Masifunde ngotyando lwamva nje olusindisa ivalvu yentliziyo (iValve-Sparing Aortic Root Replacement).

Ngaba ugqirha ukuxelele ukuba udinga utyando lwentliziyo? Kuqhelekile ukuba uzive usoyika kancinci xa esitsho loo nto. Kodwa namhlanje, amayeza aphucuke kakhulu. Kukho utyando oluzama ukukhusela amalungu amaninzi omzimba wakho kangangoko kunokwenzeka. Namhlanje siza kuthetha ngotyando olulodwa olukhethekileyo. Oko kukuthi, ivalvu yentliziyo, olu lutyando olukhusela ivalvu.

Ngamafutshane, yintoni utyando lweValve-Sparing?

Kulungile, ukuze sikuqonde oku, masiqale sifunde ngenxalenye encinci yentliziyo yethu. Igumbi eliphambili lokumpompa lentliziyo yethu (i-ventricle yasekhohlo) liqhagamshela kumthambo wegazi omkhulu emzimbeni wethu, i-aorta. Olu qhagamshelo silubiza ngokuba yi-'Aortic Root'. Lufana nengcambu yomthi. Ngaphakathi kweli 'Aortic Root' kukho isango elibaluleke kakhulu, i-'Aortic Valve'.

Ngalo lonke ixesha intliziyo ibetha, le 'Aortic Valve' iyavula ize ipompe igazi emzimbeni, ize ivale. Olu kuvala kuyayithintela igazi ukuba lingabuyeli entliziyweni.

Khawuthelekelele, kwabanye abantu, 'Ingcambu ye-Aortic', oko kukuthi, inxalenye yesango ebonakala njengesango, ibuthathaka, idumbile, kwaye ibe nkulu. Ifana nebhaluni evuthelwayo. Oku sikubiza ngokuba yi-'Aortic Root Aneurysm'. Xa eli sango liba likhulu, ucango olukulo, oko kukuthi, i-'Aortic Valve', aluvaleki kakuhle. Emva koko igazi liqala ukuvuza kwakhona entliziyweni. Oku kubizwa ngokuba yi-'Aortic Regurgitation'.

Kwindlela yotyando lwendabuko (inkqubo yeBentall), oogqirha basusa zombini i-'Aortic Root' evuvukileyo kunye ne-'Aortic Valve' baze bafake ezimbini ezintsha ezenziweyo.

Eyona nzuzo inkulu yoku kukuba ungagcina ivalvu yakho, ngoko ke akufuneki usele amayeza okubulala igazi ubomi bakho bonke (njengeCoumadin) njengoko ubuya kwenza ngevalvu yoomatshini.

Zeziphi iimeko ezinyangwa lolu tyando?

Olu tyando lwenziwa ikakhulu kwiimeko ezilandelayo:

• I-Aortic Root Aneurysm: Njengoko benditshilo ngaphambili, oku kukudumba okungaqhelekanga kwingcambu ye-aorta edibana nentliziyo. Ukuba oku kukhulu kakhulu, kungaqhuma ngequbuliso (`Aortic Dissection` okanye i-Rupture). Kuyingozi kakhulu ebomini.
• I-Aortic Aneurysm Enyukayo Ene-Dilated Aortic Sinuses: Amaxesha apho izithuba ezincinci zendalo kwi-'Aortic Root' ('Aortic Sinuses') zikhula kancinci, kunye nokudumba kwinxalenye enyukayo ye-aorta.

Abantu abanezifo ezithile zemfuza ezidityanisiweyo, ezifana neMarfan syndrome, basengozini enkulu yokuba ne-aortic root aneurysm. Ngenxa yoko, oogqirha botyando bahlola ngononophelo imeko yesigulana baze bajonge iingenelo kunye neengozi zotyando ngaphambi kokuba bagqibe ekubeni lufanelekile na.

Ingaba ufanelekile kolu tyando?

Ukuba ivalvu yakho ye-aortic inezi mpawu, unokuba ngumviwa kolu tyando:

• Ukuba kukho i-calcium deposits encinci kakhulu okanye akukho calcium deposits (calcification) kwivalvu.
• Ngaphandle kokuba ivalvu yonakele kakhulu.
• Ukuba ivalvu isebenza kakuhle okanye ingalungiswa ngokulungiswa okuncinci.

Uzilungiselela njani ngaphambi kotyando?

Ugqirha wakho uza kukuchazela yonke into ekufuneka uyenze ngaphambi kotyando. Kubaluleke kakhulu ukulandela loo miyalelo ngqo. Ngokwesiqhelo, le yinto ekufuneka uyenze.

Ukongeza, ugqirha uza kwenza iimvavanyo ezininzi ukuze acwangcise utyando, ezifana nezi:

• I-Echocardiogram (ukuskena kwentliziyo)
• Uvavanyo lwegazi
• `I-CT scan egated EKG yentliziyo nesifuba`
• I-Angiogram yeCoronary
• Uvavanyo lwegazi oluvela kwimfuza ukuba kukho isifo esidluliselwa kwilifa esirhanelwayo

Kwenzeka ntoni ngexesha lotyando?

Olu tyando ludla ngokuthatha iiyure ezi-4 ukuya kwezi-6. Xa ugqirha onamava esenza olu tyando, intliziyo kufuneka ime kangangeyure. Ungakhathazeki, ngelo xesha, umatshini uya kwenza umsebenzi wentliziyo nemiphunga.

