Ukukhubazeka kwenhliziyo okuzalwa - ukuhlinzwa okulungisa

Ukuhlinzwa kokulungiswa kokukhubazeka kwenhliziyo kulungisa noma kulapha ukukhubazeka kwenhliziyo ingane ezalwa nakho. Ingane ezalwe inenkinga yenhliziyo eyodwa noma ngaphezulu inesifo senhliziyo esizalwe naso. Ukuhlinzwa kuyadingeka uma isici singalimaza impilo yesikhathi eside yengane noma inhlalakahle.

Kunezinhlobo eziningi zokuhlinzwa kwenhliziyo yezingane.

Ukuhlanganiswa kwe-Patent ductus arteriosus (PDA):

• Ngaphambi kokuzalwa, ingane inesitsha segazi esihamba phakathi kwe-aorta (umthambo omkhulu oya emzimbeni) nomthambo wamaphaphu (umthambo oyinhloko oya emaphashini), obizwa ngokuthi i-ductus arteriosus. Lo mkhumbi omncane uvame ukuvalwa ngemuva nje kokuzalwa lapho ingane iqala ukuziphefumlela yodwa. Uma ingavali. Ibizwa ngokuthi i-patent ductus arteriosus. Lokhu kungadala izinkinga kamuva empilweni.
• Ezimweni eziningi, udokotela uzovala ukuvula esebenzisa umuthi. Uma lokhu kungasebenzi, kusetshenziswa amanye amasu.
• Kwesinye isikhathi i-PDA ingavalwa ngenqubo engabandakanyi ukuhlinzwa. Inqubo ivame ukwenziwa elabhoratri esebenzisa ama-x-ray. Kule nqubo, udokotela ohlinzayo usika okuncane emgodini. Ucingo nentambo ebizwa nge-catheter ifakwa emthanjeni emlenzeni bese idluliselwa enhliziyweni. Bese kuthi, ikhoyili yensimbi encane noma enye into idluliswe nge-catheter iye emthanjeni we-ductus arteriosus wosana. Ikhoyili noma enye idivayisi ivimba ukuhamba kwegazi, futhi lokhu kuyayilungisa inkinga.
• Enye indlela ukwenza ukusika okuncane ohlangothini lwesobunxele sesifuba. Udokotela ohlinzayo uthola i-PDA abese ebopha noma aqhebe i-ductus arteriosus, noma ayihlukanise ayisika. Ukuhlanganisa i-ductus arteriosus kubizwa ngokuthi yi-ligation. Le nqubo ingenziwa egumbini lokunakekelwa kwabasanda kuzalwa (NICU).

Ukuhlangana kokulungiswa kwe-aorta:

• Ukubumbana kwe-aorta kwenzeka lapho ingxenye ye-aorta inesigaba esincane kakhulu. Ukuma kubukeka njengesibali sikhathi se-hourglass. Ukuncipha kwenza kube nzima ngegazi ukuthi lifinyelele emaphethelweni aphansi. Ngokuhamba kwesikhathi, kungaholela ezinkingeni ezifana nomfutho wegazi ophezulu ngokweqile.
• Ukulungisa le nkinga, ukusika kuvame ukwenziwa ohlangothini lwesobunxele sesifuba, phakathi kwezimbambo. Kunezindlela eziningana zokulungisa ukuhlangana kwe-aorta.
• Indlela ejwayelekile yokuyilungisa ukusika ingxenye encane bese uyenza ibe nkulu ngesiqeshana esenziwe ngeGore-tex, into eyenziwe ngabantu (yokwenziwa).
• Enye indlela yokulungisa le nkinga ukususa ingxenye encane ye-aorta bese uhlanganisa imikhawulo esele ndawonye. Lokhu kungenziwa kakhulu ezinganeni ezindala.
• Indlela yesithathu yokulungisa le nkinga ibizwa ngokuthi i-subclavian flap. Okokuqala, ukusika kwenziwa engxenyeni encane ye-aorta. Ngemuva kwalokho, kuthathwa isichibi emthanjeni ongakwesobunxele we-subclavian (umthambo oya engalweni) ukukhulisa ingxenye encane ye-aorta.
• Indlela yesine yokulungisa inkinga ukuxhuma ishubhu ezingxenyeni ezijwayelekile ze-aorta, ohlangothini ngalunye lwesigaba esincanyana. Igazi ligeleza ngeshubhu bese lidlula esigabeni esincane.
• Indlela entsha ayidingi ukuhlinzwa. Ucingo oluncane lubekwa ngomthambo osemgodini kuze kufike ku-aorta. Ngemuva kwalokho kuvulwa ibhaluni elincane endaweni encane. Ishubhu elincane noma elincane lishiywa lapho ukusiza ukugcina umthambo uvulekile. Inqubo yenziwa elabhoratri enama-x-ray. Le nqubo ivame ukusetshenziswa lapho i-coarctation iphinda yenzeke ngemuva kokulungiswa.

