Isigqibo sokuba unyango lwe- mitral stenosis lukhohlisayo, kwaye kufuneka luqwalaselwe ngokuzimeleyo.
Ukuba wena kunye nogqirha wakho sele ugqibe ekubeni ixesha le nkqubo , uya kuba uluhlu lwezinto ezintathu ezisisiseko zokunyanga ngonyango lwe-mitration stenosis yakho: Kusuka kuninzi ukuya kuncinci kukhuthazwa, zezi zilandelayo:
- i-perralaneous balralon valvotomy (PMBV)
- mitral commissurotomy
- i-mitral valve esikhundleni
Akuzona zonke ezi ndlela ezifanelekileyo kumntu wonke onomthambo stenosis.
I-Perralaneous Mitral Balloon Valvotomy
Kwi-mitral stenosis, iiflethi ze- mitral valve (iingubo eziguquguqukayo ezivulekileyo kwaye zivaliwe njengeenkontileka zentliziyo) zidibene kunye, zithintela i-valve ukuba ivule ngokupheleleyo. I-PMBV izama ukuhlula amaphecana omnye komnye ukukhupha umqobo.
Kwi-PMBV, ityhubhu ende, enobunzima, eguquguqukayo (i-catheter) enebhokisi edibeneyo idityaniswe nayo idlula ngapha kwe-valve mitral. Ibhaluni iyakwandiswa. Injongo kukuphula ii-adhesions eziye zatshintshela i-mitral valve leaftlets komnye nomnye.
Ngenxa yokuba i-PMBV yinkqubo yokunyanzelisa i- catheterization kwaye ayiyi kuvulwa intliziyo , yinto engaphantsi kweengxaki kwizigulane kunezinye iifom ye-mitral valve. Iingxaki zivame ukuba zincinci, kwaye ukubuyiswa kwenkqubo ngokuqhelekileyo kulula kakhulu.
I-PMBV nayo isebenza kakuhle xa iyenziwa kubantu abakhethiweyo ngokufanelekileyo.
Ngokubanzi, i-PMBV yinkqubo yokugqirha ugqirha uya kuphakamisa ukulungisa i-mitral stenosis yakho, ngaphandle kokuba unayo:
- i-thribri ye- arriyo yekhohlo (i-clot yegazi)
- i-calcium enamandla kwi-valve ye-mitral
- i- modral evurgation- xa i-mitral valve ingasondeli kakuhle, ivumela igazi ukuba livule kwi-valve
Ukongeza, i-PMBV ayisoloko inokukhetha ukuba i-mitral stenosis ihamba kunye nezinye iimeko ezinzima zesifo.
Emva kwenkqubo ye-PMBV, kunokwenzeka ukuba i-mitral stenosis iqale ukuqhuma kancane kancane. Ngenxa yalesi sizathu, nangona emva kokuba nale nkqubo, kubalulekile ukuba nokuvavanya kwimizimba yexesha elide kunye ne- echocardiography . Ukufikelela kuma-21 eepesenti zezigulane ezine-PMBV ekugqibeleni zifuna unyango lwesibini.
I-Mitral Commissurotomy
Injongo ye-mitral commissurotomy iyafana ne-PMBV-ukuhlukanisa amaphetshana afakelweyo. Yintoni eyahlukileyo kunye ne-mitral commissurotomy, nangona kunjalo, kukuba yinkqubo evulekileyo yenhliziyo efezekisa le njongo ngokusetyenziswa kwesalathiso esicacileyo.
I-Commissurotomy kaninzi iveza iziphumo ezilungileyo kakhulu. Sekunjalo, unobungozi bokuhlinzwa okugqithiseleyo kunye nexesha elide lokubuyisela ngaphandle kwe-PMBV, oko kukuthi ugqirha oogqirha ukuba bayincome njengokhetho lokuqala.
I-Commissurotomy ivame ukuba yinto enhle kubantu abaya kuba ngabaviwa be-PMBV ngaphandle kobukho be-thrombus ye-orrial, i-valve calcification, okanye i-mitral regurgitation.
