Ukutshintshwa kwemithambo enkulu

Ukutshintshwa kweemithambo ezinkulu (TGA) sisiphene sentliziyo esivela ekuzalweni (kokuzalwa). Imithambo emibini ephambili ehambisa igazi lisuka entliziyweni-i-aorta kunye ne-pulmonary artery-itshintshiwe (idlulisiwe).

Unobangela we-TGA awaziwa. Ayinxulunyaniswa nayo nayiphi na into engaqhelekanga yemfuza. Ayifane yenzeke kwamanye amalungu osapho.

I-TGA sisiphene sentliziyo esine-cyanotic. Oku kuthetha ukuba kuncitshisiwe ioksijini egazini elimpompoweyo ukusuka entliziyweni ukuya kuwo wonke umzimba.

Kwiintliziyo eziqhelekileyo, igazi elibuyayo emzimbeni lihamba kwicala lasekunene lentliziyo kunye nemithambo yemiphunga ukuya emiphungeni ukuze ifumane ioksijini. Igazi emva koko libuyele kwicala lasekhohlo lentliziyo kwaye liphume lisiya emzimbeni.

Kwi-TGA, igazi le-venous libuyela ngokwesiqhelo entliziyweni ngokusebenzisa i-atrium elungileyo. Kodwa, endaweni yokuba liye emiphungeni liyokufunxa ioksijini, eli gazi likhutshelwa ngaphandle nge-aorta libuyele emzimbeni. Eli gazi aliphindanga lagcwaliswa ngeoksijini kwaye likhokelela kwi-cyanosis.

Iimpawu zibonakala ekuzalweni okanye kungekudala emva koko. Ukuba zimbi kangakanani iimpawu zixhomekeke kuhlobo kunye nobungakanani beziphene ezongezelelekileyo zentliziyo (ezinje ngesiphene se-atrial septal, i-ventricular septal defect, okanye i-patent ductus arteriosus) kunye nokuba lingakanani igazi elingadibanisa phakathi kwezi zijikelezo zimbini zingaqhelekanga.

Iimpawu zingabandakanya:

• Ukuba mhlophe kwesikhumba
• Ukubhabha kweminwe okanye iinzwane
• Ukutya okungalunganga
• Ukuqhawukelwa ngumphefumlo

Umboneleli wezempilo unokubona ukukrokra kwentliziyo ngelixa umamele isifuba nge-stethoscope. Umlomo wosana nolusu luya kuba ngumbala oluhlaza okwesibhakabhaka.

Iimvavanyo zihlala zibandakanya oku kulandelayo:

• Ukucinywa kwentliziyo
• I-x-ray yesifuba
• ECG
• I-Echocardiogram (ukuba yenziwe ngaphambi kokuzalwa, ibizwa ngokuba yi-fetal echocardiogram)
• I-Pulse oximetry (ukujonga inqanaba leoksijini yegazi)

Inyathelo lokuqala kunyango kukuvumela igazi eline-oksijini exutywe negazi elingena oxygen. Usana luyakufumana kwangoko iyeza elibizwa ngokuba yi-prostaglandin nge-IV (intravenous line).Eli yeza linceda ukugcina isitya segazi esibizwa ngokuba yi-ductus arteriosus evulekileyo, ivumela ukudityaniswa kwemijikelezo yegazi. Kwezinye iimeko, ukuvula phakathi kwe-atrium yasekunene kunye nekhohlo kunokwenziwa ngenkqubo usebenzisa i-catheter yebhaluni. Oku kuvumela igazi ukuba lixube. Le nkqubo yaziwa njengebhaluni ye-septostomy.

Unyango olusisigxina lubandakanya utyando lwentliziyo ngexesha apho imithambo emikhulu isikwa ize ithungwe ibuyele kwindawo yayo echanekileyo. Oku kubizwa ngokuba ngumsebenzi wokutshintsha utshintsho (ASO). Phambi kokuphuhliswa kolu tyando, utyando olubizwa ngokuba lutshintsho lwe-atrial (okanye inkqubo ye-Mustard okanye inkqubo ye-Senning) yasetyenziswa.

Iimpawu zomntwana ziya kuphucula emva kotyando ukulungisa isiphako. Uninzi lweentsana ezenza utshintsho lwe-arterial alunazo iimpawu emva kotyando kwaye zihlala ubomi obuqhelekileyo. Ukuba utyando lolungiso alwenziwa, ixesha lokuphila liinyanga nje.

Iingxaki zinokubandakanya:

• Iingxaki zomthambo weCoronary
• Iingxaki zevalvu zentliziyo
• Isingqisho sentliziyo esingaqhelekanga (arrhythmias)

Le meko inokuchongwa ngaphambi kokuzalwa kusetyenziswa i-echocardiogram yomntwana. Ukuba akunjalo, kuhlala kufunyaniswa ukuba umntwana sele ezelwe.

Yiya kwigumbi likaxakeka okanye fowunela inombolo yongxamiseko yendawo (enje nge-911) ukuba ulusu lomntwana wakho luvelisa umbala oluhlaza okwesibhakabhaka, ngakumbi ebusweni okanye esiqwini.

Biza umnikezeli wakho ukuba umntwana wakho unale meko kwaye iimpawu ezintsha zikhula, ziba mandundu, okanye ziqhubeke emva konyango.

Abasetyhini abaceba ukukhulelwa kufuneka bagonywe i-rubella ukuba abakhuselekanga. Ukutya kakuhle, ukunqanda utywala, kunye nokulawula isifo seswekile ngaphambili kunye nangexesha lokukhulelwa kunokuba luncedo.

d-TGA; Isiphene sentliziyo esibelekwe - utshintsho; Isifo sentliziyo iCyanotic - utshintsho; Isiphene sokuzalwa - utshintsho; Ukutshintshwa kweenqanawa ezinkulu; I-TGV

• Ukuhlinzwa kwentliziyo yabantwana-ukukhutshwa

• Icandelo lentliziyo phakathi embindini
• Intliziyo - umbono wangaphambili
• Ukutshintshwa kweenqanawa ezinkulu

Isifo sentliziyo esizalwe sisifo seCyanotic: kuvavanyo lwe-neonate egula kakhulu ene-cyanosis kunye noxinzelelo lokuphefumla. Ku: Kliegman RM, Stanton BF, St Geme JW, Schor NF, ii-eds. Incwadi kaNelson yeNcwadi yePediatrics. Umhla wama-21. IPhiladelphia, PA: Elsevier; I-2019: isahluko 456.

I-Fraser CD, iKane LC. Isifo sentliziyo. Ku: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, ii-eds. Incwadi yeSabiston yoNyango: Isiseko sebhayiloji yoQeqesho lwangoku. 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.