Ukulungiswa kwe-Atrial septal defect (ASD):

• I-septum ye-atrial iludonga phakathi kwe-atria yangakwesokunxele nangakwesokudla (amakamelo aphezulu) enhliziyo. Imbobo kulolo donga ibizwa nge-ASD. Lapho kukhona le nkinga, igazi elingena-oxygen nangaphandle kwalo lingaxubeka futhi ngokuhamba kwesikhathi, lidale izinkinga zezokwelapha nama-arrhythmias.
• Kwesinye isikhathi, i-ASD ingavalwa ngaphandle kokuhlinzwa kwenhliziyo. Okokuqala, udokotela ohlinzayo usika okuncane emgodini. Ngemuva kwalokho udokotela ohlinzayo ufaka ucingo emthanjeni wegazi oya enhliziyweni. Okulandelayo, kubekwa amadivayisi amabili amancane wesambulela "clamshell" abekwe ezinhlangothini ezingakwesokudla nangakwesobunxele septum. Lawa madivayisi amabili anamathiselwe komunye nomunye. Lokhu kuvala imbobo enhliziyweni. Akuzona zonke izikhungo zezokwelapha ezenza le nqubo.
• Ukuhlinzwa kwenhliziyo evulekile nakho kungenziwa ukulungisa i-ASD. Kulokhu kusebenza, i-septum ingavalwa kusetshenziswa imithungo. Enye indlela yokumboza umgodi ngesichibi.

Ukulungiswa kwe-Ventricular septal defect (VSD):

• I-sectum ye-ventricular iludonga phakathi kwama-ventricles angakwesobunxele nangakwesokudla (amakamelo aphansi) enhliziyo. Imbobo ku-septum ye-ventricular ibizwa nge-VSD. Lo mgodi uvumela igazi ne-oxygen lihlangane negazi elisetshenzisiwe libuyele emaphashini. Ngokuhamba kwesikhathi, ukushaya kwenhliziyo okungajwayelekile nezinye izinkinga zenhliziyo kungenzeka.
• Ngeminyaka engu-1, ama-VSD amaningi amancane avale yedwa. Kodwa-ke, lawo ma-VSD ahlala evulekile ngemuva kwalesi sikhathi angadinga ukuvalwa.
• Ama-VSD amakhulu, afana namancane ezingxenyeni ezithile ze-ventricular septum, noma lawo abangela ukwehluleka kwenhliziyo noma i-endocarditis, (ukuvuvukala) adinga ukuhlinzwa kwenhliziyo evulekile. Umgodi we-septum uvame ukuvalwa nge-patch.
• Okunye ukukhubazeka kwamanzi kungavalwa ngaphandle kokuhlinzwa. Inqubo ifaka ukudlulisa ucingo oluncane enhliziyweni nokubeka ithuluzi elincane ukuvala iphutha.

