Kobadwa nako mtima chilema - kukonza opaleshoni

Operewera operewera mtima operewera amakonza kapena amathana ndi vuto la mtima lomwe mwana amabadwa nalo. Mwana wobadwa ndi vuto limodzi kapena angapo amakhala ndi matenda amtima obadwa nawo. Kuchita opaleshoni kumafunika ngati chilema chikhoza kuvulaza thanzi la mwana kwa nthawi yayitali kapena thanzi.

Pali mitundu yambiri ya opaleshoni ya mtima ya ana.

Kuphatikiza patent ductus arteriosus (PDA):

• Asanabadwe, khandalo limakhala ndi chotengera chamagazi chomwe chimayenda pakati pa msempha (mtsempha waukulu wa thupi) ndi mtsempha wamagazi (mtsempha waukulu wopita kumapapu), wotchedwa ductus arteriosus. Chombo chaching'ono ichi chimatsekedwa atangobadwa kumene pamene mwana ayamba kupuma payekha. Ngati satseka. Amatchedwa patent ductus arteriosus. Izi zitha kubweretsa mavuto pambuyo pake m'moyo.
• Nthawi zambiri, adokotala amatseka kutsegula pogwiritsa ntchito mankhwala. Ngati izi sizigwira ntchito, ndiye kuti njira zina zimagwiritsidwa ntchito.
• Nthawi zina PDA imatha kutsekedwa ndi njira yomwe siyikuphatikiza opaleshoni. Njirayi imachitika nthawi zambiri mu labotale yomwe imagwiritsa ntchito ma x-ray. Pochita izi, dokotalayo amadula pang'ono. Chingwe ndi chubu chotchedwa catheter zimalowetsedwa mumtsempha wamumendo ndikuzipereka pamtima. Kenako, kachingwe kakachitsulo kapenanso kachipangizo kena kamadutsa mu catheter kupita mumtsempha wa khanda la ductus arteriosus. Koyilo kapena chida china chimatseka kuyenda kwa magazi, ndipo izi zimawongolera vutoli.
• Njira inanso ndikudula pang'ono mbali yakumanzere ya chifuwa. Dokotalayo amapeza PDA kenako ndikumangirira kapena kudulira ductus arteriosus, kapena kumagawa ndikudula. Kuchotsa ductus arteriosus kumatchedwa ligation. Njirayi itha kuchitidwa mu chipinda chosamalirako chaukhanda (NICU).

Kuphatikizika kwa kukonza kwa aorta:

• Coarctation ya aorta imachitika pamene gawo la morta limakhala ndi gawo lochepetsetsa. Mawonekedwewo amawoneka ngati timer ya hourglass. Kupanikizika kumapangitsa kuti zikhale zovuta kuti magazi azidutsa kumapeto kwenikweni. Popita nthawi, zimatha kubweretsa mavuto monga kuthamanga kwambiri kwa magazi.
• Pofuna kukonza vutoli, amadula nthawi zambiri kumanzere kwa chifuwa, pakati pa nthiti. Pali njira zingapo zokonzera coarctation ya aorta.
• Njira yodziwikiratu ndikudula kachigawo kakang'ono ndikupanga kakulidwe kake ndi chigamba chopangidwa ndi Gore-tex, chopangidwa ndi anthu.
• Njira ina yothetsera vutoli ndi kuchotsa gawo lopapatiza la aorta ndikusoka malekezero otsalawo. Izi zimachitika nthawi zambiri kwa ana okulirapo.
• Njira yachitatu yothetsera vutoli amatchedwa subclavian flap. Choyamba, amadulidwa mu gawo lopapatiza la aorta. Kenako, chigamba chimatengedwa kuchokera kumtunda wamanzere wa subclavia (mtsempha wopita kumanja) kukulitsa gawo lopapatiza la aorta.
• Njira yachinayi yothetsera vutoli ndi kulumikiza chubu ndi magawo abwinobwino a aorta, mbali zonse zazing'onozi. Magazi amayenda kudzera mu chubu ndikudutsa gawo locheperako.
• Njira yatsopano sikutanthauza opaleshoni. Tambo tating'onoting'ono timayikidwa kudzera mumtsempha m'mabowo mpaka kumtunda. Kenako chibaluni chaching'ono chimatsegulidwa m'deralo. Kachubu kakang'ono kapena kakang'ono kamasiyidwa pamenepo kothandiza kuti mitsempha ikhale yotseguka. Njirayi imachitika mu labotale yokhala ndi ma x-ray. Njirayi imagwiritsidwa ntchito nthawi zambiri coarctation ikawonekanso ikakonzedwa.

