Kuvhiya kweaortic vharuvhu - kushomeka zvishoma

Ropa rinoyerera richibuda mumoyo mako uye richipinda mutsinga huru yeropa inonzi aorta. Iyo aortic vharuvhu inoparadzanisa moyo uye aorta. Iyo aortic vheji inovhura kuitira kuti ropa rigone kubuda. Inobva yavhara kuchengetedza ropa kuti risadzokere pamoyo.

Ungangoda aortic vharuvhu kuvhiya kutsiva aortic vharafu mumoyo mako kana:

• Yako aortic vharuvhu haivhare nzira yese, saka ropa rinodonha richidzokera mukati memoyo. Izvi zvinonzi aortic kudzoka.
• Yako aortic vharafu haina kuvhura zvakazara, saka kuyerera kweropa kunze kwemoyo kunoderedzwa. Izvi zvinonzi aortic stenosis.

Iyo aortic vharuvhu inogona kutsiviwa uchishandisa:

• Zvishoma zvinokanganisa kuvhiya kweaortic vharuvhu, kunoitwa uchishandisa imwe kana kupfuura zvidiki zvidiki
• Vhura kuvhiya kweaortic vharuvhu, yakaitwa nekucheka kukuru mubhokisi rako

Usati wavhiyiwa, iwe uchagamuchira anesthesia yakajairika.

Iwe unenge wakarara uye usina kurwadziwa.

Kune nzira dzinoverengeka dzekuita zvishoma zvisingaiti kuvhiya aortic vharuvhu kuvhiya. Matekiniki anosanganisira min-thoracotomy, min-sternotomy, robhoti-yakabatsirwa kuvhiyiwa, uye nekuvhiya kamwe chete. Kuita akasiyana maitiro:

• Chiremba wako anogona kuita 2-inch kusvika 3-inch (5 kusvika 7.6 masentimita) akachekwa muchikamu chekurudyi chechipfuva chako pedyo ne sternum (breastbone). Misumbu iri munzvimbo inozopatsanurwa. Izvi zvinoita kuti chiremba anovhiya asvike pamoyo uye aortic vharafu.
• Chiremba wako anovhiya anogona kupatsanura chete chikamu chepamusoro chepfupa rako rechipfuva, zvichibvumira kuburitswa kune aortic vharafu.
• Zve robhoti-yakabatsirwa vharuvhu kuvhiyiwa, chiremba anovhiya anoita maviri kusvika mana madiki akacheka mubhokisi rako. Chiremba anovhiya anoshandisa komputa chaiyo kudzora maoko erobhoti panguva yekuvhiya. A 3D maonero emoyo uye aortic vharafu anoratidzwa pakombuta mune yekuvhiya mukamuri.

Iwe ungangoda kuve uri pamwoyo-mapapu muchina kune ese aya ekuvhiya.

Kana iyo aortic vharuvhu yakanyanya kukuvara kuti igadziriswe, vharuvhu nyowani inoiswa munzvimbo. Chiremba wako anobvisa yako aortic vharuvhu uye osona nyowani munzvimbo. Kune maviri akakosha mhando evhavha nyowani:

• Mechanical, yakagadzirwa nezvinhu zvakagadzirwa nevanhu, senge titanium kana kabhoni. Aya mavhavha anogara kwenguva refu. Iwe unozofanirwa kutora mushonga wekuonda-ropa, senge warfarin (Coumadin), kweupenyu hwako hwese kana uine rudzi urwu rwevhavha.
• Biological, yakagadzirwa nevanhu kana mhuka mhuka. Aya mavhavha anotora makore gumi kusvika makumi maviri, asi iwe ungangodaro usingade kutora vatete veropa kweupenyu hwese.

Imwe nzira ndeye transcatheter aortic vheji yekutsiva (TAVR). TAVR aortic vharuvhu kuvhiyiwa kunogona kuitwa kuburikidza nekacheka incision yakaitwa mukati meguruva kana mubhokisi reruboshwe. Iyo vheji yekutsiva inopfuudzwa mukati meropa reropa kana pamoyo uye ndokusimudzira kumusoro kune aortic vharafu. Iyo catheter ine bharumu kumagumo. Bhaluni rakafemerwa kutambanudza kuvhura kwevhavha. Iyi nzira inonzi percutaneous valvuloplasty uye inobvumira kuti vharuvhu nyowani iiswe panzvimbo ino. Chiremba anovhiya anotumira catheter ine vharuvhu yakasungirirwa uye obvisa vharuvhu kutora nzvimbo yeakavharika aortic vharafu. Vheji yehupenyu inoshandiswa paTAVR. Iwe haufanire kunge uri pamwoyo-mapapu muchina weiyi nzira.

