Isiphene sentliziyo yento yokuzalwa - utyando lokulungisa

Isiphene sentliziyo esibelekileyo silungisa okanye sinyanga isiphene sentliziyo umntwana azalwe naso. Umntwana ozelwe enesiphene sentliziyo esinye okanye nangaphezulu unesifo sentliziyo. Utyando luyafuneka ukuba isiphako sinokwenzakalisa impilo yexesha elide okanye impilo-ntle yomntwana.

Zininzi iintlobo zotyando lwentliziyo lwabantwana.

Ukupheliswa kwepatent ductus arteriosus (PDA):

• Ngaphambi kokuzalwa, umntwana unesitya segazi esihamba phakathi kwe-aorta (umthambo ophambili emzimbeni) kunye nomthambo we-pulmonary (umthambo ophambili wemiphunga), obizwa ngokuba yi-ductus arteriosus. Le nqanawa incinci ihlala ivala kwakamsinya emva kokuzalwa xa umntwana eqala ukuphefumla yedwa. Ukuba ayivali. Ibizwa ngokuba yi-patent ductus arteriosus. Oku kunokubangela iingxaki kamva ebomini.
• Kwiimeko ezininzi, ugqirha uya kuvala ukuvulwa ngokusebenzisa iyeza. Ukuba oku akusebenzi, kusetyenziswa ezinye iindlela.
• Ngamanye amaxesha i-PDA inokuvalwa ngenkqubo engabandakanyi utyando. Inkqubo ihlala isenziwa elabhoratri esebenzisa ii-x-reyi. Kule nkqubo, ugqirha wotyando usika kancinci kwi-groin. Ucingo kunye netyhubhu ebizwa ngokuba yi-catheter ifakwa kumthambo emlenzeni kwaye uyigqithisele entliziyweni. Emva koko, ikhoyili encinci yesinyithi okanye esinye isixhobo sidluliselwa nge-catheter kumthambo we-ductus arteriosus wosana. Ikhoyili okanye esinye isixhobo sivimba ukuhamba kwegazi, kwaye oku kuyayilungisa ingxaki.
• Enye indlela kukwenza utyando oluncinci kwicala lasekhohlo lesifuba. Ugqirha uyayifumana i-PDA aze abophe okanye acofe i-ductus arteriosus, okanye ayabe aze ayisika. Ukudibanisa i-ductus arteriosus ibizwa ngokuba yi-ligation. Le nkqubo inokwenziwa kwiyunithi yokhathalelo olunzulu lweentsana (i-NICU).

Ukulungelelaniswa kokulungiswa kweaorta:

• Ukudibanisa i-aorta kwenzeka xa inxenye ye-aorta inecandelo elimxinwa kakhulu. Ubume bujongeka njengexesha leyure. Ukuncipha kwenza kube nzima ukuba igazi lifikelele kwiziphelo ezisezantsi. Ixesha elingaphezulu, kunokukhokelela kwiingxaki ezinje ngoxinzelelo oluphezulu lwegazi.
• Ukulungisa le ngxaki, ukusikwa kudla ngokwenziwa kwicala lasekhohlo lesifuba, phakathi kweembambo. Kukho iindlela ezininzi zokulungisa ukubola kwe-aorta.
• Eyona ndlela iqhelekileyo yokuyilungisa kukusika icandelo elimxinwa kwaye ulenze libe likhulu ngesiqwengana esenziwe ngeGore-tex, into eyenziwe ngabantu (eyenziweyo).
• Enye indlela yokulungisa le ngxaki kukususa icandelo elimxinwa le-aorta kwaye uthunge iziphelo ezisele kunye. Oku kunokwenziwa rhoqo kubantwana abadala.
• Indlela yesithathu yokulungisa le ngxaki ibizwa ngokuba yi-subclavian flap. Okokuqala, kunqunyulwa kwinxalenye encinci ye-aorta. Emva koko, kuthathwa isiqwenga kumthambo ongasekhohlo we-subclavian (umthambo oya engalweni) ukwandisa icandelo elimxinwa le-aorta.
• Indlela yesine yokulungisa ingxaki kukudibanisa ityhubhu kumacandelo aorta aqhelekileyo, ngapha nangapha kwecandelo elimxinwa. Igazi lihamba ngombhobho kwaye lidlula kwicandelo elimxinwa.
• Indlela entsha ayifuni kutyando. Ucingo oluncinci lubekwa kumthambo kwindawo yokuqaqamba kuze kufike kwi-aorta. Ibhaluni encinci iyavulwa kwindawo emxinwa. Istent okanye ityhubhu encinci ishiywe apho ukunceda ukugcina umthambo uvulekile. Inkqubo yenziwa elabhoratri ene-x-reyi. Le nkqubo ihlala isetyenziswa xa ukubonwa kwakhona kwenzeka emva kokulungiswa.

