Ngaba umntwana wakho wazalwa enengxaki yentliziyo enzima? Ngamanye amaxesha oogqirha basenokuba bakuxelele ukuba intliziyo yomntwana wakho inempompo enye ephambili, i-ventricle. Utyando olukhethekileyo olucetyiswa ngoogqirha kwiimeko ezinjalo lubizwa ngokuba yi-'Fontan procedure'. Kuqhelekile ngokwenene ukuziva usoyika kwaye ungaqinisekanga xa usiva eli gama. Kodwa ukuba siyazi kakuhle oku, uya kufumana amandla amakhulu kunye namandla okuqhubeka nolu hambo. Ngaba singathetha ngale nto ngokulula?
Ithini iNkqubo yeFontan ngokulula?
Ukuze siqonde oku, masiqale sijonge indlela esebenza ngayo intliziyo ephilileyo. Intliziyo ephilileyo ineegumbi ezine eziphambili. Ezimbini phezulu (atria) nezimbini ezantsi (ventricles). Ezi gumbi zimbini ziipompo ezimbini eziphambili zentliziyo. Elinye lithumela igazi elingenaoksijini, elingcolileyo emiphungeni ukuze lithathe ioksijini. Elinye likhupha igazi elicocekileyo nelizele yioksijini emzimbeni wonke.
Nangona kunjalo, abanye abantwana bazalwa benenye yezi seli zimbini engakhiwanga kakuhle. Emva koko iseli enye eyenza loo msebenzi kufuneka yenze yomibini le misebenzi. Khawuthelekelele indlela ekudinisa ngayo ukuba umntu omnye enze imisebenzi emibini. Kanye ngaloo ndlela, le seli enye inokudinwa ngokukhawuleza kuba kufuneka ipompe igazi liye emaphashini nasemzimbeni.
Into eyenziwa yinkqubo yeFontan kukunciphisa umthwalo womsebenzi kuloo seli inye. Kufana nokunika omnye umntu ukuba akuncede usebenze nzima.
Kule nkqubo, oogqirha badibanisa igazi elingenaoksijini ukusuka emzimbeni ongezantsi ukuya kumthambo wemiphunga, bedlula intliziyo. Oku kufana nokudala 'indlela emfutshane' entsha. Ngokwesiqhelo, ngaphambi kwale nkqubo, kwenziwa enye inkqubo ebizwa ngokuba yinkqubo kaGlenn yokuqondisa igazi elingenaoksijini ukusuka emzimbeni ongaphezulu ukuya emiphungeni. Inkqubo yeFontan linyathelo lokugqibela kolu luhlu lweenkqubo.
Xa kudalwa iindlela ezintsha ngale ndlela, umsebenzi kuphela wale seli inye kukupompa igazi elicocekileyo nelinomoya-mpilo emzimbeni wonke. Oku kuyanceda kakhulu kuloo ntliziyo incinci.
Ngubani odinga olu tyando kwaye ngoba?
Olu tyando lwenziwa ikakhulu kubantwana abazelwe bene-ventricle enye. Ngokwesiqhelo lwenziwa phakathi kweminyaka emi-2 ne-5 ubudala .
Kodwa olu tyando alulungelanga wonke umntu. Ugqirha uza kumhlola ngononophelo umntwana wakho ukuze abone ukuba ufanelekile na kulo msebenzi. Umzekelo:
- Iseli esebenzayo yomntwana kufuneka ibe namandla kakhulu.
- Imiphunga kufuneka ibe sempilweni ngokwaneleyo ukuze ifumane igazi eliza ngqo emiphungeni.
Le theyibhile ingezantsi idwelisa ezinye zeengxaki eziphambili zentliziyo ezinyangwa ngolu tyando.
| Imeko | Ingcaciso elula |
|---|---|
| I-Hypoplastic Left Heart Syndrome (HLHS) | Icala lasekhohlo lentliziyo (kuquka ne-ventricle yasekhohlo) alikhuli kakuhle. (Esi sesona sizathu siqhelekileyo sotyando lweFontan) |
| I-Tricuspid Atresia | Ivalvu ye-tricuspid kwicala lasekunene lentliziyo ayiphuhli kakuhle. |
| I-Pulmonary Atresia | Ukuvaleka kwevalvu yemiphunga ethwala igazi ukuya emiphungeni. |
| I-Ventricle yasekhohlo ephindwe kabini | Zombini imithambo yegazi ephambili engena entliziyweni idibana ne-ventricle yasekhohlo. |
Kwenzeka ntoni ngaphambi nangexesha lotyando?
Emva kokugqiba kwelokuba umntwana wakho ufanelekile utyando, ugqirha uza kwenza iimvavanyo ezininzi.
- I-Transthoracic Echocardiogram (TTE): Olu luvavanyo lwe-ultrasound lwentliziyo. Lunika umfanekiso ocacileyo wesakhiwo sentliziyo, iivalvu, kunye nomsebenzi wayo.
- I-Electrocardiogram (EKG): Ilinganisa umsebenzi wombane wentliziyo.
- Ukufakwa kweCatheter kwintliziyo: Ityhubhu encinci (i-catheter) idluliselwa ngemithambo yegazi iye entliziyweni ukuze kulinganiswe uxinzelelo kunye namanqanaba eoksijini ngaphakathi entliziyweni.
