Isiphene se-Endocardial cushion

Isiphene se-Endocardial cushion (ECD) yimeko yentliziyo engaqhelekanga. Iindonga ezahlula onke amagumbi amane entliziyo azenziwanga kakuhle okanye azikho. Kwakhona, izivalo ezahlula amagumbi aphezulu nasezantsi entliziyo zineziphene ngexesha lokwakheka. I-ECD sisifo sentliziyo esizalwa naso, oko kuthetha ukuba sikhona kwasekuzalweni.

I-ECD yenzeka ngelixa umntwana esakhula esibelekweni. Imiqamelo ye-endocardial ziindawo ezimbini ezishinyeneyo ezikhula zibe ziindonga (septum) ezahlula amagumbi amane entliziyo. Benza i-mitral kunye ne-tricuspid valves. Ezi zizivalo ezahlula i-atria (amagumbi aphezulu okuqokelela) kwii-ventricles (amagumbi okupompa asezantsi).

Ukusilela kokwahlukana phakathi kwamacala amabini entliziyo kubangela iingxaki ezininzi:

• Ukwanda kokuhamba kwegazi ukuya emiphungeni. Oku kubangela ukwanda koxinzelelo emiphungeni. Kwi-ECD, igazi lihamba ngokuvuleka okungaqhelekanga ukusuka ngasekhohlo ukuya ngasekunene kwentliziyo, emva koko kuye emiphungeni. Ukuhamba kwegazi okungakumbi kwimiphunga kwenza uxinzelelo lwegazi kwimiphunga inyuke.
• Ukumelwa yintliziyo. Umzamo owongezelelweyo ofunekayo wokupompa wenza ukuba intliziyo isebenze nzima kunesiqhelo. Imisipha yentliziyo inokwandisa kwaye ibuthathaka. Oku kunokubangela ukudumba kosana, iingxaki zokuphefumla, kunye nobunzima ekondleni nasekukhuleni.
• ICyanosis. Njengoko uxinzelelo lwegazi lonyuka emiphungeni, igazi liqala ukuhamba ukusuka kwicala lasekunene lentliziyo liye ngasekhohlo. Igazi elingena-oxygen lixubana negazi elinobutyebi beoksijini. Ngenxa yoko, igazi elineoksijini encinci kunesiqhelo lichithwa emzimbeni. Oku kubangela i-cyanosis, okanye ulusu oluhlaza okwesibhakabhaka.

Zimbini iintlobo ze-ECD:

• Gqibezela i-ECD. Le meko ibandakanya isiphene se-atrial septal (ASD) kunye ne-ventricular septal defect (VSD). Abantu abane-ECD epheleleyo bane-valve yentliziyo enye kuphela (ivalve yesiqhelo ye-AV) endaweni yezivalo ezimbini ezahlukileyo (mitral kunye netricuspid).
• Inxalenye (okanye engaphelelanga) ye-ECD. Kule meko, yi-ASD kuphela, okanye i-ASD kunye ne-VSD ekhoyo. Kukho izivalo ezimbini ezahlukileyo, kodwa enye yazo (mitral valve) ihlala ingaqhelekanga ngokuvula ("ukucandeka") kuyo. Esi siphene sinokuvuza ngokubuya kwegazi kwivelufa.

I-ECD inxibelelene kakhulu ne-Down syndrome. Iinguqu ezininzi zofuzo zinxibelelene ne-ECD. Nangona kunjalo, oyena nobangela we-ECD awaziwa.

I-ECD inokudibaniswa nezinye iziphene zentliziyo, ezinje:

• Ikhupha kabini i-ventricle yasekunene
• I-ventricle enye
• Ukutshintshwa kweenqanawa ezinkulu
• Tetralogy yoBuxoki

Iimpawu ze-ECD zinokubandakanya:

• Amatayara abantwana ngokulula
• Umbala wolusu oluhlaza okwesibhakabhaka, okwabizwa ngokuba yi-cyanosis (imilebe inokuba luhlaza okwesibhakabhaka)
• Ubunzima bokutya
• Ukusilela ukutyeba kunye nokukhula
• Inyumoniya rhoqo okanye usulelo
• Ulusu oluthuthu (pallor)
• Ukuphefumla ngokukhawuleza
• Ukubetha kwentliziyo okukhawulezayo
• Ukubila
• Imilenze edumbileyo okanye isisu (kunqabile ebantwaneni)
• Ukuphefumla ubunzima, ngakumbi ngexesha lokondla

Ngexesha loviwo, umboneleli wezempilo uya kufumana iimpawu ze-ECD, kubandakanya:

• I-electrocardiogram engaqhelekanga (ECG)
• Intliziyo eyandisiweyo
• Ukumbombozela kwentliziyo

Abantwana abane-ECD ekhethekileyo abanakho ukuba neempawu okanye iimpawu zokuphazamiseka ebuntwaneni.

