Aortic stenosis ndi mtundu wa matenda a mtima wamagetsi chifukwa cholepheretsedweratu a valtic valve. Ndi aortic stenosis, zimakhala zovuta kwa mtima kupopera magazi ku ziwalo za thupi. Aortic stenosis ingakhudze kwambiri ntchito ya mtima, kutulutsa zizindikiro zazikulu, ndipo pamapeto pake ikhoza kufa popanda kupatsidwa chithandizo.
Kodi Aortic Stenosis N'chiyani?
Vuvu ya aortic imayang'anira kutsegula pakati pa ventricle lakumanzere ndi aorta. Monga chowombera chakumanzere chimayamba kugwira ntchito, valavu ya aortic imatsegulira kuti alole magazi mwachitsulo chakumanzere kuti achoke pamtima , mu aorta, ndi kwa thupi lonse. Pambuyo poti ventricle yakumaliza ikatha, mgwirizano wa aortic umatseka kuti magazi asamatsuke kubwalo.
Munthu akayamba aortic stenosis, mpweya wawo wa aortic sungathe kutseguka kwathunthu pamene chimvula chimayamba kugunda, choncho mtima umayenera kugwira ntchito molimbika kuti athetse magazi pa valavu yotsekedwa. Kupsinjika kwakukulu pamtima kungachititse kukhumudwa mtima ndi mavuto ena amtima.
Kodi N'chiyani Chimayambitsa Aortic Stenosis?
Pali mavuto ambiri omwe angapangitse aortic stenosis, kuphatikizapo:
- Kukhazikitsidwa ndi kuwerengera : Kwa anthu oposa zaka 70, vuto lalikulu la aortic stenosis ndi "kuvala ndi kugwedeza." Pakapita nthawi, valavu ya aortic ikhoza kuyamba kuchepa, zomwe zimayambitsa calcium deposits kuti ikhalepo pa valve. Mavitamini ameneŵa amatsutsana ndi kutsegula kwa valvular, kuchititsa aortic stenosis.
- Mphuno yotchedwa aortic valve : Chowopsa kwambiri cha aortic stenosis kwa achinyamata ndi congenital bicuspid valve. Mu chikhalidwe ichi munthu amabadwa ndi valve ya aortic yokhala ndi "ziphuphu" ziwiri (mwachitsanzo, ziphuphu) mmalo mwa zitatu zachilendo. Ma valve amadzimadzi amathandiza kwambiri kupanga mapulogalamu a calcium-ndipo motero, kwa aortic stenosis. Anthu omwe ali ndi bicuspid aortic stenosis amakhala ndi zizindikiro m'ma 40s ndi 50s.
- Matenda a mtima wa Rheumatic : Osati kuti zaka makumi ambiri zapitazo, matenda a rheumatic mtima ndiwo omwe amachititsa kuti aortic stenosis iwonongeke padziko lapansi. Koma ndi chitukuko cha maantibayotiki ogwira ntchito motsutsana ndi mabakiteriya a streptococcus , ndipo kuchepetsedwa kumeneku kumachepetsa matenda a rheumatic fever , matenda a mtima wa rheumatic wasanduka wamba.
- Congenital aortic stenosis : Mavuto angapo okhudzidwa kuphatikizapo bluupid valve angapangitse aortic stenosis. Izi zimaphatikizapo malingaliro osiyanasiyana a valve aortic yokha, komanso mawonekedwe osadziwika olepheretsa minofu ya mtima pamwamba kapena pansi pa valavu ya aortic. Mitundu yodabwitsa imeneyi yobadwa ndi aortic stenosis imawoneka mwa ana.
Kodi Ndi Mavuto Otani Amene Amayambitsa Aortic Stenosis?