I-Tetralogy yokulungisa ama-Fallot:

• ITetralogy of Fallot ukukhubazeka kwenhliziyo okukhona kusukela ekuzalweni (kokuzalwa). Imvamisa kufaka ukukhubazeka okune enhliziyweni futhi kubangele ukuthi ingane iguqule umbala oluhlaza okwesibhakabhaka (i-cyanosis).
• Ukuhlinzwa kwenhliziyo evulekile kuyadingeka, futhi kuvame ukwenziwa lapho ingane iphakathi kwezinyanga eziyisithupha neminyaka emibili ubudala.

Ukuhlinzwa kuhilela:

• Ukuvala i-ventricular septal defect nge-patch.
• Ukuvula i-valve yamaphaphu nokususa imisipha eqinile (stenosis).
• Ukubeka isichibi ku-ventricle efanele kanye nomthambo oyinhloko wamaphaphu ukwenza ngcono ukugeleza kwegazi liye emaphashini.

Ingane ingahle yenziwe inqubo ye-shunt. I-shunt ihambisa igazi lisuka kwenye indawo liye kwenye. Lokhu kwenziwa uma ukuhlinzwa kwenhliziyo evulekile kudinga ukubambezeleka ngoba ingane igula kakhulu ukuthi ingahlinzwa.

• Ngesikhathi senqubo ye-shunt, udokotela ohlinzayo usika ngokuhlinzwa ohlangothini lwesobunxele sesifuba.
• Lapho ingane isikhulile, i-shunt ivaliwe futhi ukulungiswa okuyinhloko enhliziyweni kuyenziwa.

Ukuguqulwa kokulungiswa kwemikhumbi emikhulu:

• Enhliziyweni ejwayelekile, i-aorta ivela ohlangothini lwesobunxele lwenhliziyo, kanti umthambo wamaphaphu uvela ohlangothini lwesokunene. Ekuguqukeni kwemikhumbi emikhulu, le mithambo yegazi ivela ezinhlangothini eziphambene zenhliziyo. Ingane nayo ingaba nezinye izinkinga zokuzalwa.
• Ukulungiswa kokushintshwa kwemikhumbi emikhulu kudinga ukuhlinzwa kwenhliziyo evulekile. Uma kunokwenzeka, lokhu kuhlinzwa kwenziwa ngemuva nje kokuzalwa.
• Ukulungiswa okuvame kakhulu kubizwa ngokuthi i-arterial switch. Umthambo i-aorta ne-pulmonary artery uhlukene phakathi. Umthambo wamaphaphu uxhunywe ku-ventricle efanele, lapho kufanele khona. Bese kuthi, i-aorta nemithambo yegazi yenhliziyo ixhunywe ku-ventricle yangakwesobunxele, lapho ingeyakhona.

Ukulungiswa kweTruncus arteriosus:

• I-Truncus arteriosus yisimo esingajwayelekile esenzeka lapho i-aorta, i-coronary artery, ne-pulmonary artery konke kuphuma esiqwini esisodwa esivamile. Lesi sifo singaba lula kakhulu, noma sibe yinkimbinkimbi kakhulu. Kuzo zonke izimo, kudinga ukuhlinzwa kwenhliziyo evulekile ukulungisa iphutha.
• Ukulungisa kuvame ukwenziwa ezinsukwini zokuqala noma emavikini ambalwa okuphila kosana. Imithambo yamaphaphu ihlukaniswe nesiqu somthambo i-aortic, futhi noma yikuphi ukukhubazeka kuyamamaniswa. Imvamisa, izingane nazo zinokukhubazeka kwangaphakathi kwe-ventricular, futhi lokho nakho kuvaliwe. Ukuxhuma bese kubekwa phakathi kwe-ventricle efanele kanye nemithambo yegazi yamaphaphu.
• Iningi lezingane lidinga ukuhlinzwa okukodwa noma okubili njengoba zikhula.

