Ngaba ugqirha ukuxelele ukuba umthambo wegazi oyintloko othwala igazi lisuka entliziyweni yakho liye emzimbeni wakho wonke uye waba buthathaka kwaye uneqhubu ezantsi? Okanye ukuxelele ukuba udinga utyando? Kuqhelekile ukuba uzive usoyika kancinci xa usiva into efana naleyo. Kodwa olu lutyando olubaluleke kakhulu olunokusindisa ubomi bakho. Namhlanje, siza kuthetha ngokuba luyintoni olu tyando lokubuyisela iingcambu ze-Aortic, indlela oluqhutywa ngayo, kunye nayo yonke into ekufuneka uyazi ngalo.
Ngamafutshane, yintoni i-Aortic Root Replacement?
Umthambo wegazi omkhulu nobaluleke kakhulu emzimbeni, i-aorta, uqhagamshelwe entliziyweni yethu. Inxalenye yokuqala yale aorta apho iqhagamshelwe khona entliziyweni ibizwa ngokuba yingcambu ye-aorta. Ngamanye amaxesha udonga lwale nxalenye luba buthathaka luze luqale ukudumba njengebhaluni. Oku kubizwa ngokuba yi-aneurysm.
Ingozi yokuba ne-aneurysm efana nale kukuba inoku "qhekeza" okanye "iqhekeke" nangaliphi na ixesha. Ukuba oko kuyenzeka, kunokubangela ukopha okukhulu emzimbeni kwaye kube yingozi ebomini.
Ngoko ke, utyando lwe-`Aortic Root Replacement` lubandakanya ukususa ingcambu ebuthathaka nedumbileyo ye-aorta uze uyifake umjelo wokwenziwa (i-graft). Oku kunokuthintela iimeko eziyingozi endizikhankanyileyo kwaye kusindise ubomi bakho.
Ziziphi iintlobo eziphambili zolu tyando?
Kukho iindlela ezimbini eziphambili zokwenza olu tyando. Ugqirha wakho uza kukhetha indlela efanelekileyo kuwe ngokwemeko yakho.
| Uhlobo lotyando | Inkcazo |
|---|---|
| Inkqubo yokutshintshwa kweengcambu ze-Aortic (ARR) okanye iBentall | Kule nkqubo, ingcambu ye-aortic kunye nevalvu ye-aortic eqhotyoshelwe kuyo ziyasuswa kwaye kufakwa entsha eyenziweyo. Le nkqubo ingcono ukuba ivalvu yakho ye-aortic ibuthathaka (iyavuza) okanye ityebile (i-calcification). Ukuba kufakwa ivalvu yoomatshini, kuya kufuneka uthathe amayeza okunciphisa ukugabha kwegazi ubomi bakho bonke. |
| Ukutshintshwa kweengcambu zeValve-Sparing (VSRR) | Njengoko igama lisitsho, le nkqubo ibandakanya ukutshintsha kuphela inxalenye ebuthathaka yevalvu yakho ye-aortic ngaphandle kokuyonakalisa. Le nkqubo ilungele abantu abenza utyando besebancinci, ingakumbi ukuba ivalvu yakho ikwimeko entle, ingakumbi abo baneengxaki zemfuza (ezifana ne-Marfan syndrome). Inzuzo ephambili kukuba akufuneki uthathe amayeza okunciphisa igazi ubomi bakho bonke. Kukho iintlobo ezimbini zale nkqubo : inkqubo kaYacoub kunye nenkqubo kaDavid. |
Iinxalenye zotyando lwe-VSRR
Utyando lwe-VSR lwahlulwe ngeendlela ezimbini: iindlela zikaYacoub kunye nekaDavid.
- Inkqubo kaYacoub: Oku kubandakanya ukuhlaziya ivalvu ye-aorta. Oku kulungele ngakumbi abantu abadala abaye baba ne-aneurysm ngenxa yezizathu ezingezizo ezemfuza.
- Inkqubo kaDavid: Oku kubandakanya ukufakelwa kwakhona kwevalvu ye-aortic. Le nkqubo inzima ngakumbi kunenkqubo kaYacoub, kodwa isetyenziswa kakhulu. Ifanelekile ngakumbi kubantu abancinci abanezifo zemfuza ezifana ne-'Marfan syndrome'.
