Ingaba umntwana wakho omncinci unengxaki yentliziyo elolu hlobo? (Total Anomalous Pulmonary Venous Return - TAPVR) Masithethe ngale nto!

Xa umntwana wakho ezelwe, ngaba ngamanye amaxesha uziva ngathi kunzima ukuphefumla? Ngaba ngamanye amaxesha ulusu lubonakala ngathi luba luhlaza okwesibhakabhaka? Kuqhelekile ukuba uzive usoyika kakhulu xa ubona into efana naleyo. Namhlanje siza kuthetha ngesifo sentliziyo esizalwa naso esibonisa ezi mpawu. Oku kubizwa ngokuba yi -TAPVR (Total Anomalous Pulmonary Venous Return) . Nangona igama lisenokubonakala liyinkimbinkimbi kancinci, masiliqonde ngokulula.

Yintoni iTAPVR? Ngamafutshane...

Cinga nje, imizimba yethu ifumana ioksijini kwimiphunga, akunjalo? Ngoko ke, kule miphunga, igazi elineoksijini (masiyibize ngokuba "ligazi elilungileyo") liziswa entliziyweni ngemithambo yegazi , uhlobo lomthambo wegazi. Ngokwesiqhelo, eli "gazi lilungileyo" kufuneka lize kwi-atrium yasekhohlo kwicala lasekhohlo lentliziyo. Ukusuka apho, igazi liphonswa ukuze linike ioksijini kuwo wonke umzimba.

Nangona kunjalo, kumntwana one-TAPVR, endaweni yokudibana ne-atrium yasekhohlo yentliziyo, lo mthambo we-pulmonary uqhagamshela kwindawo engalunganga, eyi -atrium yasekunene . I-atrium yasekunene idla ngokufumana "igazi elibi" elisetyenziswe ngumzimba, elinomoya-mpilo omncinci. Ngoku "igazi elihle" elizele yi-oksijini lixubana neli "gazi libi." Kwenzeka ntoni ke? Ubungakanani be-oksijini egazini ekufuneka iye kuwo wonke umzimba buyancipha. Le yimeko eyingozi kakhulu kwaye isongela ubomi kumntwana. Esi sisifo sentliziyo esizalwa naso .

Phantse zonke iintsana ezine-TAPVR zinomngxuma omncinci (i-Atrial Septal Defect - ASD) phakathi kwamagumbi amabini entliziyo yazo, i-atrium yasekunene kunye ne-atrium yasekhohlo. Lo mngxuma uvumela igazi elithile elineoksijini ukuba lihambe liye kwicala lasekhohlo lentliziyo lize liye kuwo wonke umzimba. Ngaphandle koko, imeko ibinokuba mandundu kakhulu.

Eyona nto ibalulekileyo kukuba iintsana ezine-TAPVR ngokuqinisekileyo ziyaludinga utyando. Ukuba utyando lwenziwa kwangethuba, uninzi lwabantwana lunokuphila ubomi obusempilweni baze babe ngabantu abadala. Nangona kunjalo, ngamanye amaxesha, izinto ezifana nokuncitshiswa kwemithambo-luvo kamva ebomini zinokufuna utyando olongezelelweyo okanye olunye unyango. Ke ngoko, nokuba emva kotyando lwe-TAPVR, kuya kufuneka ujongwe yingcali yentliziyo ubomi bakho bonke.

Ngamanye amaxesha oogqirha babiza le meko ngokuthi yi-TAPVC (Total Anomalous Pulmonary Venous Connection). Zombini zifana kakhulu.

Ngaba kukho iintlobo ezahlukeneyo ze-TAPVR?

Ewe, kukho iintlobo ezininzi eziphambili ze-TAPVR. Ezi zahlulwe ngokwendlela "igazi elilungileyo" elivela emiphungeni eliqhagamshelwe ngayo ngendlela engafanelekanga kwi-atrium esekunene.

• I-Supracardiac TAPVR: Kule nto, imithambo yemiphunga idibana kwaye iqhagamshelane nomthambo omkhulu ophezu kwentliziyo (obizwa ngokuba yi-vena cava ephezulu , engumthombo omkhulu othwala igazi ukusuka kwiindawo eziphezulu zomzimba ukuya kwicala lasekunene lentliziyo).
• I-Cardiac TAPVR: Apha, imithambo yemiphunga ingena ngqo kwi-coronary sinus kwicala lasekunene lentliziyo.Idibanisa. Le mithambo yentliziyo yindawo apho igazi elingenaoksijini lihlala liqokelelana khona kwimisipha yentliziyo.
• I-Infracardiac TAPVR: Kolu hlobo, umthambo wemiphunga udlula ngaphantsi kwentliziyo, ngesibindi, uze uqhagamshele kumthambo omkhulu ( inferior vena cava ) othwala igazi ukusuka kwiindawo ezisezantsi zomzimba ukuya kwicala lasekunene lentliziyo.
• I-Mixed TAPVR: Olu lolona hlobo lunqabileyo nolunzima ukululungisa. Apha, kunokubakho imithambo engaphezulu komnye evela emiphungeni, ngokudibanisa olunye okanye ngaphezulu lweentlobo ezikhankanyiweyo apha ngasentla.