Ukulungiswa kwe-Atrial septal defect (ASD):

• I-septum ye-atrial ludonga phakathi kwe-atria yasekhohlo nasekunene (amagumbi aphezulu) entliziyo. Umngxunya kolo donga ubizwa ngokuba yi ASD. Phambi kwesi siphene, igazi ngaphandle kweoksijini linokudityaniswa kwaye ngokuhamba kwexesha, kunokubangela iingxaki kwezonyango kunye ne-arrhythmias.
• Ngamanye amaxesha, iASD ingavalwa ngaphandle kotyando lwentliziyo oluvulekileyo. Okokuqala, ugqirha wotyando usika kancinane emiphakathini. Emva koko ugqirha ufaka ucingo kwisitya segazi esiya entliziyweni. Emva koko, izixhobo ezibini ezimile kwesambrela ezimile okwe "clamshell" zibekwe kwicala lasekunene nakwesobunxele septum. Ezi zixhobo zimbini ziqhotyoshelwe kwenye nenye. Oku kuvala umngxuma entliziyweni. Ayingawo onke amaziko onyango enza le nkqubo.
• Utyando lwentliziyo evulekileyo lunokwenziwa ukulungisa i-ASD. Kulo msebenzi, septum ingavalwa usebenzisa imithungo. Enye indlela yokugquma umngxunya kukungqisha.

Ukulungiswa kwesiphene seVentricular septal (VSD):

• I-septum ye-ventricular ludonga phakathi kweefestile zasekhohlo nasekunene (amagumbi asezantsi) entliziyo. Umngxunya kwi-septum ye-ventricular ibizwa ngokuba yi-VSD. Lo mngxunya uvumela igazi kunye neoksijini lixutywe negazi elisetyenzisiweyo elibuyela kwimiphunga. Ixesha elingaphezulu, ukubetha kwentliziyo okungaqhelekanga kunye nezinye iingxaki zentliziyo zinokwenzeka.
• Ngeminyaka eyi-1, uninzi lwee-VSD ezincinci zivala ngokwazo. Nangona kunjalo, ezo VSDs zihlala zivulekile emva kwale minyaka zinokufuna ukuvalwa.
• Ii-VSD ezinkulu, ezinjengezincinci kwiindawo ezithile ze-ventricular septum, okanye ezo zibangela ukusilela kwentliziyo okanye i-endocarditis, (ukudumba) kufuna uqhaqho lwentliziyo oluvulekileyo. Umngxunya kwi septum ngokufuthi ivaliwe nge isiziba.
• Ezinye iziphene ze-septal zinokuvalwa ngaphandle kotyando. Inkqubo ibandakanya ukuhambisa ucingo oluncinci entliziyweni kwaye ubeke isixhobo esincinci ukuvala isiphene.

I-Tetralogy yokulungiswa kweFallot:

• I-Tetralogy ye-Fallot sisiphene sentliziyo esikho ekuzalweni (ekuzalweni). Ihlala ibandakanya iziphene ezine entliziyweni kwaye ibangele ukuba umntwana ajike umbala oluhlaza okwesibhakabhaka (cyanosis).
• Utyando lwentliziyo evulekileyo luyafuneka, kwaye lwenziwa rhoqo xa umntwana ephakathi kweenyanga ezi-6 kunye neminyaka emi-2 ubudala.

Utyando lubandakanya:

• Ukuvala isiphene se-ventricular septal nge patch.
• Ukuvula ivelufa yemiphunga nokususa umsipha otyebileyo (stenosis).
• Ukubeka isiziba kwi-ventricle efanelekileyo kunye nomthambo ophambili wemiphunga ukuphucula ukuhamba kwegazi ukuya emiphungeni.

