Ake sifunde ngokwelashwa kwe-valve ye-mitral (TMVR) ngaphandle kokuhlinzwa

Ingabe wena noma othile omaziyo noma umngane oseduze wake watshelwa udokotela ukuthi unenkinga nge-'Mitral Valve' yenhliziyo yakho nokuthi udinga ukuhlinzwa? Uma sizwa igama elithi "ukuhlinzwa kwenhliziyo," abaningi bethu bayasaba kancane, akunjalo? Lokho kuvamile. Ngoba sizwile ngokuhlinzwa okuhilela ukuvula isifuba nokwenza ukuhlinzwa okukhulu. Kodwa bewazi, isayensi yezokwelapha isithuthuke kakhulu manje. Ngakho-ke, kukhona indlela entsha engathatha indawo yale valve ngaphandle kokuvula isifuba nangokusikwa okuncane kakhulu. Namuhla, sizokhuluma ngendlela yokwelapha eye yaba impumuzo enkulu kubantu abaningi, ebizwa ngokuthi 'iTranscatheter Mitral Valve Replacement' noma i-TMVR ngamafuphi.

Kalula nje, iyini i-TMVR?

Kulungile, ake sikubeke kalula. I-TMVR inqubo ethatha indawo ye-valve ye-mitral enhliziyweni yakho. Kodwa into ekhethekile ngayo ukuthi ayenziwa ngokuvula isifuba sakho ngokuphelele njengokuhlinzwa kwenhliziyo evulekile. Esikhundleni salokho, kufakwa ipayipi elincane (i-catheter) ngomsikelo omncane kakhulu, bese i-valve entsha ifakwa enhliziyweni yakho.

Cabanga ukuthi esikhundleni sokususa ivalvu enkulu bese uyishintsha ngentsha, uthatha izingxenye zevalvu entsha ngembobo encane bese uzilungisa ngaphakathi. Lena inqubo engangenisi kakhulu kunokuhlinzwa okukhulu. Ivalvu entsha efakwa ngale ndlela ingaba yinto yokwenziwa. Noma ingaba ivalvu yemvelo eyenziwe ngezicubu zenhliziyo zenkomo, zengulube, noma zabantu. Ngemva kokufakwa kwevalvu entsha, iqala ukwenza into efanayo naleyo eyayenziwa yivalvu yakho endala, enesifo.

Ubani odinga lolu hlobo lokwelashwa nge-TMVR?

Ukuze siqonde lokhu, ake siqale sibheke ukuthi iyini le 'valvu ye-mitral' nokuthi kwenzekani kuyo.

Inhliziyo yethu inamakamelo amane amakhulu. Amabili phezulu namabili phansi. I-valve ye-mitral itholakala phakathi kwe-atrium yesobunxele kanye ne-ventricle yesobunxele. Ifana nomnyango ophakathi kwamakamelo amabili. Lo mnyango unama-flap amabili (amapheshana). Isikhathi ngasinye lapho inhliziyo ishaya, la ma-flap ayavuleka futhi avalwe. Lokhu kuvumela igazi ukuthi ligeleze ohlangothini olulodwa kuphela, lisuka ekamelweni eliphezulu liye ekamelweni elingezansi. Umsebenzi oyinhloko waleli valve ukuvimbela igazi ukuthi ligeleze emuva.

Kodwa ngezinye izikhathi, kungaba kusukela ekuzalweni noma kamuva, izinkinga ezahlukahlukene zingavela ngale valve. Kunezinhlobo ezimbili zezinkinga ngokuyinhloko.

Uma lezi zimo ziba zimbi kakhulu, zingadala izimpawu ezifana nokuphelelwa umoya, ukukhathala, kanye nobuhlungu besifuba. Zingaphinde ziholele ezimweni ezingathi sína njenge-atrial fibrillation (ukushaya kwenhliziyo okungajwayelekile), umfutho wegazi ophezulu wamaphaphu (umfutho wegazi ophezulu emaphashini), noma ukwehluleka kwenhliziyo.

Ingabe i-TMVR ne-MitraClip ziyinto efanayo?

Cha. Nakuba zombili ziyindlela yokwelapha engangenisi kakhulu izinkinga ze-mitral valve, kunomehluko phakathi kwazo zombili.

