Ngaba Ukuvala i-Patent Foramen Ovale ivimbela izibetho?
Sonke sasibe nomngxuma entliziyweni yethu. Igazi lihamba ngokugqithisileyo kumzimba womntwana ongakazalwa xa kuthelekiswa nomntu omdala. Ngenye, igazi ligeleza phakathi kokuvula phakathi kwekhohlo kunye nekhohlo yentliziyo ngokuvula ebizwa ngokuba yi-foramen ovale.
Ngomoya wokuqala wokuphefumula umoya, nangona kunjalo, ingcinezelo yecala eliphakathi kwekhohlo kunye nekunene yentliziyo ishintsha, kwaye i-flap of tissue igxina i-foramen ovale.
Ukususela ngelo xesha, igazi ligeleza kumzekelo oqhelekileyo phantse bonke abantu abadala.
Ngamanye amaxesha, nangona kunjalo, i-oamle ye-foramen ayinamathelani ngokupheleleyo, ishiya into ebizwa ngokuba yi-patent foramen ovale, okanye i-PFO. Oku kuyinto eqhelekileyo kakhulu kwaye kuye kwathiwa kuthintela malunga nabantu abahlanu.
Njengothusayo njengoko kuzwakala ukuba unxibelelwano phakathi kwamacala amabini entliziyo, uphando oluninzi lubonisa ukuba i-PFO ayinobungozi kakhulu ixesha. Abanye oogqirha, nangona kunjalo, bakholelwa ukuba i-PFO inokunyusa umngcipheko wesifo.
Ingaba isebenza kanjani?
Iingcamango zihamba ngale ndlela: iifom ze-blood clot kwimilenze kwaye ihamba nge-systemous venous kuze kube yintliziyo. Igazi livame ukuthunyelwa ukusuka kwicala lasekunene lentliziyo kwimiphunga ukuze ilahle i-carbon dioxide kwaye ilayishe i-oxygen. Imithambo yegazi apho ukutshintshiselana kwegesi kwenzeka khona kuncinci, kwaye naziphi na iiplanga ezihamba ngeemvini ( emboli ) ziza kuhlanjululwa kwimiphunga.
Uluhlu lwezinto ezingokwemvelo lunokuba lubekwe ngapha nangapha, ukuba igazi likwazi ukuhamba ukusuka ekunene ukuya kwicala lasekhohlo lentliziyo ngaphandle kokuhamba emiphakeni. Oku kunokwenza oku ukuba kukho imingcele phakathi kwamacala entliziyo enjenge-PFO, kwaye ukuba i-gradient ingxaki ngamanye amaxesha ephakamileyo kwicala elifanelekileyo lentliziyo kunasekhohlo (engavamile).
Ngaphantsi kwezi meko, i-clot yegazi ingaya kwinqanaba elisekhohlo lentliziyo, apho iphoswe khona emzimbeni, kubandakanywa nengqondo, apho i-clot ibangela ukuhamba kwegazi ngakumbi kwaye ikhokelela kwisifo sobomi . I-clot ehamba ngendlela ebizwa ngokuba yi-paradoxical embolus, ukusuka kwisiqendu (ezimbini) kunye ne- doxical (side).
Khetha
Kukho iikhosi ezimbini zokuthatha isenzo xa umntu onentsapho ye-PFO enesifo esicacileyo kungekho sizathu esicacileyo. Indlela yokuqala, njengoko kunconywe yi-2012 ye-American College of Chest Physicians (ACCP) izikhokelo, ukusebenzisa i-antiplatelet unyango njenge-aspirin. Ukuba i-thrombus ikhona kwimilenze, i-antiticoagulation kunye ne-agent efana ne-heparin okanye i- warfarin ikhethwa.
Indlela yesibini kukutywinwa kwe-PFO. Oku kubonakala kakhulu kwizigulane ezithandwayo nje kwaye zifumana iindaba eziphazamisayo ukuba kukho "umgodi entliziyweni yabo." Ngaphantsi kweemeko, umntu unokufuna ukwenza konke okusemandleni ukuze angabi nomnye, mhlawumbi unobungozi obukhulu.
Ingxaki kukuba, nangona ukutywinwa kwe-PFO kubonakala kuyinto enengqiqo yokwenza, uphando olunzulu alubonisanga nzuzo ecacileyo kule nkqubo engenakwenzeka.
