Isixazululo sokuqhekeka kwegazi enhliziyweni? (Ukuvalwa kwe-Atrial Appendage kwesobunxele) Ake sifunde ngakho kalula!

Udokotela wakho ukutshelile yini ukuthi une-Atrial Fibrillation, ukushaya kwenhliziyo okusheshayo ngendlela engavamile? Cishe uyazi ukuthi abantu abanalesi simo banamathuba amathathu kuya kwahlanu okuba nesifo sohlangothi kunabanye. Isizathu esiyinhloko salokhu amahlule egazi akhiwa ngaphakathi kwenhliziyo. Ngakho-ke namuhla sikhuluma ngokwelashwa okukhethekile okulethe impumuzo enkulu kubantu abaningi futhi okusetshenziselwa ukunciphisa le ngozi eyingozi.

Kalula nje, kuyini ukuvalwa kwe-Left Atrial Appendage?

Kulungile, lokhu kungase kuzwakale njengegama eliyinkimbinkimbi, kodwa indaba ilula kakhulu. Cabanga nge-atrium yangakwesobunxele, igumbi eliphezulu lenhliziyo yethu. Kukhona ingxenye encane efana nesikhwama ephuma odongeni lwaleli gumbi. Yilokho odokotela abakubiza ngokuthi i-Left Atrial Appendage (LAA) .

Ngokuvamile, uma inhliziyo ishaya kahle, igazi ligeleza kulesi sikhwama bese liphuma futhi. Kodwa kumuntu one- Atrial Fibrillation (Afib), amakamelo aphezulu enhliziyo awanciphi kahle, kodwa kunalokho ayathuthumela. Bese, igazi liqoqana kuleso sikhwama esibizwa ngokuthi i-LAA, bese kuqala ukwakheka amahlule egazi. Ama-90% amahlule egazi abangela ukushaywa yisifo kubantu abane-Afib akha kulesi sikhwama esincane esibizwa ngokuthi i-LAA.

Into engcono kakhulu ukuthi ukuvala le ngxenye ye-LAA akuthinti ukusebenza kwenhliziyo okusele. Inhliziyo ingasebenza kahle ngaphandle kwayo.

Ubani odinga lokhu kwelashwa?

Lokhu kwelashwa kunconywa kakhulu kubantu abane-Atrial Fibrillation (Afib) abasengozini enkulu yokushaywa yisifo sohlangothi. Kuyisixazululo esihle kakhulu kulabo abanezinkinga ngemithi yokunciphisa igazi.

Odokotela bavame ukunikeza imithi yokunciphisa igazi efana ne -warfarin (Coumadin®) ukuze kuncishiswe ingozi yokushaywa yisifo sohlangothi. Kodwa abanye abantu banezinkinga ngale mithi:

• Ukuhlolwa kwegazi okuvamile: Udinga ukuhlolwa kwegazi okuvamile ukuqinisekisa ukuthi uthatha umthamo ofanele wemithi.
• Ukulawula ukudla: Okunye ukudla, njengemifino equkethe i-vitamin K, kungadingeka kuncishiswe.
• Ingozi yokopha: Lo muthi ungase unciphise inqubo yokopha ngisho noma kungokulimala okuncane. Lokhu kuyingozi kumuntu owela njalo noma osengozini yokopha emathunjini.
• Lomuthi awusebenzi kwabanye abantu.

I-Apixaban (Eliquis®), i-rivaroxaban (Xarelto®) ngaphandle kwe-warfarinNakuba kunemithi emisha efana nale, ayisebenzi kuwo wonke umuntu. Ibiza kakhulu kwabanye abantu, futhi inengozi yokopha.

Ngakho-ke, kulabo abakuthola kunzima ukuqhubeka nokuphuza imithi yokunciphisa igazi ngezizathu ezinjengalezi, ungakhuluma nodokotela wakho mayelana nokwelashwa okubizwa ngokuthi i-LAA Closure.

Yiziphi izindlela ezisetshenziswayo ukuvala i-LAA?

Kunezindlela namadivayisi ahlukahlukene okuvala le ngxenye ye-LAA. Ezinye zazo yilezi:

Ukulungiselela nokwenza ukwelashwa

Ngaphambi kokwelashwa

Ngaphambi kokuba wenze lokhu kwelashwa, udokotela wakho uzohlola inhliziyo yakho nge -Transesophageal Echocardiogram (TEE).Kwenziwa ukuskena okubizwa ngokuthi i-TEE noma i-cardiac CT scan. I-TEE ihilela ukufaka ikhamera encane phansi komphimbo ukuze kulinganiswe ukuma nobukhulu obuqondile be-LAA enhliziyweni. Lokhu kungenxa yokuthi akuwona wonke umuntu ofana ne-LAA. Ama-LAA abanye abantu abunjwe njengephiko lenkukhu, kanti ama-LAA abanye abunjwe njengebhabhathane. Lokhu kuskena kusetshenziselwa ukukhetha idivayisi nosayizi ofanele wena.