Ngubani odinga olu tyando kwaye nini?
Nabani na onomthambo ovuvukileyo we-aortic kwaye osengozini yokuqhekeka okanye ukukrazuka unokufuna olu tyando. Ngamanye amaxesha le meko ibangelwa lutshintsho olwenzeka ngokuhamba kweminyaka. Kwakhona, izifo zemfuza ezifana ne-Marfan syndrome kunye ne-Loeys-Dietz syndrome zinokubangela le aneurysm iyingozi ebuntwaneni.
Utyando ludla ngokucetyiswa ngokusekelwe kubungakanani be-aneurysm kunye nezinye izinto ezinobungozi.
- Ukuba azikho ezinye izifo zemfuza okanye izinto ezinobungozi, ububanzi be-aneurysm bukhulu kuneesentimitha ezi-5.5 .
- Ukuba une-Marfan syndrome, ububanzi bayo bungaphezulu kweesentimitha ezi-5.0 .
- Ukuba une-Marfan syndrome, imbali yosapho olu hlobo lwe-aneurysm, uceba ukukhulelwa, okanye ukuba i-aneurysm ikhula ngokukhawuleza kuneemilimitha ezi-3 ngonyaka, utyando lunokucetyiswa nokuba luyi -4.5 centimeters ububanzi.
- Ukuba une-aortic valve ene-bicuspid (ii-cusps ezimbini kuphela) kunye nezinye izinto ezinobungozi, ezinje ngoxinzelelo lwegazi oluphezulu, utyando lunokucetyiswa kububanzi obuyi- 5.0 centimeters .
Into ebalulekileyo kukuba ezi zigqibo azifani kuye wonke umntu. Ugqirha wakho uya kumisela ixesha elifanelekileyo lotyando ngokuxhomekeke kwiminyaka yakho, impilo yakho iyonke, kunye nezinye iimeko zempilo.
Uzilungiselela njani ngaphambi kotyando?
Ekubeni olu lutyando olukhulu, lufuna ukulungiswa ngononophelo. Ugqirha wakho uza kukuxilonga kakuhle aze akunike uvavanyo oluninzi olufunekayo.
- Uvavanyo lwegazi: Jonga ukusebenza kwezintso.
- Iiskeni zentliziyo ze-CT okanye ze-MRI: Hlola zonke iindawo ze-aorta.
- I-Coronary angiography: Jonga imeko yemithambo yegazi yentliziyo ehambisa igazi entliziyweni.
- I-Duplex ultrasound: Jonga impilo yemithambo entanyeni (imithambo ye-carotid).
Kwakhona, ngokuqinisekileyo kufuneka uthethe nogqirha wakho ngezi zinto zilandelayo:
- Malunga nawo onke amayeza owasebenzisayo: Oku kuquka iivithamini kwanemveliso yezityalo. Amanye amayeza anokufuna ukuba uyeke ukuwasebenzisa ngaphambi kotyando.
- Malunga nezinye izifo onazo: Izinto ezifana noxinzelelo lwegazi oluphezulu kufuneka zilawulwe kakuhle ngaphambi kotyando.
- Ukuba uyatshaya: Kufuneka uyeke ngokupheleleyo ukutshaya ubuncinane inyanga enye ngaphambi kotyando. Cela uncedo kugqirha wakho ngale nto.
Kwenzeka ntoni ngexesha nasemva kotyando?
Ngexesha lotyando, uza kufakwa phantsi kwe-anesthesia kwaye ulale ngokupheleleyo. Emva koko uza kuqhagamshelwa kumatshini wentliziyo nemiphunga (cardiopulmonary bypass) . Lo matshini uza kwenza umsebenzi wentliziyo nemiphunga yakho ngexesha lotyando.
