Endocardial khushoni chilema

Endocardial cushion defect (ECD) ndimatenda amtima. Makoma olekanitsa zipinda zinayi zonse za mtima sanapangidwe bwino kapena kulibe. Komanso mavavu omwe amalekanitsa zipinda zakumtunda ndi zapansi za mtima amakhala ndi zofooka popanga. ECD ndimatenda amtima obadwa nawo, zomwe zikutanthauza kuti amapezeka pobadwa.

ECD imachitika mwana akamakula m'mimba. Ma cushion a endocardial ndi malo awiri olimba omwe amakula kulowa m'makoma (septum) omwe amagawa zipinda zinayi zamtima. Amapangitsanso ma valve amitral ndi tricuspid. Awa ndi mavavu omwe amalekanitsa atria (zipinda zosanja pamwamba) kuchokera kuma ventricles (zipinda zapansi zopopera).

Kulephera kupatukana pakati pa mbali ziwiri za mtima kumabweretsa mavuto angapo:

• Kuchuluka kwa magazi kumapita m'mapapu. Izi zimapangitsa kupanikizika kowonjezereka m'mapapu. Mu ECD, magazi amayenda kudzera m'mabowo osadziwika kuchokera kumanzere kupita kumanja kwamtima, kenako kumapapu. Kuchuluka kwa magazi m'mapapu kumapangitsa kuthamanga kwa magazi m'mapapu kukwera.
• Mtima kulephera. Khama lowonjezera lomwe limafunika kupopera limapangitsa mtima kugwira ntchito molimbika kuposa masiku onse. Minofu ya mtima itha kukulitsa ndikufooka. Izi zitha kuyambitsa kutupa kwa mwana, kupuma movutikira, komanso kuvutika kudyetsa ndikukula.
• Cyanosis. Kuthamanga kwa magazi kumawonjezeka m'mapapu, magazi amayamba kuyenda kuchokera kumanja kwamtima kupita kumanzere. Magazi opanda oxygen amasakanikirana ndi magazi omwe ali ndi oxygen. Zotsatira zake, magazi okhala ndi oxygen yocheperako kuposa nthawi zonse amaponyedwa m'thupi. Izi zimayambitsa cyanosis, kapena khungu labuluu.

Pali mitundu iwiri ya ECD:

• ECD yonse. Vutoli limakhala ndi vuto la asrial septal defect (ASD) komanso vuto la ventricular septal defect (VSD). Anthu omwe ali ndi ECD yathunthu amakhala ndi valavu imodzi yamtima (valve wamba ya AV) m'malo mwa mavavu awiri osiyana (mitral ndi tricuspid).
• ECD yochepa (kapena yosakwanira). Momwemonso, pali ASD, kapena ASD ndi VSD okha. Pali ma valve awiri osiyana, koma imodzi mwayo (mitral valve) nthawi zambiri imakhala yopanda tanthauzo ndikutseguka ("cleft"). Vutoli limatha kutulutsa magazi kudzera mu valavu.

ECD imagwirizana kwambiri ndi Down syndrome. Kusintha kwamitundu ingapo kumalumikizidwa ndi ECD. Komabe, chomwe chimayambitsa ECD sichikudziwika.

ECD itha kukhala yolumikizidwa ndi zovuta zina zobadwa nazo za mtima, monga:

• Kawiri kubwereketsa ventricle kumanja
• Vuto limodzi
• Kusintha kwa zotengera zazikulu
• Zolemba Zachinyengo

Zizindikiro za ECD zitha kuphatikizira izi:

• Matayala a ana mosavuta
• Mtundu wa khungu la Bluish, womwe umadziwikanso kuti cyanosis (milomo imatha kukhalanso yabuluu)
• Kudyetsa zovuta
• Kulephera kunenepa ndikukula
• Chibayo chambiri kapena matenda
• Khungu loyera (pallor)
• Kupuma mofulumira
• Kugunda kwamtima mwachangu
• Kutuluka thukuta
• Kutupa miyendo kapena pamimba (zosowa mwa ana)
• Kuvuta kupuma, makamaka mukamadyetsa

Mukamayesa mayeso, wothandizira zaumoyo atha kupeza zizindikilo za ECD, kuphatikiza:

• Electrocardiogram yachilendo (ECG)
• Mtima wokulitsidwa
• Kung'ung'uza mtima

Ana omwe ali ndi ECD yapadera sangakhale ndi zizindikilo za matendawa ali mwana.

