Kawiri polowera kumanzere kwamitsempha yamagetsi

Kawiri kolowera kumanzere kwamitsempha yamagetsi (DILV) ndi vuto la mtima lomwe limakhalapo kuyambira pakubadwa (kobadwa nako). Zimakhudza ma valve ndi zipinda zamtima. Ana obadwa ndi vutoli ali ndi chipinda chimodzi chokha chopopera (ventricle) mumtima mwawo.

DILV ndi imodzi mwaziphuphu zingapo zamtima zomwe zimadziwika kuti ma ventricle osalakwitsa (kapena wamba). Anthu omwe ali ndi DILV ali ndi ventricle yayikulu yakumanzere ndi kanyumba kakang'ono kakumanja. Vuto lamanzere ndi chipinda chopopera chamtima chomwe chimatumiza magazi okhala ndi oxygen m'thupi. Vuto loyenera ndi chipinda chopopera chomwe chimatumiza magazi opanda mpweya m'mapapu.

Mumtima wabwinobwino, ma ventricle akumanja ndi kumanzere amalandila magazi kuchokera kumanja kumanzere ndi kumanzere. Atria ndi zipinda zapamwamba za mtima.Magazi osauka okosijeni obwerera kuchokera mthupi amayenda kupita ku atrium yoyenera ndi ventricle wamanja. Vuto lamitsempha lamanja kenako limapopa magazi kupita kumtunda wama pulmonary. Ichi ndiye chotengera chamagazi chomwe chimanyamula magazi kupita nawo m'mapapu kukatenga mpweya.

Magazi okhala ndi oxygen yatsopano amabwerera ku atrium yakumanzere ndikutsalira kwamanzere. Aorta kenako amanyamula magazi olemera okosijeni kumthupi lonse kuchokera kumanzere kumanzere. Aorta ndiye mitsempha yayikulu yotuluka mumtima.

Mwa anthu omwe ali ndi DILV, ventricle yakumanzere yokha imapangidwa. Onse atria amatulutsa magazi mu ventricle iyi. Izi zikutanthauza kuti magazi olemera okosijeni amasakanikirana ndi magazi opanda oxygen. Chosakanizacho chimapopera thupi ndi mapapu onse.

DILV itha kuchitika ngati mitsempha yayikulu yamagazi yochokera mumtima ili m'malo olakwika. Morte imachokera ku kachingwe kakang'ono koyenera ndipo mtsempha wamagazi umachokera kumtunda wakumanzere. Zitha kuchitika pomwe mitsempha imakhala pamalo oyenera ndipo imachokera ku ma ventricles wamba. Poterepa, magazi amayenda kuchokera kumanzere kupita kumanjenje kudzera pakabowo pakati pa zipinda zotchedwa ventricular septal defect (VSD).

DILV ndiyosowa kwambiri. Zomwe zimayambitsa sizikudziwika. Vutoli limapezeka kwambiri nthawi yomwe mayi ali ndi pakati, pomwe mtima wa mwana umayamba. Anthu omwe ali ndi DILV nthawi zambiri amakhalanso ndi mavuto ena amtima, monga:

• Kupanga kwa aorta (kuchepa kwa aorta)
• Pulmonary atresia (pulmonary valve ya mtima siinapangidwe bwino)
• Pulmonary valve stenosis (kuchepa kwa valavu yamapapo)

Zizindikiro za DILV zitha kuphatikiza:

• Mtundu wabuluu pakhungu ndi milomo (cyanosis) chifukwa cha mpweya wochepa m'magazi
• Kulephera kunenepa ndikukula
• Khungu loyera (pallor)
• Kudya moperewera kuti asatope mosavuta
• Kutuluka thukuta
• Kutupa miyendo kapena pamimba
• Kuvuta kupuma

Zizindikiro za DILV zitha kuphatikiza:

• Mtima wosazolowereka, monga tawonera pa electrocardiogram
• Kuchuluka kwa madzimadzi kuzungulira mapapo
• Mtima kulephera
• Kung'ung'uza mtima
• Kugunda kwamtima mwachangu

Kuyesera kuti mupeze DILV kungaphatikizepo:

• X-ray pachifuwa
• Kuyeza kwa zamagetsi mumtima (electrocardiogram, kapena ECG)
• Kuyesa kwa mtima wa Ultrasound (echocardiogram)
• Kupatsira chubu chowonda, chosinthasintha mumtima kuti mufufuze mitsempha (catheterization yamtima)
• MRI ya Mtima

Kuchita opaleshoni kumafunika kuti magazi aziyenda bwino kudzera mthupi komanso m'mapapu. Opaleshoni yodziwika bwino yochizira DILV ndi zochitika ziwiri kapena zitatu. Opaleshoni imeneyi ndi yofanana ndi yomwe imagwiritsidwa ntchito pochizira matenda am'magazi am'mimba ndi tricuspid atresia.

