Ukuhlinzwa kwe-aortic valve - kungangenisi kakhulu

Igazi liphuma liphuma enhliziyweni yakho lingene emthanjeni omkhulu wegazi obizwa nge-aorta. I-aortic valve ihlukanisa inhliziyo ne-aorta. I-aortic valve iyavula ukuze igazi liphume. Bese ivala ukugcina igazi lingabuyeli enhliziyweni.

Ungadinga ukuhlinzwa kwe-aortic valve ukufaka i-aortic valve enhliziyweni yakho uma:

• I-valve yakho ye-aortic ayivali yonke indlela, ngakho-ke igazi liyavuza lingene enhliziyweni. Lokhu kubizwa ngokuthi yi-aortic regurgitation.
• I-valve yakho ye-aortic ayivuli ngokugcwele, ngakho ukuphuma kwegazi okuphuma enhliziyweni kuyancipha. Lokhu kubizwa nge-aortic stenosis.

I-aortic valve ingashintshwa kusetshenziswe:

• Ukuhlinzwa okuncane okuhlasela i-aortic valve, kwenziwa kusikeka okukodwa noma ngaphezulu
• Vula ukuhlinzwa kwe-aortic valve, okwenziwe ngokusika okukhulu esifubeni sakho

Ngaphambi kokuhlinzwa kwakho, uzothola i-anesthesia ejwayelekile.

Uzobe ulele futhi ungenazinhlungu.

Kunezindlela eziningana zokwenza ukuhlinzwa kwe-aortic valve okungajwayelekile. Amasu afaka phakathi i-min-thoracotomy, i-min-sternotomy, ukuhlinzwa okusizwa ngamarobhothi, kanye nokuhlinzwa okuzenzakalelayo. Ukwenza izinqubo ezihlukile:

• Udokotela wakho ohlinzayo angenza ukusika okungu-2-intshi kuya ku-3-intshi (5 kuye ku-7.6 sentimitha) engxenyeni efanele yesifuba sakho eduze kwe-sternum (isifuba sesifuba). Kuzohlukaniswa imisipha endaweni. Lokhu kuvumela udokotela ohlinzayo ukuthi afinyelele enhliziyweni naku-aortic valve.
• Udokotela wakho ohlinzayo angahlukanisa kuphela ingxenye engenhla yesifuba sakho sesifuba, avumele ukuvezwa kwe-valve ye-aortic.
• Ekuhlinzweni kwe-valve okusizwa irobhothi, udokotela ohlinzayo usika izingcezu ezimbili kuya kwezi-4 esifubeni sakho. Udokotela ohlinzayo usebenzisa ikhompyutha ekhethekile ukulawula izingalo zamarobhothi ngesikhathi sokuhlinzwa. Ukubukwa kwe-3D kwenhliziyo ne-aortic valve kukhonjiswa kukhompyutha egumbini lokuhlinza.

Ungahle udinge ukuba semshinini wenhliziyo namaphaphu kukho konke lokhu kuhlinzwa.

Lapho i-aortic valve yonakele kakhulu ukuthi ingalungiswa, kufakwa i-valve entsha. Udokotela wakho ohlinzayo uzosusa i-valve yakho ye-aortic bese ethunga entsha. Kunezinhlobo ezimbili eziyinhloko zama-valve amasha:

• Imishini, eyenziwe ngezinto ezenziwe ngabantu, njenge-titanium noma i-carbon. La ma-valve ahlala isikhathi eside kakhulu. Uzodinga ukuthatha umuthi wokunciphisa igazi, njenge-warfarin (i-Coumadin), impilo yakho yonke uma unalolu hlobo lwe-valve.
• Okuphilayo, okwenziwe ngezicubu zomuntu noma zesilwane. Lawa ma-valve ahlala iminyaka eyi-10 kuya kwengu-20, kepha kungenzeka ungadingi ukuthatha abacoci begazi impilo yakho yonke.

Enye inqubo ukushintshwa kwe-transcatheter aortic valve (TAVR). Ukuhlinzwa kwe-TAVR aortic valve kungenziwa ngokusikwa okuncane okwenziwe emgodini noma esifubeni sobunxele. I-valve yokufaka esikhundleni idluliselwa emthanjeni wegazi noma enhliziyweni futhi inyukele phezulu ku-aortic valve. I-catheter inebhaluni ekugcineni. Ibhaluni ligcwele umoya ukuze welule ukuvuleka kwe-valve. Le nqubo ibizwa ngokuthi yi-valvuloplasty enqamulelayo futhi ivumela ukuthi kufakwe i-valve entsha kule ndawo. Udokotela ohlinzayo ube esethumela ipayipi eline-valve enamathiselwe bese ekhipha i-valve ukuthatha indawo ye-aortic valve eyonakele. I-valve yemvelo isetshenziselwa i-TAVR. Awudingi ukuba semshinini wenhliziyo-namaphaphu wale nqubo.

