Ngaba ugqirha wakho ukuxelele ukuba ingcambu yakho ye-aortic ikhulisiwe kancinci kwaye udinga utyando? Kuqhelekile ukuba uzive usoyika kwaye uxhalabile xa usiva loo nto. Ngubani ongalithandiyo igama elithi "utyando lwentliziyo"? Kodwa ungakhathazeki. Ubuchwepheshe buhambele phambili kakhulu namhlanje. Namhlanje, siza kuthetha ngotyando oluphumeleleyo nolukhethekileyo olusombulula le ngxaki ngaphandle kokususa eyona ndawo ixabisekileyo yentliziyo yakho, eyi-'valve' yakho yendalo.
Yintoni iValve-Sparing Aortic Root Replacement?
Ukuze sikuqonde oku, masiqale sijonge indlela esebenza ngayo intliziyo. Cinga ngentliziyo yakho njengempompo yamanzi ekhayeni lakho. Le mpompo ipompa igazi emzimbeni wakho wonke.
- I-Aorta: Le yityhubhu enkulu nephambili ephuma entliziyweni. Ithwala igazi liye emzimbeni wonke.
- Ingcambu ye-Aortic: Le yinxalenye yokuqala yomthambo oyintloko odibana nentliziyo. Kufana nalapho uncamathisela khona ityhubhu kwi-motor.
- I-Aortic Valve: Le yeyona nxalenye ibalulekileyo yebali. Apho idibana khona nentliziyo, kukho inxalenye esebenza njengocango. Xa intliziyo ipompa igazi, olu cango luyavuleka, lukhuphe igazi. Emva koko olu cango luyavalwa ukuze igazi lingabuyeli entliziyweni. Le yinto esiyibiza ngokuba yi-`(Aortic Valve)`.
Ngoku, kwabanye abantu, ingcambu yale mithambo mikhulu edibana nentliziyo, i-`(Aortic Root)` iba buthathaka kancinci ize iqale ukudumba ibe nkulu njengebhaluni. Siyibiza ngokuba yi-`(Aortic Root Aneurysm)`. Xa ikhula ngolu hlobo, loo mnyango, loo valve, ayivaleki kakuhle. Emva koko igazi liqala ukuvuza ngasemva, `(Aortic Regurgitation)`.
Ngaphambili, xa kuvela olu hlobo lwengxaki, oogqirha babesusa zombini ingcambu ye-aortic kunye ne-aortic valve, baze bathathe indawo yazo ngeengcambu ze-aortic kunye ne-valve yokwenziwa. Olu tyando lubizwa ngokuba yi-Bentall procedure .
Kodwa ngoku, ukuba ivalvu yakho ikwimeko entle, oko kuthetha ukuba ayonakalanga kakhulu, endaweni yokususa loo valve yendalo ixabisekileyo, kususwa kuphela i-`(Aortic Root)` eyonakeleyo, kufakwa ityhubhu entsha yokwenziwa (`graft`), kwaye ivalvu yakho iqhotyoshelwe kuyo kwakhona. Ngamafutshane, oku kubizwa ngokuba yiValve-Sparing Aortic Root Replacement .
Zeziphi iimeko ezinyangwa ngolu tyando?
Olu tyando lwenziwa ikakhulu kwimeko ebizwa ngokuba yi-`(Aortic Root Aneurysm)`. Oku kuthetha ukuba ingcambu ye-aorta idumbile njengebhaluni. Oku kunokuba yingozi, kuba ukuba iba nkulu kunomda othile, ingaqhuma (iqhekeke) okanye ikrazuke (i-aortic dissection).
Abanye abantu baneengxaki zemfuza ezidibanisa izicubu zomzimba, ezifana neMarfan syndrome. Abantu abanezi meko basengozini enkulu yokuba ne-aortic root aneurysm.
Ngubani ofanelekileyo kolu tyando?
Ugqirha wakho uza kwenza uvavanyo olwahlukeneyo ukuze abone ukuba ungumntu ofanelekileyo na kolu tyando. Ngokubanzi, usenokuba ngumntu ofanelekileyo kolu tyando.
- Ukuba i-Aortic Valve yakho ayina-calcification ingako okanye ayinayo kwaphela.
- Ngaphandle kokuba ivalvu yonakele kakhulu.
- Ukuba ivalvu isebenza kakuhle, okanye ingalungiswa ngokulungiswa okuncinci.
- Olu tyando lucetyiswa ngokukodwa kubantu abangaphantsi kweminyaka engama-75 ubudala kunye nabo banezifo zemfuza.
Uzilungiselela njani ngaphambi kotyando?
Ekubeni olu lutyando olukhulu, kubaluleke kakhulu ukululungiselela kakuhle. Ugqirha wakho uza kukunika imiyalelo ecacileyo ngalo mba.
- Amayeza: Ufanele uxelele ugqirha wakho malunga namayeza owasebenzisayo ngoku. Angakucela ukuba uyeke okanye utshintshe amanye amayeza (ingakumbi amayeza okunciphisa igazi) ngaphambi kotyando.
