Ukuhlolwa okubheka enhliziyweni: Ake sifunde nge-Transesophageal Echocardiogram (TEE)!

Ingabe udokotela wakho u-ode ukuhlolwa okukhethekile ukuhlola noma yiziphi izinkinga ngenhliziyo yakho? Kungaba ukuhlolwa kwe-`(Transesophageal Echocardiogram)`, noma njengoba sikubiza ngokuthi `(TEE)`. Nakuba kungase kuzwakale kungavamile, kuyindlela ekuvumela ukuthi ubone isimo senhliziyo yakho ngokucacile, kusukela ngaphakathi. Ngakho-ke ungase wesabe kancane noma ube nesifiso sokwazi ngalokhu. Ngakho-ke ake sixoxe ngalokhu kuhlolwa kwe-`(TEE)` kalula, ngendlela ongayiqonda.

Kuyini lokhu kuhlolwa (TEE)? Kwenziwa kanjani?

Kalula nje, i-Transesophageal Echocardiogram iyisivivinyo esisebenzisa amaza omsindo ukuthatha izithombe zenhliziyo yakho. Lokhu futhi kuyisivivinyo se-echo. Kodwa kuhlukile kancane kwi-Transthoracic Echocardiogram (TTE) evame kakhulu eyenziwa esifubeni. Lokhu kungenxa yokuthi izithombe zithathwa ngaphakathi emzimbeni.

UDokotela, ithuluzi elincane, elide elifana nethubhu, silibiza ngokuthi "i-Endoscope," lifakwa ngokucophelela emphinjeni wakho lingene epayipini lakho lokudla (esophagus). Ekupheleni kwaleli thubhu kukhona "i-Transducer" encane. Le "Transducer" ikhipha amaza omsindo. Lawa maza omsindo ashaya izingxenye ezahlukene zenhliziyo futhi abuye abuye, njenge-echo. I-"Transducer" ithatha lawo maza abuyayo bese iwathumela kukhompyutha. Ikhompyutha iguqula leyo datha ibe izithombe. Lezi zithombe zibonisa ukuma nomsebenzi wenhliziyo ngemininingwane eminingi.

Ngezinye izikhathi odokotela basebenzisa amasu akhethekile abizwa ngokuthi i-Doppler ultrasound kanye ne-Color Doppler kanye nalolu vivinyo lwe-TEE. Lokhu kungalinganisa ngokunembile ijubane kanye nesiqondiso sokugeleza kwegazi enhliziyweni.

Yini odokotela abayitholayo ngalolu vivinyo (i-TEE)?

Lokhu kuhlolwa kwe-`(TEE)` kunganikeza isithombe esicacile sesakhiwo senhliziyo, okungukuthi, indlela izingxenye zayo ezihlelwe ngayo, nokuthi inhliziyo isebenza kanjani. Lokhu kungasiza ekuxilongeni izifo ezahlukahlukene futhi kuzilawule ngesikhathi sokwelashwa. Nazi izibonelo ezimbalwa:

• I-Aortic aneurysm: Lokhu kwenzeka lapho udonga lomthambo wegazi omkhulu kunayo yonke emzimbeni wethu (i-aorta) luba buthakathaka futhi luvuvukala njengebhaluni.
• Amahlule egazi enhliziyweni: Abantu abane-atrial fibrillation, ikakhulukazi, banamathuba amaningi okuba namahlule egazi emakamelweni aphezulu enhliziyo (i-atria).
• Izimila zenhliziyo: Lezi zingaba umdlavuza noma zingabi umdlavuza.
• Isifo senhliziyo esizalwa naso: Lokhu kubhekisela ezifweni zenhliziyo ezahlukahlukene ezikhona lapho umuntu ezalwa.
• Isifo se-valve yenhliziyo: Isibonelo, isifo se-mitral valve. Le valve ingaba mncane (stenosis) noma ivuza igazi emuva (regurgitation). Futhi, abantu abane-prosthetic valve bangahlolwa ukuthi abanazo yini izinkinga ngama-valve abo, njengokutheleleka noma amahlule egazi.
• Ukutheleleka kwezicubu zenhliziyo noma ama-valve: Isibonelo, izimo ezifana `(Infective endocarditis)`.
• Isifo senhliziyo: Lokhu kubhekisela ezifweni ezenzeka esikhwameni esincane (i-pericardium) esizungeze inhliziyo.