Ngaphezu kwalokho, uzokwaziswa ukuthi uyeke ukudla nokuphuza (ukuzila ukudla) amahora ambalwa ngaphambi kokwelashwa.

Ngesikhathi sokwelashwa

Kunezindlela ezimbili eziyinhloko zokwenza lokhu.

1. Ukukwenza ngesikhathi esifanayo nokunye ukuhlinzwa kwenhliziyo: Uma wenza okunye ukuhlinzwa okukhulu kwenhliziyo, njengokuhlinzwa kwe-bypass, udokotela ohlinzayo angase asike futhi asuse le ngxenye ye-LAA ngesikhathi esifanayo, noma ayithunge ivalwe.

2. Okungangeni Kakhulu: Lena yindlela evame kakhulu. Akukho ukusikwa okukhulu lapha. Nakhu okwenzekayo:

• Kwenziwa ukusika okuncane esikhumbeni eduze kwe-groin, bese kuthi ipayipi elincane elibizwa ngokuthi i-catheter lidluliselwe ngemithambo yegazi lapho liye enhliziyweni.
• Leli payipi lifakwa lisuka ku-atrium yesokudla yenhliziyo liye ku-atrium yesobunxele, ngembobo encane odongeni oluphakathi kwamakamelo amabili. (Ungakhathazeki, lembobo ivame ukuvala yodwa zingakapheli izinyanga eziyisithupha).
• Ipayipi libe selithuthukiswa liye ku-LAA, bese idivayisi ekhethiwe ngaphambilini iphoqeleka ukuvala umlomo we-LAA.
• Konke lokhu kwenziwa ngokubheka ngaphakathi ngezikrini ezifana ne -Fluoroscopy (ividiyo ye-X-ray) kanye ne -TEE .
• Uma umsebenzi usuqediwe, i-catheter iyakhishwa.

Kwenzekani ngemva kokwelashwa?

Uma lokhu kwelashwa kwenziwa ngokusikwa okuncane, cishe kuzodingeka uhlale esibhedlela ubusuku obubodwa bese uzokwazi ukuya ekhaya ngakusasa.

Uhlelo lwemithi luzoshintsha kancane ngemva kokuba usubuyele ekhaya.

• Ngokuvamile, ezinsukwini zokuqala ezingu-45 , uzotshelwa ukuthi uthathe umuthi wokulwa nokuvuvukala kanye ne-aspirin. Phakathi naleso sikhathi, izicubu zesikhumba zizokwakheka zizungeze idivayisi, ziyivale kahle.
• Uma ukuhlolwa kwe-TEE ngemva kwezinsuku ezingu-45 kuqinisekisa ukuthi i-LAA ivaliwe ngokuphelele, ungayeka ukuthatha imithi yokunciphisa igazi. Uzobe usunikwa i-clopidogrel (Plavix®) kanye ne-aspirin izinyanga ezingu-6 .
• Ngezinye izikhathi udokotela weluleka ukuthi kuthathwe i-aspirin isikhathi eside.

Yiziphi izinzuzo nezingozi?

Njenganoma yikuphi ukwelashwa kwezokwelapha, kunezinzuzo kanye nezingozi ezincane. Udokotela wakho uzokuchazela konke lokhu.

Kunini lapho udinga ukukhuluma nodokotela?

Uma uhlangabezana nanoma yiziphi izimpawu ezilandelayo ngemva kokuya ekhaya ngemva kokwelashwa, yazisa udokotela wakho ngokushesha.

• Umkhuhlane noma ezinye izimpawu zokutheleleka (ukuvuvukala, ukubomvu kwesilonda).
• Ukushaya kwenhliziyo okungajwayelekile, umuzwa wokuphaphazela esifubeni.
• Ubuhlungu obukhulu esifubeni.
• Ubunzima bokuphefumula.

Ukuphila ne-Afib kungaba yinto ekucindezelayo, ikakhulukazi uma unezinkinga ngemithi yakho yokunciphisa igazi. Ukuvalwa kwe-LAA akusikho okwawo wonke umuntu, kodwa kungaba yindlela ongakhetha kuyo. Ngakho-ke khuluma nodokotela wakho wenhliziyo, ubuze imibuzo yakho, bese wenza isinqumo esikulungele wena.