Indlela eyaziwayo kakhulu yokutywinwa kwe-patent foramen ovale inenkqubo yenkqubo.
Ugqirha oqeqeshiwe utyunyuza i-catheter ngokusebenzisa iiswini zomzimba entliziyweni, apho isetyenziselwa ukutywinwa kwi-PFO. Enye indlela iquka utyando olungakumbi.
Izifundo ezinkulu zokuvalwa kwe-PFO kwi-stroke show akukho nzuzo kuyo nayiphi inkqubo. Enye yezilingo ezintle, ezibizwa ngokuba ngu-CLOSURE 1, zikhangele abantu abangaphantsi kweminyaka engama-60 kunye ne-PFO abaye bahlaselwa yintlungu okanye ukuhlaselwa kwe-ischemic . Kwakungekho nje kuphela inzuzo emva kwemibini emibini, kodwa abantu ababenokwenziwa kwenkqubo babenokuba neengxaki ezinkulu ze-vascular okanye i-fibrillation ye-atrial kunabo bafumana unyango lweyeza.
Iziphumo zabo zaphazamiseka kubantu abaye babona ukuba kwezinye iindawo, ezicokisekileyo izifundo zokuvalwa kwezixhobo zazibonakala zisebenza. Njengawe nawuphi na ulingo, UKUVALWA 1 kunamaphutha. Abacebisi bacebisa ukuba mhlawumbi isisombululo esingcono sinokunciphisa umngcipheko weengxaki, okanye ukuba ubungakanani besampula abukhulu ngokwaneleyo. Oko kwathiwa, UKUVALWA 1 kunobungqina obungcono boluphi na ulingo lwangaphambili, kwaye iziphumo zigqithiseleyo. ngelixa abanye bebhikishe ukuba ukuqhubela phambili kwezobugcisa ezisetyenziselwa ukuvalwa kwe-PFO kungoku kuqikelela ukusetyenziswa kwayo, i-counterargument kukuba ulawulo lwezokwelapha luya phambili, kwaye luyakwazi ukuncintisana nokuvalwa kwe-PFO.
Izigqibo
I-American Academy ye-Neurology kunye nezinye ziye zagqiba akukho nzuzo kwinkqubo ye-PFO, nangona ukuvalwa komzimba ngokuqinisekileyo kusekunyanzelweni kwiindlela ezingaqhelekanga kunye nezona zinzima kakhulu zonxibelelwano phakathi kwamacala asekhohlo kunye namanqanaba entliziyo. Ezi ziimeko ziquka i-defect septal defect.
Kukho namagqirha azungeze ngubani ozimisele ukwenza le nqubo kulabo bafuna ukuba ne-patent foramen ovale ivaliwe. Abanye abantu abanakukuthwala ingcamango yokuba kukho imingxuma entliziyweni, nokuba ingaba ingumngcipheko sonke esinayo, kwaye abantu abaninzi bayaqhubeka bengenazo iingxaki. Kwabo bahlala benomdla naphezu kokungabikho kwenzuzo eqinisekisiweyo, kubalulekile ukufumana uluvo kumgqirha ongenanto yemali ekwenzeni le nkqubo.
Imithombo:
Furlan AJ, Reisman M, Massaro J, et al. Ukuvalwa okanye unyango lonyango lwe-cryptogenic stroke kunye ne-patent foramen ovale. N Engl J Med 2012; 366: 991.
Hagen PT, iScholz DG, u-Edwards WD. Isiganeko kunye nobukhulu be-patent foramen ovale kwiminyaka eyi-10 yokuqala yobomi: isifundo se-autopsy se-965 iintliziyo eziqhelekileyo. IMayo Clin Proc. 1984; 59: 17-20.
ULansberg MG, O'Donnell MJ, uKhatri P, et al. I-Antithrombotic kunye ne-thrombolytic therapy ye-stroke ye-ischemic: Uthintelo lwe-Antithrombotic kunye noThintelo lwe-Thrombosis, 9th: Ikholeji yaseMerika yase-Chest Physicians Izikhokelo zoBuchule boLwazi lweZiklinikhi. Ngomhla ka-2012; 141: e601S.