Kuberekwa kwemoyo kukanganisa - kuvhiya kwekugadzirisa

Congenital moyo hurema hwekugadzirisa kuvhiya kunogadzirisa kana kugadzirisa chirwere chemwoyo icho mwana anozvarwa nacho. Mwana akazvarwa aine kana chimwe chete kana hurema hwemwoyo anozvarwa aine chirwere chemwoyo. Kuvhiya kunodiwa kana hurema hunga kukuvadza hutano hwemwana kwenguva refu kana hutano hwakanaka.

Kune mhando dzakawanda dzevana kuvhiyiwa moyo.

Patent ductus arteriosus (PDA) ligation:

• Asati azvarwa, mwana ane tsinga yeropa inomhanya pakati peaorta (tsinga huru kumuviri) uye tsinga yemapapu (tsinga huru kumapapu), inonzi ductus arteriosus. Mudziyo uyu mudiki unowanzo vhara nguva pfupi mushure mekuzvarwa apo mwana anotanga kufema ega. Kana ikasavhara. Inonzi patent ductus arteriosus. Izvi zvinogona kukonzera matambudziko gare gare muhupenyu.
• Muzviitiko zvakawanda, chiremba achavhara kuvhura achishandisa mushonga. Kana izvi zvikasashanda, saka mamwe maitiro anoshandiswa.
• Dzimwe nguva PDA inogona kuvharwa nemaitiro asingabatanidzi kuvhiyiwa. Maitiro acho anowanzoitwa murabhoritari inoshandisa x-ray. Mumaitiro aya, chiremba anovhiya anoita akacheka mudiki. Tambo uye chubhu inonzi catheter inoiswa mune tsinga mugumbo ndokupfuudza kumusoro kumoyo. Ipapo, koiri diki yesimbi kana chimwe chishandiso chinopfuudzwa kuburikidza nekateti kupinda mucheche ductus arteriosus tsinga. Iyo coil kana chimwe chigadzirwa chinodzivirira kuyerera kweropa, uye izvi zvinogadzirisa dambudziko.
• Imwe nzira ndeyekucheka kuvhiya kudiki kuruboshwe rwechipfuva. Chiremba anovhiya anowana iyo PDA uye obva asungira kure kana kutema iyo ductus arteriosus, kana kuigovanisa nekuicheka. Kusunga iyo ductus arteriosus inonzi ligation. Maitiro aya anogona kuitwa mune yechecheche nzvimbo yekuchengetedza vanhu (NICU).

Kubatana kweaorta kugadzirisa:

• Kubatana kweaorta kunoitika kana chikamu cheaorta chine chikamu chakamanikana. Icho chimiro chinotaridzika seye hourglass timer. Iyo yekudzikisira inoita kuti zviome kuti ropa ripfuure kusvika kumucheto kwakadzika. Nekufamba kwenguva, zvinogona kutungamira kumatambudziko senge yakanyanya BP.
• Kugadzirisa kukanganisa uku, kucheka kunowanzoitwa kuruboshwe rwechipfuva, pakati pembabvu. Kune nzira dzinoverengeka dzekugadzirisa kubatana kwemaorta.
• Nzira yakajairika yekuigadzirisa ndeyekucheka chikamu chakamanikana uye nekuita kuti chiwedzere kukura nechigamba chakagadzirwa cheGore-tex, yakagadzirwa nevanhu (synthetic).
• Imwe nzira yekugadzirisa dambudziko iri kubvisa chikamu chakamanikana cheaorta uye kusona magumo asara pamwechete. Izvi zvinogona kazhinji kuitwa muvana vakura.
• Nzira yechitatu yekugadzirisa dambudziko iri inonzi subclavian flap. Kutanga, kucheka kunoitwa muchikamu chakamanikana cheaorta. Ipapo, chigamba chinotorwa kubva kuruboshwe subclavia arteri (arteri kuruoko) kuwedzera chikamu chakamanikana cheaorta.
• Nzira yechina yekugadzirisa dambudziko iri kubatanidza chubhu kune zvakajairika zvikamu zveaorta, kune ese mativi echikamu chakamanikana. Ropa rinoyerera nepombi uye inodarika chikamu chakamanikana.
• Nzira nyowani haidi kuvhiyiwa. Tambo diki inoiswa kuburikidza neateri mune iyo groin uye kumusoro kune aorta. Bhaluni diki rinobva ravhurwa munzvimbo nhete. Iyo stent kana diki chubhu inosara imomo kubatsira kuchengetedza tsinga yakavhurika. Maitiro acho anoitwa murabhoritari ine x-ray. Maitiro aya anowanzo shandiswa kana coarctation yadzokazve mushure mekugadziriswa.