Kungani kwenziwa lokhu kuhlolwa (TEE)? Kuziphi izimo?

Kunezizathu eziningana zokuthi kungani ukuhlolwa kwe-TEE kungenziwa. Ake sibheke ukuthi ziyini:

1. Uma i-echocardiogram ejwayelekile (TTE) inganele: Ngemva kwe-echocardiogram ejwayelekile (TTE) eyenziwe esifubeni sakho, udokotela wakho angadinga umbono ocacile noningiliziwe wenhliziyo yakho. Ezimweni ezinjalo, ukuhlolwa kwe-TEE kungenziwa ngaphezu kwe-TTE ukusiza ekuxilongeni inkinga yenhliziyo noma ukuhlela ukwelashwa.

Zicabange uhamba emgwaqweni bese ubona amapuleti amahle esitolo ngengilazi. Ungabona ukuthi amapuleti aneziphethini zezimbali, kodwa akucaci kahle ukuthi yiziphi izimbali, imininingwane yazo iyini, ngoba kunabantu abaseduze futhi kukhona ingilazi. Ngakho-ke ungena ngaphakathi esitolo ubheke amapuleti eduze. Yilapho-ke ubona khona ukuthi ayizimbali.

Yileyo ndlela i-echocardiogram evamile (TTE) eyenziwa ngayo esifubeni efana nokubuka ngengilazi esitolo. Ingakutshela izinto eziningi. Kodwa le TEE ifana nokuya esitolo bese uthatha ipuleti. Ezinye izingxenye zenhliziyo, ikakhulukazi lezo ezingemuva, zicacile kakhulu kule TEE. Ngenxa yokuthi umphimbo wakho utholakala ngemuva kwenhliziyo yakho, yindawo enhle kakhulu lapho i-transducer ingathumela futhi yamukele khona amaza omsindo.

Kuhle ukubheka lezi zingxenye ikakhulukazi:

* I-atrium yangakwesobunxele: Igumbi eliphezulu ngakwesobunxele lenhliziyo.

* I-left atrial appendage (LAA): Isikhwama esincane, esifana nendlebe esise-atrium yesobunxele. Yilapho ngezinye izikhathi kwakheka khona amahlule egazi.

* I-Interatrial septum: Udonga oluhlukanisa i-atria yesobunxele nesokudla.

* I-aorta yesifuba: Ingxenye ye-aorta edlula esifubeni.

Ngezinye izikhathi odokotela benza i-TEE esikhundleni se-TTE. Lokhu kungenxa yezizathu ezilandelayo:

• Uma isakhiwo sesifuba sisesimweni esenza kube nzima ukwenza i-TTE.
• Uma unezifo zamaphaphu (njengoba zingasitha umbono wenhliziyo).

2. Ezimweni eziphuthumayo, ezisongela ukuphila: Kwezinye izimo eziphuthumayo, odokotela kudingeka babone isimo senhliziyo ngokushesha. Khona-ke `(TEE)` iwusizo kakhulu. Isibonelo:

• Ukungazinzi kwe-hemodynamic (umfutho wegazi nezinkinga zokujikeleza kwegazi)
• Umfutho wegazi ophansi (i-Hypotension)
• Ukwehla kwamazinga omoya-mpilo (i-Hypoxia)
• Izimo eziphuthumayo ezidinga ukuhlolwa okusheshayo, njengokusikwa kwe-aorta.
• Uma kusolwa ukuthi uhlaselwe yinhliziyo.
• Izinkinga ngama-valve okufakelwa (njengokuqhekeka kwegazi, ukutheleleka).
• Ukulimala esifubeni.