Nantsi into eyenzekayo inyathelo ngenyathelo:

1. I-Anesthesia: Okokuqala, uza kulaliswa ngokupheleleyo. Ngoko awuyi kuva ntlungu.

2. Ukuvula isifuba: Ugqirha wenza utyando phakathi kwesifuba (i-'median sternotomy') ukuze afikelele entliziyweni.

3. Ukudibanisa nomatshini wentliziyo nemiphunga: Uza kudityaniswa nomatshini we-`Cardiopulmonary Bypass`. Lo matshini uza kuthatha umsebenzi wentliziyo nemiphunga yakho ngexesha lotyando. Ngeli xesha, iyeza elibizwa ngokuba yi-`cardioplegia solution` liza kunikwa ukuze limise intliziyo yakho okwethutyana.

4. Ukukhulula iValve: Ugqirha uza kwahlula ngononophelo ivalve yakho ye-aortic kwizicubu ezijikelezileyo.

5. Ukususwa kweendawo ezonakeleyo: `Ingcambu ye-Aortic` evuvukileyo kunye nezinye iindawo ezonakeleyo ziyasikwa zize zisuswe.

6. I-Graft: Ityhubhu yokwenziwa ('i-graft') ifakwa endaweni yenxalenye esusiweyo. Le yenziwe ngohlobo oluthile lwelaphu ('i-polyester').

7. Ukufakelwa kwakhona kwevalvu: Ivalvu yakho ye-aorta iyathathwa, kufakwa igrafti entsha, ize ifakelwe endaweni yayo.

8. Ukujonga iValve: Ukuqinisekisa ukuba yonke into ilungile, kudlula ulwelo kwi-'Graft' ukujonga ukuba ivalve isebenza kakuhle na, iyavuleka kwaye iyavalwa.

9. Inyathelo lokugqibela: Imithambo yentliziyo iqhagamshelwe kwi-'Graft' entsha. Emva koko ususwa kwi-'Heart-Lung Machine' kwaye intliziyo yakho ivunyelwe ukuba isebenze kwakhona. Emva koko isilonda sesifuba siyavalwa.

Iindlela zotyando zanamhlanje (Ukufakelwa kwakhona okuGuquliweyo)

Ekuhambeni kwexesha, oogqirha botyando bongeze iindlela ezintsha zokwenza olu tyando luphumelele ngakumbi. Umzekelo:

• Ukudala iiSinuses ezintsha ze-Aortic (`Neosinuses`): Ngokwesiqhelo, i-`Graft` yityhubhu ethe tye. Kodwa i-`Aortic Root` yendalo inezithuba ezincinci (`sinuses`). Kule ndlela intsha, ezo zithuba zenziwe ngokwenziwa kwi-`Graft`. Oku kwenza ukuhamba kwegazi kube kwendalo ngakumbi, kwaye umonakalo kwivalvu uyancitshiswa.
• Ubungakanani be-Aortic Annulus: Ubungakanani benxalenye efana neringi ebekwe kuyo ivalvu (i-'aortic annulus') bulungiswa ukuze bulingane nobukhulu bomzimba wakho. Oku kunciphisa umngcipheko wokuvuza kwegazi kwivalvu kwixesha elizayo.

Kwenzeka ntoni emva kotyando? Kwaye kuthatha ixesha elingakanani ukuba umntu aphile?

Emva kotyando, uza kugcinwa kwigumbi labagula kakhulu (ICU) usuku olunye okanye ezimbini, uze udluliselwe kwigumbi eliqhelekileyo. Ngokwesiqhelo ungaya ekhaya kwiintsuku ezi-4 ukuya kwezi-7.

Nokuba unelayisenisi yokuqhuba, ungaqhubi de ugqirha wakho akunike imvume. Kuya kufuneka ulinde ubuncinane iiveki ezi-6 ngaphambi kokuba wenze nantoni na efana nokuphakamisa iintsimbi okanye ukuya emsebenzini.

Ukuba yinxalenye yenkqubo yokuvuselela intliziyo (`cardiac rehab`) kuya kukunceda uphile ngokukhawuleza. Kwakhona, qiniseka ukuba uya kugqirha wakho emva kokudibana naye. Baza kuqhubeka nokujonga imeko yentliziyo yakho.

Zithini iingozi kunye neenzuzo zolu tyando?

Njengalo naluphi na utyando olukhulu, kukho iingozi ezithile ezibandakanyekileyo. Nangona kunjalo, xa kwenziwa ngugqirha onamava esibhedlele esinezibonelelo ezilungileyo, ezi ngozi zincinci .

Iingenelo eziphambili:

• Akunyanzelekanga ukuba usele amayeza okunciphisa igazi ubomi bakho bonke.
• Umngcipheko wokuqhekeka kwegazi, istroke, kunye nosulelo lwevalvu (i-endocarditis) uyancitshiswa.
• Amathuba okuba kufuneke kwenziwe utyando lokutshintsha ivalvu kwakhona kwixesha elizayo aphantsi kakhulu.

Uphando lubonise ukuba izinga lempumelelo yolu tyando lingaphezulu kwama-99%. Nokuba emva kweminyaka eli-10, malunga nama-95% abantu abaye benza olu tyando abayi kufuna olunye utyando.

Ukuba unayo nayiphi na kwezi mpawu, fowunela ugqirha wakho ngoko nangoko okanye uye kwiSebe leNgxamiseko (i-ETU) lesibhedlele esikufutshane.