Atrial septal defect (ASD) kugadzirisa:

• Iyo atrial septum ndiyo madziro pakati peiyo kuruboshwe uye kurudyi atria (kumusoro makamuri) emoyo. Buri pamadziro iwayo inonzi ASD. Mukuvapo kwechikanganiso ichi, ropa rine uye risina oxygen rinogona kusanganiswa uye nekufamba kwenguva, zvichikonzera matambudziko ekurapa uye arrhythmias.
• Dzimwe nguva, ASD inogona kuvharwa pasina kuvhiya kwemoyo wakashama. Kutanga, chiremba anovhiya anoita kucheka kudiki muguyo. Ipapo chiremba anovhiya anoisa waya mumudziyo weropa unoenda pamoyo. Tevere, maviri madiki emumburera-akaumbwa "clamshell" zvishandiso zvinoiswa kurudyi uye kuruboshwe mativi e septum. Aya majaira maviri akabatanidzwa kune mumwe nemumwe. Izvi zvinovhara gomba mumoyo. Haasi ese ekurapa nzvimbo anoita izvi maitiro.
• Kuvhura-kwemoyo kuvhiya kunogona kuitwawo kugadzirisa ASD. Mukushanda uku, iyo septum inogona kuvharwa uchishandisa stitches. Imwe nzira yekuvhara gomba ine chigamba.

Ventricular septal defect (VSD) kugadzirisa:

• Iyo ventricular septum ndiyo madziro ari pakati pekuruboshwe uye kurudyi ventricles (akadzika makamuri) emoyo. Buri mu septum ye ventricular inonzi VSD. Buri iri rinoita kuti ropa neoksijeni rivhengane neropa rakambodzokera mumapapu. Nekufamba kwenguva, kurova kwemoyo zvisina kujairika uye mamwe matambudziko emoyo anogona kuitika.
• Nezera 1, mazhinji madiki maVDS anozvivhara ega. Nekudaro, iwo maVDS anogara akavhurika mushure mezera iri angangoda kuvharwa.
• Makuru maVSDs, senge madiki mune mamwe mativi e ventricular septum, kana iwo anokonzeresa kutadza kwemoyo kana endocarditis, (kuzvimba) vanoda kuvhiyiwa-kwemoyo wakasununguka. Iyo gomba mune septum inowanzo kuvharwa nechigamba.
• Zvimwe zvikanganiso zve septal zvinogona kuvharwa pasina kuvhiyiwa. Maitiro acho anosanganisira kupfuudza tambo diki mumoyo nekuisa diki diki kuti ivhare hurema.

Tetralogy yekunyepedzera kugadzirisa:

• Tetralogy yeFallot kukanganisa kwemoyo kuripo kubva pakuzvarwa (kuberekwa). Zvinowanzo sanganisira zvikanganiso zvina zviri mumoyo uye zvinokonzeresa kuti mwana achinje bhuruu (cyanosis).
• Kuvhiya-kwemoyo wakasununguka kunodiwa, uye kunowanzoitwa kana mwana ari pakati pemwedzi mitanhatu nemakore maviri ekuberekwa.

Kuvhiya kunosanganisira:

• Kuvhara iyo ventricular septal kuremara ine chigamba.
• Kuvhura iyo pulmonary vharafu uye kubvisa iyo yakakora mhasuru (stenosis).
• Kuisa chigamba pane kurudyi ventricle uye main pulmonary arteri yekuvandudza kuyerera kweropa kumapapu.

Mwana anogona kuita shunt maitiro akaitwa kutanga. Shunt inofambisa ropa kubva kune imwe nzvimbo kuenda kune imwe. Izvi zvinoitwa kana akavhurika-moyo kuvhiya kuchida kunonoka nekuti mwana ari kurwara zvakanyanya kuti asvike pakuvhiyiwa.

• Munguva ye shunt maitiro, chiremba anovhiya anoita kucheka kwekuvhiya muruboshwe rwechipfuva.
• Kana mwana akura, shunt yakavharwa uye chikuru kugadzirisa mumoyo kunoitwa.