- Ukuzila Ukutya: Uza kucelwa ukuba ungatyi okanye ungaseli nto emva kweentsuku ezinzulwini zobusuku ngaphambi kotyando. Ungaseli namanzi.
- Uvavanyo: Ugqirha uza kuyalela iimvavanyo ezininzi ukuze acwangcise utyando.
- I-Echocardiogram (ukuskena kwentliziyo)
- Uvavanyo lwegazi
- Iskeni ye-CT evalwe nge-EKG
- I-MRI yentliziyo
- I-Angiogram yeCoronary
- Ukutshaya: Ukuba ungumntu otshayayo, kubalulekile ukuba uyeke ngokupheleleyo ukutshaya ubuncinane inyanga enye ngaphambi kotyando.
- Buza imibuzo: Thetha ngokukhululekileyo nogqirha wakho malunga nazo naziphi na izinto ezikuxhalabisayo okanye uloyiko onalo. Kuya kuba luncedo kakhulu ukwazi yonke into ngokucacileyo.
Lwenziwa njani utyando?
Olu tyando ludla ngokuthatha iiyure ezi-4 ukuya kwezi-6. Xa lusenziwa ngesandla ngugqirha onamava, intliziyo iyamiswa okwethutyana, malunga neyure. Amanyathelo abandakanyekayo kule nkqubo ngala alandelayo.
1. I-Anesthesia: Okokuqala, uza kunikwa i-anesthesia ukuze ulale ubuthongo obunzulu. Ngoko awuyi kuva ntlungu.
2. Ukuvula isifuba: Ugqirha wenza utyando phakathi kwesifuba (i-median sternotomy) ukuze afikelele entliziyweni.
3. Umatshini wentliziyo nemiphunga: Okulandelayo, uza kuqhagamshelwa kumatshini wentliziyo nemiphunga (umatshini we-cardiopulmonary bypass). Lo matshini uza kwenza umsebenzi wentliziyo nemiphunga yakho ngexesha lotyando. Uza kukunika amayeza okumisa intliziyo yakho okwethutyana.
4. Ukwahlulwa kweevalvu: Ugqirha uza kwahlula ngononophelo ivalvu yakho ye-aorta kwizicwili ezijikelezileyo.
5. Ukulungiswa:Ukuba kukho umonakalo omncinci kwiivalvu ezivalayo, zilungiswa ngoko nangoko.
6. Ukususa inxalenye eyonakeleyo: Inxalenye evuvukileyo neyonakeleyo ye-`(Aortic Root)` iyanqunyulwa ize isuswe.
7. Ukufakelwa kwetyhubhu yokwenziwa: Endaweni yoko, kuthathwa ityhubhu yokwenziwa ``graft`` eyenziwe ngelaphu elikhethekileyo, yenziwe ngobukhulu obufanelekileyo kuwe, ize ifakwe kuloo ndawo.
8. Ukudibanisa kwakhona ivalvu: Emva koko , ivalvu yakho yendalo , esuswe ngononophelo, ifakwa ngaphakathi kwityhubhu esandul’ ukufakwa ize ithungwe kwakhona (ukufakelwa kwakhona).
9. Ukujonga: Jonga ukuba yonke into ilungile na, ukuba ivalvu iyavula kwaye ivala ngokufanelekileyo na, kwaye ukuba kukho ukuvuza na.
10. Ukuvala: Imithambo yentliziyo ehambisa igazi entliziyweni idityaniswa ne-graft entsha. Uyasuswa kumatshini wentliziyo nemiphunga kwaye xa intliziyo yakho iqala ukusebenza kwakhona, umngxuma osesifubeni sakho uyavalwa.
11. Uvavanyo lokugqibela: Ngaphambi kokuba ukhutshwe kwigumbi lotyando, kwenziwa i-"transesophageal echocardiogram" ukuqinisekisa impumelelo yotyando.
Uphuculo lwanamhlanje kwindlela yotyando
Ekuhambeni kwexesha, oogqirha bongeze iindlela ezintsha zokwenza olu tyando luphumelele ngakumbi.
- Ukunciphisa i-Annulus: Ngamafutshane, isiseko esibamba ivalvu (i-aortic annulus) sicinezelwe ukuze silingane nomzimba wakho. Oku kuya kuthintela igazi ekuphumeni kwivalvu kwixesha elizayo.
- Ukudala iiSinuses ezintsha ze-Aortic (iiNeosinuses): Ingcambu ye-aorta yendalo ineentshukumo ezincinci. Ekubeni i-graft entsha iyityhubhu ethe tye, ikwadala neentshukumo ezincinci. Oku kwenza ukuhamba kwegazi kube kwendalo ngakumbi kwaye kunciphisa umonakalo kwiincwadana zevalvu.
Zithini iingenelo zolu tyando?