Njengoko ngenkqubo ye-PMBV, i-mitral stenosis ingaphinda iphinde ibuye emva kwe-commissurotomy. Abantu ababenayo le nkqubo bafuna ukuhlaziywa kwemizimba yexesha elide.
Indawo yaseMitral Valve
Ukutshintshwa kwe-valve ye-Mitral kukukhetha okokugqibela, kuba inomngcipheko ophezulu weengxaki kunokuba yi-PMBV okanye i-commissurotomy. Ukutshintshwa kwe-valve kuyimfuneko xa i-mitral stenosis ibangele i-mitral valve ukuba ibonakale yonakaliswe kakhulu okanye ibaliwe, okwenza ezinye iinkqubo zibe zingenakwenzeka.
Kwi-valral substalve valve, i-valve ithathelwe indawo kunye ne -valve (prosthetic) valve . Iiphini zeprosthetic zinokuthi zibandakanye izinto ezenziwe ngabantu (iiplavines mechanical), okanye ziyakwenziwa kwintliziyo yesilwanyana yesilwanyana, ngokuqhelekileyo ihagu (i-valve bioprosthetic).
Ukugqiba ukuba yiyiphi uhlobo le-valve yokufakelwa eliyisebenzisayo kuxhomekeke kwiminyaka yakho kwaye nokuba ungathatha igazi elincinci laseCoumadin .
Zonke iipilisi zentliziyo zengqondo zandisa ukunyuka kwegazi. Nangona kunjalo, i-clotting yegazi ingaphantsi kwengxaki kunye ne-bioprosthetic kunamagatya e-mechanical, ngoko abantu abanokuthi bangabikho kufuneka bathathe unyango olungapheliyo lwe-Coumadin; abo banamagqoba engcingo.
Nangona kunjalo, iiplavines zemishini ngokuqhelekileyo zibonakala zihlala ixesha elide kunezivenge ze-bioprosthetic. Ukuba ufuna i-mitral valve esikhundleni, uneminyaka engaphantsi kweminyaka engama-65, kwaye ungathatha i-Coumadin, ugqirha wakho uya kucetyiswa ukuba aphakamise i-valve mechanical. Ukuba uneminyaka engaphezulu kwama-65, okanye usemncinci kodwa awukwazi ukuthatha i-Coumadin, i-valve ye-bioprosthetic iyacetyiswa ngokubanzi.
I-Mitral Stenosis Surgery Isinqumo
Ukuba une-mitral stenosis, kuya kufuneka usebenze ngokusondeleyo kunye ne-cardiologist yakho ukuba uthathe isigqibo sokuba ngaba utyando luya kuba luyimfuneko, kwaye ukhethe indlela yokugada efanelekileyo iimeko zakho. Ngokuxilongwa kwangaphambili kunye nokunyamekela kwenhliziyo, abaninzi abantu abanomdla wokuphila namhlanje banokulindela ukuphila ubomi obuqhelekileyo.
Imithombo:
Bonow, RO, Carabello, BA, Chatterjee, K, et al. Ukuhlaziywa okugxininisiweyo ka-2008 kufakwe kwi-ACC / AHA 2006 izikhokelo zokulawula izigulane ezinesifo senhliziyo: iNgxelo ye-American College of Cardiology / i-American Heart Association Task Force kwi-Practice Guidelines (IKomiti yokuBhala ukuHlola izikhokelo zoLawulo lwe-1998 Izigulane nge-Valvular Heart Disease): zivunywe nguMbutho wee-Cardiovascular Anesthesiologists, uMbutho wee-Cardiovascular Angiography kunye neNongenelo, kunye noMbutho weeNgcali zeTriracic. Uhambo luka-2008; 118: e523.
Ben Farhat M, Ayari M, Maatouk F, et al. I-balloon ye-percutaneous ngokuphathelele ukhetho oluvaliweyo luvulekile kwaye luvulekile ukuhamba kwe-mitral commissurotomy: iziphumo ezilandelelweyo zokulandelelwa kweeminyaka ezisixhenxe zolu vavanyo olungenamsebenzi. Ukuhamba ngo-1998; 97: 245.