namanqanaba empumelelo otyando?
| Icandelo | Inkcazo |
|---|---|
| Inzuzo ephambili | Ukuthintela imeko engxamisekileyo enokuba yingozi apho i-aneurysm iqhuma okanye iqhekeke. Ngamafutshane, olu lutyando olusindisa ubomi. |
| Iingozi kunye neengxaki | Njengalo naluphi na utyando olukhulu, kukho iingozi. Ukopha, amahlwili egazi, usulelo, ukuhlaselwa yintliziyo okanye istroke, kunye nokungasebenzi kakuhle kwezintso kunokwenzeka. Kodwa ezi aziqhelekanga. |
| Ixesha lokuchacha | Kungathatha iiveki ezi-6 ukuya kwezili-12 okanye iinyanga ezimbini ukuya kwezintathu ukuze umntu aphile ngokupheleleyo. Kubaluleke kakhulu ukuba nenxaxheba kwinkqubo yokuvuselela intliziyo ngeli xesha. |
| Impumelelo nokusinda | Olu tyando luphumelele kakhulu. Phakathi kwama-98% nama-99% abantu bayasinda kolu tyando. Nokuba emva kweminyaka eli-10, malunga nama-86% - 90% abayi kufuna olunye utyando. Esi sisisombululo sexesha elide. |
Ufanele uye nini kugqirha?
Nika ingqalelo emzimbeni wakho ngexesha lokuchacha kwakho. Ukuba ubona nayiphi na kwezi zilandelayo , fowunela ugqirha wakho ngoko nangoko:
- Imibuzo enxulumene nokusikwa:
- Ububomvu, iintlungu, ukudumba, okanye ubushushu obujikeleze inxeba.
- Ibhandeji iba manzi kangangokuba igazi okanye ulwelo olucacileyo luphuma.
- Ukukhupha ubovu obuluhlaza okanye obumthubi.
- Imiphetho yesikhewu iyahlukana.
- Eminye imibuzo:
- Intlungu esifubeni okanye ubunzima bokuphefumla nokuba uphumle.
- Ukudumba kwemilenze okanye ukungakwazi ukuhambisa imilenze.
- Ukudinwa, ukozela, okanye ukudinwa kakhulu.
- Ukukhohlela igazi okanye i-mucus eluhlaza/etyheli.
- Ukuba nomkhuhlane kunye nomkhuhlane.
- Igazi esitulweni.
Kufuneka uye nini kwiYunithi yoNyango oluNgxamisekileyo (i-ETU)?
Ukuba une-aneurysm enganyangwanga, yiya kwicandelo lezonyango ezingxamisekileyo (ETU) elikufutshane nawe ngoko nangoko ukuba ufumana ezi mpawu zilandelayo. Ezi zisenokuba ziimpawu ze-aneurysm eqhumayo:
- Intlungu engathethekiyo esifubeni okanye emqolo ongasentla. Isenokuvakala ngathi kukho into ekrazukileyo emzimbeni.
- Ukubila nokuziva ngathi uthambile.
- Ubunzima bokuphefumla.
- Ukuba nesiyezi okanye ukuba nentloko ebuthathaka.
- Isantya sentliziyo siyanda.
- Isicaphucaphu nokuhlanza.
Kuqhelekile ukuba uzive usoyika xa usiva ngotyando lwentliziyo. Kodwa khumbula, olu tyando luyinto enokusindisa ubomi bakho kwaye ikunike ithuba lokuphila ubomi obusempilweni ixesha elide. Ugqirha wakho kunye neqela lezonyango banamava ekwenzeni olu hlobo lotyando. Ngoko ke thetha nabo ngayo nayiphi na imibuzo okanye uloyiko onokuba nalo.
Umyalezo Wokuya Ekhaya
- Ukutshintshwa kweengcambu ze-Aortic lutyando olusindisa ubomi olwenziwayo ukuthintela ukugqabhuka kwe-aneurysm kwiingcambu ze-aorta yentliziyo.
- Ngokuxhomekeke kwimeko yevalvu yakho ye-aortic, olu tyando lunokwenziwa ngevalvu (ARR) okanye ngevalvu egciniweyo (VSRR).
- Olu tyando luphumelele kakhulu. Izinga lokusinda lingaphezulu kwama-98%. Kwakhona, sisisombululo sexesha elide.
- Kubalulekile ukuyeka ukutshaya nokulawula izifo ezifana noxinzelelo lwegazi oluphezulu ngaphambi kotyando.
- Ukuba ufumanisa naziphi na iimpawu ezingaqhelekanga (ukosuleleka kwesilonda, iintlungu eziqatha esifubeni) ngexesha lokuchacha kwakho, yazisa ugqirha wakho ngoko nangoko.
- Ukuba unenkxalabo okanye amathandabuzo malunga nolu tyando, thetha nogqirha wakho ngalo mba ngokukhululekileyo. Baza kukunceda.
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