Olu hlobo lolwahlulo lubalulekile koogqirha ukuze bacebe utyando baze bamisele iindlela zonyango.

Ixhaphake kangakanani i-TAPVR?

I-TAPVR sisifo sentliziyo esingaqhelekanga kakhulu . Kwanakwilizwe elifana neMelika, esi sifo sichaphazela umntwana omnye kuphela kwiintsana ezisandul’ ukuzalwa ezingama-7,500. Sikwanqabile naseSri Lanka.

Zithini iimpawu ze-TAPVR?

Iimpawu ze-TAPVR zihlala zibonakala xa umntwana ezalwa , ingakumbi ukuba kukho ukuncitshiswa kwemithambo yemiphunga apho idibana khona nentliziyo. Nangona kunjalo, abanye abantwana basenokungabonakalisi zimpawu kangangeeveki ezininzi.

Iimpawu eziphambili zezi:

• I-Cyanosis: Ukutshintsha kombala wesikhumba, iinzipho, kunye nemilebe okuluhlaza okwesibhakabhaka okanye okungwevu (kwiintsana ezinesikhumba esimnyama). Oku kubangelwa kukungabikho komoya-mpilo egazini.
• Ubunzima bokuncanca: Umntwana unengxaki yokuncanca aze adinwe emva kokusela kancinci.
• Ukudinwa nokudinwa: Usana luhlala ludiniwe kwaye lubonakala ludiniwe.
• Ukugquma kwentliziyo: Xa ugqirha emamele intliziyo yomntwana (nge-stethoscope), kuvakala isandi esingaqhelekanga.
• Ukuphefumla kancinci (ukuphelelwa ngamandla): Usana luphefumla ngokukhawuleza kwaye kubonakala ngathi lunengxaki yokuphefumla.
• Ukukhula okungekuhle kunye nokutyeba: Usana alutyebi kakuhle kwaye alukhuli ngokwaneleyo.

Ukuba umntwana wakho unenye okanye ngaphezulu kwezi mpawu, kufuneka ufune iingcebiso zonyango ngokukhawuleza .

Yintoni ebangela i-TAPVR?

Enyanisweni, oogqirha abakayazi eyona nto ibangela i-TAPVR. Ibangelwa sisiphene esikwintliziyo nakwimithambo yegazi ngexesha lokukhula komntwana ongekazalwa .

Akuqhelekanga ukubonwa njengesifo esizuzwe njengelifa. Nangona kunjalo, kukho iingxelo zeziganeko ezenzeka kubantakwabo noodadewabo kusapho olunye. Ezinye izifundo zibonise ukuba kunokubakho unxibelelwano phakathi kwabantwana abaneempawu ezithile kunye nokuvezwa kwizixhobo zokususa ipeyinti, izibulali-zinambuzane kunye nelothe ngexesha lokukhulelwa. Nangona kunjalo, oku akukaqinisekiswa okwangoku.

Ziziphi iingxaki ezinokubakho ze-TAPVR?

Umntwana one-TAPVR unesifo sentliziyo kunye noxinzelelo lwegazi oluphezulu emaphaphu.Nokuba emva kotyando, ngamanye amaxesha izingqisho zentliziyo ezingaqhelekanga okanye ukuvaleka kwemithambo yemiphunga kunokwenzeka. Yiyo loo nto ukuxilongwa rhoqo kwezonyango kubalulekile.

Ifunyaniswa njani i-TAPVR?

Ngamanye amaxesha, le meko inokubonwa ngaphambi kokuba umntwana azalwe, nge -echocardiogram (i-scan yentliziyo) eyenziwa ngexesha lokukhulelwa. Nangona kunjalo, uninzi lwexesha lokuxilonga lwenziwa kwiiveki okanye kwiinyanga ezimbalwa emva kokuba umntwana ezelwe.