Kukonzekera kwa atrial septal defect (ASD):

• Septum ya atrial ndi khoma pakati pa atria kumanzere ndi kumanja (zipinda zam'mwamba) zamtima. Bowo pakhomolo limatchedwa ASD. Pamaso pa vutoli, magazi omwe ali ndi mpweya wopanda komanso okosijeni amatha kusakanizidwa komanso pakapita nthawi, amayambitsa mavuto azachipatala ndi arrhythmias.
• Nthawi zina, ASD imatha kutsekedwa popanda kuchita opaleshoni ya mtima. Choyamba, dokotalayo amadula pang'ono pakhosi. Kenako dokotalayo amalowetsa waya mumtsempha wamagazi wopita kumtima. Kenako, zida ziwiri zazing'ono zopangidwa ndi ambulera "clamshell" zimayikidwa kumanja ndi kumanzere kwa septum. Zipangizo ziwirizi zimagwirizana. Izi zimatseka dzenje mumtima. Si malo onse azachipatala omwe amachita izi.
• Opaleshoni ya mtima ingathenso kuchitidwa kukonzanso ASD. Pochita izi, septum ikhoza kutsekedwa pogwiritsa ntchito ulusi. Njira inanso yotsekera dzenje ili ndi chigamba.

Ventricular septal defect (VSD) kukonza:

• Septum yamitsempha yamagazi ndiyo khoma pakati pa ma ventricle akumanzere ndi kumanja (zipinda zapansi) zamtima. Bowo mu septum yamitsempha yotchedwa VSD. Bowo limeneli limalola magazi ndi mpweya kusakanikirana ndi magazi omwe agwiritsidwa ntchito kubwerera m'mapapu. Popita nthawi, kugunda kwamtima kosazolowereka komanso mavuto ena amtima zimatha kuchitika.
• Pofika zaka 1, ma VSD ang'onoang'ono amatseka okha. Komabe, ma VSD omwe amakhala otseguka pambuyo pa msinkhu uwu angafunike kutsekedwa.
• Ma VSD akuluakulu, monga ang'onoang'ono m'magawo ena amitsempha yamagetsi, kapena omwe amachititsa mtima kulephera kapena endocarditis, (kutupa) amafunika kuchitidwa opaleshoni yotseguka. Bowo la septum nthawi zambiri limatsekedwa ndi chigamba.
• Zovuta zina za septal zitha kutsekedwa popanda opareshoni. Njirayi imaphatikizapo kupititsa kachingwe kakang'ono mumtima ndikuyika kachipangizo kakang'ono kotseka cholakwikacho.

Tetralogy ya Kukonzanso Kwabodza:

• Tetralogy of Fallot ndi vuto la mtima lomwe limakhalapo kuyambira pakubadwa (kobadwa nako). Nthawi zambiri zimaphatikizapo zolakwika zinayi mumtima ndikupangitsa kuti mwanayo asinthe mtundu wabluish (cyanosis).
• Kuchita opaleshoni yotseguka kumafunika, ndipo nthawi zambiri kumachitika mwana ali pakati pa miyezi 6 ndi zaka ziwiri.

Kuchita opaleshoni kumaphatikizapo:

• Kutseka vuto la septal yamitsempha yamagazi ndi chigamba.
• Kutsegula valavu yamapapo ndikuchotsa minofu yolimba (stenosis).
• Kuyika chigamba pa ventricle yoyenera ndi mtsempha wamagazi wam'mapapo kuti muthane ndi magazi m'mapapu.