• I-TMVR iyindlela yokufaka esikhundleni se-valve ephelele .
• I-MitraClip™ iwukulungiswa kwevalvu. Kufana nokubeka i-clip encane phakathi kwezimbobo ezimbili zevalvu evuzayo, ukuvimba ukuvuza.

Udokotela wakho wenhliziyo uzonquma ukuthi yikuphi ukwelashwa okungcono kakhulu kuwe.

Kwenzekani ngaphambi kokwelashwa nge-TMVR?

Ngaphambi kwalokhu kwelashwa, ithimba lakho lezokwelapha lizokuhlola ngokucophelela. Lokhu kuzobandakanya kakhulu ukuhlolwa okulandelayo:

• I-Echocardiogram: Lokhu ukuskena kwenhliziyo nge-ultrasound. Kungabona ngokucacile ukuthi amakamelo nama-valve enhliziyo asebenza kanjani.
• I-CT Scan: Lokhu kuthatha izithombe zenhliziyo nemithambo yegazi ezinezinhlangothi ezintathu (3D) futhi kusiza ukuhlela ukwelashwa.

Besebenzisa ulwazi oluvela kulezi zivivinyo, ithimba lezokwelapha lihlela usayizi wevalvu engcono kakhulu kanye nendlela yokwelapha.

Ngaphezu kwalokho, udokotela wezinzwa uzokhuluma nawe futhi anqume uhlobo olungcono kakhulu lwe-anesthesia ukuze akuvimbele ukuthi uzizwe ubuhlungu ngesikhathi senqubo. Ungase ulale ngokuphelele (i-anesthesia ejwayelekile), noma ungase ulale ungazizwa ubuhlungu (i-hypothesis).

Ezinsukwini ezimbalwa ngaphambi kokwelashwa kwakho, udokotela wakho uzokunikeza imiyalelo ecacile yokuthi ungalungiselela kanjani. Lokhu kungafaka:

• Eminye imithi, njengemithi yokunciphisa igazi, ingadinga ukuyekiswa izinsuku ezimbalwa.
• Ngosuku lokwelashwa, uzocelwa ukuba uzile ukudla (ngaphandle kokudla noma ukuphuza) amahora ambalwa.
• Ngemva kokwelashwa, bacela ukuhlela imoto ezokuthatha ikuyise ekhaya usuka esibhedlela.

Kwenzekani ngesikhathi sokwelashwa nge-TMVR?

Yonke inqubo ivame ukuthatha cishe amahora amabili kuya kwamathathu futhi yenziwa yithimba elikhulu lodokotela, okuhlanganisa odokotela abahlinza inhliziyo, odokotela benhliziyo abangenelelayo, ochwepheshe bezithombe, kanye nodokotela ababulala izinzwa.

Nasi incazelo elula yesinyathelo ngesinyathelo yalokho okwenzekayo ngesikhathi sokwelashwa:

1. Okokuqala, indawo lapho kuzosikwa khona (ngokuvamile i-groin noma indawo encane esifubeni) iyahlanzwa bese izinwele zisuswa uma kudingeka.

2. Ngemuva kwalokho, i-cannula (umugqa we-IV) izofakwa emthanjeni ongalweni yakho, lapho uzonikezwa khona imithi edingekayo kanye noketshezi.

3. Okulandelayo, ivalvu entsha inamathiselwa ekugcineni kwepayipi elincane neliguquguqukayo elibizwa ngokuthi i-catheter .

4. Manje, kwenziwa ukusika okuncane kakhulu endaweni ethile endukwini noma esifubeni, futhi ngaleyo ndlela, le catheter ifakwa emthanjeni wegazi.

5. Besebenzisa ubuchwepheshe obukhethekile bokuthwebula izithombe, njenge-X-ray, odokotela baqondisa ngokucophelela le catheter ngemithambo yegazi iye ku-valve ye-mitral enhliziyweni.

6. Uma isikhona, ivalvu entsha ifakwa ngaphakathi kwevalvu endala, enesifo.

7. Uma ivalvu entsha isisendaweni efanele, i-catheter isuswa ngokucophelela bese inxeba elincane livalwa.

Phakathi nalesi sikhathi, ithimba lezokwelapha lizoqhubeka nokuqapha konke kusukela ekucindezelweni kwegazi lakho kanye namazinga e-oxygen egazini kuya endleleni inhliziyo yakho esebenza ngayo kusetshenziswa i-echocardiogram.

