I-atresia yePulmonary

I-pulresary atresia luhlobo lwesifo sentliziyo apho ivelufa yemiphunga ingekho kakuhle. Ikho kwasekuzalweni (isifo sentliziyo). I-valve yemiphunga kukuvula kwicala lasekunene lentliziyo elilawula ukuhamba kwegazi ukusuka kwi-ventricle elungileyo (kwigumbi lasekunene lokupompa igumbi) ukuya emiphungeni.

Kwi-pulmonary atresia, amaphecana e-valve ahlanganisiwe. Oku kubangela ukuba iphepha eliqinileyo lezicubu lenze apho kuvulwa khona ivalve. Ukuhamba kwegazi eliqhelekileyo ukuya emiphungeni kuyavalwa ngenxa yoko. Ngenxa yesi siphene, igazi elivela kwicala lasekunene lentliziyo lithintelwe ekufikeleleni emiphungeni ukuze lithathe ioksijini.

Njengoninzi lwezifo zentliziyo yokuzalwa, akukho sizathu saziwayo se-pulmary atresia. Le meko inxulunyaniswa nolunye uhlobo lwesiphene sentliziyo esibelekwayo esibizwa ngokuba yi-patent ductus arteriosus (PDA).

I-pulresary atresia inokwenzeka kunye okanye ngaphandle kwesiphene se-ventricular septal (VSD).

• Ukuba umntu akanayo i-VSD, imeko ibizwa ngokuba yi-pulmonary atresia ene-intricular septum (PA / IVS).
• Ukuba umntu uneengxaki zombini, imeko ibizwa ngokuba yi-pulmonary atresia ene-VSD. Olu luhlobo olugqithisileyo lwe-tetralogy ye-Fallot.

Nangona zombini ezi meko zibizwa ngokuba yi-pulmonary atresia, eneneni ziziphene ezahlukileyo. Eli nqaku lixoxa nge-pulmary atresia ngaphandle kwe-VSD.

Abantu abane-PA / IVS banokuba ne-valve ye-tricuspid engaphuhliswanga kakuhle. Banokuba ne-ventricle engaphuhliswanga kakuhle okanye engqindilili kakhulu, kunye nemithambo yegazi engaqhelekanga yokondla intliziyo. Ngaphantsi kwesiqhelo, izakhiwo kwi-ventricle yasekhohlo, i-aortic valve, kunye ne-atrium yasekunene ziyabandakanyeka.

Iimpawu zihlala zivela kwiiyure ezimbalwa zokuqala zobomi, nangona zinokuthatha ukuya kwiintsuku ezimbalwa.

Iimpawu zingabandakanya:

• Ulusu olunombala oluhlaza okwesibhakabhaka (cyanosis)
• Ukuphefumla ngokukhawuleza
• Ukudinwa
• Ukutya okungalunganga (iintsana zinokudinwa ngelixa lokonga okanye ukubila ngexesha lokondla)
• Ukuqhawukelwa ngumphefumlo

Umboneleli wezempilo uya kusebenzisa i-stethoscope ukumamela intliziyo kunye nemiphunga. Abantu abane-PDA banentliziyo yokumbombozela enokuviwa ngestethoscope.

Ezi mvavanyo zilandelayo zinoku-odolwa:

• I-x-ray yesifuba
• Echocardiogram
• I-Electrocardiogram (ECG)
• Ukucinywa kwentliziyo
• I-oximetry ye-pulse-ibonisa inani le-oksijini egazini

Iyeza elibizwa ngokuba yi-prostaglandin E1 lihlala lisetyenziselwa ukunceda ukuhamba kwegazi (ukujikeleza) kwimiphunga. Eli yeza ligcina isitya segazi sivulekile phakathi kwemithambo yemiphunga kunye ne-aorta. Inqanawa ibizwa ngokuba yi-PDA.

Unyango oluninzi lunokwenzeka, kodwa luxhomekeke kubungakanani bokuphazamiseka kwentliziyo okuhamba nesiphene se-valve yemiphunga. Unyango olunokubakho olungenelelayo lubandakanya:

• Ukulungiswa kwe-Biventricular - Olu tyando lwahlula ukuhamba kwegazi kwimiphunga ukusuka ekujikelezeni kuye kuwo wonke umzimba ngokudala ii-ventricles ezimbini zokumpompa.
• I-univentricular palliation - Olu tyando lwahlula ukuhamba kwegazi kwimiphunga ukusuka ekujikelezeni kuye kuwo wonke umzimba ngokwakha umpompo womoya omnye.
• Ukufakelwa kwentliziyo.

Uninzi lwamatyala anokuncedwa kutyando. Indlela aqhuba ngayo umntwana ixhomekeke:

• Ubungakanani kunye nokudibanisa kwe-pulmonary artery (umthambo othatha igazi ukuya emiphungeni)
• Intliziyo ibetha kakuhle
• Zenziwe kakuhle njani ezinye iivevsi zentliziyo okanye zivuza kangakanani

Iziphumo ziyahluka ngenxa yeendlela ezahlukeneyo zesi siphene. Umntwana unokufuna inkqubo enye kuphela okanye unokufuna utyando kathathu okanye nangaphezulu kwaye abe ne-ventricle enye esebenzayo.

Iingxaki zinokubandakanya:

• Ukukhula okulibazisekileyo kunye nophuhliso
• Ukuxhuzula
• Ukubetha
• I-endocarditis echaphazelayo
• Ukumelwa yintliziyo
• Ukufa

Fowunela umboneleli wakho ukuba umntwana:

• Iingxaki zokuphefumla
• Ulusu, iinzipho okanye imilebe ebonakala luhlaza okwesibhakabhaka (cyanosis)

Akukho ndlela yaziwayo yokuthintela le meko.

Bonke abasetyhini abakhulelweyo kufuneka bafumane unonophelo lwangaphambi kokubeleka. Uninzi lweziphene zokuzalwa lunokufumaneka kwiimviwo eziqhelekileyo ze-ultrasound.

Ukuba isiphako sifunyenwe ngaphambi kokuzalwa, iingcali zonyango (ezinje ngengcali yezigulo zentliziyo yabantwana, ugqirha we-cardiothoracic, kunye neonatologist) zinokubakho ekuzalweni, kwaye zikulungele ukunceda xa kufuneka njalo. Olu lungiselelo lunokuthetha umahluko phakathi kobomi nokufa kwezinye iintsana.

I-pulmary atresia - i-septum ye-ventricular ehambileyo; I-PA / IVS; Izifo zentliziyo yokuzalwa - i-atresia yemiphunga; Isifo sentliziyo iCyanotic - isifo semiphunga; I-Valve-disorder pulmonary atresia

• Icandelo lentliziyo phakathi embindini
• Intliziyo - umbono wangaphambili

I-Fraser CD, iKane LC. Isifo sentliziyo. Ku: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, ii-eds. Incwadi yeSabiston yoNyango. Umhla we-20. IPhiladelphia, PA: Elsevier; Ngo-2017: isahluko 58.

IWebb GD, i-Smallhorn JF, iTherrien J, iRedington AN. Isifo sentliziyo esibelekwe kumntu omkhulu nakwisigulana sabantwana. Ku: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, ii-eds. Isifo sentliziyo seBraunwald: Incwadi yesifundo seMpilo yeNtliziyo. Ngomhla we-11. IPhiladelphia, PA: Elsevier; I-2019: isahluko 75.