Umntwana unokufumana inkqubo yokukhutshwa kuqala. I-shunt ihambisa igazi lisuka kwenye indawo liye kwenye. Oku kuyenziwa ukuba utyando lwentliziyo evulekileyo ludinga ukulibaziseka ngenxa yokuba umntwana egula kakhulu ukuba angahlinzwa.

• Ngexesha lenkqubo ye-shunt, ugqirha wotyando usika utyando kwicala lasekhohlo lesifuba.
• Xa umntwana sele ekhulile, i-shunt ivaliwe kwaye ukulungiswa okuyintloko entliziyweni kuyenziwa.

Ukutshintshwa kokulungiswa kweenqanawa ezinkulu:

• Kwintliziyo eqhelekileyo, i-aorta ivela kwicala lasekhohlo lentliziyo, kwaye umthambo wemiphunga uvela kwicala lasekunene. Ekuguqukeni kweenqanawa ezinkulu, ezi mithambo zivela kumacala achaseneyo entliziyo. Umntwana unokuba nezinye iziphene zokuzalwa.
• Ukulungisa ukuhanjiswa kweenqanawa ezinkulu kufuna utyando lwentliziyo oluvulekileyo. Ukuba kunokwenzeka, olu tyando lwenziwa kwakamsinya emva kokuzalwa.
• Olona hlobo lolungiso luqhelekileyo lubizwa ngokuba kukutshintsha kwemithambo. I-aorta kunye ne-pulmonary artery yahlulwe. I-pulmonary artery idityaniswe kwi-ventricle elungileyo, apho kufanelekileyo. Emva koko, i-aorta kunye ne-coronary arteries zidityaniswe kwi-ventricle yasekhohlo, apho ikhoyo.

Ukulungiswa kwetruccus arteriosus:

• I-Truncus arteriosus yimeko enqabileyo eyenzekayo xa i-aorta, i-coronary arteries, kunye ne-pulmonary artery zonke ziphume esiqwini esinye esiqhelekileyo. Ukuphazamiseka kunokuba lula kakhulu, okanye kunzima kakhulu. Kuzo zonke iimeko, kufuna utyando lwentliziyo evulekileyo ukulungisa isiphene.
• Ukulungiswa kuhlala kwenziwa kwiintsuku zokuqala okanye kwiiveki zokuqala zobomi bosana. Imithambo yemiphunga yahlulwe kumboko we-aortic, kwaye naziphi na iziphene zifakelwe. Ngokwesiqhelo, abantwana banesiphene se-ventricular septal, kwaye nayo ivaliwe. Unxibelelwano lubekwa phakathi kwe-ventricle elungileyo kunye ne-pulmonary arteries.
• Uninzi lwabantwana lufuna olunye utyando okanye ezimbini njengoko bekhula.

Ukulungiswa kwetricuspid atresia:

• Ivalve ye-tricuspid ifunyanwa phakathi kwamagumbi aphezulu nasezantsi kwicala lasekunene lentliziyo. I-Tricuspid atresia yenzeka xa le valve ikhubazekile, imxinwa, okanye ilahlekile.
• Iintsana ezizalwe zine-tricuspid atresia ziluhlaza okwesibhakabhaka kuba azinako ukufumana igazi kwimiphunga ukuze lithathe ioksijini.
• Ukufika emiphungeni, igazi kufuneka linqumle isiphako se-septal (ASD), i-ventricular septal defect (VSD), okanye i-patent ductus artery (PDA). (Ezi meko zichazwe apha ngasentla.) Le meko ithintela kakhulu ukuhamba kwegazi ukuya emiphungeni.
• Ngokukhawuleza emva kokuzalwa, umntwana anganikwa iyeza elibizwa ngokuba yi-prostaglandin E. Eli yeza liza kunceda ukugcina ipatent ductus arteriosus ivulekile ukuze igazi liqhubeke nokuhamba liye emiphungeni. Nangona kunjalo, oku kuyakusebenza kuphela okwethutyana. Ekugqibeleni umntwana uya kufuna utyando.
• Umntwana unokufuna uthotho lokutshixwa kunye notyando ukulungisa esi siphene. Injongo yolu tyando kukuvumela igazi emzimbeni ukuba liphume liye emiphungeni. Ugqirha kufuneka alungise i-valve ye-tricuspid, atshintshe i-valve, okanye afake i-shunt ukuze igazi lifike emiphungeni.