Mune zvimwe zviitiko, iwe unenge uine coronary artery bypass kuvhiyiwa (CABG), kana kuvhiyiwa kutsiva chikamu cheaorta panguva imwe chete.

Kamwe iyo vharuvhu nyowani iri kushanda, chiremba wako anovhiya anozo:

• Vhara iyo diki yakatemwa kumoyo wako kana aorta
• Isa makateti (anoshanduka machubhu) kutenderedza moyo wako kudurura zvinwiwa zvinovaka
• Vhara iyo yekucheka cheka mumhasuru dzako uye ganda

Kuvhiyiwa kunogona kutora maawa matatu kusvika matanhatu, zvisinei, maitiro eTVV anowanzo kuve mapfupi.

Kuvhiya kweaortic vharuvhu kunoitwa kana iyo vharuvhu isingashande mushe. Kuvhiya kunogona kuitwa nekuda kwezvikonzero izvi:

• Shanduko muaortic vharuvhu yako iri kukonzera zviratidzo zvikuru zvemoyo, sekurwadziwa pachipfuva, kufema kwekufema, kupera simba, kana kukundikana kwemoyo.
• Miedzo inoratidza kuti shanduko muaortic vharuvhu yako iri kukuvadza basa remwoyo wako.
• Kukuvadza kwemoyo wako vharuvhu kubva kuhutachiona (endocarditis).

Maitiro mashoma anokanganisa anogona kuve nemabhenefiti mazhinji. Kune marwadzo mashoma, kurasikirwa neropa, uye njodzi kutapukirwa. Iwe unozopora nekukasira kupfuura iwe zvaungaita kubva kuvhura moyo kuvhiya.

Percutaneous valvuloplasty uye catheter-based vheji kutsiva senge TAVR inoitwa chete muvanhu vanorwara zvakanyanya kana vari pangozi yakanyanya yekuvhiyiwa kukuru kwemoyo. Mhedzisiro ye percutaneous valvuloplasty haigare kwenguva refu.

Ngozi dzekuvhiyiwa chero ndedzipi:

• Kubuda ropa
• Ropa rinovhara mumakumbo ayo anogona kuenda kumapapu
• Matambudziko ekufema
• Utachiona, kusanganisira mumapapu, itsvo, dundira, chifuva, kana mavhavha emwoyo
• Zviitiko kumishonga

Dzimwe njodzi dzinosiyana nezera remunhu. Dzimwe dzenjodzi idzi ndeidzi:

• Kukuvadza kune dzimwe nhengo, tsinga, kana mapfupa
• Kurwara kwemoyo, sitiroko, kana kufa
• Kubatwa kwevhavha nyowani
• Itsvo kutadza
• Kusajairika kurova kwemoyo kunofanirwa kurapwa nemishonga kana pacemaker
• Kupora kwakashata kwekucheka
• Rufu

Nguva dzose udza mupi wako wehutano:

• Kana iwe uri kana uchigona kuve nepamuviri
• Ndeapi mishonga yauri kutora, kunyangwe zvinodhaka, zvinowedzera, kana mahebhu awakatenga pasina mushonga

Iwe unogona kukwanisa kuchengeta ropa mubhengi reropa kuitira kuwedzerwa mukati uye mushure mekuvhiyiwa kwako. Kumbira mupiki wako nezvekuti iwe nenhengo dzemhuri yako mungape sei ropa.

Kwevhiki pamberi pekuvhiyiwa, unogona kukumbirwa kuti urege kunwa mishonga inoita kuti ropa rako rigwinike. Izvi zvinogona kukonzera kuwedzera kubuda ropa panguva yekuvhiyiwa.

• Mamwe acho aspirin, ibuprofen (Advil, Motrin), uye naproxen (Aleve, Naprosyn).
• Kana iwe uri kutora warfarin (Coumadin) kana clopidogrel (Plavix), taura nachiremba wako usati wamira kana kushandura maitiro aunotora izvi zvinodhaka.

Munguva yemazuva usati wavhiyiwa:

• Bvunza kuti ndeipi mishonga yaunofanira kutora pazuva rekuvhiyiwa kwako.
• Ukasvuta, unofanira kurega. Kumbira mupiki wako kuti akubatsire.
• Nguva dzose rega mupi wako azive kana iwe uine kutonhora, furuwenza, fivhiri, herpes breakout, kana chero chimwe chirwere munguva inotungamira kune yako kuvhiyiwa.

Gadzirira imba yako kuitira paunosvika kumba kubva kuchipatara.

