Ake sifunde ngokuhlinzwa kwakamuva okusindisa ivalvu yenhliziyo (i-Valve-Sparing Aortic Root Replacement).

Ingabe udokotela ukutshelile ukuthi udinga ukuhlinzwa kwenhliziyo? Kuvamile ukuzizwa wesaba kancane uma esho lokho. Kodwa namuhla, ezokwelapha sezithuthuke kakhulu. Kunezinye izindlela zokuhlinzwa ezizama ukuvikela izingxenye eziningi zomzimba wakho ngangokunokwenzeka. Namuhla sizokhuluma ngokuhlinzwa okukhethekile kangaka. Okungukuthi, i-valve yenhliziyo, okuwukuhlinzwa okuvikela i-valve.

Kalula nje, kuyini ukuhlinzwa kwe-Valve-Sparing?

Kulungile, ukuze siqonde lokhu, ake siqale sifunde ngengxenye encane yenhliziyo yethu. Igumbi eliyinhloko lokupompa lenhliziyo yethu (i-ventricle yesobunxele) lixhuma emthanjeni wegazi omkhulu kunayo yonke emzimbeni wethu, i-aorta. Lokhu kuxhumana sikubiza ngokuthi 'Impande ye-Aortic'. Kufana nempande yesihlahla. Ngaphakathi kwale 'mpande ye-Aortic' kunesango elibaluleke kakhulu, 'i-Aortic Valve'.

Njalo uma inhliziyo ishaya, le 'Aortic Valve' iyavula futhi ipompe igazi emzimbeni, bese ivala. Lokhu kuvala kuvimbela igazi ukuthi libuyele enhliziyweni.

Manje cabanga, kwabanye abantu, 'Impande ye-Aortic', okungukuthi, ingxenye yesango ebukeka njengesango, isibuthakathaka, ivuvukile, futhi yaba nkulu. Kufana nebhaluni elivuvukele. Lokhu sikubiza ngokuthi 'i-Aortic Root Aneurysm'. Uma leli sango liba likhulu, umnyango okulo, okungukuthi, i-'Aortic Valve', awuvaleki kahle. Bese igazi liqala ukuvuza libuyele enhliziyweni. Lokhu kubizwa ngokuthi 'i-Aortic Regurgitation'.

Ekuhlinzeni okuvamile (inqubo ethi `Bentall`), odokotela abahlinzayo basusa kokubili i-`Aortic Root` evuvukele kanye ne-`Aortic Valve` bese befaka ezimbili ezintsha zokwenziwa.

Inzuzo enkulu yalokhu ukuthi ungagcina ivalvu yakho, ngakho-ke awudingi ukuthatha imithi yokubulala amanxeba impilo yakho yonke (njengeCoumadin) njengoba ubungenza ngevalvu yomshini.

Yiziphi izimo ezelaphayo lokhu kuhlinzwa?

Lokhu kuhlinzwa kwenziwa kakhulu ezimweni ezilandelayo:

• I-Aortic Root Aneurysm: Njengoba ngishilo ekuqaleni, lokhu kuwukuvuvukala okungavamile empandeni ye-aorta okuxhuma enhliziyweni. Uma lokhu kuba kukhulu kakhulu, kungaqhuma ngokuzumayo (`Ukuqhekeka kwe-Aortic` noma Ukuqhekeka). Kuyingozi kakhulu empilweni.
• I-Aneurysm Ekhuphukayo Ye-Aortic Ene-Dilated Aortic Sinuses: Amacala lapho izikhala ezincane zemvelo 'ku-Aortic Root' (`Aortic Sinuses`) zikhula kancane, kube nokuvuvukala engxenyeni ekhuphukayo ye-aorta.

Abantu abanezifo ezithile zezicubu ezixhumeneyo ezizuzwe njengefa, njenge-Marfan syndrome, basengozini enkulu yokuthola i-aortic root aneurysm. Ngakho-ke, odokotela abahlinzayo bahlola ngokucophelela isimo sesiguli futhi balinganise izinzuzo nezingozi zokuhlinzwa ngaphambi kokunquma ukuthi kufanelekile yini.

Ingabe uyakufanelekela lokhu kuhlinzwa?

Uma i-valve yakho ye-aortic inalezi zici, ungase ube yilungu lalolu hlinzeko:

• Uma kukhona i-calcium deposits encane kakhulu noma ingekho nhlobo ku-valve.
• Ngaphandle kokuthi ivalvu yonakele kakhulu.
• Uma ivalvu isebenza kahle noma ingalungiswa ngokulungiswa okuncane.

Uzilungiselela kanjani ngaphambi kokuhlinzwa?

Udokotela wakho ohlinzayo uzochaza konke okudingeka ukwenze ngaphambi kokuhlinzwa. Kubaluleke kakhulu ukulandela leyo miyalelo ngqo. Ngokuvamile, yilokhu okuzodingeka ukwenze.

Ngaphezu kwalokho, udokotela uzokwenza izivivinyo eziningana ukuhlela ukuhlinzwa, njengokuthi:

• I-Echocardiogram (ukuskena kwenhliziyo)
• Ukuhlolwa kwegazi
• `I-CT scan egadwe yinhliziyo nesifuba`
• I-Angiogram ye-Coronary
• Ukuhlolwa kwegazi ngofuzo uma kusolwa ukuthi unesifo esizuzwe njengefa

Kwenzekani ngesikhathi sokuhlinzwa?

Lokhu kuhlinzwa kuvame ukuthatha phakathi kwamahora ama-4 nayi-6. Uma udokotela ohlinzayo onolwazi enza lokhu kuhlinzwa, inhliziyo kufanele imiswe cishe ihora. Ungakhathazeki, phakathi naleso sikhathi, umshini uzokwenza umsebenzi wenhliziyo namaphaphu.