Iyonke imposiso yokubuya kwemiphunga engalunganga (TAPVR):

• I-TAPVR yenzeka xa imithambo yemiphunga izisa igazi eline-oksijini eninzi emiphungeni ibuyele kwicala lasekunene lentliziyo, endaweni yecala lasekhohlo lentliziyo, apho ihlala inabantu abaphilileyo.
• Le meko kufuneka ilungiswe ngotyando. Utyando lunokwenziwa ngexesha lokuzalwa komntwana ukuba umntwana uneempawu ezinzima. Ukuba ayenziwanga kanye emva kokuzalwa, yenziwa kwiinyanga ezi-6 zokuqala zobomi bosana.
• Ukulungiswa kwe-TAPVR kufuna utyando lwentliziyo oluvulekileyo. Imithambo ye-pulmonary ibuyiselwe kwicala lasekhohlo lentliziyo, apho ikhoyo, kwaye naluphi na unxibelelwano olungaqhelekanga luvaliwe.
• Ukuba ikho i-PDA, iyabotshwa kwaye yahlulwe.

Ukulungiswa kwentliziyo yasekhohlo Hypoplastic:

• Esi sisiphene sentliziyo esibi kakhulu esibangelwa yintliziyo ekhohlakeleyo engakhuli kakuhle. Ukuba ayinyangwa, ibangela ukufa kuninzi lwabantwana abazelwe benayo. Ngokungafaniyo neentsana ezinezinye iziphene zentliziyo, abo baneentliziyo ezishiyeke benesifo sentliziyo abanazo naziphi na iziphene. Imisebenzi yokunyanga esi siphene yenziwa kumaziko onyango akhethekileyo. Ngokwesiqhelo, utyando luyayilungisa le ngxaki.
• Uthotho lweentliziyo ezintathu zenziwa rhoqo. Umsebenzi wokuqala wenziwa kwiveki yokuqala yobomi bosana. Olu lutyando oluntsonkothileyo apho kwenziwa khona umthambo wegazi omnye kwimithambo ye-pulmonary kunye ne-aorta. Esi sitya sitsha sithwala igazi liye emiphungeni nasemzimbeni wonke.
• Utyando lwesibini, olubizwa ngokuba luza kwenziwa, xa lusenza iinyanga ezi-4 ukuya kwezi-6 ubudala.
• Umsebenzi wesithathu wenziwa ngonyaka emva kokusebenza kwesibini.

Uqhaqho lwentliziyo lokuzalwa; Ipatent ductus arteriosus ligation; Ukulungiswa kwentliziyo ekhohlo Hypoplastic; Itetralogy yokulungiswa kweFallot; Ukulungelelaniswa kokulungiswa kwe-aorta; Ukulungiswa kwesiphene se-Atrial; Ukulungiswa kwesiphene se-Ventricular septal; Ukulungiswa kweTruncus arteriosus; Ukulungiswa kwemithambo engalunganga ngokupheleleyo; Ukutshintshwa kokulungiswa kweenqanawa ezinkulu; Ukulungiswa kwetricuspid atresia; Ukulungiswa kwe-VSD; Ukulungiswa kwe-ASD

• Ukhuseleko kwigumbi lokuhlambela - abantwana
• Ukuzisa umntwana wakho ukuba atyelele umntakwabo ogula kakhulu
• Ukuhlinzwa kwentliziyo yabantwana-ukukhutshwa
• Unonophelo lwenxeba lotyando - luvulekile

• Icandelo lentliziyo phakathi embindini
• Ukucinywa kwentliziyo
• Intliziyo - umbono wangaphambili
• I-Ultrasound, umbungu oqhelekileyo - ukubetha kwentliziyo
• I-Ultrasound, i-ventricular septal defect - ukubetha kwentliziyo
• Ipatent ductus arteriosis (PDA) - uthotho
• Usana oluvulekileyo lwentliziyo

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UBhatt AB, uFoster E, uKuehl K, et al; I-American Heart Association Council kwiKlinikhi yeCardiology. Isifo sentliziyo ekhulelwe kubantu abadala abadala: ingxelo yesayensi evela kuMbutho weNtliziyo yaseMelika. Ukujikeleza. Ngo-2015; 131 (21): 1884-1931. IINKCUKACHA: 25896865 www.ncbi.nlm.nih.gov/pubmed/25896865.

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IWebb GD, i-Smallhorn JF, iTherrien J, iRedington AN. Isifo sentliziyo.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.