Kuyesa kupeza ECD ndi monga:

• Echocardiogram, yomwe ndi ultrasound yomwe imawona momwe mtima umakhalira komanso magazi amayenda mkati mwa mtima
• ECG, yomwe imayesa zochitika zamagetsi pamtima
• X-ray pachifuwa
• MRI, yomwe imapereka chithunzi chatsatanetsatane cha mtima
• Catheterization yamtima, njira yomwe chubu yocheperako (catheter) imayikidwa mumtima kuti muwone kuthamanga kwa magazi ndikutenga mulingo woyenera wa kuthamanga kwa magazi ndi kuchuluka kwa mpweya

Kuchita opaleshoni kumafunikira kuti titseke mabowo pakati pazipinda zamtima, ndikupanga ma valve amtundu wa tricuspid ndi mitral. Nthawi ya opaleshoniyi imadalira momwe mwanayo alili komanso kuuma kwa ECD. Nthawi zambiri zimatha kuchitika mwana akakhala miyezi itatu kapena isanu ndi umodzi yakubadwa. Kuwongolera ECD kungafune kuchitidwa opaleshoni yopitilira imodzi.

Dokotala wa mwana wanu akhoza kukupatsani mankhwala:

• Kuchiza zizindikiro za mtima kulephera
• Asanamuchite opaleshoni ngati ECD yadwalitsa mwana wanu kwambiri

Mankhwalawa amuthandiza mwana wanu kunenepa komanso kulimba asanamupange opaleshoni. Mankhwala omwe amagwiritsidwa ntchito nthawi zambiri ndi awa:

• Odzetsa (mapiritsi amadzi)
• Mankhwala omwe amalimbitsa mtima mwamphamvu kwambiri, monga digoxin

Opaleshoni ya ECD yathunthu iyenera kuchitika mchaka choyamba cha mwana. Kupanda kutero, kuwonongeka kwamapapu komwe sikungasinthidwe kumatha kuchitika. Ana omwe ali ndi Down syndrome amakhala ndi matenda am'mapapo koyambirira. Chifukwa chake, opaleshoni yoyambirira ndiyofunika kwambiri kwa ana awa.

Momwe mwana wanu amachitira zimadalira:

• Kukula kwa ECD
• Thanzi lonse la mwanayo
• Kaya matenda am'mapapo adayamba kale

Ana ambiri amakhala moyo wabwinobwino, wokangalika ECD ikakonzedwa.

Zovuta kuchokera ku ECD zitha kuphatikizira izi:

• Kulephera kwa mtima
• Imfa
• Matenda a Eisenmenger
• Kuthamanga kwa magazi m'mapapu
• Kuwonongeka kosasinthika m'mapapu

Zovuta zina za opareshoni ya ECD sizingawonekere kufikira mwana atakula. Izi zikuphatikiza zovuta zamagalimoto amtima ndi mitral valavu yotayikira.

Ana omwe ali ndi ECD atha kukhala pachiwopsezo chotenga matenda amtima (endocarditis) asanafike komanso pambuyo pa opaleshoni. Funsani dokotala wa mwana wanu ngati mwana wanu akufunika kumwa maantibayotiki asanayambe njira zina zamano.

Itanani yemwe amakupatsani mwana wanu ngati mwana wanu:

• Matayala mosavuta
• Ali ndi vuto kupuma
• Ali ndi khungu labuluu kapena milomo

Komanso lankhulani ndi wothandizira ngati mwana wanu sakukula kapena akulemera.

ECD imalumikizidwa ndi zovuta zingapo zamtundu. Mabanja omwe ali ndi mbiri ya banja la ECD atha kufunafuna upangiri wa majini asanakhale ndi pakati.

Atrioventricular (AV) ngalande chilema; Atrioventricular septal chilema; Kutulutsa; Chipangizo wamba cha AV; Ostium primum atrial septal zilema; Kobadwa nako mtima chilema - ECD; Kubadwa kobadwa - ECD; Matenda a cyanotic - ECD

• Ventricular septal chilema
• Matenda osokoneza bongo
• Mtsinje wa atrioventricular (vuto la endocardial cushion)

Basu SK, Dobrolet NC. Kobadwa nako zopindika dongosolo mtima. Mu: Martin RJ, Fanaroff AA, Walsh MC, olemba., Eds. Fanaroff ndi Martin's Neonatal-Perinatal Medicine. 11th ed. Philadelphia, PA: Elsevier; 2020: chap 75.

Ebels T, Tretter JT, Spicer DE, Anderson RH. Antroventricular septal zopindika. Mayi: Wernovsky G, Anderson RH, Kumar K, et al. Matenda a Ana a Anderson. Wolemba 4. Philadelphia, PA: Elsevier; 2020: chap 31.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Acyanotic matenda obadwa nawo amtima: zotupa zakumanzere kumanzere. 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 453.