Mwanayo atha kukhala ndi njira yoyeserera yoyamba. Shunt imasunthira magazi kuchokera kudera lina kupita kwina. Izi zimachitika ngati opaleshoni yotseguka imafunika kuchedwa chifukwa mwanayo akudwala kwambiri kuti sangachite opaleshoni.

• Pa nthawi ya shunt, dokotalayo amadula opaleshoni kumanzere kwa chifuwa.
• Mwana atakula, shunt imatsekedwa ndipo kukonza kwakukulu pamtima kumachitika.

Kusintha kwa ziwiya zazikulu:

• Mumtima wabwinobwino, aorta imachokera kumbali yakumanzere ya mtima, ndipo mtsempha wamagazi umachokera mbali yakumanja. Mukusintha kwa zotengera zazikulu, mitsempha iyi imachokera mbali zotsutsana za mtima. Mwanayo amathanso kukhala ndi zovuta zina zobadwa.
• Kuwongolera kusintha kwa zotengera zazikulu kumafuna kuchitidwa opaleshoni yotseguka. Ngati ndi kotheka, opaleshoniyi imachitika atangobadwa kumene.
• Kukonzekera kofala kwambiri kumatchedwa kusintha kwamagetsi. Mitsempha ya aorta ndi pulmonary imagawanika. Mitsempha yam'mapapo imalumikizidwa ndi ventricle yolondola, komwe ndiyofunika. Kenako, aorta ndi mitsempha yamitsempha yolumikizidwa yolumikizidwa ndi ventricle wakumanzere, komwe kuli.

Kukonza kwa Truncus arteriosus:

• Truncus arteriosus ndimavuto osowa omwe amapezeka pomwe aorta, coronary artery, ndi pulmonary artery zonse zimatuluka mu thunthu limodzi. Matendawa akhoza kukhala osavuta, kapena ovuta kwambiri. Nthawi zonse, pamafunika kuchitidwa opareshoni ya mtima wonse kuti akonze zolakwika.
• Kukonza kumachitika masiku angapo kapena milungu yoyambirira ya moyo wa khanda. Mitsempha yam'mapapo imasiyanitsidwa ndi thunthu la aortic, ndipo zolakwika zilizonse ndizigamba. Nthawi zambiri, ana amakhalanso ndi vuto la septal sectal, ndipo nawonso amatsekedwa. Kulumikizana kumayikidwa pakati pa ventricle yoyenera ndi mitsempha ya m'mapapo.
• Ana ambiri amafunika kuchitidwa maopaleshoni kamodzi kapena kawiri akamakula.

Kukonzekera kwa tricuspid atresia:

• Valavu ya tricuspid imapezeka pakati pazipinda zakumtunda ndi zapansi kumanja kwamtima. Tricuspid atresia imachitika valavu iyi ikapunduka, yopapatiza, kapena ikasowa.
• Ana obadwa ndi tricuspid atresia amakhala amtambo chifukwa samatha kupatsira magazi m'mapapu kuti akatenge mpweya.
• Kuti mufike kumapapu, magazi amayenera kudutsa cholakwika cha atrial septal (ASD), ventricular septal defect (VSD), kapena patent ductus artery (PDA). (Izi zanenedwa pamwambapa.) Vutoli limalepheretsa magazi kuyenda m'mapapu.
• Mwana akangobadwa, amatha kupatsidwa mankhwala otchedwa prostaglandin E. Mankhwalawa amathandiza kuti patent ductus arteriosus ikhale yotseguka kuti magazi apitirire kuyenda m'mapapu. Komabe, izi zingogwira ntchito kwakanthawi. Mwanayo pamapeto pake adzafunika kuchitidwa opaleshoni.
• Mwanayo angafunike kuzimitsidwa kangapo ndi maopaleshoni kuti athetse vutoli. Cholinga cha opaleshoniyi ndikulola magazi kuchokera mthupi kuthamangira m'mapapu. Dokotalayo angafunikire kukonza valavu ya tricuspid, kusintha valavu, kapena kuyika shunt kuti magazi apite kumapapu.