Ndi aortic stenosis, kutulukira kwa magazi kuchokera kumapeto kwa ventricle kumakhala koletsedwa pang'ono, kotero zimakhala zovuta kwambiri kuti mtima uchotse magazi. Ntchito yowonjezera ya mtima imeneyi imapangitsa kuti munthu asamapanikizidwe kwambiri, zomwe zimayambitsa matendawa, kapena kuti "hypertrophy".
Izi zasiya njira zowonongeka zowonongeka zingayambitse matenda osokoneza bongo ndi diastolic mtima kulephera , kumene minofu yowonjezereka "imapangitsa" kuvomberana, ndipo zimapangitsa kuti zikhale zovuta kuti zinyamazi zikhale ndi magazi pakati pa kugunda kwa mtima.
Zizindikiro zimabweretsa. Zizindikirozi zimaphatikizapo dyspnea (kupuma pang'ono), kutopa mosavuta komanso kuchepetseratu kuchepetsa thupi, komanso kuopsa kokhala ndi matenda opatsirana pogonana .
Pamene aortic stenosis ikufalikira, angina ikhoza kuchitika, komanso zizindikiro za mutu wautali komanso syncope (kutaya chidziwitso) pakuyesera.
Ndi nthenda yaikulu ya aortic stenosis, minofu ya kumapeto kwa ventricle ingasinthe kuchokera pakukhala wandiweyani ndi wolimba kuti ukhale wofooka ndi wong'onongeka-chikhalidwe chotchedwa cardiomyopathy . Pomwe mphuno ya storosis imatulutsa mtima wochuluka, mtima umatha kukhala wosasinthika.
Imfa ya mwadzidzidzi imapezeka ndi aortic stenosis.
Kodi Aortic Stenosis Ipezeka Bwanji?
Chifukwa chakuti aortic stenosis osatetezedwa nthawi zambiri amafa, kupanga matenda oyenera ndi ofunikira. Mwamwayi, kupezeka kwa aortic stenosis lero sikovuta.
Madokotala amadandaula ndi aortic stenosis pamene odwala awo amadandaula ndi zizindikiro "zofanana" (kupuma pang'ono, kuchepetsa kuchita zolimbitsa thupi, kupweteka pachifuwa, chizungulire, kapena syncope). Zowonjezereka, dokotala adzakayikira aortic stenosis musanakhale zizindikiro pamene amva kuti mtima ukudandaula chomwe chiri chikhalidwe ichi. Matendawa akhoza kutsimikiziridwa mosavuta kapena kutchulidwa ndi echocardiogram .
Kuchiza Aortic Stenosis
Mankhwala a aortic stenosis ndiwo malo opangira opaleshoni. Mankhwalawa akhoza kusintha zizindikiro kwa kanthaŵi, koma potsirizira pake sizingatheke chifukwa vuto ndilokutsekemera kwa aortic valve. Choncho pamene munthu ali ndi aortic stenosis, funsoli siloyenera kuchita ngati opaleshoni, koma liti.
Monga lamulo, kusinthika kwa valve aortic kuyenera kuchitidwa kokha munthu atayamba kuonetsa zizindikiro-kupuma pang'ono, kupweteka pachifuwa, chizungulire, kapena syncope. Chimodzi mwa zizindikiro izi zimachokera ku aortic stenosis, pafupifupi nthawi yokhala ndi moyo popanda kudzoza valve ndi zaka ziwiri kapena zitatu. Kusintha kwa valve nthawi yake kumalimbikitsa kwambiri izi. Munthu akapezeka kuti ali ndi aortic stenosis, nkofunika kuti ayang'anitsedwe mosamala kuti asonyeze zizindikirozi.
Chifukwa opaleshoni imachotsa mwazidzidzidzi kuchepetsa kuthamanga kwa magazi, nthawi zambiri ntchito ya mtima imapanga bwino kwambiri mutagonjetsa valve. Choncho ngakhale anthu omwe ali okalamba komanso odwala kwambiri amatha kuchita bwino opaleshoni ya aortic stenosis.