Kwezinye izimo, uzoba nokuhlinzwa kokutholwa komthambo we-coronary (CABG), noma ukuhlinzwa ukufaka ingxenye ye-aorta ngasikhathi sinye.

Lapho nje i-valve entsha isebenza, udokotela wakho ohlinzayo uzokwenza lokhu:

• Vala ukusika okuncane enhliziyweni yakho noma ku-aorta
• Beka ama-catheters (amashubhu aguquguqukayo) azungeze inhliziyo yakho ukukhipha uketshezi olwakhayo
• Vala ukusika kokuhlinzwa emisipheni nasesikhunjeni sakho

Ukuhlinzwa kungathatha amahora amathathu kuya kwayisithupha, kepha inqubo ye-TAVR ivame ukuba mfushane.

Ukuhlinzwa kwe-aortic valve kwenziwa lapho i-valve ingasebenzi kahle. Ukuhlinzwa kungenziwa ngenxa yalezi zizathu:

• Izinguquko ku-valve yakho ye-aortic zidala izimpawu ezinkulu zenhliziyo, njengobuhlungu besifuba, ukuphefumula okuncane, ukuphelelwa amandla, noma ukwehluleka kwenhliziyo.
• Ukuhlolwa kukhombisa ukuthi izinguquko ku-aortic valve yakho zilimaza umsebenzi wenhliziyo yakho.
• Ukulimala kwe-valve yenhliziyo yakho ekutheleleni (endocarditis).

Inqubo encane yokuhlasela ingaba nezinzuzo eziningi. Kunobuhlungu obuncane, ukulahleka kwegazi, kanye nengozi yokutheleleka. Futhi uzolulama ngokushesha kunalokho ongakuthola ekuhlinzweni kwenhliziyo okuvulekile.

I-valvuloplasty ye-pervutoplasty ne-catheter-based valve esikhundleni se-TAVR yenziwa kuphela kubantu abagula kakhulu noma abasengozini enkulu kakhulu yokuhlinzwa okukhulu kwenhliziyo. Imiphumela ye-valvuloplasty enqamulelayo ayihlali isikhathi eside.

Izingozi zanoma yikuphi ukuhlinzwa yilezi:

• Ukopha
• Amahlule egazi emilenzeni angahamba aye emaphashini
• Izinkinga zokuphefumula
• Ukutheleleka, kufaka phakathi amaphaphu, izinso, isinye, isifuba, noma ama-valve wenhliziyo
• Ukusabela emithini

Ezinye izingozi ziyahluka ngokweminyaka yomuntu. Ezinye zalezi zingozi yilezi:

• Ukulimala kwezinye izitho, izinzwa, noma amathambo
• Isifo senhliziyo, isifo sohlangothi, noma ukufa
• Ukutheleleka kwe-valve entsha
• Ukuhluleka kwezinso
• Ukushaya kwenhliziyo okungafanele okufanele kulashwe ngemithi noma nge-pacemaker
• Ukuphulukiswa kabi kokusikwa
• Ukufa

Njalo utshele umhlinzeki wakho wezokunakekelwa kwempilo:

• Uma ukhulelwe noma ungakhulelwa
• Imiphi imithi oyiphuzayo, ngisho nezidakamizwa, izithasiselo, noma amakhambi owathengile ngaphandle kwencwadi kadokotela

Ungakwazi ukugcina igazi ebhange legazi ukuze lifakwe phakathi nangemva kokuhlinzwa kwakho. Buza umhlinzeki wakho mayelana nokuthi wena namalungu akho omndeni unganikela kanjani ngegazi.

Esontweni ngaphambi kokuhlinzwa, ungacelwa ukuthi uyeke ukuthatha imishanguzo eyenza kube nzima ngegazi lakho ukuminyana. Lokhu kungadala ukopha okwengeziwe ngesikhathi sokuhlinzwa.

• Ezinye zazo i-aspirin, ibuprofen (Advil, Motrin), ne-naproxen (i-Aleve, iNaprosyn).
• Uma uthatha i-warfarin (i-Coumadin) noma i-clopidogrel (i-Plavix), khuluma nodokotela wakho ohlinzayo ngaphambi kokuma noma ukushintsha indlela oyisebenzisa ngayo le mithi.

Phakathi nezinsuku ngaphambi kokuhlinzwa kwakho:

• Buza ukuthi imiphi imithi okufanele uyithathe ngosuku lokuhlinzwa kwakho.
• Uma ubhema, kufanele uyeke. Cela usizo kumhlinzeki wakho.
• Ngaso sonke isikhathi vumela umhlinzeki wakho azi ukuthi unomkhuhlane, umkhuhlane, umkhuhlane, ukuphuma kwe-herpes, noma esinye isifo esikhathini esiholela ekuhlinzweni kwakho.

Lungisa indlu yakho lapho ufika ekhaya uvela esibhedlela.

Geza bese ugeza izinwele zakho kusuku olungaphambi kokuhlinzwa. Ungadinga ukugeza umzimba wakho ngaphansi kwensipho yakho ngensipho ekhethekile. Khuhla isifuba sakho amahlandla ama-2 noma ama-3 ngale nsipho. Ungacelwa futhi ukuthi uthathe i-antibiotic ukuvikela ukutheleleka.

