Ukuhlukaniswa kwe-aortic

Ukuhlukaniswa kwe-aortic yisimo esibi lapho kuba khona izinyembezi odongeni lomthambo omkhulu okhipha igazi enhliziyweni (aorta). Njengoba izinyembezi zanda odongeni lwe-aorta, igazi lingagobhoza phakathi kwezingqimba zodonga lomthambo wegazi (ukuhlukaniswa). Lokhu kungaholela ekuqhekekeni kwe-aortic noma ekwehliseni ukugeleza kwegazi (ischemia) ezithweni.

Lapho ishiya inhliziyo, i-aorta kuqala inyuka iye esifubeni iye ekhanda (i-aorta ekhuphukayo). Bese iyagoba noma imengamo, bese ekugcineni yehle iye esifubeni nasesiswini (i-aorta eyehlayo).

Ukuhlukaniswa kwe-aortic kuvame ukwenzeka ngenxa yezinyembezi noma ukulimala odongeni lwangaphakathi lwe-aorta. Lokhu kuvame ukwenzeka engxenyeni yesifuba (thoracic) yomthambo, kepha futhi kungenzeka naku-aorta yesisu.

Lapho ukukhala kwenzeka, kudala iziteshi ezi-2:

• Enye lapho igazi liqhubeka nokuhamba khona
• Enye lapho igazi lihlala khona linganyakazi

Uma isiteshi esinegazi elingahambi siba sikhulu, singacindezela kwamanye amagatsha e-aorta. Lokhu kunganciphisa amanye amagatsha futhi kunciphise ukuhamba kwegazi kuwo.

Ukuhlukaniswa kwe-aortic nakho kungadala ukwanda okungavamile noma ukubhaliswa kwe-aorta (aneurysm).

Imbangela ngqo ayikaziwa, kepha izingozi ezejwayelekile zifaka phakathi:

• Ukuguga
• I-atherosclerosis
• Ukuhlukumezeka okungaqondakali esifubeni, njengokushaya isondo lokushayela lemoto ngesikhathi sengozi
• Umfutho wegazi ophezulu

Ezinye izinto ezinobungozi nezimo ezixhunyaniswe nokuhlukaniswa kwe-aortic kufaka:

• I-bicuspid aortic valve
• Ukuhlangana (ukuncipha) kwe-aorta
• Izinkinga zezicubu ezixhunyiwe (njengeMarfan syndrome ne-Ehlers-Danlos syndrome) kanye nokuphazamiseka kofuzo okungavamile
• Ukuhlinzwa kwenhliziyo noma izinqubo
• Ukukhulelwa
• Ukuvuvukala kwemithambo yegazi ngenxa yezimo ezifana ne-arteritis ne-syphilis

Ukuhlukaniswa kwe-aortic kwenzeka cishe kubantu aba-2 kwabangu-10 000. Kungathinta noma ngubani, kepha kuvame ukubonwa emadodeni aneminyaka engama-40 kuye kwengama-70.

Ezimweni eziningi, izimpawu ziqala ngokuzumayo, futhi zibandakanya ubuhlungu obukhulu besifuba. Ubuhlungu bungazizwa njengokuhlaselwa yinhliziyo.

• Ubuhlungu bungachazwa njengokubukhali, ukugwaza, ukudwengula, noma ukudwengula.
• Izwakala ngaphansi kwethambo lesifuba, bese ihamba ngaphansi kwamahlombe noma emuva.
• Ubuhlungu bungadlulela ehlombe, entanyeni, engalweni, emhlathini, esiswini noma okhalweni.
• Ubuhlungu buyashintsha isikhundla, imvamisa buya ezingalweni nasemilenzeni njengoba ukuhlukaniswa kwe-aortic kuba kubi kakhulu.

Izimpawu zidalwa ukwehla kwegazi eligelezela kuwo wonke umzimba, futhi kungafaka:

• Ukukhathazeka nomuzwa wokulahlwa
• Ukuquleka noma isiyezi
• Ukujuluka okunzima (isikhumba se-clammy)
• Isicanucanu nokuhlanza
• Isikhumba esiphaphathekile (i-pallor)
• Ishayela ngokushesha, ebuthakathaka
• Ukuphefumula okuncane nokuphefumula kanzima lapho ulele phansi (i-orthopnea)

Ezinye izimpawu zingafaka:

• Ubuhlungu esiswini
• Izimpawu zesifo sohlangothi
• Ukugwinya ubunzima kusuka ekucindezelweni komphimbo

Umhlinzeki wezempilo uzothatha umlando womndeni wakho futhi alalele inhliziyo yakho, amaphaphu, nesisu nge-stethoscope. Ukuhlolwa kungathola:

• Ukububula "okushayayo" nge-aorta, ukububula kwenhliziyo, noma omunye umsindo ongajwayelekile
• Umehluko kumfutho wegazi phakathi kwengalo yangakwesokudla nengakwesobunxele, noma phakathi kwezingalo nemilenze
• Umfutho wegazi ophansi
• Izimpawu ezifana nesifo senhliziyo
• Izimpawu zokushaqeka, kepha ngomfutho wegazi ojwayelekile

Ukuhlukaniswa kwe-aortic noma i-aortic aneurysm kungabonakala ku:

• I-aortic angiography
• I-x-ray yesifuba
• I-MRI yesifuba
• Ukuhlolwa kwesifuba kwe-CT ngombala
• I-Doppler ultrasonography (eyenziwa ngezikhathi ezithile)
• I-Echocardiogram
• I-Transceophageal echocardiogram (TEE)

Umsebenzi wegazi ukukhipha isifo senhliziyo kuyadingeka.