Kwenzekani ngemva kokwelashwa?

Ngemva kokuphela kokwelashwa, uzoyiswa ekamelweni lokululama. Ithimba lezokwelapha lizokunakekela kahle uze ululame ekubulaweni yizinzwa. Abanye abantu kungadingeka bahlale egunjini lokunakekelwa okujulile (ICU) isikhashana. Ngokuvamile, kuzodingeka uhlale esibhedlela izinsuku ezimbalwa.

Ngaphambi kokuba uye ekhaya, odokotela bazochaza ngokucacile ukuthi yini okudingeka uyenze ngokulandelayo.

• Ukuvuselelwa kwenhliziyo: Iseluleko ngokuzivocavoca kanye nokushintsha indlela yokuphila ukusiza ukuqinisa inhliziyo futhi.
• Ama-aphoyintimenti okulandelela: Izinsuku okudingeka ubuye uzobona udokotela.
• Imithi: Iseluleko ngemithi emisha yokuqala noma imithi emidala yokuqala kabusha.
• Umsebenzi ojwayelekile: Ungabuyela nini emsebenzini bese uqhubeka nemisebenzi ejwayelekile?

Yiziphi izinzuzo zokwelashwa nge-TMVR?

Uma kuqhathaniswa nokuhlinzwa kwenhliziyo okuvulekile, le ndlela ye-catheter inezinzuzo eziningana.

• Isifo se-valve ye-mitral singalungiswa.
• Ukuncipha kwezimpawu ezibangelwa yilesi sifo, njengokuphelelwa umoya nokukhathala.
• Ukunciphisa ingozi yezinkinga ezinkulu zempilo.
• Uyakwazi ukululama ngokushesha kunokuhlinzwa okuvulekile.
• Ukunciphisa umthelela emzimbeni nasebuhlungwini.

Ingabe kukhona izingozi noma izinkinga ngalokhu kwelashwa?

Yebo. Nakuba izingozi ziphansi kunokuhlinzwa kwenhliziyo okuvulekile, njenganoma iyiphi inqubo yezokwelapha, i-TMVR ingaba nezingozi nezinkinga ezithile. Kodwa-ke, lezi azivamile.

Lezi ezinye zezinkinga ezinkulu ezingase zenzeke:

• Amahlule egazi: Uma la mahlule egazi eya ebuchosheni, kungenzeka isifo sohlangothi.
• Ukulimala kwezicubu: Udonga lwenhliziyo (ukubhoboka kwe-ventricular kwesobunxele) noma umthambo wegazi ohlinzeka ngegazi enhliziyweni (umthambo we-coronary) lungase luhluleke.
• Ukuvaleka kwendlela yokuphuma kwegazi kwe-ventricular yangakwesobunxele: I-valve entsha ivimba indlela yokugeleza kwegazi ephuma ekamelweni eliphansi langakwesobunxele.
• Ukunyakaza kwevalvu: Ukunyakaza kwevalvu kusuka endaweni yayo eqinile.

Ezinye izinkinga zingadinga ukwelashwa okwengeziwe noma ukuhlinzwa.

Kuthatha isikhathi esingakanani ukululama?

Iningi labantu lingabuyela emisebenzini yalo evamile futhi lisebenze zingakapheli amasonto ambalwa. Kodwa-ke, kungathatha izinyanga ezimbili kuya kwezintathu ukululama ngokuphelele . Into ebaluleke kakhulu ukulandela imiyalelo kadokotela wakho ngokucophelela. Ungasheshi ukwenza umsebenzi onzima noma umsebenzi onzima.

Kukuziphi izimo lapho kufanele ufune khona iseluleko sezokwelapha ngemva kokwelashwa?

Lena yingxenye ebaluleke kakhulu. Uma ubuyela ekhaya ngemva kokwelashwa, kufanele unake izinguquko emzimbeni wakho. Kunezimpawu ezithile, uma zivela, kufanele ufune iseluleko sezokwelapha ngokushesha .

I-TMVR iyindlela yokwelapha ewusizo kakhulu kubantu abanesifo se-mitral valve abangakwazi ukuhlinzwa inhliziyo. Uma uneminye imibuzo mayelana nalokhu, sicela ukhululeke ukukhuluma nodokotela wakho. Uzokwazi ukuchaza indlela yokwelapha engcono kakhulu kuwe.