Tricuspid atresia

Tricuspid atresia ndi mtundu wamatenda amtima omwe amapezeka pakubadwa (matenda obadwa nawo amtima), momwe valavu yamtima ya tricuspid imasowa kapena kukula bwino. Cholakwikacho chimatseka magazi kuchokera ku atrium kumanja kupita ku ventricle yoyenera. Zofooka zina za mtima kapena chotengera nthawi zambiri zimakhalapo nthawi yomweyo.

Tricuspid atresia ndi mtundu wachilendo wamatenda obadwa nawo amtima. Zimakhudza pafupifupi 5 mwa 100,000 aliwonse obadwa amoyo. M'modzi mwa anthu asanu omwe ali ndi vutoli amakhalanso ndi mavuto ena amtima.

Nthawi zambiri, magazi amatuluka m'thupi kupita ku atrium yoyenera, kenako kudzera pa valavu ya tricuspid kupita ku ventricle yolondola mpaka kumapapu. Ngati valavu ya tricuspid siyotsegula, magazi sangatuluke kuchokera ku atrium yolondola kupita ku ventricle yoyenera. Chifukwa cha vuto la valavu ya tricuspid, magazi pamapeto pake sangathe kulowa m'mapapu. Apa ndipomwe iyenera kupita kukatenga mpweya (umakhala mpweya).

M'malo mwake, magazi amadutsa kudzera mu dzenje pakati pa dzanja lamanja ndi lamanzere. Kudzanja lamanzere, limasakanikirana ndi magazi olemera okosijeni omwe amabwera kuchokera m'mapapu. Kusakanikirana kumeneku kwa magazi olemera okosijeni komanso opanda mpweya wabwino amaponyedwa m'thupi kuchokera kumanzere kumanzere. Izi zimapangitsa kuti mpweya wa okosijeni m'magazi utsike kuposa nthawi zonse.

Mwa anthu omwe ali ndi tricuspid atresia, mapapo amalandila magazi kudzera pabowo pakati pa ma ventricle akumanja ndi kumanzere (ofotokozedwa pamwambapa), kapena pokonza chotengera cha fetus chotchedwa ductus arteriosus. Ductus arteriosus imagwirizanitsa mitsempha ya m'mapapo (mitsempha kumapapu) kupita ku aorta (mtsempha waukulu wa thupi). Ilipo mwana akabadwa, koma nthawi zambiri amatseka yekha atangobadwa.

Zizindikiro zake ndi izi:

• Mtundu wabuluu pakhungu (cyanosis) chifukwa cha kuchepa kwa oxygen m'mwazi
• Kupuma mofulumira
• Kutopa
• Kukula kosauka
• Kupuma pang'ono

Vutoli limatha kupezeka pamalingaliro azolowera kubadwa kwa ultrasound kapena mwana akamayesedwa atabadwa. Khungu labuluu limakhalapo pakubadwa. Kung'ung'udza kwamtima nthawi zambiri kumakhalapo pakubadwa ndipo kumatha kukulira mokweza kwa miyezi ingapo.

Mayeso atha kuphatikizira izi:

• ECG
• Zojambulajambula
• X-ray pachifuwa
• Catheterization yamtima
• MRI yamtima
• Kujambula kwa CT pamtima

Akazindikira, mwanayo nthawi zambiri amaloledwa kupita kuchipatala cha NICU. Mankhwala otchedwa prostaglandin E1 atha kugwiritsidwa ntchito kusunga ductus arteriosis kuti magazi azizungulira m'mapapu.

Nthawi zambiri, odwala omwe ali ndi vutoli amafunika kuchitidwa opaleshoni. Ngati mtima sungathe kutulutsa magazi okwanira m'mapapu ndi thupi lonse, opareshoni yoyamba nthawi zambiri imachitika m'masiku ochepa oyamba amoyo. Pochita izi, shunt yokumba imayikidwa kuti magazi aziyenda m'mapapu. Nthawi zina, opaleshoni yoyamba iyi sikofunikira.

Pambuyo pake, mwana amapita kunyumba nthawi zambiri. Mwanayo adzafunika kumwa mankhwala amodzi kapena angapo tsiku lililonse ndikutsatiridwa ndi dokotala wamtima wa ana. Dokotala uyu adzasankha kuti gawo lachiwiri la opaleshoni liyenera kuchitidwa.

Gawo lotsatira la opaleshoni limatchedwa njira ya Glenn shunt kapena hemi-Fontan. Njirayi imalumikiza theka la mitsempha yomwe imanyamula magazi opanda okosijeni kuchokera kumtunda kwa thupi molunjika ku mtsempha wamagazi. Kuchita opaleshoni kumachitika nthawi zambiri mwana ali pakati pa miyezi 4 mpaka 6.

Munthawi yoyamba I ndi II, mwanayo amawonekabe wabuluu (cyanotic).

Gawo lachitatu, gawo lomaliza, limatchedwa njira ya Fontan. Mitsempha yotsala yomwe imanyamula magazi opanda mpweya kuchokera mthupi imalumikizidwa molunjika ku mtsempha wamagazi wopita kumapapu. Vuto lamanzere tsopano liyenera kupopera mthupi, osati m'mapapu. Kuchita opaleshoniyi kumachitika mwana ali ndi miyezi 18 mpaka 3 wazaka. Pambuyo pa gawo lomalizirali, khungu la mwanayo silimakhalanso labuluu.

Nthaŵi zambiri, opaleshoni imasintha vutoli.

Zovuta zingaphatikizepo:

• Nyimbo zosasinthasintha, zamtima (arrhythmias)
• Kutsekula m'mimba (kuchokera ku matenda otchedwa protein-losing enteropathy)
• Mtima kulephera
• Madzimadzi m'mimba (ascites) komanso m'mapapu (kupuma kwamphamvu)
• Kutsekedwa kwa shunt yokumba
• Sitiroko ndi zovuta zina zamanjenje
• Imfa mwadzidzidzi

Lumikizanani ndi omwe akukuthandizani nthawi yomweyo ngati khanda lanu lili:

• Kusintha kwatsopano kwamachitidwe opumira
• Mavuto akudya
• Khungu lomwe likusintha buluu

Palibe njira yodziwika yopewera tricuspid atresia.

Tri atresia; Valavu matenda - tricuspid atresia; Kobadwa nako mtima - tricuspid atresia; Matenda a mtima wa cyanotic - tricuspid atresia

• Mtima - gawo kupyola pakati
• Tricuspid atresia

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.