Shanduko yemidziyo mikuru inogadziriswa:

• Mumoyo wakajairika, aorta inouya kubva kuruboshwe rwemoyo, uye tsinga yemapapu inobva kurudyi. Mukuchinjika kwemidziyo mikuru, idzi tsinga dzinobva kumativi akatarisana emoyo. Mwana anogona zvakare kuve nehumwe hurema hwekuzvara.
• Kugadzirisa kushandurwa kwemidziyo mikuru kunoda kuvhiyiwa-moyo wakavhurika. Kana zvichibvira, kuvhiya uku kunoitwa nguva pfupi mushure mekuberekwa.
• Iyo yakajairika kugadzirisa inonzi arterial switch. Iyo aorta uye pulmonary arteri yakakamurwa. Iyo pulmonary arteri yakabatana kune kurudyi ventricle, uko kuri iko. Ipapo, aorta uye coronary arteri zvakabatana kune yekuruboshwe ventricle, uko kwairi.

Truncus arteriosus kugadzirisa:

• Truncus arteriosus chinhu chisingawanzoitika chinoitika apo aorta, coronary arteri, uye pulmonary arteri zvese zvinobuda mune imwechete trunk. Dambudziko ringave rakareruka, kana rakaomarara. Muzviitiko zvese, zvinoda kuvhurika-kwemoyo kuvhiya kukanganisa.
• Kugadzirisa kunowanzoitwa mumazuva mashoma ekutanga kana mavhiki ehupenyu hwemucheche. Tsinga dzemapapu dzinopatsanurwa kubva mutrort trunk, uye chero hurema hunowanikwa. Kazhinji, vana zvakare vane ventricular septal chirema, uye izvo zvakare zvakavharwa. Kubatana kunozoiswa pakati peiyo kurudyi ventricle uye pulmonary arteri.
• Vazhinji vana vanoda kuvhiiwa kamwe chete kana maviri pavanenge vachikura.

Tricuspid atresia kugadzirisa:

• Iyo tricuspid vharafu inowanikwa pakati pemakamuri epamusoro uye ezasi kurudyi kwemoyo. Tricuspid atresia inoitika kana iri vharafu rakaremara, rakamanikana, kana kushayikwa.
• Vacheche vanozvarwa vane tricuspid atresia vane bhuruu nekuti havagone kuendesa ropa kumapapu kunotora oxygen.
• Kuti usvike kumapapu, ropa rinofanira kuyambuka atrial septal defect (ASD), ventricular septal defect (VSD), kana patent ductus arteri (PDA). (Aya mamiriro akatsanangurwa pamusoro.) Aya mamiriro anotadzisa zvakanyanya kuyerera kweropa kuenda kumapapu.
• Achangoberekwa, mwana anogona kupihwa mushonga unonzi prostaglandin E. Mushonga uyu unobatsira kuti patent ductus arteriosus irambe yakavhurika kuitira kuti ropa rirambe richiyerera kusvika mumapapu. Nekudaro, izvi zvinongoshanda kwechinguva. Mwana anozoda kuvhiyiwa.
• Mwana anogona kuda akateedzana akavharirwa uye kuvhiyiwa kugadzirisa hurema uhu. Chinangwa chekuvhiya uku ndechekutendera ropa kubva mumuviri kuti ripinde mumapapu. Chiremba anovhiya angafanirwa kugadzirisa iyo tricuspid vharuvhu, kutsiva vharuvhu, kana kuisa mushunt kuitira kuti ropa risvike kumapapu.

Yakazara anomalous pulmonary venous kudzoka (TAPVR) kururamisa:

• TAPVR inoitika apo tsinga dzemapapu dzinounza ropa-rakapfuma reropa kubva mumapapu kudzokera kurudyi kwemoyo, pachinzvimbo chekuruboshwe kwemoyo, uko kunowanzoenda kune vanhu vane hutano.
• Aya mamiriro anofanira kugadziriswa nekuvhiyiwa. Kuvhiya kwacho kunogona kuitwa munguva ichangoberekwa kana mwana ane zviratidzo zvakakomba. Kana ikasaitwa mushure mekuzvarwa, zvinoitwa mumwedzi mitanhatu yekutanga yehupenyu hwemwana.
• Kugadziriswa kweTAPVR kunoda kuvhiyiwa kwemoyo wakasununguka. Tsinga dzemapapu dzinoendeswa kumashure kuruboshwe rwemoyo, kwadziri, uye chero hukama husina kujairika hwakavharwa.
• Kana PDA iripo, inosungwa uye yakakamurwa.