Uvavanyo lokufumanisa i-ECD lubandakanya:

• I-Echocardiogram, eyi-ultrasound ejonga ukwakheka kwentliziyo kunye nokuhamba kwegazi ngaphakathi entliziyweni
• I-ECG, eyenza umlinganiso wombane wentliziyo
• I-x-ray yesifuba
• I-MRI, ebonelela ngomfanekiso oneenkcukacha zentliziyo
• I-catheterization yentliziyo, inkqubo apho ityhubhu encinci (catheter) ibekwa entliziyweni ukubona ukuhamba kwegazi kunye nokuthatha imilinganiselo echanekileyo yoxinzelelo lwegazi kunye namanqanaba eoksijini

Utyando luyafuneka ukuvala imingxunya phakathi kwamagumbi entliziyo, kunye nokwenza iicicuspid kunye ne-mitral valves. Ixesha lotyando luxhomekeke kwimeko yomntwana kunye nobukrakra be-ECD. Inokwenziwa rhoqo xa umntwana enenyanga ezi-3 ukuya kwezi-6 ubudala. Ukulungiswa kwe-ECD kunokufuna utyando olungaphezulu kwesinye.

Ugqirha womntwana wakho unokukunika amayeza:

• Ukunyanga iimpawu zokusilela kwentliziyo
• Phambi kotyando ukuba i-ECD ilugulise kakhulu usana lwakho

Amayeza aya kumnceda umntwana wakho atyebe kwaye abe namandla phambi kotyando. Amayeza ahlala esetyenziswa abandakanya:

• I-diuretics (iipilisi zamanzi)
• Iziyobisi ezenza ikhontrakthi yentliziyo ngamandla ngakumbi, njenge-digoxin

Utyando lwe-ECD olupheleleyo kufuneka lwenziwe kunyaka wokuqala wokuzalwa wosana. Ngaphandle koko, umonakalo wemiphunga ongenako ukuguqulwa unokuvela. Iintsana ezine-Down syndrome zihlala zinesifo semiphunga ngaphambili. Ke ngoko, utyando lwakwangoko lubaluleke kakhulu kwezi ntsana.

Indlela aqhuba ngayo umntwana wakho ixhomekeke:

• Ubungqongqo be-ECD
• Impilo yomntwana iyonke
• Nokuba isifo semiphunga sele siphuhlisiwe

Uninzi lwabantwana luphila ubomi obuqhelekileyo, obusebenzayo emva kokuba i-ECD ilungisiwe.

Iingxaki ezivela kwi-ECD zingaquka:

• Ukusilela kwentliziyo
• Ukufa
• Isifo se-Eisenmenger
• Uxinzelelo lwegazi oluphezulu emiphungeni
• Umonakalo ongenakulungiseka kwimiphunga

Iingxaki ezithile zotyando lwe-ECD zisenokungabonakali de umntwana abe mdala. Oku kubandakanya iingxaki zesingqisho senhliziyo kunye nevalvu evuzayo yemitral.

Abantwana abane-ECD banokuba semngciphekweni wosulelo lwentliziyo (endocarditis) ngaphambi nasemva kotyando. Buza ugqirha womntwana wakho ukuba ngaba umntwana wakho ufuna ukuthatha i-antibiotics ngaphambi kweenkqubo ezithile zamazinyo.

Tsalela umnikezeli womntwana wakho ukuba umntwana wakho:

• Amavili ngokulula
• Unengxaki yokuphefumla
• Inesikhumba esimnyama okanye imilebe

Thetha nomboneleli ukuba umntwana wakho akakhuli okanye uzuza ubunzima.

I-ECD inxulunyaniswa nezinto ezininzi ezingaqhelekanga kwimfuza. Amaqabane anembali yosapho ye-ECD anganqwenela ukufumana iingcebiso ngemfuzo ngaphambi kokuba akhulelwe.

Isiphene somjelo we-Atrioventricular (AV); Isiphene se-septal se-atrioventricular; I-AVSD; Indawo ye-AV eqhelekileyo; Iziphene ze-Ostium primum atrial septal; Isiphene sentliziyo yentliziyo - i-ECD; Isiphene sokuzalwa - i-ECD; Isifo seCyanotic - ECD

• Isiphene se-Ventricular septal
• Isiphene se-Atrial septal
• Umjelo we-atrioventricular (isiphelo se-endocardial cushion)

I-Basu SK, iDobrolet NC. Isiphene sokuzalwa kwenkqubo yentliziyo. Ku: UMartin RJ, uFanaroff AA, uWalsh MC, ii-eds. UFanaroff kunye noMartin's Neonatal-Perinatal Medicine. Ngomhla we-11. IPhiladelphia, PA: Elsevier; 2020: isahluko 75.

Ebels T, Tretter JT, Spicer DE, kunye noAnderson RH. Iziphene ze-septal ze-Antroventricular. Ku: Wernovsky G, Anderson RH, Kumar K, et al. Anderson's Cardiology yabantwana. Ngomhla we-4. IPhiladelphia, PA: Elsevier; 2020: isahl 31.

IKliegman RM, iSt. Geme JW, iBlum NJ, i-Shah SS, iTasker RC, uWilson KM. Isifo sentliziyo esizalwe sinesifo se-Acyanotic: izilonda ezisekhohlo ukuya ekunene. Ku: Kliegman RM, St Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, ii-eds. Incwadi kaNelson yeNcwadi yePediatrics. Umhla wama-21. IPhiladelphia, PA: Elsevier; 2020: isahluko 453.