Kungenzeka ukuthi uke wezwa nge-Atrial Fibrillation (Afib), isimo lapho inhliziyo yakho ishaya khona ngokungajwayelekile nangokushesha. Mhlawumbe wena noma othile emndenini wakho unalesi simo. Ingozi enkulu ye-Afib ingozi eyengeziwe yesifo sohlangothi. Njengesixazululo salokhu, odokotela bavame ukunikeza imithi yokunciphisa igazi. Kodwa ukuthatha le mithi isikhathi eside akulula kuwo wonke umuntu. Kubantu abanjalo, sikhuluma ngendlela ekhethekile yokwelapha enganciphisa ingozi yesifo sohlangothi.
Kalula nje, kuyini ukuvalwa kwe-Left Atrial Appendage (LAA Closure)?
Ukuze siqonde lokhu, ake siqale sifunde ngengxenye encane yenhliziyo yethu. Ekamelweni eliphezulu kwesobunxele senhliziyo yethu, elibizwa ngokuthi i-Left Atrium, kukhona ukuvela okuncane okufana nesikhwama. Yilokhu esikubiza ngokuthi i-Left Atrial Appendage (LAA) .
Ngokuvamile, lapho inhliziyo ishaya ngesigqi, igazi elingaphakathi kwale LAA liphonswa liye engxenyeni esele yenhliziyo. Kodwa-ke, kumuntu one- Atrial Fibrillation (Afib) , inhliziyo ishaya ngokungajwayelekile, ngakho igazi elingaphakathi kwalesi sikhwama elibizwa ngokuthi i-LAA aliphonfi kahle bese liqala ukuhlangana. Lokhu kuhlangana kwegazi kungagcina kuphenduke amahlule egazi .
Ngeshwa, uma leli hlule liphuma bese libhajwa emthanjeni wegazi oholela ebuchosheni, lingabangela isifo sohlangothi . Cishe ama-90% ezinhlungu kubantu abane-Afib abangelwa ukwakheka kwamahlule ku-LAA.
Ngakho-ke, kulokhu kwelashwa okubizwa ngokuthi i-LAA Closure, isikhwama esibizwa ngokuthi i-LAA lapho kwakheka khona amahlule egazi avaleka khona, kungaba ngokuhlinzwa noma ngokusikwa okuncane kakhulu. Ngemva kokuthi lokhu kuvalwe, noma ngabe kwakheka amahlule egazi, awakwazi ukungena egazini. Ngakho-ke, ingozi yokushaywa yisifo sohlangothi incishiswa kakhulu.
Into ebalulekile ukuthi lokhu kwelashwa akuyilaphi i-Afib, kodwa kunciphisa kakhulu ingozi yokushaywa yisifo sohlangothi esibangelwa yiyo.
Ubani ofanele lolu hlobo lokwelashwa? Kungani ungasebenzisi imithi yokunciphisa igazi kuphela?
Ukuvalwa kwe-LAA akuyona indlela yokwelapha wonke umuntu osengozini enkulu yokushaywa yisifo sohlangothi ngenxa ye-Afib. Kucatshangelwa ikakhulukazi abantu aba:
- Kulabo abangafuni ukuthatha ama-anticoagulant isikhathi eside.
- Abantu abawa njalo futhi ngenxa yalokho basengozini enkulu yokopha (ngoba ngisho nokulimala okuncane kungabangela ukopha okukhulu lapho bethatha imithi yokunciphisa igazi).
- Kulabo ababhekana neminye imiphumela emibi evela emithini yokunciphisa igazi.
- Kulabo abangakwazi ukukhokhela imithi yokunciphisa igazi ebiza kakhulu.
Abantu abaningi babhekana nobunzima obuhlukahlukene lapho bethatha imithi emidala yokunciphisa igazi njengeWarfarin.
| Izinkinga zokuthatha imithi efana neWarfarin |
|---|
| - Udinga ukuya esibhedlela njalo ukuze uhlolwe igazi lakho ukuqinisekisa ukuthi umthamo wemithi ulungile. |
| - Ukudla okuthile okuqukethe i-vitamin K (njengesipinashi) kudingeka kuncishiswe. |
| - Ingozi yokopha iphezulu kakhulu. |
| - Imizimba yabanye abantu ayikwazi ukubekezelela lo muthi. |
Nakuba kunemithi emisha efana ne-Apixaban ne-Rivaroxaban, izindleko zayo eziphakeme kanye nengozi eqhubekayo yokopha kuyizinkinga kwabanye abantu. Kufanele nakanjani ukhulume nodokotela wakho wenhliziyo ukuze anqume ukuthi yikuphi ukwelashwa okukulungele.
Yiziphi izindlela ezisetshenziswayo ukuvala le LAA?
Kunezindlela namadivayisi ahlukahlukene alokhu. Cabanga ngakho njengokuvala umlomo webhodlela lamanzi, le divayisi isetshenziselwa ukuvala umlomo walesi sikhwama esibizwa nge-LAA.
- Amadivayisi okuvaleka kwangaphakathi: Lawa afana nesambulela esincane. Afakwa enhliziyweni kusetshenziswa i-catheter futhi asetshenziselwa ukuvala ukuvulwa kwe-LAA ngaphakathi. I-WATCHMAN™ kanye ne-Amulet™ amadivayisi adumile alolu hlobo.
- Amadivayisi okuvala angaphandle: Ngezinye izikhathi, ngesikhathi sokuhlinzwa kwenhliziyo okunye, i-LAA ingavalwa ngaphandle nge-clip (`AtriClip™`) noma nge-suture ekhethekile (`Lariat™`).
Indlela efanele wena ikhethwa ngemva kwengxoxo phakathi kwakho nodokotela wakho.