3. Hlola amahlule egazi ngaphambi kwanoma iyiphi inqubo yezokwelapha: Lapho welapha izifo ezithile zesigqi senhliziyo (i-arrhythmias), njenge-catheter ablation noma i-electrical cardioversion, kwenziwa i-TEE ukuhlola amahlule egazi enhliziyweni ngaphambi kwenqubo. Lokhu kungenxa yokuthi uma kukhona amahlule egazi, angaqhekeka ngesikhathi senqubo futhi avimbe umthambo wegazi (thromboembolism).

4. Ukusiza ngokuhlinzwa nezinye izinqubo zezokwelapha: I-TEE iyithuluzi eliwusizo kakhulu phakathi nokuhlinzwa kanye nezinqubo zezokwelapha. Isetshenziselwa ukubona isakhiwo senhliziyo ngaphambi kokuhlinzwa nokuqinisekisa impumelelo yokuhlinzwa ngemva kokuba kwenziwe. Izibonelo:

• Ukuhlinzwa kwesifo senhliziyo esizalwa naso.
• Ukulungiswa kwevalvu.
• Ukushintsha ivalvu.

Futhi, kwezinye izindlela zokwelapha ezisekelwe ku-catheter, okungukuthi, izindlela zokwelapha lapho ipayipi elincane lidluliselwa khona ngemithambo yegazi liye enhliziyweni, i-TEE isetshenziswa ukubheka ngaphakathi emzimbeni nokunikeza izithombe zesikhathi sangempela ukuqondisa inqubo. Izibonelo:

• `(Ukufakwa esikhundleni kwe-Transcatheter aortic valve - TAVR)`
• `(Ukulungiswa kwe-Transcatheter mitral valve)`
• `(Ukulungiswa kwevalvu ye-transcatheter tricuspid)`
• `(Ukuvalwa kwe-Transcatheter left atria appendage)`

Ingabe ukuhlolwa kwe-TEE kwenziwa ngaphakathi emzimbeni? Ingabe kusetshenziswa i-anesthesia?

Yebo, i-TEE ibhekwa njengokuhlolwa okuhlaselayo ngoba ihilela ukufaka idivayisi emzimbeni. Ungase uzizwe ungakhululekile, kodwa ingozi yezinkinga ezinkulu iphansi.

Esikhathini esiningi, ukuhlolwa kwe-TEE kudinga kuphela i-anesthesia yendawo kanye nokupholisa okulinganiselwe . Lokhu kusho ukuthi udokotela uzofafaza umuthi oqeda izinhlungu ngemuva komphimbo wakho. Uzokunikeza nomuthi we-intravenous (IV) ukukusiza uphumule.

Iningi labantu alidingi i-anesthesia ejwayelekile, kodwa kuwumqondo omuhle ukukhuluma nodokotela wakho ngalokho okukulungele.

Ngakho-ke, ingabe siyalaliswa ngalesi sikhathi? Ingabe siyaqaphela?

Ukwelapha okulinganiselwe kuzokwenza uzizwe ulele futhi kuzokuvumela ukuthi uhlolwe ngaphandle kokungakhululeki kakhulu. Abasebenzi bezokwelapha bazoqhubeka nokukuqapha ukuze babone ukuthi kukhona yini ukungakhululeki onakho. Bangase bakunike ukwelapha okwengeziwe uma kudingeka.

Ngisho noma ubunganikwa `(i-anesthesia ejwayelekile)`, ubuzolala ubuthongo obuphelele futhi ubungeke ukhumbule lutho ngokuhlolwa. Kodwa-ke, uma unikezwa `(i-anesthesia ejwayelekile)`, kuzodingeka uxhunywe `(emshinini wokuphefumula). Futhi, ngoba ulala ubuthongo obujulile, kuthatha isikhathi eside ukululama kunokusebenzisa umuthi wokudambisa olinganiselayo.

Kuthatha isikhathi esingakanani lokhu kuhlolwa?

Ukuhlolwa kwe-TEE kungathatha imizuzu efinyelela kwengama-90 ukuqedwa. Kodwa-ke,Ukuthwebula izithombe kuvame ukuthatha imizuzu eyi-15.