Shamba uye geza bvudzi rako zuva rapfuura kuvhiyiwa. Ungangoda kusuka muviri wako pazasi pemutsipa wako nesipo yakakosha. Svina chipfuva chako kaviri kana katatu nesipo iyi. Iwe zvakare unogona kukumbirwa kutora mushonga unodzivirira kudzivirira hutachiona.

Pazuva rekuvhiyiwa kwako:

• Unogona kubvunzwa kuti usanwa kana kudya chero chinhu pakati pehusiku husiku usati waitwa oparesheni. Izvi zvinosanganisira kushandisa chingamu nemindi. Sukurudza muromo wako nemvura kana ichinzwa kuoma. Chenjera kuti usamedze.
• Tora mishonga yawakaudzwa kunwa nekamwe kamvura.
• Unozoudzwa nguva yekuuya kuchipatara.

Mushure mekuvhiya kwako, iwe uchapedza mazuva matatu kusvika manomwe muchipatara. Iwe uchapedza husiku hwekutanga munzvimbo yevanotarisirwa (ICU). Vanamukoti vanoongorora mamiriro ako nguva dzese.

Kazhinji yenguva, iwe unozotamisirwa kune yakajairwa kamuri kana yeanoshandira yekuchengeta unit muchipatara mukati maawa makumi maviri nemana. Iwe unotanga basa zvishoma nezvishoma. Unogona kutanga chirongwa chekusimbisa moyo wako nemuviri wako.

Iwe unogona kunge uine maviri kana matatu machubhu muchipfuva chako kuti ubudise fluid kubva kwakatenderedza moyo wako. Kazhinji yenguva, izvi zvinotorwa kunze kwemazuva 1 kusvika matatu mushure mekuvhiyiwa.

Iwe unogona kunge uine catheter (inoshanduka chubhu) mudundira rako kudhonza weti. Iwe unogona zvakare kuve nemitsinga (IV) mitsara yemvura. Vanamukoti vanonyatso tarisa monitors anoratidza ako akakosha zviratidzo (kupisa, tembiricha, uye kufema). Uchave nekuongororwa ropa zuva rega rega uye maECGs kuyedza moyo wako mashandiro kusvikira wagona zvekuenda kumba.

A pacemaker yenguva pfupi inogona kuiswa mumoyo mako kana moyo wako mutinhimira ukanonoka mushure mekuvhiyiwa.

Paunenge uchinge wave kumba, kupora kunotora nguva. Zvitore nyore, uye shivirira iwe pachako.

Mechanical moyo mavharuvhu haakundikani kazhinji. Zvisinei, kuvhara ropa kunogona kukura pavari. Kana ropa rakagwamba rikaumbika, unogona kunge uine sitiroko. Kubuda ropa kunogona kuitika, asi izvi hazviwanzo.

Biological mavharuvhu ane njodzi yakaderera yekugwamba kweropa, asi anowanzo kutadza nekufamba kwenguva. Kuvhiya kushoma kwemoyo wevhavhavha yemoyo kwakagadziriswa mumakore apfuura. Aya matekiniki akachengeteka kune vanhu vazhinji uye anogona kudzikamisa nguva yekudzosa uye kurwadziwa. Kuti uwane mhedzisiro yakanaka, sarudza kuve neako aortic vharuvhu kuvhiya pane imwe nzvimbo inoita yakawanda yemaitiro aya.

Mini-thoracotomy aortic vharafu kutsiva kana kugadzirisa; Cardiac valvular kuvhiya; Mini-sternotomy; Robotically-yakabatsira aortic vharafu kutsiva; Transcatheter aortic vharafu kutsiva

• Antiplatelet zvinodhaka - P2Y12 inhibitors
• Aspirin uye chirwere chemwoyo
• Kuvhiya kwevhavha yemoyo - kubuda
• Chiremba wemwoyo kuvhiya - kubuda
• Kutora warfarin (Coumadin)

Herrmann HC, Mack MJ. Transcatheter kurapwa kweiyo valvular 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: chap 72.

Lamelas J. Minimas invasive, mini-thoracotomy aortic vheji kutsiva. Mune: Sellke FW, Ruel M, eds. Atlas yeCardiac Nzira dzekuvhiya. 2nd ed. Philadelphia, PA: Elsevier; 2019: chits.

Reiss GR, Williams MR. Basa rechiremba wechiremba wemoyo. Mune: Topol EJ, Teirstein PS, eds. Chinyorwa cheInopindirana Cardiology. 7th ed. Philadelphia, PA: Elsevier; 2016: chits.

Rosengart TK, Anand J. Yakawana chirwere chemwoyo: valvular. Mu: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Chinyorwa Chekuvhiya. 20th ed. Philadelphia, PA: Elsevier; 2017: chitsiko 60.