- I-CT okanye i-MRI Scan: Kwezinye iimeko, oku kuyimfuneko ukuze kufunyanwe imifanekiso yentliziyo kunye nemithambo yegazi ejikelezileyo enamacala amathathu (3D).
Ngomhla wotyando, umntwana unikwa i-anesthesia ukuze alale. Oku kuthetha ukuba umntwana akayi kuva ntlungu. Ngexesha lotyando, umntwana uya kuqhagamshelwa kumatshini okhethekileyo owenza umsebenzi wentliziyo nemiphunga okwethutyana (umatshini wentliziyo nemiphunga) . Lo matshini uya kubonelela ngegazi emzimbeni de ugqirha enze unxibelelwano olutsha (ukusuka kwi-vena cava engaphantsi ukuya kwi-pulmonary artery).
Ngamanye amaxesha ugqirha wenza umngxuma omncinci (i-fenestration) kule ndlela intsha.Kwenziwa ukunciphisa uxinzelelo entliziyweni emva kotyando. Lonke utyando lungathatha malunga neeyure ezi-4-5 .
Kwenzeka ntoni emva kotyando? Ngaba kukho naziphi na iingozi?
Emva kotyando, umntwana ungeniswa kwigumbi lokhathalelo olunzulu (ICU) ukuze ajongwe ngokusondeleyo. Emva kweentsuku ezimbalwa, udluliselwa kwigumbi eliqhelekileyo. Ixesha eliqhelekileyo lokuhlala esibhedlele liphakathi kweentsuku ezisi-7 ukuya kwezili-13 .
Olu tyando luneengenelo kunye neengozi kunye neengxaki zalo, kwaye kubaluleke kakhulu ukuba uzazi.
| Uhlobo lomngcipheko | Iingxaki ezinokwenzeka |
|---|---|
| Iingozi zexesha elifutshane (Emva kotyando) | Ukuqhekeka kwemithambo yegazi, iingxaki zezintso, ukungasebenzi kakuhle kwentliziyo, ukubetha kwentliziyo okungaqhelekanga, isifo sesibindi. |
| Iingozi zexesha elide (ngexesha) | I-enteropathy elahlekelwa yiproteni, amahlwili egazi (i-thromboembolism), isifo sesibindi esinxulumene neFontan (FALD), kunye ne-plastic bronchitis. |
Ekuhambeni kwexesha, ezinye izigulana zisenokubona ukwehla kokusebenza kolu tyando. Oku kubizwa ngokuba yi-'Fontan ehlulekileyo'. Ngelo xesha, ukufakelwa intliziyo kunokufuneka. Oogqirha bajonga le nxalenye yohambo.
Luhlobo luni lwekamva umntwana anokuba nalo?
Ngaphambili, ikamva lomntwana ozelwe eneseli enye lalingaziwa. Kodwa namhlanje, ngenxa yokuqhubela phambili kwesayensi yezonyango, utyando lweFontan lunike aba bantwana ithuba lokudlulela ngaphaya kobuntwana, ukuya ebutsheni, kunye nokukhula.
Ngokwezibalo, kwabo basebenze ngeFontan:
- Malunga nama-90% ayaphila emva kweminyaka eli-10.
- Malunga nama-85% ayaphila emva kweminyaka engama-30.
Abantu abaninzi ngoku baphila ubomi obusempilweni ngaphaya kweminyaka engama-50 ubudala. Kodwa eyona nto ibalulekileyo kukuba, aba bantwanaKubalulekile ukuba phantsi kweliso likagqirha wentliziyo ubomi bakho bonke. Kuyimfuneko ukuba wenze uvavanyo rhoqo kunye nokuhlolwa rhoqo.
Udinga nini ukubona ugqirha?
Xa ubuyela ekhaya emva kotyando, yazisa ugqirha wakho ngoko nangoko ukuba unezinye zezi mpawu zilandelayo:
- Ukuba igazi okanye olunye ulwelo luvuza kwinxeba lotyando.
- Ukuba unomkhuhlane okanye ezinye iimpawu zosulelo (ukukhwehlela, ukubanda).
Ekubeni imeko yomntwana wakho inzima, ungoyiki ukubuza ugqirha ngayo nantoni na ongayiqondiyo. Ukuyiqonda kakuhle imeko yomntwana wakho kuya kukunceda ukuba umnyamekele kakuhle umntwana wakho.
Umyalezo Wokuya Ekhaya
- Inkqubo yeFontan ayilonyango olupheleleyo lwesifo sentliziyo esineseli enye. Yinkqubo ebaluleke kakhulu etshintsha ukuhamba kwegazi, inciphise uxinzelelo entliziyweni, kwaye yenza ubomi bube lula.
- Olu tyando lunciphisa umthwalo womsebenzi kwiseli enye yomntwana kwaye lunyusa kakhulu amanqanaba eoksijini emzimbeni.
- Kubalulekile ukuqaphela iingxaki ezihlala ixesha elide, ezifana nesifo sesibindi, ezinokuvela ngokuhamba kwexesha.
- Eyona nto ibalulekileyo: Kubalulekile ukubona ugqirha wentliziyo kwaye uhlolwe rhoqo ubomi bakho bonke emva kotyando.
- Thetha ngokukhululekileyo nogqirha wakho. Xoxa naye ngayo nayiphi na imibuzo okanye izinto ezikuxhalabisayo. Ukwazi kwakho kubaluleke kakhulu kwimpilo-ntle yomntwana wakho.
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