Kufanele sizilungiselele kanjani ngaphambi kokuhlolwa (i-TEE)?

Qiniseka ukuthi uxoxa ngomlando wakho wezokwelapha nodokotela wakho. Ezinye izimo zezokwelapha zingenza ukuhlolwa kwe-TEE kube yingozi. Qiniseka ukuthi utshela udokotela wakho uma unezinye zezimo ezilandelayo:

• Umdlavuza we-Esophageal
• I-Gastritis
• I-GERD (i-reflux ye-acid engapheli)
• I-hernia ye-hiatal
• Umlando wokusebenzisa izidakamizwa ngemithambo yegazi (ukusebenzisa izidakamizwa nge-IV)
• Izinkinga zokugwinya
• Ukuphefumula komoya ngesikhathi sokulala
• Umdlavuza wesisu

Futhi, sitshele uma uthatha imithi yalezi zinto:

• Izinkinga zokulala
• Ukukhathazeka
• Ubuhlungu

Udokotela wakho uzokunikeza imiyalelo eningiliziwe yokuthi ungalungiselela kanjani ukuhlolwa kwe-TEE. Qiniseka ukuthi ulandela leyo miyalelo ngqo. Ungesabi ukubuza ukuthi kukhona yini ongakuqondi. Imiyalelo izofaka okulandelayo:

• Isikhathi sokuyeka ukudla nokuphuza (ngokuvamile okungenani amahora ayisithupha ngaphambi kokuhlolwa).
• Kufanele uthathe nini imithi yakho evamile?
• Gwema ukuphuza utshwala isikhathi esithile (mhlawumbe izinsuku ezimbalwa ngaphambi kokuhlolwa).
• Ezinye izinto okufanele uzenze noma okungafanele uzenze ngaphambi kokuthi `(TEE)`.

Kwenzekani ngesikhathi sokuhlolwa (i-TEE)?

Lezi yizinyathelo ezivame ukwenzeka ngesikhathi sokuhlolwa kwe-`(TEE)`:

1. Uzonikezwa ingubo yasesibhedlela ozoyigqoka.

2. Udokotela uzobeka izitikha ezincane ezibizwa ngokuthi "ama-Electrode" esifubeni sakho. Lezi zingasetshenziswa ukuqapha ukusebenza kukagesi kwenhliziyo yakho ngesikhathi se-"TEE".

3. I-blood pressure cuff izobekwa engalweni yakho, bese kufakwa i-pulse oximeter emunweni wakho ukuze kuqashwe amazinga akho e-oxygen.

4. Uzonikezwa i-gargle ukuze uqede umphimbo wakho. Udokotela uzofutha umuthi emphinjeni wakho. Lokhu kuyisidakamizwa sokubulala izinzwa sendawo. Yingakho ungeke uzwe ubuhlungu ngesikhathi sokuhlinzwa kwe-TEE.

5. Uzonikezwa umuthi wokudambisa imithambo (IV) ukuze uphumule.

6. Ungadinga ithubhu elincane (i-nasal cannula) elifakwe ekhaleni lakho ukuze likunike umoya-mpilo.

7. Uzophendulwa uye ohlangothini lwesobunxele lwetafula lokuhlolwa bese ulaliswa phansi.

8. Udokotela uzofaka kancane kancane i-"Endoscope" (ipayipi elincane, elide, eliguquguqukayo) emlonyeni wakho. Esiqongweni sepayipi kukhona i-"Transducer". Leli payipi lehla emphinjeni wakho liye epayipini lakho lokudla. Ligcotshwe ukuze kube lula ukwehla. Ngezinye izikhathi uzocelwa ukuthi ugwinye ukuze usize i-"Transducer" ifike endaweni efanele. Lokhu kungase kubonakale kungakhululekile, kodwa udokotela uzokwenza lokhu ngokucophelela. Bazokunikeza umuthi wokudambisa umphimbo wakho, ukuze ungazizwa ubuhlungu obukhulu.

9. Udokotela uthatha izithombe. Ungase uzwe ubuhlungu. Kodwa i-`(Transducer)` ihlukile.Ungase uzizwe ucindezeleka kancane esifubeni sakho uma usishukumisa. Le ngxenye ithatha cishe imizuzu eyi-10-15.