Hypoplastic kuruboshwe kugadziriswa kwemoyo:

• Uku kukanganisa kwakakomba kwemoyo kunokonzereswa nemoyo wakasara wakasimukira kwazvo. Kana ikasarapwa, inokonzera rufu muvacheche vazhinji vanozvarwa vainayo. Kusiyana nevacheche vane zvimwe zvinokanganisa moyo, avo vane hypoplastic kuruboshwe moyo havana zvimwe zvikanganiso. Kuvhiya kwekuremara uku kunoitwa kunzvimbo dzakakosha dzezvokurapa. Kazhinji, kuvhiya kunogadzirisa kukanganisa uku.
• Nhevedzano yekuvhiya kwemoyo mitatu inowanzodiwa. Kuvhiya kwekutanga kunoitwa muvhiki yekutanga yehupenyu hwemucheche. Uku kuvhiya kwakaomarara uko imwe tsinga yeropa inogadzirwa kubva mupurmonary arteri uye aorta. Mudziyo mutsva uyu unotakura ropa kuenda mumapapu nemuviri wese.
• Kuvhiya kwechipiri, kunodaidzwa kuti kuvhiya kwePontan, kunowanzoitwa kana mwana aine mwedzi mina kusvika kumwedzi mitanhatu yekuberekwa.
• Kuvhiya kwechitatu kunoitwa gore mushure mekuita kwechipiri.

Congenital moyo kuvhiyiwa; Patent ductus arteriosus ligation; Hypoplastic kuruboshwe kugadziriswa kwemoyo; Tetralogy yekunyepedzera kugadzirisa; Kubatana kweaorta kugadzirisa; Kugadziriswa kweatrial septal kukanganisa; Ventricular septal kuremara kugadzirisa; Truncus arteriosus kugadzirisa; Yakazara anomalous pulmonary artery kururamisa; Kuchinja kwemidziyo mikuru kugadzirisa; Tricuspid atresia kugadzirisa; VSD kugadzirisa; ASD kugadzirisa

• Kuchengetedzwa kwekugezera - vana
• Kuunza mwana wako kuti ashanyire hama inorwara zvakanyanya
• Chiremba wemwoyo kuvhiya - kubuda
• Kuchengeta ronda rekuvhiya - rakavhurika

• Mwoyo - chikamu kuburikidza nepakati
• Catheterization yemwoyo
• Moyo - pamberi pekutarisa
• Ultrasound, zvakajairika fetus - kurova kwemoyo
• Ultrasound, ventricular septal chirema - kurova kwemoyo
• Patent ductus arteriosis (PDA) - akateedzana
• Mucheche akavhura moyo kuvhiyiwa

Bernstein D. General misimboti yekurapa kwewakazvarwa mwoyo chirwere Mune: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Chinyorwa chePediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020: chap 461.

Bhatt AB, Foster E, Kuehl K, et al; American Moyo Association Council paKiriniki Cardiology. Congenital chirwere chemoyo mune mukuru akura: chirevo chesainzi kubva kuAmerican Heart Association. Kutenderera. 2015; 131 (21): 1884-1931. PMID: 25896865 www.ncbi.nlm.nih.gov/pubmed/25896865.

LeRoy S, Elixson EM, O'Brien P, et al. American Moyo Association Pediatric Nursing Subcommittee yeKanzuru paMwoyo Nursing; Kanzuru yeZvepfungwa Zvirwere zvevechidiki. Kurudziro yekugadzirira vana nevechiri kuyaruka nzira dzinokanganisa moyo: chirevo kubva kuAmerican Heart Association Pediatric Nursing Subcommittee yeKanzuru yeCardiovascular Nursing mukubatana neDare reCardiovascular Zvirwere zvevechidiki. Kutenderera. 2003; 108 (20): 2250-2564. PMID: 14623793 www.ncbi.nlm.nih.gov/pubmed/14623793.

Webb GD, Smallhorn JF, Therrien J, Redington AN. Congenital chirwere chemoyo.Mune: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Chirwere Chemwoyo cheBraunwald: A Chinyorwa cheCardiovascular Medicine. 11th ed. Philadelphia, PA: Elsevier; 2019: chits. 75.