Olu tyando luneenzuzo ezininzi ezinkulu kunotyando lwendabuko lweBentall (olubandakanya ukutshintsha ivalvu kunye nevalvu).
| Inzuzo | Utyando Lokunciphisa Iivalvu | Utyando lweBentall (olunevalvu yoomatshini) |
|---|---|---|
| Izinto zokunciphisa igazi ubomi bonke | Akunyanzelekanga ukuba uyithathe. | Amayeza afana neCoumadin (Warfarin) kufuneka asetyenziswe ubomi bonke. |
| Amahlwili egazi, umngcipheko westroke | Isezantsi kakhulu . | Okubaluleke ngakumbi . |
| Umngcipheko wosulelo lwevalvu (i-endocarditis) | Isezantsi kakhulu . | Kaninzi . |
| Isidingo sotyando lokutshintshwa kwevalvu | Iphantsi kakhulu. Abantu abangama-95% abayi kuyidinga kangangeminyaka eli-10. | Kunokuba yimfuneko ekuhambeni kwexesha. |
Kuthatha ixesha elingakanani ukuphola emva kotyando?
Emva kotyando, uza kugcinwa kwigumbi labagula kakhulu (ICU) usuku olunye okanye ezimbini, uze udluliselwe kwigumbi eliqhelekileyo. Ngokwesiqhelo ungaya ekhaya usuka esibhedlele kwiintsuku ezi-4 ukuya kwezi-7.
Kuthatha malunga neeveki ezi-6 ukuchacha ngokupheleleyo nokubuyela kwimisebenzi eqhelekileyo.
Ngeli xesha,
- Ukuba yinxalenye yenkqubo yokuvuselela intliziyo yingcinga entle. Kuya kukunceda uphile ngokukhawuleza kwaye ube namandla.
- Ugqirha uthi musa ukwenza nantoni na efana nokuphakamisa iintsimbi okanye ukuqhuba imoto kangangeeveki ezi-6.
- Amadinga okulandela: Usenokungacingi ukuba kufuneka uphinde ubonane nogqirha wakho emva kokuba uphilile. Kodwa kubalulekile ukwenza njalo . Kubalulekile ukugcina imeko yentliziyo yakho ijongwa rhoqo.
Ufanele ufowunele ugqirha nini ngoko nangoko
Emva kokubuyela ekhaya, ukuba ufumanisa naziphi na kwezi mpawu zilandelayo, fowunela ugqirha wakho ngoko nangoko okanye uye kwiSebe lezeMpilo eziNgxamisekileyo (ETU) lesibhedlele esikufutshane.
| Uphawu | Yintoni ekufuneka uyiqwalasele |
|---|---|
| Utshintsho kwindlela yokusika | Ububomvu, ukudumba, iintlungu ezigqithisileyo, ubushushu, kunye nobomvu obumthubi okanye obuluhlaza obujikeleze inxeba. |
| Iintlungu zesifuba | Intlungu yesifuba ekhawulezileyo okanye enzima. |
| Ubunzima bokuphefumla | Ukuphefumla okukhawulezileyo. |
| Ukudumba kwemilenze | Ukudumba kwemilenze okanye ukungakwazi ukuhambisa imilenze. |
| Ukudinwa okanye ukuquleka | Ukudinwa kakhulu, ukutyhafa, okanye ukudinwa kakhulu. |
| Umkhuhlane okanye umkhuhlane | Umkhuhlane ohambisana nokubanda, ukuphuma kwencindi emthubi okanye eluhlaza. |
Kuqhelekile ukuba novalo ngaphambi kokuba utyando olukhulu. Kodwa khumbula, olu tyando lwenzelwa ukusindisa ubomi bakho nokukunceda uhlale usempilweni ixesha elide. Thetha nosapho lwakho kunye nabahlobo ngale nto. Inkxaso yabo iya kuba namandla amakhulu kuwe ngeli xesha.
Umyalezo Wokuya Ekhaya
- Ukutshintshwa kweengcambu ze-Aortic ezigcina iValve lutyando oluphambili olugcina ivalvu yakho yendalo ye-aortic kwaye lunyanga ukwanda kweengcambu ze-aortic.
- Eyona nzuzo inkulu yoku kukuba akufuneki usele amayeza okunciphisa igazi ubomi bakho bonke, njengokuba ubuya kwenza ngevalvu yomatshini.
- Olu tyando lunokwenziwa phantsi kweliso logqirha onamava kwisibhedlele esinezibonelelo ezilungileyo kwaye lunezinga eliphezulu lempumelelo (ngaphezulu kwe-99%).
- Kuthatha malunga neeveki ezi-6 ukuze umntu aphile ngokupheleleyo emva kotyando. Ngeli xesha, kubaluleke kakhulu ukulandela imiyalelo kagqirha.
- Ungoyiki ukuthetha nogqirha wakho ngayo nayiphi na imibuzo okanye izinto ezikuxhalabisayo. Kungamandla amakhulu ukuba nolwazi olupheleleyo ngaphambi kokuba ungene kutyando.
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