10. Udokotela uzokhipha ipayipi emphinjeni wakho futhi aqhubeke nokuqapha umfutho wegazi lakho, ukushaya kwenhliziyo, kanye namazinga omoya-mpilo.

11. Linda kuze kube yilapho udokotela ethi ungaya ekhaya.

Yini engingayilindela ngemva kokuhlolwa (kwe-TEE)?

Uzodinga umuntu ozokushayela ekhaya ngemuva kokuhlolwa kwe-TEE. Ngeke ukwazi ukushayela amahora angama-24 ngenxa yemiphumela yemithi yokudambisa. Ungalindela okulandelayo:

• Umphimbo wakho uzoba ndikindiki cishe ihora. Uzophela ngemva kwesikhashana. Ungadli noma uphuze lutho kuze kube yilapho indikindiki iphela. Uma udla noma uphuza ngokushesha kakhulu, ungase uminze.
• Ungase ube nomphimbo obuhlungu cishe izinsuku ezimbili. Lokhu kuvamile futhi kuzophela ezinsukwini ezimbalwa. Kodwa-ke, uma ubuhlungu buqhubeka noma buba bubi kakhulu, khuluma nodokotela wakho.

Ingabe zikhona izingozi enqubweni (ye-TEE)?

Abanye abantu bahlushwa umphimbo ngemva kokuhlinzwa kwe-TEE. Kungahlala amahora ambalwa noma izinsuku ezintathu kuya kwezinhlanu.

Ezinye izinkinga azivamile, kodwa zingenzeka:

• Ukusabela kokungezwani komzimba nemithi.
• I-pneumonia yokuphefumula ibangelwa ukudla noma uketshezi olungena emgudwini wokuphefumula.
• Izinkinga ngomfutho wegazi noma isigqi senhliziyo.
• Ukopha okuncane okuvela emgudwini wokugaya ukudla.

Ngaphambi kokwenza lokhu kuhlolwa, kubalulekile ukukhuluma nodokotela wakho ngezingozi ze-TEE.

Ngiyithola kanjani imiphumela yokuhlolwa (i-TEE)?

Udokotela wakho uzokhuluma nawe ngemiphumela yakho yokuhlolwa. Ungase futhi ube nayo njengengxenye yerekhodi lakho lezokwelapha elekthronikhi (uhlelo oluku-inthanethi lapho ungabona khona ulwazi lwakho lwezokwelapha). Khuluma nodokotela wakho ngokuthi uzothola nini imiphumela nokuthi ungayinakekela kanjani.

Kujwayelekile ukuthi abanye abantu bazizwe benovalo noma besaba uma kukhulunywa ngokuhlolwa kwezokwelapha. Kodwa-ke, ukuhlolwa okufana ne-Transesophageal Echocardiogram (TEE) kungadlala indima enkulu ekukugcineni uphilile noma ekwelapheni izinkinga ezivelayo. I-TEE ukuhlolwa okuvamile okunengozi encane yezinkinga. Uma une-TEE, khuluma nodokotela wakho mayelana nokuthi ungayilungiselela kanjani nokuthi yini ongayilindela.

Ekugcineni, khumbula lokhu.

Ukuhlolwa kwe-TEE kuyindlela ekhethekile ekuvumela ukuthi ubone ingaphakathi lenhliziyo yakho ngokucacile. Nakuba kungase kubonakale kungakhululekile kancane, kuwusizo olukhulu ekuxilongeni izifo zenhliziyo nasekuziphatheni ngendlela efanele. Into ebaluleke kakhulu ukuthi uma unemibuzo noma ukungabaza, khuluma nodokotela wakho ngakho. Khona-ke ungabhekana nalolu vivinyo ngaphandle kokwesaba nangokuzethemba.

I- Transesophageal echocardiogram, i-TEE, ukuhlolwa kwenhliziyo, inhliziyo, i-endoscope, ukuhlolwa kwe-echo, i-esophagus