Ake sifunde ngokushintshwa kwezimpande ze-Aortic ngamagama alula.

Kumelwe ukuba uke wezwa nge-aorta, umthambo wegazi oyinhloko opompa igazi emzimbeni wethu wonke. Cabanga, kuthiwani uma lo mthambo oyinhloko, lapho uxhumeka khona enhliziyweni, "empandeni," uba buthakathaka kancane futhi uqhume njengebhaluni? Yilokho esikubiza ngokuthi i-aneurysm kwezokwelapha. Lokhu kuyingozi kakhulu, ngoba nganoma yisiphi isikhathi lolu donga olubuthakathaka lungaqhekeka noma luqhekeke. Uma lokho kwenzeka, kungaba nokopha ngokweqile emzimbeni ngisho nemiphumela esongela ukuphila. Ngakho-ke, ukushintshwa kwe-Aortic Root kuyindlela ebaluleke kakhulu yokuhlinzwa eyenziwayo ukuvimba izimo ezinjalo ezisongela ukuphila. Namuhla, sizokhuluma ngalokhu kalula, ngendlela ongayiqonda.

Iyini le ndlela yokuhlinzwa yokubuyisela izimpande ze-Aortic?

Kalula nje, lokhu kuwukuhlinzwa kokulungisa i-aneurysm empandeni ye-aorta, umthambo oyinhloko oxhumanisa inhliziyo yakho. Ngezinye izikhathi, kokubili impande ye-aorta yakho kanye ne-valve ekuyo kuyashintshwa. Ngezinye izikhathi, impande ye-aorta yakho kuphela eshintshwayo, okushiya i-valve yakho evamile ingashintshiwe. Udokotela wakho uzonquma ukuthi yiluphi uhlobo lokuhlinzwa olukufanele ngokusekelwe ezicini eziningi, okuhlanganisa nesimo se-valve yakho.

Yiziphi izinhlobo eziyinhloko zalokhu kuhlinzwa?

Kunezindlela ezimbili eziyinhloko zalokhu kuhlinzwa. Eyokuqala ukufaka impande ye-aorta kanye ne-valve. Enye ukufaka impande kuphela, kushiye i-valve ingathintekile. Zombili zinezinzuzo kanye nokungalungi.

1. Ukufakwa Kwezimpande Ze-Aortic (ARR)

Le nqubo ibizwa nangokuthi inqubo yeBentall . Yenzelwa abantu abane-aortic aneurysm kanye nenkinga ngevalvu. Isibonelo, uma ivalvu ingavali kahle futhi igazi livuza emuva (ukubuyiselwa kwevalvu ye-aortic) noma uma ivalvu isibe yi-calcified (iqinisiwe).

• Inzuzo eyinhloko: Inzuzo enkulu yalokhu ukuthi awudingi ukuhlinzwa okuhlukile ukuze ulungise ivalvu futhi ngemva kokuhlinzwa. Kokubili inkinga ye-aneurysm kanye nevalvu kuxazululwa ngesikhathi esisodwa.
• Izingozi: Uma ufakwe i-valve yomshini ngesikhathi sokuhlinzwa, kuzodingeka uthathe imithi yokunciphisa igazi/imithi yokunciphisa igazi impilo yakho yonke. Kukhona ingozi encane yokuqhekeka kwegazi noma ukopha ngenxa yale mithi.

2. Ukufakwa Kwezimpande Ezingashiyi Amavalvu (VSRR)

Lena inketho engcono kakhulu uma ivalvu yakho ye-aorta isebenza kahle ngaphandle kwezinkinga. Isibonelo, uma kungekho ukuvuza kwegazi noma ukuqina kwevalvu, le ndlela ingakhethwa. Lena ikhambi elihle kakhulu kubantu abathola ama-aneurysms besebancane ngenxa yezimo zofuzo.

Le nqubo ihilela ukufaka impande ye-aorta yakho esikhundleni sayo bese unamathisela i-valve yakho yemvelo kuyo. Kunezindlela ezimbili eziyinhloko, eziqanjwe ngodokotela abazitholile.

• Inqubo kaYacoub: Lokhu kuhilela ukulungisa kabusha i-aortic valve. Lokhu kuvame ukufaneleka kubantu asebekhulile abane-aneurysms ngenxa yezimbangela ezingezona ezezakhi zofuzo.
• Inqubo kaDavid: Lokhu kuhilela ukufakelwa kabusha kwe-aortic valve. Lena inqubo evamile kodwa eyinkimbinkimbi kakhulu kunenqubo kaJacob. Ingcono kakhulu kubantu abasebasha abanesimo sofuzo noma i-bicuspid aortic valve .

Ingabe kufanele sifunde kancane ngempande ye-aorta?