Ngosuku lokuhlinzwa kwakho:

• Ungacelwa ukuthi ungaphuzi noma ungadli lutho ngemuva kwamabili ebusuku ngaphambi kokuhlinzwa kwakho. Lokhu kufaka phakathi ukusebenzisa i-chewing gum naminti. Hlanza umlomo wakho ngamanzi uma uzizwa womile. Qaphela ukuthi ungagwinyi.
• Thatha imithi otshelwe ukuthi uyiphuze ngophuzo oluncane lwamanzi.
• Uzotshelwa ukuthi ufika nini esibhedlela.

Ngemuva kokuhlinzwa kwakho, uzohlala izinsuku ezintathu kuya kwezi-7 esibhedlela. Uzochitha ubusuku bokuqala egumbini labagula kakhulu (i-ICU). Abahlengikazi bazosiqapha isimo sakho ngaso sonke isikhathi.

Isikhathi esiningi, uzothuthelwa egumbini elijwayelekile noma egumbini lokunakekelwa kwesikhashana esibhedlela kungakapheli amahora angama-24. Uzoqala umsebenzi kancane. Ungaqala uhlelo lokwenza inhliziyo nomzimba wakho uqine.

Ungaba namashubhu amabili noma amathathu esifubeni sakho ukukhipha uketshezi olusuka enhliziyweni yakho. Isikhathi esiningi, lezi zikhishwa ezinsukwini ezi-1 ukuya kwezi-3 ngemuva kokuhlinzwa.

Ungaba nepayipi (ishubhu eliguquguqukayo) esinyeni sakho ukukhipha umchamo. Ungase futhi ube nemigqa ye-intravenous (IV) yamanzi. Abahlengikazi bazobheka ngokucophelela abaqaphi abakhombisa izimpawu zakho ezibalulekile (ukushaya kwenhliziyo, izinga lokushisa, nokuphefumula). Uzoba nokuhlolwa kwegazi nsuku zonke nama-ECG wokuhlola ukusebenza kwenhliziyo yakho uze ululame ngokwanele ukuya ekhaya.

I-pacemaker yesikhashana ingafakwa enhliziyweni yakho uma isigqi senhliziyo yakho sihamba kancane ngemuva kokuhlinzwa.

Uma ususekhaya, ukululama kuthatha isikhathi. Yehlisa umoya, futhi ubekezele kuwe.

Ama-valve wenhliziyo asebenzayo awaphumeleli kaningi. Kodwa-ke, amahlule egazi angavela kuwo. Uma kwenzeka amahlule egazi, ungahle ube nesifo sohlangothi. Ukopha kungenzeka, kepha lokhu akuvamile.

Ama-valve wezinto eziphilayo anengozi encane yamahlule egazi, kepha athanda ukwehluleka ngokuhamba kwesikhathi. Ukuhlinzwa kancane kwe-valve yenhliziyo sekuthuthukile eminyakeni yamuva. Lezi zindlela ziphephile kubantu abaningi futhi zinganciphisa isikhathi sokululama nobuhlungu. Ukuze uthole imiphumela emihle, khetha ukuhlinzwa kwe-aortic valve esikhungweni esenza eziningi zalezi zinqubo.

Ukushintshwa noma ukulungiswa kwe-mini-thoracotomy aortic valve; Ukuhlinzwa kwe-valvular yenhliziyo; Mini-sternotomy; Ukushintshwa kwe-aortic valve okusizwayo; Ukushintshwa kwe-transcatheter aortic valve

• Izidakamizwa ze-antiplatelet - P2Y12 inhibitors
• I-Aspirin nesifo senhliziyo
• Ukuhlinzwa kwe-valve yenhliziyo - ukukhipha
• Ukuhlinzwa kwenhliziyo yezingane - ukukhishwa
• Ukuthatha i-warfarin (Coumadin)

UHerrmann HC, uMack MJ. Izindlela zokwelapha zeTranscatheter zesifo senhliziyo se-valvular. 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 72.

I-Lamelas J. Ingene kancane, i-mini-thoracotomy aortic valve esikhundleni. Ku: Sellke FW, Ruel M, ama-eds. I-Atlas Yezindlela Zokuhlinza Zenhliziyo. Okwesibili. IPhiladelphia, PA: Elsevier; 2019: isahluko 10.

Reiss GR, Williams MR. Indima kadokotela ohlinzayo wenhliziyo. Ku: Topol EJ, Teirstein PS, eds. Incwadi Yemibhalo Yezinhliziyo Eziphakathi. Umhla wesi-7. IPhiladelphia, PA: Elsevier; 2016: isahluko 32.

URosengart TK, u-Anand J. Isifo senhliziyo esitholakele: i-valvular. Ku: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. ISabiston Incwadi Yokuhlinzwa. Umhla ka-20. IPhiladelphia, PA: Elsevier; 2017: isahluko 60.