Ukulungiswa kwetricuspid atresia:

• Iveluvu ye-tricuspid itholakala phakathi kwamakamelo aphezulu nangaphansi ohlangothini lwesokudla senhliziyo. I-tricuspid atresia yenzeka lapho le valve ikhubazekile, incane, noma ilahlekile.
• Izingane ezizalwa zine-tricuspid atresia ziluhlaza okwesibhakabhaka ngoba azikwazi ukuthola igazi emaphashini ukuze zithathe umoya-mpilo.
• Ukufika emaphashini, igazi kufanele liwele i-atrial septal defect (ASD), i-ventricular septal defect (VSD), noma i-patent ductus artery (PDA). (Lezi zimo zichazwe ngenhla.) Lesi simo sivimbela kakhulu ukugeleza kwegazi kuye emaphashini.
• Ngokushesha nje emva kokuzalwa, ingane inganikezwa umuthi obizwa ngokuthi yi-prostaglandin E. Lo muthi uzosiza ukugcina i-patent ductus arteriosus ivulekile ukuze igazi liqhubeke ligelezele emaphashini. Noma kunjalo, lokhu kuzosebenza isikhashana. Ingane ekugcineni izodinga ukuhlinzwa.
• Ingane ingadinga uchungechunge lwama-shunts nokuhlinzwa ukuze ilungise le nkinga. Inhloso yalokhu kuhlinzeka ukuvumela igazi emzimbeni ukuba ligobhozele emaphashini. Udokotela ohlinzayo kungadingeka ukuthi alungise i-tricuspid valve, afake i-valve esikhundleni, noma afake i-shunt ukuze igazi lifinyelele emaphashini.

Ukulungiswa okuphelele kwe-pulmonary venous return (TAPVR) okuphelele:

• I-TAPVR yenzeka lapho imithambo yamaphaphu iletha igazi elinomoya-mpilo elivela emaphashini libuyele ohlangothini lokunene lwenhliziyo, esikhundleni sohlangothi lwesobunxele lwenhliziyo, lapho luhlala luhamba khona kubantu abaphilile.
• Lesi simo kufanele silungiswe ngokuhlinzwa. Ukuhlinzwa kungenziwa esikhathini esisanda kuzalwa uma usana lunezimpawu ezinzima. Uma kungenziwanga ngemuva nje kokuzalwa, kwenziwa ezinyangeni eziyisithupha zokuqala zempilo yengane.
• Ukulungiswa kwe-TAPVR kudinga ukuhlinzwa kwenhliziyo evulekile. Imithambo yamaphaphu ibuyiselwa emuva ohlangothini lwesobunxele lwenhliziyo, lapho ikhona, futhi noma yikuphi ukuxhumana okungajwayelekile kuvaliwe.
• Uma i-PDA ikhona, iboshiwe futhi ihlukaniswe.

Ukulungiswa kwenhliziyo kwe-Hypoplastic:

• Lokhu ukukhubazeka kwenhliziyo okubi kakhulu okubangelwa yinhliziyo engakhuli kahle engakhuli kahle. Uma ingalashwa, ibanga ukufa ezinganeni eziningi ezizalwa nayo. Ngokungafani nezingane ezinokukhubazeka kwenhliziyo, labo abanezinhliziyo ezingakwesobunxele abanazo ezinye izinkinga. Imisebenzi yokwelapha le nkinga yenziwa ezikhungweni zezokwelapha ezikhethekile. Imvamisa, ukuhlinzwa kulungisa lesi sici.
• Uchungechunge lokuhlinzwa kwenhliziyo kathathu kuyadingeka kakhulu. Ukuhlinzwa kokuqala kwenziwa ngesonto lokuqala lokuphila kwengane. Lokhu ukuhlinza okuyinkimbinkimbi lapho kwenziwa khona umthambo owodwa wegazi kusuka emithanjeni yamaphaphu kanye ne-aorta. Lesi sitsha esisha sithwala igazi liye emaphashini nasemzimbeni wonke.
• Ukuhlinzwa kwesibili, okubizwa ngokuthi yi-Fontan operation, kuvame ukwenziwa lapho ingane inezinyanga ezi-4 kuya kwezi-6 ubudala.
• Umsebenzi wesithathu wenziwa ngemuva konyaka ngemuva kokuhlinzwa kwesibili.