Impande ye-aorta yingxenye yokuqala yomthambo wegazi omkhulu emzimbeni, i-aorta, lapho ixhumana khona nenhliziyo. Ifana nempande yesihlahla. I-aorta, ephuma enhliziyweni, igoba iye phezulu, njengegoba. Leyo goba iqala lapho impande ye-aorta iqala khona. Le ngxenye iyinkimbinkimbi kakhulu.

• I-Aortic Valve: Yilapho i-valve esebenza njengesango ivumela khona igazi ukuthi ligeleze lisuka enhliziyweni liye ku-aorta, kodwa liyivimbele ukuthi igeleze libuye.
• Imithambo Yenhliziyo: Imithambo yegazi emibili ebaluleke kakhulu ehambisa igazi enhliziyweni iqala phansi kwale aorta.
• Ama-sinuses eValsalva: Leli igama elinikezwa ukuvuvukala okuncane okwakheka lapho kuqala khona imithambo yenhliziyo.

Uma sisebancane, zonke lezi zingxenye ziyaguquguquka kakhulu. Kodwa njengoba sikhula, lokhu kuguquguquka kuncipha. Yingakho kuvela ezinye izinkinga. Njengoba le ngxenye iyinkimbinkimbi kakhulu, ukuhlinzwa okwenziwa kuyo nakho kuyinkimbinkimbi. Kodwa-ke, ngosizo lodokotela abahlinzayo abanolwazi nabanekhono, lokhu kuhlinzwa kungenziwa ngempumelelo futhi inhliziyo yakho ingaphinde ibe nempilo enhle.

Ubani ngempela odinga lokhu kuhlinzwa?

Lokhu kuhlinzwa kuyadingeka kubantu abane-aneurysm ku-aorta esengozini yokuqhuma noma ukuqhekeka. Ngezinye izikhathi lokhu kuvela ngenxa yezinguquko ku-aorta njengoba iminyaka ikhula. Futhi, izimo zofuzo ezifana ne -Marfan syndrome kanye ne-Loeys-Dietz syndrome zingabangela ama-aneurysm abulalayo besebancane.

Cabanga nje, uma umuntu one-Marfan syndrome engatholi ukwelashwa, kunethuba elikhulu lokuqhuma kwe-aneurysm nokufa. Isilinganiso seminyaka yokufa kwabantu abakulelo qembu sineminyaka engaba ngu-32 ubudala. Kodwa, uma uthola lokhu kuhlinzwa, ungandisa isikhathi sakho sokuphila sibe ngesomuntu ojwayelekile.Ngakho-ke, uma kukhona emndenini wakho onalezi zinhlobo zezifo zofuzo, kubalulekile ukukhuluma nodokotela wakho ngengozi yakho bese unquma isikhathi esingcono kakhulu sokuhlinzwa.

Kwenzekani ngaphambi, ngesikhathi nangemva kokuhlinzwa?

Njengoba lokhu kuwukuhlinzwa okukhulu, kudinga ukulungiselela okuhle.

Ngaphambi kokuhlinzwa

Udokotela wakho uzokuhlola ngokuphelele. Uzokudlulisela kudokotela wamazinyo ukuze ahlolwe amazinyo. Ngaphezu kwalokho, bazokwenza izivivinyo eziningana, ezifana nalezi:

• Ukuhlolwa kwegazi: Hlola ukusebenza kwezinso.
• Ukuskena kwenhliziyo nge-CT noma nge-MRI: Lokhu kungahlola zonke izingxenye ze-aorta. Ezinye izinkinga ngezinye izikhathi zingalungiswa ngesikhathi sokuhlinzwa okufanayo.
• I-Coronary Angiography: Hlola isimo semithambo yenhliziyo ehambisa igazi enhliziyweni.
• I-Duplex Ultrasound: Ihlola isimo semithambo ye-carotid entanyeni. Izinkinga ngalezi zingandisa ingozi yokukhubazeka ngesikhathi sokuhlinzwa.

Futhi, udokotela wakho uzokubuza ngalezi zinto:

• Imithi oyithathayo: Kufanele utshele udokotela wakho nganoma yimiphi imithi noma amavithamini owathathayo. Eminye imithi ingadinga ukuthi uyeke ukuyithatha ngaphambi kokuhlinzwa.
• Ezinye izimo zezokwelapha: Uma unezinkinga zezokwelapha ezifana nomfutho wegazi ophakeme, kufanele zilawulwe kahle ngaphambi kokuhlinzwa.
• Isimo sakho samanje: Qiniseka ukuthi uyasitshela uma unesifo esithile, njengomkhuhlane noma umkhuhlane.
• Ukubhema: Ukubhema kufanele kuyekwe ngokuphelele okungenani inyanga eyodwa ngaphambi kokuhlinzwa.

