Kusintha kwa mitsempha yayikulu

Kusintha kwa mitsempha yayikulu (TGA) ndi vuto la mtima lomwe limachitika kuyambira pakubadwa (kobadwa nako). Mitsempha ikuluikulu iwiri yomwe imanyamula magazi kuchokera pamtima - aorta ndi mtsempha wamagazi - yasinthidwa (kusinthidwa).

Zomwe zimayambitsa TGA sizikudziwika. Sichikugwirizana ndi vuto limodzi lodziwika bwino lachibadwa. Sizimachitika kawirikawiri mwa mamembala ena.

TGA ndi vuto la mtima wa cyanotic. Izi zikutanthauza kuti kuchepa kwa mpweya m'magazi omwe amaponyedwa kuchokera pamtima kupita ku thupi lonse.

M'mitima yabwinobwino, magazi omwe amabwerera kuchokera m'thupi amapita mbali yakumanja yamtima ndi mtsempha wamagazi m'mapapu kuti akalandire mpweya. Magaziwo amabwerera mbali yakumanzere ya mtima ndikutuluka mthupi kupita mthupi.

Mu TGA, magazi amanjenje amabwerera pamtima kudzera pa atrium yoyenera. Koma, m'malo mopita m'mapapu kukatenga mpweya, magazi awa amapopedwa kudzera mu aorta ndikubwerera m'thupi. Magazi awa sanapangidwenso ndi mpweya ndipo amatsogolera ku cyanosis.

Zizindikiro zimawoneka pobadwa kapena posakhalitsa pambuyo pake. Zizindikiro zake ndizoyipa kutengera mtundu ndi kukula kwa zopindika zina pamtima (monga atrial septal defect, ventricular septal defect, kapena patent ductus arteriosus) komanso kuchuluka kwa magazi omwe angasakanizike pakati pamavuto awiriwo.

Zizindikiro zimaphatikizapo:

• Kukula kwa khungu
• Kalabu yazala kapena zala zakumiyendo
• Kudya moperewera
• Kupuma pang'ono

Wopereka chithandizo chamankhwala amatha kuzindikira kudandaula kwa mtima kwinaku akumvera pachifuwa ndi stethoscope. Pakamwa ndi khungu la mwana lidzakhala mtundu wabuluu.

Mayeso nthawi zambiri amakhala ndi izi:

• Catheterization yamtima
• X-ray pachifuwa
• ECG
• Echocardiogram (ngati yachitika asanabadwe, amatchedwa fetal echocardiogram)
• Kutulutsa oximetry (kuti muwone kuchuluka kwa mpweya wa magazi)

Gawo loyambirira la mankhwala ndikulola magazi olemera okosijeni kusakanikirana ndi magazi omwe alibe mpweya wabwino. Khanda limalandira mankhwala otchedwa prostaglandin kudzera mu IV (intravenous intra).Mankhwalawa amathandiza kuti chotengera chamagazi chotchedwa ductus arteriosus chitseguke, kulola kusanganikirana kwa magazi awiri. Nthawi zina, kutsegula pakati pa atrium yakumanja ndi kumanzere kumatha kupangidwa ndi njira yogwiritsira ntchito catheter ya baluni. Izi zimapangitsa magazi kusakanikirana. Njirayi imadziwika kuti balloon atrial septostomy.

Chithandizo chamuyaya chimaphatikizapo kuchitidwa opaleshoni yamtima pomwe mitsempha yayikulu imadulidwa ndikulumikanso pamalo ake oyenera. Izi zimatchedwa kusintha kwamagetsi (ASO). Asanachitike opaleshoniyi, opaleshoni yotchedwa atrial switch (kapena njira ya Mustard kapena njira ya Senning) idagwiritsidwa ntchito.

Zizindikiro za mwana zidzasintha pambuyo pa opaleshoni kuti athetse vutoli. Makanda ambiri omwe amasinthidwa mwamphamvu samakhala ndi zizindikiritso pambuyo pochitidwa opaleshoni ndikukhala moyo wabwinobwino. Ngati opaleshoni yokonza siikuchitidwa, chiyembekezo cha moyo ndi miyezi yokha.

Zovuta zingaphatikizepo:

• Mavuto a mitsempha yamtendere
• Mavuto a valavu yamtima
• Nyimbo zosasinthasintha (arrhythmias)

Vutoli limatha kupezeka asanabadwe pogwiritsa ntchito fetal echocardiogram. Ngati sichoncho, amapezeka nthawi zambiri mwana akangobadwa.

Pitani kuchipinda chodzidzimutsa kapena itanani nambala yadzidzidzi yakomweko (monga 911) ngati khungu la mwana wanu lipanga mtundu wabuluu, makamaka pamaso kapena thunthu.

Itanani omwe akukuthandizani ngati mwana wanu ali ndi vutoli ndipo zizindikilo zatsopano zikukula, zikuipiraipira, kapena kupitiliza kulandira chithandizo.

Amayi omwe akufuna kutenga pakati ayenera kulandira katemera wa rubella ngati alibe chitetezo chokwanira. Kudya bwino, kupewa mowa, komanso kuwongolera matenda ashuga musanakhale komanso nthawi yapakati kungakhale kothandiza.

d-TGA; Kobadwa nako mtima chilema - kusintha; Matenda a cyanotic mtima - kusintha; Kubadwa kwa chilema - kusintha; Kusintha kwa zotengera zazikulu; TGV

• Kuchita opaleshoni yamtima wa ana - kutulutsa

• Mtima - gawo kupyola pakati
• Mtima - kuwonera kutsogolo
• Kusintha kwa zotengera zazikulu

Bernstein D. Cyanotic wobadwa ndi matenda amtima: kuwunika odwala kwambiri omwe ali ndi cyanosis komanso kupuma kwamatenda. Mu: Kliegman RM, Stanton BF, St Geme JW, Schor NF, olemba. Nelson Textbook of Pediatrics. Wolemba 21th. Philadelphia, PA: Elsevier; 2019: mutu 456.

CD ya Fraser, Kane LC. Matenda amtima obadwa nawo. Mu: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery: Maziko Achilengedwe a Njira Zamakono Zopangira 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.