Ugqirha wenza utyando phakathi kwesifuba sakho, afikelele entliziyweni yakho, asuse inxalenye ebuthathaka yomthambo, aze ayitshintshe ngetshaneli entsha yokwenziwa (i-graft). Imithambo yentliziyo ehambisa igazi entliziyweni yakho emva koko iqhagamshelwe kumjelo omtsha kwaye utyando luthungelwe luvalwe. Olu tyando ludla ngokuthatha iiyure ezi-4 ukuya kwezi-6 .
Emva kotyando, kuya kufuneka uhlale kwigumbi labagula kakhulu (ICU) kangangeentsuku ezimbalwa. Emva koko uya kudluliselwa kwigumbi eliqhelekileyo. Ukuhlala esibhedlele kungathatha malunga neveki. Ngeli xesha, uya kunikwa amayeza okudambisa iintlungu, amayeza okunciphisa igazi, kunye nolunye unyango olufunekayo.
Kuthatha ixesha elingakanani ukuchacha?
Kungathatha malunga neeveki ezi-6 ukuya kwezili-12 , okanye mhlawumbi iinyanga ezimbini ukuya kwezintathu, ukuze uphile ngokupheleleyo kolu tyando. Olu lutyando olukhulu, ngoko ke kufuneka unike umzimba wakho ixesha lokuphola.
- Kangangeeveki ezi-6: Musa ukuqhuba okanye ukuphakamisa izinto ezinzima.
- Ngomsebenzi waseofisini: Uya kukwazi ukubuya kwiiveki ezi-6-8.
- Ngomsebenzi onzima ngokwasemzimbeni: Kuya kufuneka ulinde ixesha elide.
Ukulandela imiyalelo kagqirha wakho ngokuchanekileyo kunye nokuthatha inxaxheba kwiinkqubo zokuvuselela intliziyo kuya kunceda kakhulu ekupholeni ngokukhawuleza.
Ixesha lokubona ugqirha ngoko nangoko
Emva kokubuyela ekhaya, ukuba ufumanisa naziphi na kwezi mpawu zilandelayo , fowunela ugqirha wakho ngoko nangoko.
| Iimpawu ekufuneka uziqaphele | |
|---|---|
| Iingxaki ezinxulumene notyando lokusikwa: | |
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| Eminye imiba: | |
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Ungayiqaphela njani imeko engxamisekileyo?
Ukuba une-aneurysm enganyangwanga, ezi mpawu zilandelayo zinokuba luphawu lokuqhekeka okanye ukuqhekeka. Kwimeko enjalo , yiya kwangoko kwiSebe lezeMpilo eziNgxamisekileyo (ETU) lesibhedlele esikufutshane okanye utsalele umnxeba inkonzo ye-ambulensi ka-1990.
- Intlungu engathethekiyo esifubeni okanye emqolo ongasentla (ukuziva ngathi kukho into ekrazulwayo ngaphakathi emzimbeni).
- Ukubila nokuziva ngathi uthambile.
- Ubunzima bokuphefumla.
- Ukudinwa okanye ukuquleka.
- Ukubetha kwentliziyo ngokukhawuleza.
Umyalezo Wokuya Ekhaya
- Ukutshintshwa kweengcambu ze-Aortic lutyando olukhulu, olunokusindisa ubomi olwenziwa ingcambu ebuthathaka ye-aorta.
- Kukho iintlobo ezimbini eziphambili zolu tyando; olunye oluthatha indawo yevalvu ye-aortic (ARR) kunye nolunye oluthatha indawo yevalvu (VSRR) kuphela. Ugqirha wakho uya kugqiba ukuba yeyiphi indlela efanelekileyo kuwe.
- Nangona kuthatha iinyanga ezininzi ukuba umntu aphile ngokupheleleyo kolu tyando, impumelelo kunye nomlinganiselo wokusinda kolu tyando uphezulu kakhulu (malunga ne-98%-99%).
- Ukulandela imiyalelo kagqirha ngononophelo ngaphambi nasemva kotyando kubalulekile ukuze uphile ngokukhawuleza.
- Musa ukuba namahloni okuxoxa ngayo nayiphi na inkxalabo okanye uloyiko onalo nogqirha wakho. Nangona olu tyando luqhelekile koogqirha, kuyinto eqhelekileyo ukuba ube neenkxalabo kuba ngamava amatsha.
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