Kuchita opareshoni koyamba kungafunike mwanayo ali ndi masiku ochepa okha. Nthawi zambiri, mwana amatha kupita kunyumba kuchokera kuchipatala pambuyo pake. Mwanayo nthawi zambiri amafunika kumwa mankhwala tsiku lililonse ndikutsatiridwa ndi dokotala wamtima wa ana. Dokotala wa mwanayo adzazindikira nthawi yomwe gawo lachiwiri la opaleshoni liyenera kuchitidwa.

Opaleshoni yotsatira (kapena opaleshoni yoyamba, ngati mwanayo sanafunikire njira ngati mwana wakhanda) amatchedwa bidirectional Glenn shunt kapena Hemifontan. Kuchita opaleshoniyi kumachitika mwana ali ndi miyezi 4 mpaka 6.

Ngakhale atachita opareshoni pamwambapa, mwanayo angawoneke wabuluu (cyanotic). Gawo lomaliza limatchedwa njira ya Fontan. Kuchita opaleshoniyi kumachitika nthawi zambiri mwana akakhala miyezi 18 mpaka 3 wazaka. Pambuyo pa gawo lomaliza ili, mwanayo salinso wabuluu.

Ntchito ya Fontan siyimapanga magwiritsidwe abwinobwino mthupi. Koma, zimapangitsa kuti magazi aziyenda mokwanira kuti mwanayo akhale ndi moyo ndikukula.

Mwana angafunike kuchitidwa maopaleshoni enanso pazovuta zina kapena kupitiliza kukhala ndi moyo podikirira njira ya Fontan.

Mwana wanu angafunike kumwa mankhwala asanachite opaleshoni komanso pambuyo pake. Izi zingaphatikizepo:

• Maanticoagulants oletsa kupewa magazi
• ACE inhibitors kuti achepetse kuthamanga kwa magazi
• Digoxin yothandizira mgwirizano wamtima
• Mapiritsi amadzi (okodzetsa) kuti achepetse kutupa mthupi

Kuika mtima kumalimbikitsidwa, ngati njira zomwe tatchulazi zikalephera.

DILV ndi vuto la mtima lovuta kwambiri lomwe silivuta kuchiza. Zomwe mwana amachita bwino zimadalira:

• Mkhalidwe wonse wa mwanayo panthawi yodziwitsa ndi kulandira chithandizo.
• Ngati pali mavuto ena amtima.
• Kulemala kwake ndi kovuta bwanji.

Pambuyo pochiritsidwa, makanda ambiri omwe ali ndi DILV amakhala kukhala achikulire. Koma, adzafunika kutsatira kwa moyo wawo wonse. Akhozanso kukumana ndi zovuta ndipo angafunikire kuchepetsa zochita zawo zakuthupi.

Zovuta za DILV ndizo:

• Kalabu (kukulitsa misomali) kumapazi ndi zala (chizindikiro chakumapeto)
• Mtima kulephera
• Chibayo chafupipafupi
• Mavuto amtundu wamtima
• Imfa

Imbani wothandizira zaumoyo wanu ngati mwana wanu:

• Zikuwoneka kuti zatopa mosavuta
• Ali ndi vuto kupuma
• Ali ndi khungu labuluu kapena milomo

Komanso lankhulani ndi omwe amakupatsani ngati mwana wanu sakukula kapena akulemera.

Palibe njira yodziwika yopewera.

DILV; Vuto limodzi; Ventricle wamba; Mtima wosasunthika; Mtima wosasunthika wamtundu wamanzere wamanzere; Kobadwa nako mtima chilema - DILV; Cyanotic mtima chilema - DILV; Chilema - DILV

• Kawiri polowera kumanzere kwamitsempha yamagetsi

Kanter KR. Kuwongolera kulumikizana kwamitsempha yamagetsi imodzi ndi ma cavopulmonary Mu: Sellke FW, del Nido PJ, Swanson SJ, olemba. Opaleshoni ya Sabiston ndi Spencer pachifuwa. 9th ed. Philadelphia, PA: Elsevier; 2016: chap 129.

Kliegman RM, St. Geme JW, Blum NJ. Shah SS, Tasker RC, Wilson KM. Schor NF. Matenda am'mimba obadwa nawo: zotupa zomwe zimakhudzana ndi kuchuluka 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 458.

Wohlmuth C, Gardiner HM. Mtima. Mu: Pandya PP, Oepkes D, Sebire NJ, Wapner RJ, eds. Mankhwala a Fetal: Basic Science ndi Clinical Practice. Wachitatu ed. Philadelphia, PA: Elsevier; 2020: chap 29.