Kubwezeretsa kwathunthu kosasunthika kwa mapapo (TAPVR):

• TAPVR imachitika pamene mitsempha ya m'mapapo imabweretsa magazi olemera okosijeni m'mapapu kubwerera kumanja kwa mtima, m'malo mbali yakumanzere ya mtima, komwe nthawi zambiri imapita kwa anthu athanzi.
• Vutoli liyenera kukonzedwa ndikuchitidwa opaleshoni. Opaleshoniyo imatha kuchitika munthawi yobadwa kumene ngati khanda lili ndi zizindikilo zazikulu. Ngati sizinachitike atangobadwa, zimachitika m'miyezi 6 yoyambirira ya moyo wa mwanayo.
• Kukonza TAPVR kumafuna kuchitidwa opaleshoni yotseguka mtima. Mitsempha yam'mapapo imabwereranso mbali yakumanzere kwa mtima, komwe ili, ndipo kulumikizana kulikonse kwachilendo kumatsekedwa.
• Ngati PDA ilipo, imangirizidwa ndikugawika.

Hypoplastic kumanzere kukonzanso mtima:

• Uku ndikulephera kwakukulu kwamtima komwe kumayambitsidwa ndi mtima wamanzere wopepuka kwambiri. Ngati sanalandire chithandizo, amapha ana ambiri obadwa nawo. Mosiyana ndi makanda omwe ali ndi zofooka zina pamtima, omwe ali ndi mitima yotsalira ya hypoplastic alibe zolakwika zina. Ntchito zothana ndi vutoli zimachitikira kuzipatala zapadera. Nthawi zambiri, opaleshoni imakonza vuto ili.
• Nthawi zingapo pamafunika maopareshoni atatu amtima. Opaleshoni yoyamba imachitika sabata yoyamba ya moyo wa mwanayo. Uku ndi opaleshoni yovuta pomwe chotengera chimodzi chamagazi chimapangidwa kuchokera pamitsempha yama pulmonary ndi aorta. Chombo chatsopanochi chimanyamula magazi kupita nawo m'mapapu ndi thupi lonse.
• Opaleshoni yachiwiri, yotchedwa opareshoni ya Fontan, imachitika nthawi zambiri mwana akakhala ndi miyezi 4 mpaka 6.
• Ntchito yachitatu idachitika patatha chaka chimodzi kuchokera pa ntchito yachiwiri.

Kobadwa nako mtima opaleshoni; Maluso a patent ductus arteriosus ligation; Hypoplastic kumanzere kukonza mtima; Tetralogy yokonza Mabodza; Kuphatikizika kwa kukonza kwa aorta; Kukonzekera kwa vuto la atrial septal; Ventricular septal chilema kukonza; Truncus arteriosus kukonza; Kukonzekera kwathunthu kwamitsempha yam'mapapo; Kusintha kwa ziwiya zazikulu; Kukonzekera kwa tricuspid atresia; Kukonza VSD; ASD kukonza

• Chitetezo cha bafa - ana
• Kubweretsa mwana wanu kuti adzachezere m'bale wanu wodwala kwambiri
• Kuchita opaleshoni yamtima wa ana - kutulutsa
• Chisamaliro cha bala la opaleshoni - chotseguka

• Mtima - gawo kupyola pakati
• Catheterization yamtima
• Mtima - kuwonera kutsogolo
• Ultrasound, yachibadwa mwana wosabadwayo - kugunda kwa mtima
• Ultrasound, yamitsempha yamagazi septal chilema - kugunda kwa mtima
• Patent ductus arteriosis (PDA) - mndandanda
• Khanda lotseguka mtima la opaleshoni

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Bhatt AB, Foster E, Kuehl K, et al; American Heart Association Council pa Zamankhwala Achipatala. Matenda amtima obadwa nawo mwa achikulire: mawu asayansi ochokera ku American Heart Association. Kuzungulira. 2015; 131 (21): 1884-1931. PMID: 25896865 www.ncbi.nlm.nih.gov/pubmed/25896865. (Adasankhidwa)

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