Ukulungiselela ukwelashwa kanye nendlela ukwelashwa okwenzeka ngayo
Ngaphambi kokwelashwa...
Ngaphambi kwale nqubo, udokotela wakho kuzodingeka alinganise usayizi kanye nesimo se-LAA yakho ngqo. Akuwona wonke umuntu ofana ne-LAA. Abanye bathi ibunjwe njengephiko lenkukhu, i-cactus, noma i-cauliflower. Lokhu kuzobandakanya i-Transesophageal Echocardiogram (TEE) (ukuskena kwenhliziyo okwenziwa ngepayipi elibizwa ngokuthi i-larynx) noma i -Cardiac CT scan. Uzophinde ufundiswe ukuthi uzile ukudla (ungadli noma uphuze) amahora ambalwa ngaphambi kwenqubo.
Ngesikhathi sokwelashwa...
Lokhu kungenziwa ngezindlela ezimbili eziyinhloko:
1. Ngolunye ukuhlinzwa kwenhliziyo:Uma wenza okunye ukuhlinzwa okukhulu kwenhliziyo, njengokuhlinzwa kwe-bypass, udokotela ohlinzayo angase asuse noma athunge i-LAA ngesikhathi esifanayo.
2. Okungangeni Kancane: Lena yindlela evame ukusetshenziswa kakhulu. Lapha, ipayipi elincane, elibizwa ngokuthi i-catheter, lifakwa nge-groin yakho lingene emthanjeni bese liqondiswa enhliziyweni yakho. Ngemuva kwalokho, kufakwa idivayisi ekhethiwe kusengaphambili embotsheni ye-LAA bese ivalwa ukuze kuvinjelwe amahlule egazi ukuba angaphumi. Lonke lolu hlelo lwenziwa ngaphansi kwesiqondiso sobuchwepheshe obukhethekile be-X-ray (Fluoroscopy) kanye ne-scan (TEE/Intracardiac Ultrasound).
Ngemva kokwelashwa...
- Ngokuvamile kufanele uhlale esibhedlela ubusuku bonke.
- Ukuskena kwe-TEE kuzokwenziwa futhi ezinsukwini ezingaba ngu-45 ukuze kubonakale ukuthi ukwelashwa kuphumelele yini.
- Uzonikezwa umuthi wokunciphisa igazi kanye ne-aspirin ukuze uwuthathe kuze kube yilapho izicubu zomzimba zikhula zizungeze le divayisi, okuthatha cishe inyanga nesigamu.
- Ngemva kwalokho, kuzodingeka uyeke ukuthatha umuthi wokunciphisa igazi bese uthatha i-Clopidogrel kanye ne-aspirin cishe izinyanga eziyisithupha. Kungase kudingeke nokuthi uphuze i-aspirin impilo yakho yonke. Konke lokhu kuzokwenziwa ngeseluleko sikadokotela wakho.
Yiziphi izinzuzo nezingozi zalokhu kwelashwa?
Njenganoma yiluphi uhlobo lokwelashwa, lolu lunezinzuzo kanye nezingozi.
| Izinzuzo | Izingozi/Izinkinga |
|---|---|
| Ingozi yokushaywa yisifo sohlangothi incishiswe kakhulu. | Inkinga ngedivayisi yokufaka. |
| Ukukwazi ukukhululeka ekuthatheni imithi yokunciphisa igazi isikhathi eside (ama-anticoagulant). | Ukusabela okungekuhle ekubulaweni yizinzwa. |
| Ukululama okusheshayo ngoba kwenziwa ngokusikwa okuncane. | Ukopha. |
| Ukuthuthukisa ikhwalithi yokuphila. | Ubuhlungu besifuba, ukutheleleka. |
| Ukuqongelela koketshezi oluzungeze inhliziyo (i-pericardial effusion). | |
| Isimo esingavamile kakhulu esifana nesifo sohlangothi. |
Lokhu kwelashwa kusebenza kahle kakhulu. Ngokwezinye izifundo, le ndlela inganciphisa ingozi yokushaywa yisifo sohlangothi cishe ngo-80%. Kodwa khumbula, kubalulekile ukuxoxa ngakho konke lokhu nodokotela wakho ngaphambi kokunquma ukuthi lokhu kulungile yini kuwe.
Kufanele ngimbone nini udokotela?
Ngaphezu kokuya emihlanganweni yakho yokulandelela ehleliwe, yazisa udokotela wakho ngokushesha uma uhlangabezana nezimpawu ezilandelayo:
- Izimpawu zomkhuhlane noma olunye ukutheleleka
- Ukushaya kwenhliziyo okungajwayelekile
- Ubuhlungu besifuba
- Ubunzima bokuphefumula
Uma uhlangabezana nanoma yiziphi zalezi zimpawu, hamba ngokushesha eMnyangweni Wezimo Eziphuthumayo (ETU).
Umlayezo Wokuya Nawe Ekhaya
- Ukuvalwa kwe-LAA kuyindlela yokwelapha abantu abane-Atrial Fibrillation (Afib) ukunciphisa ingozi yokushaywa yisifo sohlangothi.
- Lokhu kusebenza ngokuvala isikhwama esincane enhliziyweni esibizwa ngokuthi i-LAA, ukuvimbela amahlule egazi akheka lapho ukuthi angangeni emzimbeni.
- Lokhu kwelashwa kuyindlela enhle kulabo abangakwazi ukuthatha imithi yokunciphisa igazi isikhathi eside.
- Lokhu ngeke kwelaphe i-Afib, kodwa kungavimbela ingozi enkulu, okuyisifo sohlangothi.
- Yenza isinqumo ngemuva kokukhuluma nodokotela wakho wenhliziyo mayelana nokuthi lokhu kwelashwa kulungile yini kuwe nokuthi yiziphi izinzuzo nezingozi zako.
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