Xa ugqirha wakho ekuxelela ukuba umntwana wakho omncinci kufuneka enziwe iFontan Procedure ngenxa yesifo sentliziyo sokuzalwa, ungaziva uloyiko olukhulu kunye noloyiko. Imibuzo eliwaka ingafika engqondweni ngequbuliso. Kuqhelekile ukucinga izinto ezinje, "Luhlobo luni lotyando?", "Kutheni umntwana wam edlula kule nto?", "Ngaba uza kuphila emva koku?" Ungakhathazeki. Masithethe ngale nto ngokuzolileyo nangokucacileyo. Kweli nqaku, ndiza kuzama ukuphendula imibuzo yakho malunga noku ngendlela elula.
Ngamafutshane, yintoni iFontan Procedure?
Ukuze siqonde oku, masiqale sikhumbule kancinci ngendlela intliziyo yethu esebenza ngayo. Intliziyo ephilileyo ineegumbi ezine eziphambili. Ezimbini phezulu nezimbini ezantsi. Sizibiza ngokuba ziigumbi ezimbini ezinkulu neziqinileyo ezingaphantsi kwezi ventricles . Elinye igumbi liqokelela igazi "elingcolileyo" lomzimba elingenaoksijini kwaye limpompe liye emiphungeni ukuze lifumane oksijini. Elinye igumbi liqokelela igazi "elicocekileyo" elinooksijini kwaye limpompe liye emzimbeni wonke. Ezi zimbini zisebenza njengeenjini ezimbini zamanzi.
Nangona kunjalo, xa kuzalwa abanye abantwana, enye yezi seli zimbini ayikhuli ngokupheleleyo. Emva koko, iseli elungileyo yodwa kufuneka yenze le misebenzi yomibini. Oko kukuthi, kufuneka ipompe igazi emaphashini nasemzimbeni wonke. Khawuthelekelele ukuba loo moto ivakalelwa bubunzima obungakanani xa kufuneka ipompe amanzi ezindlwini ezimbini ezinemoto enye. Ngoko ke, le seli inye kufuneka isebenze phantsi komthwalo onzima.
Nantsi into eyenziwa yinkqubo yeFontan : Oogqirha benza "indlela emfutshane" encinci eya entliziyweni. Oku kuvumela igazi elingenaoksijini elivela emzimbeni ongezantsi ukuba lihambe ngqo emiphungeni, lidlule intliziyo. Ngokusisiseko lidlula ezinye zeengxaki ezininzi zentliziyo.
Ngokwenza indlela emfutshane efana nale, umthwalo kuloo seli inye eyayisebenza nzima kangaka uyancitshiswa kakhulu. Emva koko, loo seli ingasebenzisa amandla ayo apheleleyo kwaye ipompe igazi elicocekileyo nelinomoya-mpilo emzimbeni kuphela. Oku kwandisa ubungakanani beoksijini efunyanwa ngumzimba womntwana, aze azive ekhululekile ngakumbi.
Olu tyando lwenziwa kubantwana abanjani?
Utyando lweFontan aluyonto eyenziwa kube kanye. Ludla ngokwenziwa njengenyathelo lesithathu nelokugqibela kuthotho lotyando lomntwana oneengxaki zentliziyo ezinegumbi elinye. Ngaphambi koko, kunokufuneka olunye utyando olunye okanye ngaphezulu, kuxhomekeke kubudala bomntwana kunye nemeko yakhe.
| Iintlobo zotyando lwangaphambili | Kalula nje, kwenzeka ntoni? |
|---|---|
| Inkqubo yaseNorwood | Icala lasekunene lentliziyo linceda ekupompeni igazi emzimbeni nasemaphaphu. Oku kudla ngokwenziwa kwiiveki zokuqala ezimbalwa emva kokuba umntwana ezelwe. |
| Inkqubo kaGlenn | Igazi elingenaoksijini emzimbeni ongaphezulu lithunyelwa ngqo emiphungeni. Eli lidla ngokuba linqanaba lesibini. |
| I-BTT shunt (i-Blalock-Taussig-Thomas shunt) | Ityhubhu yokwenziwa isetyenziselwa ukwandisa inani legazi eliya emiphungeni. |
| Ibhendi yomthambo wepulmonary | Ilawula ukuhamba kwegazi ukuya emiphungeni kwaye ivumela igazi elingakumbi ukuba lihambe liye kwezinye iindawo zomzimba. |
Iimeko eziphambili ezifuna utyando lweFontan
Olu tyando lufuneka kakhulu kwiimeko ezimbalwa apho intliziyo ingakhekanga kakuhle ekuzalweni. Nazi:
- Isifo sentliziyo sasekhohlo esingenaplastiki: Le yeyona nto ixhaphakileyo. Kule meko, icala lasekhohlo lentliziyo alikhuli kakuhle.
- I-Hypoplastic right heart syndrome: Kule meko, icala lasekunene lentliziyo alikhuli kakuhle.
- I-Tricuspid atresia: Ivalvu ekwicala lasekunene lentliziyo ayenziwanga kakuhle.