Ngesikhathi sokuhlinzwa

Uzonikezwa i-anesthesia ukuze ulale ngokuphelele. Ngemuva kwalokho uzoxhunywa emshinini wenhliziyo namaphaphu (i-cardiopulmonary bypass) . Lo mshini uzokwenza umsebenzi wenhliziyo namaphaphu akho ngesikhathi sokuhlinzwa. Udokotela ohlinzayo uzobe eselandela lezi zinyathelo:

1. I-Median Sternotomy: Kusikwa phakathi kwesifuba ukuze kuhlukaniswe ithambo lesifuba (sternum) futhi kufinyelelwe enhliziyweni.

2. Ukususwa kwe-Aneurysm: Ingxenye ebuthaka nevuvukele ye-aorta iyasikwa bese isuswa.

3. Ukufakwa Kwesixhumi: Kufakwa umthambo wegazi wokwenziwa (i-graft) ukuze kuthathelwe indawo ingxenye esusiwe.

4. Ukufaka noma ukulondoloza ivalvu: Ufaka ivalvu esikhundleni sayo noma ufaka kabusha ivalvu yakho ngokwendlela ye-ARR noma ye-VSRR okukhulunywe ngayo ekuqaleni.

5. Ukufakelwa kwemithambo yenhliziyo nge-coronary bypass: Imithambo yenhliziyo ehambisa igazi enhliziyweni ixhunywe ku-graft entsha.

6. Ukuthunga i-incision: Ekugcineni, i-incision yesifuba iyathungwa ndawonye.

Lokhu kuhlinzwa kuvame ukuthatha amahora amane kuya kwayisithupha.

Ngemva kokuhlinzwa

Ngemva kokuhlinzwa, kuzodingeka uhlale egunjini lokunakekelwa okujulile (ICU) izinsuku ezimbalwa. Ngemuva kwalokho uzodluliselwa egunjini elijwayelekile. Ukuhlala esibhedlela konke kungathatha cishe isonto. Phakathi nalesi sikhathi:

• Ngizokunika imithi yokwelapha izinhlungu.
• Ungase uxhunywe emshinini ukuze ukusize uphefumule.
• Kugqokwa amasokisi akhethekile ukuvimbela ukuqhekeka kwegazi.
• Abanye abantu banikezwa imithi yokunciphisa igazi.

Ziyini izinzuzo, izingozi, kanye namazinga empumelelo okuhlinzwa?

Kufanele ubonane nini nodokotela?

Nakisisa umzimba wakho ngesikhathi sokululama kwakho. Uma ubona noma yikuphi kwalokhu okulandelayo , shayela udokotela wakho ngokushesha:

• Imibuzo ephathelene nokusikwa:
• Ubomvu, ubuhlungu, ukuvuvukala, noma ukufudumala eduze kwesilonda.
• Ibhandeji liba manzi kangangokuthi igazi noma uketshezi olucacile kuyaphuma.
• Ukuphuma kobomvu okuluhlaza noma okuphuzi.
• Izinhlangothi zomphetho ziyahlukana.
• Eminye imibuzo:
• Ubuhlungu esifubeni noma ubunzima bokuphefumula ngisho noma uphumule.
• Ukuvuvukala kwemilenze noma ukungakwazi ukuhambisa imilenze.
• Ukuzungeza, ukozela, noma ukukhathala okukhulu.
• Ukukhwehlela igazi noma ulwelwesi oluluhlaza/oluphuzi.
• Ukuba nomkhuhlane nokuthola umkhuhlane.
• Igazi esitulweni.

Kunini lapho kudingeka uye e-Emergency Treatment Unit (ETU)?

Uma une-aneurysm engelashwanga, iya emnyangweni wezimo eziphuthumayo esibhedlela esiseduze (i-ETU) ngokushesha uma uhlangabezana nezimpawu ezilandelayo. Lezi zingase zibe izimpawu ze-aneurysm eqhumile:

• Ubuhlungu obungazelelwe, obungabekezeleleki esifubeni noma emhlane ongaphezulu. Kungase kuzwakale sengathi kukhona okudatshulwa ngaphakathi emzimbeni.
• Ukujuluka nokuzizwa ukhululekile.
• Ubunzima bokuphefumula.
• Isiyezi noma ukuba nekhanda elibuthakathaka.
• Isilinganiso senhliziyo siyanda.
• Isicanucanu nokuhlanza.

Kuvamile ukuzizwa wesaba uma uzwa ngokuhlinzwa kwenhliziyo. Kodwa khumbula, lokhu kuhlinzwa kuyinto engasindisa impilo yakho futhi ikunike ithuba lokuphila impilo enempilo isikhathi eside. Udokotela wakho kanye nethimba lezokwelapha banolwazi ekwenzeni lolu hlobo lokuhlinzwa. Ngakho khuluma nabo nganoma yimiphi imibuzo noma ukwesaba ongase ube nakho.