Nakhu okwenzekayo isinyathelo ngesinyathelo:

1. I-Anesthesia: Okokuqala, uzolaliswa ngokuphelele. Ngakho ngeke uzwe ubuhlungu.

2. Ukuvula isifuba: Udokotela ohlinzayo wenza i-incision phakathi kwesifuba (i-'median sternotomy') ukuze afinyelele inhliziyo.

3. Ukuxhuma kuMshini Wenhliziyo Namaphaphu: Uzoxhunywa kumshini we-`Cardiopulmonary Bypass`. Lo mshini uzothatha umsebenzi wenhliziyo namaphaphu akho ngesikhathi sokuhlinzwa. Ngalesi sikhathi, kuzonikezwa umuthi obizwa ngokuthi isixazululo senhliziyo` ukuze umise inhliziyo yakho okwesikhashana.

4. Ukukhulula i-Valve: Udokotela ohlinzayo uhlukanisa ngokucophelela i-aortic valve yakho nezicubu ezizungezile.

5. Ukususwa kwezingxenye ezonakele: `Impande ye-Aortic` evuvukele kanye nezinye izingxenye ezonakele ziyasikwa bese zisuswa.

6. I-Graft: Ipayipi lokwenziwa ('i-graft') lifakwa esikhundleni sengxenye esusiwe. Lokhu kwenziwa ngendwangu ekhethekile ('i-polyester').

7. Ukufakelwa kabusha kwevalvu: Ivalvu yakho ye-aorta iyathathwa, kufakwa i-graft entsha, bese ifakwa endaweni yayo.

8. Ukuhlola iValvu: Ukuqinisekisa ukuthi konke kuhamba kahle, kudluliswa uketshezi ku-'Graft' ukuze kuhlolwe ukuthi ivalvu isebenza kahle, iyavuleka futhi iyavaleka.

9. Isinyathelo sokugcina: Imithambo yenhliziyo yenhliziyo ixhunywe ku-'Graft' entsha. Bese ukhishwa ku-'Heart-Lung Machine' bese inhliziyo yakho ivunyelwa ukuthi isebenze futhi. Bese ukusika kwesifuba kuvalwa.

Amasu okuhlinzwa esimanje (Ukufakelwa kabusha okuguquliwe)

Ngokuhamba kwesikhathi, odokotela abahlinzayo bangeze amasu amasha ukuze lokhu kuhlinzwa kuphumelele kakhulu. Isibonelo:

• Ukudala Ama-Sinuse Amasha E-Aortic (`Neosinuses`): Ngokuvamile, i-`Graft` iyipayipi eliqondile. Kodwa i-`Aortic Root` yemvelo inezikhala ezincane (`sinuses`). Ngendlela entsha, izikhala ezinjalo zakhiwa ngokwenziwa ku-`Graft`. Lokhu kwenza ukugeleza kwegazi kube ngokwemvelo, futhi umonakalo we-valve uyancipha.
• Usayizi we-Aortic Annulus: Usayizi wengxenye efana nendandatho ivalvu ehlala kuyo (i-`aortic annulus`) ilungiswa ukuze ivumelane nosayizi womzimba wakho. Lokhu kunciphisa ingozi yokuvuza kwegazi kusuka kuvalvu esikhathini esizayo.

Kwenzekani ngemva kokuhlinzwa? Futhi kuthatha isikhathi esingakanani ukululama?

Ngemva kokuhlinzwa, uzogcinwa egunjini lokunakekelwa okujulile (ICU) usuku olulodwa noma ezimbili, bese udluliselwa egunjini elivamile. Ngokuvamile ungaya ekhaya ezinsukwini ezi-4 kuya kweziyi-7.

Ngisho noma unelayisensi yokushayela, ungashayeli kuze kube yilapho udokotela wakho ekunike imvume. Kuzodingeka ulinde okungenani amasonto ayisithupha ngaphambi kokwenza noma yini efana nokuphakamisa izinsimbi noma ukuya emsebenzini.

Ukubamba iqhaza ohlelweni lokuvuselelwa kwenhliziyo (`cardiac rehab`) kuzokusiza ukuthi ululame ngokushesha. Futhi, qiniseka ukuthi uya kuma-aphoyintimenti okulandelela nodokotela wakho. Bazoqhubeka nokuqapha isimo senhliziyo yakho.

Yiziphi izingozi nezinzuzo zalokhu kuhlinzwa?

Njenganoma yikuphi ukuhlinzwa okukhulu, kunezingozi ezithile ezihilelekile. Kodwa-ke, uma kwenziwa udokotela ohlinzayo onolwazi esibhedlela esinezikhungo ezinhle, lezi zingozi zincane kakhulu .

Izinzuzo eziyinhloko:

• Akudingeki ukuthi uphuze imithi yokunciphisa igazi impilo yakho yonke.
• Ingozi yokuqhekeka kwegazi, isifo sohlangothi, kanye nokutheleleka kwe-valve (i-endocarditis) iyancipha.
• Amathuba okuthi kudingeke ukuthi kuhlinzwe ukuze kuphinde kushintshwe ivalvu esikhathini esizayo aphansi kakhulu.

Ucwaningo lukhombisile ukuthi izinga lempumelelo yalokhu kuhlinzwa lingaphezu kuka-99%. Ngisho nangemva kweminyaka eyi-10, cishe abantu abangu-95% abaye bahlinzwa ngeke badinge okunye ukuhlinzwa.

Uma unezinye zalezi zimpawu, shayela udokotela wakho ngokushesha noma uye eMnyangweni Wezimo Eziphuthumayo (i-ETU) wesibhedlela esiseduze.