- I-Pulmonary atresia: Ivalvu ethwala igazi ukuya emiphungeni ivaliwe.
- I-ventricle yasekhohlo engene kabini: Igazi elivela kumagumbi omabini aphezulu entliziyo lingena kwi-ventricle yasekhohlo kuphela.
- Ezinye iingxaki zentliziyo ezibangelwa kukuzalwa.
La magama anokukwenza uzive usoyika nangakumbi. Kodwa la ngamagama asetyenziswa ngoogqirha ukukuchonga. Into ebalulekileyo kukuba kuzo zonke ezi meko, ivalvu yentliziyo enye iphantsi koxinzelelo olukhulu. Inkqubo yeFontan izama ukunciphisa olo xinzelelo.
Kwenzeka ntoni ngaphambi kotyando?
Utyando lweFontan ludla ngokwenziwa ebantwaneni.Phakathi kweminyaka emi-2 ukuya kwemi-5 ubudala. Ngamanye amaxesha oku kunokulibaziseka de kube yiminyaka eli-15 ubudala. Kodwa olu tyando alunakwenziwa ngumntu wonke. Oogqirha baya kuqala benze uvavanyo ukuze babone ukuba umntwana wakho ufanelekile na kolu tyando.
Umzekelo, iseli enye esebenzayo yomntwana kufuneka ibe namandla ngokwaneleyo ukupompa kakuhle. Kwakhona, imiphunga kufuneka ibe sempilweni ngokwaneleyo ukwamkela igazi elingenayo ngqo ngaphandle koncedo lwentliziyo.
Ezi vavanyo zilandelayo zenziwa ngaphambi kotyando:
- I-Transthoracic echocardiogram (TTE): Oku kufana nokuskena kwentliziyo. Ingabona ngokucacileyo amagumbi entliziyo, iivalvu, kunye nokuhamba kwegazi.
- I-Electrocardiogram (EKG): Le nkqubo ivavanya umsebenzi wombane wentliziyo, oko kukuthi, indlela yokubetha kwentliziyo.
- Ukufakwa kwe-catheter kwintliziyo: Ityhubhu encinci kakhulu (i-catheter) idluliselwa ngemithambo yegazi emlenzeni okanye engalweni ukuya entliziyweni, kwaye uxinzelelo kunye namanqanaba eoksijini ngaphakathi entliziyweni ayalinganiswa. Oku kunokubonelela ngomfanekiso ochanekileyo wemeko yentliziyo ngaphambi kotyando.
- Ukujonga amanqanaba okuphefumla kunye neoksijini.
- Ngamanye amaxesha i-CT okanye i-MRI scans.
Zonke ezi mvavanyo zenziwa ukuze utyando lukhuseleke kwaye luphumelele kangangoko.
Kwenzeka ntoni ngexesha lotyando?
Kwigumbi lotyando, umntwana uqala anikwe i-anesthesia ukuze alale ukuze angeva ntlungu. Ngexesha lotyando, umatshini wentliziyo nemiphunga usetyenziswa ukwenza umsebenzi wentliziyo nemiphunga okwethutyana.
Emva koko ugqirha uqhagamshela i-vena cava ephantsi, umthambo wegazi oyintloko othwala igazi elingena-oxygen ukusuka emzimbeni ongezantsi, kumthambo we-pulmonary, othwala igazi ukuya emiphungeni, esebenzisa umjelo. Le yindlela edalwa ngayo "indlela emfutshane" esithethe ngayo ngaphambili.
Ngamanye amaxesha, ezinye izinto ezincinci, ezinje ngokulungisa ivalvu yentliziyo, zingenziwa ngaxeshanye nolu tyando.
Lonke utyando ludla ngokuthatha malunga neeyure ezine ukuya kwezintlanu . Ngeli xesha, iqela lezonyango liza kuthetha nawe rhoqo kwaye linike ulwazi ngemeko yomntwana wakho.
Zithini iingenelo kunye neengozi zotyando?
Njengalo naluphi na utyando, utyando lweFontan luneengenelo kunye neengozi ezithile.
Eyona nzuzo iphambili kukuba inciphisa umthwalo womsebenzi entliziyweni, nto leyo eyenza umsebenzi wayo ube lula kakhulu. Kwakhona, ekubeni kungekho mxube mkhulu wegazi elineoksijini kunye negazi elineoksijini encinci, umlinganiselo weoksijini ofunyanwa ngumzimba uyanda. Imilebe kunye neenzipho zomntwana ziba luhlaza okwesibhakabhaka (cyanosis), kwaye unamandla amaninzi okusebenza ngakumbi.
| Iingxaki ezinokwenzeka emva kotyando | |
|---|---|
| Iingxaki zexesha elifutshane | Iingxaki zexesha elide |
| Umonakalo wezintso | I-enteropathy yokulahlekelwa yiproteni (ubunzima bokufunxa iproteni) |
| Ukumelwa yintliziyo | Ihlwili legazi (i-embolism) |
| Ukubetha kwentliziyo okungaqhelekanga | Isifo sesibindi (isifo sesibindi esinxulumene neFontan-FALD) |
| Iziphumo ekusebenzeni kwesibindi | Ukuvalwa kweendlela zomoya yi-mucus etyebileyo (i-plastic bronchitis) |
| Ukuqokelelana kolwelo olujikeleze imiphunga (i-pleural effusions) | |
Ezi zinto zinokuba yinto eyoyikisayo ukuzibona, kodwa khumbula, iqela lezonyango liyazazi zonke ezi ngozi. Bahlala bekulungele ukuzithintela nokuzilawula ukuba ziyenzeka.
