Atresia ya m'mapapo

Pulmonary atresia ndi mtundu wamatenda amtima momwe ma valve am'mapapo samapangira bwino. Amakhalapo kuyambira pomwe adabadwa (matenda obadwa nawo amtima). Valavu yamapapu ndikutseguka kumanja kwa mtima komwe kumayendetsa magazi kuchokera ku ventricle yoyenera (chipinda chakumanja chakupopera) kupita m'mapapu.

Mu pulmonary atresia, timapepala ta ma valve timasakanizidwa. Izi zimapangitsa kuti minofu yolimba ipangidwe pomwe potsegulira valavu iyenera kukhala. Magazi abwinobwino opita m'mapapu amatsekedwa chifukwa chake. Chifukwa cha vutoli, magazi ochokera mbali yakumanja ya mtima amaletsedwa kufikira m'mapapu kukatenga mpweya.

Monga matenda ambiri obadwa nawo amtima, palibe chifukwa chodziwika cha pulmonary atresia. Vutoli limalumikizidwa ndi vuto lina lobadwa nalo la mtima lotchedwa patent ductus arteriosus (PDA).

Pulmonary atresia imatha kuchitika popanda kapena vuto la ventricular septal (VSD).

• Ngati munthuyo alibe VSD, vutoli limatchedwa pulmonary atresia yokhala ndi ventricular septum (PA / IVS).
• Ngati munthuyo ali ndi mavuto onse awiri, vutoli limatchedwa pulmonary atresia ndi VSD. Uwu ndiye mtundu wachinyengo kwambiri wachinyengo.

Ngakhale zonsezi zimatchedwa pulmonary atresia, ndizosiyana kwenikweni. Nkhaniyi ikufotokoza atresia yam'mapapo popanda VSD.

Anthu omwe ali ndi PA / IVS amathanso kukhala ndi valavu yopanda mphamvu ya tricuspid. Amathanso kukhala ndi chotupa chotseguka bwino kapena cholimba kwambiri, komanso mitsempha yachilendo yodyetsa mtima. Pafupipafupi, zopangira kumanzere kwamanzere, valavu ya aortic, ndi atrium yakumanja zimakhudzidwa.

Zizindikiro nthawi zambiri zimachitika m'maola ochepa oyamba amoyo, ngakhale zimatha kutenga masiku ochepa.

Zizindikiro zimaphatikizapo:

• Khungu labuluu (cyanosis)
• Kupuma mofulumira
• Kutopa
• Kudya kosayenera (makanda amatha kutopa akamayamwa kapena kutuluka thukuta nthawi yakudya)
• Kupuma pang'ono

Wothandizira zaumoyo amagwiritsa ntchito stethoscope kuti amvetsere mtima ndi mapapo. Anthu omwe ali ndi PDA ali ndi kung'ung'udza kwamtima komwe kumamveka ndi stethoscope.

Mayeso otsatirawa atha kulamulidwa:

• X-ray pachifuwa
• Zojambulajambula
• Electrocardiogram (ECG)
• Catheterization yamtima
• Kutulutsa oximetry - kumawonetsa kuchuluka kwa mpweya m'magazi

Mankhwala otchedwa prostaglandin E1 nthawi zambiri amagwiritsidwa ntchito kuthandiza magazi kuyenda (kufalikira) m'mapapu. Mankhwalawa amateteza mitsempha yamagazi pakati pa mtsempha wamagazi ndi minyewa. Chombocho chimatchedwa PDA.

Mankhwala angapo amatha, koma zimadalira kukula kwa mtima komwe kumatsagana ndi vuto la valavu yamapapo. Mankhwala omwe angakhalepo ndi awa:

• Kukonzanso kwa biventricular - Opaleshoni iyi imasiyanitsa magazi amayenda m'mapapu kuchokera kufalikira mpaka thupi lonse popanga ma ventricles awiri opopera.
• Univentricular palliation - Opaleshoni iyi imasiyanitsa magazi amayenda m'mapapu kuchokera kufalikira mpaka thupi lonse pomanga mpweya umodzi wopopera.
• Kuika mtima.

Nthawi zambiri amathandizidwa ndi opaleshoni. Momwe mwana amakhalira bwino zimadalira:

• Kukula ndi kulumikizana kwa mtsempha wamagazi (mtsempha womwe umatengera magazi m'mapapu)
• Mtima ukugunda bwino bwanji
• Momwe ma valve ena amtima amapangidwira bwino kapena momwe akutayira

Zotsatira zimasiyanasiyana chifukwa cha mitundu yosiyanasiyana ya vutoli. Mwana angafunike njira imodzi yokha kapena angafunike maopaleshoni atatu kapena kupitilira apo ndipo amangokhala ndi ventricle imodzi yogwira ntchito.

Zovuta zingaphatikizepo:

• Kukula kwakuchedwa ndikukula
• Kugwidwa
• Sitiroko
• Matenda opatsirana a endocarditis
• Mtima kulephera
• Imfa

Itanani yemwe akukuthandizani ngati mwanayo ali ndi:

• Mavuto kupuma
• Khungu, misomali kapena milomo yomwe imawoneka yabuluu (cyanosis)

Palibe njira yodziwika yopewera vutoli.

Amayi onse apakati ayenera kulandira chithandizo chamankhwala pafupipafupi. Zolakwika zambiri zobadwa nazo zimatha kupezeka pamayeso azolowera a ultrasound.

Ngati chilemacho chimapezeka asanabadwe, akatswiri azachipatala (monga katswiri wamatenda a ana, dokotala wa opaleshoni, ndi neonatologist) atha kupezeka pakubadwa, ndipo amakhala okonzeka kuthandizira pakufunika. Kukonzekera kumeneku kungatanthauze kusiyana pakati pa moyo ndi imfa ya ana ena.

Pulmonary atresia - osalimba yamitsempha yamagazi septum; PA / IVS; Kobadwa nako matenda a mtima - m'mapapo mwanga atresia; Cyanotic matenda amtima - pulmonary atresia; Valavu - matenda am'mapapo mwanga atresia

• Mtima - gawo kupyola pakati
• Mtima - kuwonera kutsogolo

CD ya Fraser, Kane LC. Matenda amtima obadwa nawo. Mu: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Buku Lopanga Opaleshoni. Wolemba 20th. Philadelphia, PA: Elsevier; 2017: chap 58.

Webb GD, Smallhorn JF, Therrien J, Redington AN. Matenda obadwa nawo mumtima mwa wamkulu komanso wodwala. Mu: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, olemba. Matenda a Mtima a Braunwald: Buku Lophunzitsira la Mankhwala Amtima. 11th ed. Philadelphia, PA: Elsevier; 2019: mutu 75.