Mavavu opangidwa ndi ma prosthetic omwe amagwiritsidwa ntchito m'malo mwa valve ya aortic yodwala akhoza kukhala ndi zipangizo zonse zopangidwa ndi anthu (magetsi), kapena akhoza kupanga kuchokera ku mtima wa valve wa nyama, makamaka nkhumba (bioprosthetic valve). Kusankha mtundu wa valavu yogwiritsira ntchito kumadalira msinkhu wa munthu, komanso ngati angatenge magazi ochepa monga Coumadin .
Magetsi onse opangira mtima amakula kwambiri kuti apange magazi. Komabe, kutseka magazi sikungakhale kovuta ndi mabotolo a bioprosthetic kuposa momwe zimakhalira ndi magetsi, kotero anthu omwe ali nawo kale sangafunikire kutenga mankhwala a Coumadin osatha; omwe ali ndi valve zamagetsi amachita. Komabe, ma valve opangidwa ndi mawotchi amaoneka kuti amatenga nthawi yaitali kuposa ma valve a bioprosthetic.
Kotero kwa anthu omwe ali ndi aortic stenosis ali ndi zaka 65 omwe angatenge Coumadin, magetsi amtima amadziwika nthawi zambiri. Kwa anthu oposa 65, kapena amene sangatenge Coumadin, valve ya bioprosthetic nthawi zambiri imalangizidwa.
Njira Zochepa Zosafunika Zochizira Aortic Stenosis
Mankhwala osakanikirana kwambiri kusiyana ndi malo opangira opaleshoni amapangidwa.
Mu aortic valvulotomy , cathatini ya buluni imadutsa pa valve ya aortic ndipo baluni imakonzedwa kuti iwonongeke zina mwa calcium deposits pa valve. Izi nthawi zambiri zimalola kuti valve ikhale yotsegula bwino, ndipo imathetsa ena aortic stenosis. Mwamwayi, valvulotomy sapereka zotsatira zofanana, ndipo zingayambitse mavuto aakulu.
Njira ina yothandizira kanyonga ya aortic stenosis ndi yopangira catheter aortic valve implantation (TAVI) . Mankhwala ambiri a TAVI ali pansi pa chitukuko chogwira ntchito, ndipo ochepa aloledwa kuti agwiritsidwe ntchito kwa odwala omwe ali pangozi yaikulu ya opaleshoni yowonjezeretsa valve. Komabe, zovutitsa ndi TAVI pa nthawiyi ndizochepa. Zonse za TAVI ndi valvulotomy pakali pano ndizosungidwa kwa anthu odwala aortic stenosis amene sangathe kupulumuka m'malo opangira opaleshoni.
Mawu Ochokera
Aortic stenosis ndi mtundu wa matenda a mtima a valvular omwe amalepheretsa kutuluka kwa magazi kuchokera mumtima. Matenda otchuka a aortic stenosis amachititsa zizindikiro zazikulu, ndipo amachepetsa kuchepa kwa moyo. Mwamwayi, pokhala ndi nthawi yopangira opaleshoni yabwino, anthu okhala ndi aortic stenosis akhoza kuchita bwino.
> Zotsatira:
> Eveborn GW, Schirmer H, Heggelund G, et al. The Evolving Epidemiology ya Valvular Aortic Stenosis. kufufuza kwa Tromsø. Mtima; 99: 396.
Leon MB, Smith CR, Mack M, et al. Transcatheter Aortic-valve Kukonzekera kwa Aortic sSenosis kwa Odwala Amene Sagonjera Opaleshoni. N Engl J Med 2010; 363: 1597.
> Nishimura RA, Otto CM, Bonow RO, ndi al. 2014 AHA / ACC Chitsogozo cha Ulamuliro wa Odwala Ndi Valvular Heart Disease: Lipoti la American College of Cardiology / American Heart Association Ntchito Yogwira Ntchito Zothandiza. J Am Coll Cardiol 2014; 63: e57.