Ukuhlukaniswa kwe-aortic kuyisimo esisongela impilo futhi kudinga ukwelashwa ngokushesha.

• Ukuphazamiseka okwenzeka engxenyeni ye-aorta eshiya inhliziyo (ekhuphuka) kuyelashwa ngokuhlinzwa.
• Ukuphazamiseka okwenzeka kwezinye izingxenye ze-aorta (ukwehla) kungaphathwa ngokuhlinzwa noma ngemithi.

Amasu amabili angasetshenziselwa ukuhlinzwa:

• Ukuhlinzwa okujwayelekile, okuvulekile. Lokhu kudinga ukusikeka okwenziwe esifubeni noma esiswini.
• Ukulungiswa kwe-aortic ye-Endovascular. Lokhu kuhlinzwa kwenziwa ngaphandle kokuqhekeka okukhulu kokuhlinzwa.

Izidakamizwa ezingahle zinciphise umfutho wegazi. Le mithi inganikezwa ngomthambo (ngemithambo yegazi). Ama-beta-blockers yizidakamizwa zokuqala ezizikhethelayo. Kudingeka kakhulu ukudambisa izinhlungu okuqinile.

Uma i-aortic valve yonakele, kuyadingeka ukushintshwa kwe-valve. Uma kuthinteka imithambo yenhliziyo, ukwenziwa kwe-coronary bypass kuyenziwa futhi.

Ukuhlukaniswa kwe-aortic kusongela impilo. Isimo singalawulwa ngokuhlinzwa uma senziwa ngaphambi kokuthi kuqhume i-aorta. Ngaphansi kwengxenye eyodwa yabantu abane-aorta eqhekekile bayasinda.

Labo abasindayo bazodinga ukwelashwa impilo yonke nolaka lomfutho wegazi ophakeme. Bazodinga ukulandelwa ngezikena ze-CT njalo ezinyangeni ezimbalwa ukuqapha i-aorta.

Ukuhlukaniswa kwe-aortic kungancipha noma kumise ukugeleza kwegazi kuya ezingxenyeni eziningi zomzimba. Lokhu kungaholela ezinkingeni zesikhashana noma zesikhathi eside, noma ukulimala ku:

• Ubuchopho
• Inhliziyo
• Amathumbu noma amathumbu
• Izinso
• Imilenze

Uma unezimpawu ze-aortic dissection noma ubuhlungu obukhulu besifuba, shayela u-911 noma inombolo yakho ephuthumayo yasendaweni, noma uye egumbini lezimo eziphuthumayo ngokushesha okukhulu.

Amacala amaningi wokuhlukaniswa kwe-aortic awanakuvinjelwa.

Izinto ongazenza ukunciphisa ubungozi bakho zifaka:

• Ukwelapha nokulawula ukuqina kwemithambo (i-atherosclerosis)
• Ukugcina umfutho wegazi ophakeme ulawulwa, ikakhulukazi uma usengozini yokuhlinzwa
• Ukuthatha izinyathelo zokuphepha ukuvimbela ukulimala okungadala ukuhlukana
• Uma utholwe une-Marfan noma i-Ehlers-Danlos syndrome, uqinisekisa ukuthi ulandela njalo umhlinzeki wakho

I-aortic aneurysm - ukuhlakaza; Ubuhlungu besifuba - ukuhlukaniswa kwe-aortic; I-aneurysm ye-Thoracic aortic - ukuhlukaniswa kwemisipha

• Ukuqhuma kwe-aorta - i-x-ray yesifuba
• I-aortic aneurysm
• Ukuhlukaniswa kwe-aortic

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IConrad MF, iCambria RP. Ukuhlukaniswa kwe-aortic: i-epidemiology, i-pathophysiology, isethulo somtholampilo, kanye nokuphathwa kwezokwelapha nokuhlinzwa. Ku: Sidawy AN, Perler BA, ama-eds. Rutherford’s Vascular Surgery and Endovascular Therapy. Umhlaka 9. IPhiladelphia, PA: Elsevier; 2019: isahluko 81.

ILederle FA. Izifo ze-aorta. Ku: IGoldman L, iSchafer AI, ama-eds. Imithi yeGoldman-Cecil. Umhla ka-26. IPhiladelphia, PA: Elsevier; 2020: isahluko 69.