Xa umntwana ezelwe, ugqirha uza kwenza uvavanyo lomzimba aze amamele intliziyo yomntwana. Isixhobo esincinci esibizwa ngokuba yi-pulse oximeter (i-clip ehambelana nobhontsi omkhulu womntwana) sinokusetyenziswa ukulinganisa inqanaba le-oksijini egazini.

Ukongeza, iimvavanyo ezifana nezi zilandelayo zinokwenziwa ukujonga imeko yentliziyo kunye nemithambo yegazi:

• I-X-reyi yesifuba
• I-CT scan (i-CT scan - i-computed tomography)
• I-MRI yentliziyo (i-magnetic resonance imaging)
• I-Echocardiogram
• I-EKG (EKG okanye i-ECG - i-Electrocardiogram)

Ezinye zezi mvavanyo (ezifana ne-MRI) zisenokufuna ukuba umntwana alale kancinci. Kodwa zonke ezi mvavanyo azingenisi gazi. Ezi mvavanyo zivumela oogqirha ukuba bafumane imifanekiso ecacileyo yentliziyo nemiphunga yomntwana, babone indlela igazi elihamba ngayo, baze bajonge izinto ezingaqhelekanga.

Ngamanye amaxesha uvavanyo olubizwa ngokuba yi -cardiac catheterization lukwasetyenziswa ukufumanisa isifo. Nangona kunjalo, ekubeni ulwazi olufunekayo lunokufumaneka kwiiskeni ezikhankanyiweyo apha ngasentla, umntwana akasoloko evavanywa ngendlela engafunekiyo.

Iphathwa njani i-TAPVR?

Phantse zonke iintsana ezine-TAPVR zidinga utyando ukuze ziphile. Oogqirha bayinyanga ngotyando lwentliziyo evulekileyo . Rhoqo, olu tyando lwenziwa ngokukhawuleza emva kokuba imeko ifunyenwe.

Nangona kunqabile kakhulu, abanye abantu bafunyanwa bene-TAPVR xa bebadala ngaphandle kotyando besebancinci. Nangona kunjalo, ngelo xesha basenokuba neemeko ezifana noxinzelelo lwegazi oluphezulu emaphaphu ezenza utyando lube nzima kakhulu.

Unyango lwangaphambi kotyando

Ngelixa usana lulinde utyando, lusenokufuna ukunikwa ioksijini eyongezelelweyo okanye luqhagamshelwe kwi-ventilator ukuze luncede luphefumle. Usenokunikwa nohlobo lweyeza elibizwa ngokuba yi-inotrope , elinceda intliziyo ukuba ibethe ngamandla.

Indlela oluqhutywa ngayo utyando

Emva kokuba umntwana elele ngokupheleleyo phantsi kwe -anesthesia jikelele , ugqirha uza kwenza oku kulandelayo:

1. Kusikwa isifuba nentliziyo yomntwana.

2. Imithambo yemiphunga ixhunyelelwa kwindawo echanekileyo, oko kukuthi, i-atrium yasekhohlo yentliziyo.

3. Imithambo edibene ngendlela engaqhelekanga iyavalwa.

4. Ukuba kukho ukuvaleka kwimithambo yemiphunga, kuyasuswa.

5. Rhoqo, umngxuma ophakathi kwe-atria yasekhohlo neyasekunene ( i-Atrial Septal Defect - ASD ) uyavalwa.

Nangona olu tyando lunzima kakhulu, amaqela ezonyango anamava alwenza ngempumelelo.

Iingxaki zonyango

Nazi ezinye zeengxaki ezinokwenzeka emva kotyando:

• Ukungahambi kakuhle kwentliziyo (iiArrhythmias)
• Uxinzelelo lwegazi oluphezulu lwemiphunga
• Ukuvaleka kwemithambo yegazi yemiphunga
• Ngamanye amaxesha, emva kokusebenzisa umatshini wentliziyo nemiphunga (umatshini wokudlula) ngexesha lotyando, intliziyo iba nobunzima bokuzibetha yodwa.

Oogqirha bahlala bekhangela izinto ezinje.

Ngaba i-TAPVR ingathintelwa?

Ngelishwa, akukho ndlela yokuthintela olu hlobo lwesifo sentliziyo esizalwa naso. Ukuba kukho umntu kusapho lwakho onesifo sentliziyo esizalwa naso, okanye ukuba une-TAPVR, kungcono ukuthetha nogqirha wakho ngaphambi kokuba uqalise usapho.

Ukuba umntwana wam une-TAPVR, ndimele ndilindele ntoni?