Ubomi bunjani emva kotyando?
Emva kotyando, umntwana ungeniswa kwigumbi lokhathalelo olunzulu (ICU) aze ajongwe ngokusondeleyo. Emva kweentsuku ezimbalwa, xa imeko iphucuka, udluliselwa kwigumbi eliqhelekileyo. Umntwana angahlala esibhedlele iintsuku ezisi-7 ukuya kwezili-13 zizonke.
Ngaphambi kokuba ugoduke, oogqirha kunye nabasebenzi bonyango baza kukuchazela ngokweenkcukacha indlela yokunyamekela umntwana wakho, amayeza oza kuwanikwa, kunye neempawu ekufuneka uziqaphele.
Kufuneka uthethe nini nogqirha?
Emva kokubuyela ekhaya, kufuneka ufowunele ugqirha wakho ngokukhawuleza ukuba ubona naziphi na kwezi mpawu:
- Ukuba igazi okanye olunye ulwelo luvuza kwinxeba lotyando.
- Ukuba unomkhuhlane okanye ezinye iimpawu zosulelo (umkhuhlane, ukudumba, ukubomvu).
- Ukuba ubunzima bokuphefumla buyanda.
Umntwana oye watyandwa eFontan uya kufuna unyango oluhlala ixesha elide. Ngokwesiqhelo kuya kufuneka abone ugqirha rhoqo emva kweenyanga ezi-6 ukuya kwezi-12 . Kuya kufuneka ahlolwe rhoqo ukuze kuhlolwe imeko yentliziyo nesibindi sakhe.
Into ebalulekileyo kukuba inkqubo yeFontan ayilonyango. Yindlela yokunceda intliziyo yomntwana isebenze kakuhle. Ke ngoko, ukulandelelana kwexesha elide kubalulekile.
Ungathini ngobomi bomntu?
Lo ngumbuzo omkhulu kubazali abaninzi. Ubomi obulindelekileyo emva kotyando lweFontan buxhomekeke kubukhali besifo sentliziyo umntwana awayenaso.
Kodwa, namhlanje, ezonyango zihambele phambili kakhulu. Uninzi lwabantu luphila iminyaka eli-10 emva kotyando. Abantu abasibhozo kwabalishumi baphila iminyaka engama-30 nangaphezulu . Enyanisweni, abantu abaninzi abaye benza utyando lweFontan ngoku baphila iminyaka engama-40 nangaphezulu.
Ekuhambeni kwexesha, amandla abanye abantu okupompa kwentliziyo anokuba buthathaka, okanye isibindi sichaphazeleke. Oku kubizwa ngokuba yi-"failed Fontan." Kwiimeko ezinjalo , ukufakelwa intliziyo kunokufuneka. Kodwa ayinguye wonke umntu okudingayo oku.
Xa ufumanisa ukuba umntwana wakho unesifo sentliziyo esibi kwaye uza kwenziwa utyando, unokuziva uneemvakalelo ezininzi. Uloyiko, ixhala, kunye nokungaqiniseki ngekamva zonke ziqhelekile. Kodwa eyona nto ibalulekileyo ekufuneka uyazi kukuba awuwedwa .
Emva kolu tyando, umntwana wakho angadlala, afunde, akhule, kwaye onwabele ubomi njengaye nawuphi na umntwana. Banokudinwa ngokukhawuleza, okanye banokufuna uvavanyo olongezelelweyo lwezonyango. Kodwa, ngengcebiso efanelekileyo yezonyango kunye nothando lwakho kunye nenkathalo, banokuphila ubomi obupheleleyo nobonwabisayo.
Umyalezo Wokuya Ekhaya
- Inkqubo yeFontan lutyando lwentliziyo olukhethekileyo olwenziwa kubantwana abazalwa bene-ventricle enye esebenzayo.
- Oku kudala "indlela emfutshane" yokuhamba kwegazi ukuya entliziyweni, kunciphisa umthwalo womsebenzi kwiseli enye esebenzayo.
- Eli lidla ngokuba linqanaba lokugqibela kuthotho lotyando, kwaye lenziwa kumntwana ophakathi kweminyaka emi-2 ne-5 ubudala.
- Nangona utyando lweFontan "lungasinyangi" ngokupheleleyo esi sifo, lunokunceda kakhulu umntwana ukuba aphile ubomi obungcono nobusebenzayo.
- Emva kotyando, ukulandelelana rhoqo nogqirha kubalulekile ubomi bakho bonke.
- Ngolawulo olufanelekileyo lwezonyango kunye nokhathalelo, abantwana abaninzi abenza olu tyando baphila ubomi obuphumelelayo nobupheleleyo.
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