Zovuta za Ebstein

Ebstein anomaly ndi vuto losowa la mtima lomwe magawo ena a valavu ya tricuspid amakhala achilendo. Valavu ya tricuspid imasiyanitsa chipinda chakumanja chakumanja (ventricle chakumanja) kuchokera kuchipinda chakumanja chakumtunda (kumanja kwa atrium). Mu Ebstein anomaly, kuyika kwa valavu ya tricuspid ndi momwe imagwirira ntchito kupatula zipindazi sizachilendo.

Matendawo ndi obadwa nawo, zomwe zikutanthauza kuti amapezeka pakubadwa.

Valavu ya tricuspid nthawi zambiri imakhala yopangidwa ndi magawo atatu, otchedwa timapepala kapena ziphuphu. Timapepala timatseguka kuti magazi aziyenda kuchokera kumtunda woyenera (chipinda chapamwamba) kupita ku ventricle yoyenera (chipinda chapansi) pomwe mtima umatsitsimuka. Amatseka kuti ateteze magazi kuti asayende kuchoka pamitsempha yolondola kupita ku atrium yoyenera pomwe mtima umapopa.

Mwa anthu omwe ali ndi Ebstein anomaly, timapepalato timayikidwa mozama mozungulira bwino m'malo moyenera. Timapepala timeneti nthawi zambiri timakhala tambiri kuposa nthawi zonse. Kulemala nthawi zambiri kumapangitsa kuti valavu igwire bwino ntchito, ndipo magazi amatha kuyenda molakwika. M'malo mongothamangira m'mapapu, magazi amathanso kubwerera kumalo oyenera. Kusungidwa kwa magazi kumatha kubweretsa kukulitsa kwa mtima ndi kuchuluka kwa madzi m'thupi. Pakhoza kukhala kuchepa kwa valavu komwe kumatsogolera kumapapu (valavu yamapapo).

Nthawi zambiri, anthu amakhalanso ndi chibowo pakhoma cholekanitsa zipinda ziwiri zakumtunda zam'mimba (atrial septal defect) ndipo magazi amayenda mumbaliyi amatha kupangitsa kuti magazi opanda oxygen apite mthupi. Izi zitha kuyambitsa cyanosis, mtundu wabuluu pakhungu loyambitsidwa ndi magazi wopanda oxygen.

Ebstein anomaly imachitika mwana akamakula m'mimba. Zomwe zimayambitsa sizikudziwika. Kugwiritsa ntchito mankhwala ena (monga lithiamu kapena benzodiazepines) panthawi yoyembekezera kumatha kuthandizira. Matendawa ndi osowa. Zimafala kwambiri kwa azungu.

Zovuta zimatha kukhala zochepa kapena zovuta kwambiri. Chifukwa chake, zizindikilo zimatha kukhalanso zofewa mpaka zovuta kwambiri. Zizindikiro zimatha kubadwa atangobadwa, ndipo zimatha kuphatikiza milomo yamiyala yamtambo ndi misomali chifukwa chakuchepa kwama oxygen. Zikakhala zovuta, mwanayo amawoneka wodwala kwambiri ndipo amavutika kupuma. Nthawi zochepa, munthu wokhudzidwayo amatha kukhala wopanda ziwonetsero kwa zaka zambiri, nthawi zina mwinanso mpaka kalekale.

Zizindikiro mwa ana okalamba atha kukhala:

• Tsokomola
• Kulephera kukula
• Kutopa
• Kupuma mofulumira
• Kupuma pang'ono
• Kugunda kwamtima kwambiri

Ana obadwa kumene omwe ali ndi kutayikira kwakukulu pamagawo atatu a tricuspid amakhala ndi mpweya wotsika kwambiri m'magazi awo ndikukulitsa mtima kwakukulu. Wopereka chithandizo chamankhwala amatha kumva phokoso lachilendo, monga kung'ung'udza, pomvera pachifuwa ndi stethoscope.

Mayeso omwe angathandize kuzindikira vutoli ndi awa:

• X-ray pachifuwa
• Kujambula kwamaginito (MRI) kwamtima
• Kuyeza kwa zamagetsi pamtima (ECG)
• Ultrasound yamtima (echocardiogram)

Chithandizo chimadalira kuopsa kwa chilema komanso zizindikilo zake. Chithandizo chachipatala chingaphatikizepo:

• Mankhwala othandizira kulephera kwa mtima, monga okodzetsa.
• Oxygen ndi zina zothandizira kupuma.
• Opaleshoni kuti akonze valavu.
• Kusintha kwa valavu ya tricuspid. Izi zitha kukhala zofunika kwa ana omwe akupitilirabe kukulira kapena omwe ali ndi zovuta zazikulu.

Kawirikawiri, zizindikiro zoyambirira zimayamba, matendawa ndi ovuta kwambiri.

Anthu ena mwina sangakhale ndi zizindikilo kapena zoziziritsa kwambiri. Zina zitha kukulirakulira pakapita nthawi, kukhala ndi utoto wabuluu (cyanosis), kulephera kwa mtima, kutchinga kwa mtima, kapena nyimbo zowopsa za mtima.

Kutayikira kwakukulu kumatha kubweretsa kutupa kwa mtima ndi chiwindi, komanso kulephera kwa mtima.

Zovuta zina zingaphatikizepo:

• Nyimbo zosadziwika bwino (arrhythmias), kuphatikiza mayimbidwe othamanga kwambiri (tachyarrhythmias) ndi nyimbo zosafulumira (bradyarrhythmias ndi block block)
• Magazi amaundana kuchokera pamtima kupita mbali zina za thupi
• Kutupa kwa ubongo

Itanani omwe akukuthandizani ngati mwana wanu ayamba kukhala ndi vuto ili. Pitani kuchipatala nthawi yomweyo ngati mavuto akupuma amapezeka.

Palibe njira yodziwira yodziwika, kupatula kuyankhula ndi omwe amakupatsani mwayi musanakhale ndi pakati ngati mukumwa mankhwala omwe akuganiza kuti akukhudzana ndi matendawa. Mutha kupewa zina mwazovuta zamatendawo. Mwachitsanzo, kumwa maantibayotiki musanachite opareshoni ya mano kumatha kuthandizira kupewa endocarditis.

Zovuta za Ebstein; Malformation a Ebstein; Kobadwa nako mtima chilema - Ebstein; Mtima wolakwika wobadwa - Ebstein; Matenda a mtima wa Cyanotic - Ebstein

• Zovuta za Ebstein

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

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Zilonda zam'mimba zotsekemera: zotupa zomwe zimakhudzana ndi kuchepa kwa magazi m'mapapo. Mu: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, olemba. Nelson Textbook of Pediatrics. Wolemba 21. Philadelphia, PA: Elsevier; 2020: chap 457.

Olimba KK, Daniels CJ, Aboulhosn JA, et al. Chitsogozo cha AHA / ACC cha 2018 cha kasamalidwe ka achikulire omwe ali ndi matenda amtima obadwa nawo: lipoti la American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines. Kuzungulira. 2019; 139: e698-e800. PMID: 30121239 pubed.ncbi.nlm.nih.gov/30121239/.

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.