Ngaphandle kotyando, ezinye iintlobo ze-TAPVR zinokubulala kwiiveki ezimbalwa emva kokuzalwa. Nangona kunjalo, ukuba isifo sichongiwe kwangethuba kwaye sinyangwa ngotyando, ikamva leentsana ezine-TAPVR lihle kakhulu. Izinga lokusinda emva kotyando limalunga ne-97%. Elo lizinga eliphezulu kakhulu lempumelelo.

Njengoko umntwana wakho ekhula aze afikelele ebudaleni, kufuneka abone ugqirha wentliziyo rhoqo . Olu hlolo lwemihla ngemihla ubomi bakhe bonke lunokunceda ekufumaneni nasekunyangeni iingxaki ezifana nokungahambi kakuhle kwentliziyo kunye nokuvaleka kwemithambo yegazi. Ngamanye amaxesha, ukuba ukuvaleka kuyavela, kunokufuna utyando olongezelelweyo kwaye kunokuba nzima ukunyanga. Yiyo loo nto kubalulekile ukuqhubeka nokulandela imiyalelo kagqirha wakho.

Umntwana wakho usenokufuna ukuqhubeka esela amayeza okanye afumane unyango olufana nokuxiliswa kwentliziyo .

Ndingamnyamekela njani umntwana wam?

Abantwana abane-TAPVR ngamanye amaxesha banokuba nobunzima ngezigaba eziqhelekileyo zophuhliso, ezifana nokusebenza kakuhle kwemisipha. Ungajonga izigaba zophuhliso zomntwana wakho uze umthumele kumntu onokumnceda aphuhlise ezo zakhono ukuba kuyimfuneko.

Thetha nogqirha womntwana wakho malunga nokuba umntwana wakho angakwazi na ukuthatha inxaxheba kwimidlalo nakwimisebenzi yomzimba. Kusenokufuneka unciphise umthambo onzima .

Umntwana wam ufanele aye nini kugqirha?

Emva kotyando, umntwana wakho uza kubonwa rhoqo kwiinyanga ezi-6 ukuya kwezili-12.Ukuhlolwa kwezonyango. Kufuneka uqhubeke ubona ugqirha wakho rhoqo ebomini bakho bonke. Ugqirha womntwana wakho usenokufuna ukwenza uvavanyo olufana ne -EKG, uvavanyo loxinzelelo lomthambo, okanye i-echocardiogram .

Kufuneka uye nini kwiGumbi loNgxamiseko (i-ETU) ?

Funa uncedo lwezonyango ngoko nangoko (yiya kwi-ER) ukuba umntwana wakho unezinye zezi mpawu:

• Ukuba ulusu, iinzipho, okanye imilebe ijika ibe luhlaza okwesibhakabhaka/ngwevu.
• Ukuba unengxaki yokuphefumla okanye yokutya/ukusela ubisi.
• Ukuba ubonakala ulele kakhulu okanye ungaphili.

Ndingayibuza yiphi imibuzo ugqirha wam?

Nantsi eminye imibuzo ebalulekileyo ekufuneka uyibuze ugqirha womntwana wakho:

• Luhlobo luni lwe-TAPVR umntwana wam analo?
• Ucinga ukuba umntwana wam uza kudinga utyando lwesibini?
• Zingaphi utyando oye waludinga ukuze ulungise i-TAPVR?

Umyalezo obalulekileyo oya nawo ekhaya

Usenokuba ulandele icebiso likagqirha wakho lokuhlala uphilile ngexesha lokukhulelwa. Kodwa ngamanye amaxesha, usana olusandul’ ukuzalwa lunokuba nesifo sentliziyo. Asilotyala lomntu. Ngesayensi yezonyango yanamhlanje ephucukileyo, umntwana wakho unokulindela iziphumo ezingcono kakhulu kunabantwana bezizukulwana zangaphambili. Unyango lotyando lusebenza kakhulu.

Khumbula, nangona i-TAPVR yimeko enzima, xa ixilongwa kwangethuba kwaye inyangwa ngokufanelekileyo ngotyando, abantwana banethuba elihle lokuphila ubomi obulungileyo. Emva kotyando, kubalulekile ukuba umntwana wakho ahlolwe rhoqo ngugqirha. Oku kwenzelwa ukuba impilo yomntwana wakho ijongwe kwaye naziphi na iingxaki ezinokuvela zinyangwe ngokukhawuleza. Awuwedwa, oogqirha kunye nabasebenzi bezempilo bakhona ukunceda wena nomntwana wakho.

I- TAPVR, isifo sentliziyo, usana, utyando, imithambo yemiphunga, i-cyanosis, izifo zokuzalwa