Ukuhlinzwa kwenhliziyo okuzelwe; I-patent ductus arteriosus ligation; Ukulungiswa kwenhliziyo kwe-Hypoplastic; I-Tetralogy yokulungiswa kwe-Fallot; Ukudidiyelwa kokulungiswa kwe-aorta; Ukulungiswa kwesici se-atrial septal; Ukulungiswa kwesici se-Ventricular septal; Ukulungiswa kweTruncus arteriosus; Ukulungiswa okuphelele komthambo wamaphaphu; Ukulungiswa kokulungiswa kwemikhumbi emikhulu; Ukulungiswa kweTricuspid atresia; Ukulungiswa kwe-VSD; Ukulungiswa kwe-ASD

• Ukuphepha kwendlu yangasese - izingane
• Ukuletha ingane yakho ukuthi ivakashele ingane yakini egula kakhulu
• Ukuhlinzwa kwenhliziyo yezingane - ukukhishwa
• Ukunakekelwa kwesilonda sokuhlinzwa - kuvulekile

• Inhliziyo - isigaba phakathi nendawo
• I-catheterization yenhliziyo
• Inhliziyo - ukubuka kwangaphambili
• I-Ultrasound, umbungu ovamile - ukushaya kwenhliziyo
• I-Ultrasound, i-ventricular septal defect - ukushaya kwenhliziyo
• I-Patent ductus arteriosis (PDA) - uchungechunge
• Ukuhlinzwa kwenhliziyo okuvulekile kwengane

UBernstein D. Izimiso ezijwayelekile zokwelashwa kwesifo senhliziyo esizelwe. Ku: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Incwadi kaNelson Yezingane. Umhlaka 21. IPhiladelphia, PA: Elsevier; 2020: isahluko 461.

UBhatt AB, Foster E, Kuehl K, et al; Umkhandlu Wenhlangano Yezinhliziyo ZaseMelika kwiClinical Cardiology. Isifo senhliziyo esizelwe kumuntu omdala osekhulile: isitatimende sesayensi esivela ku-American Heart Association. Ukujikeleza. 2015; 131 (21): 1884-1931. I-PMID: 25896865 www.ncbi.nlm.nih.gov/pubmed/25896865.

ULeRoy S, u-Elixson EM, u-O'Brien P, et al; Ikomidi Elincane Labahlengikazi LaseMelika Lenhlangano Yezingane yoMkhandlu Wezobuhlengikazi Benhliziyo; Umkhandlu Wezifo Zenhliziyo Yentsha. Izincomo zokulungiselela izingane nentsha izinqubo zenhliziyo ezihlaselayo: isitatimende esivela kwi-American Heart Association Pediatric Nursing Subcommittee yoMkhandlu we-Cardiovascular Nursing ngokubambisana noMkhandlu Wezifo Zenhliziyo Yabasha. Ukujikeleza. 2003; 108 (20): 2250-2564. I-PMID: 14623793 www.ncbi.nlm.nih.gov/pubmed/14623793.

I-Webb GD, iSmallhorn JF, uTherrien J, uRedington AN. Isifo senhliziyo esizalwa naso.Ku: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, ama-eds. Isifo Senhliziyo SikaBraunwald: Incwadi Yemithi Yezinhliziyo Nemithambo. Umhla ka-11. IPhiladelphia, PA: Elsevier; 2019: isahluko 75.