Chigamulo chochita opaleshoni ya mitral stenosis ndi chonyenga, ndipo chiyenera kukhala chodziwika bwino.
Ngati inu ndi adokotala mwasankha kuti ndi nthawi yokonza njirayi , muzitsatira njira zitatu zomwe mungachite kuti mupange opaleshoni ya mitral stenosis: Kuchokera kwa ambiri mpaka kawiri kawiri, ndi izi:
- mitsempha yotchedwa mitral bulvon valvotomy (PMBV)
- mitral commissurotomy
- mitral valve m'malo
Sikuti njira zonsezi ndi zoyenera kwa aliyense amene ali ndi mitral stenosis.
Percutaneous Mitral Balloon Valvotomy
Mu mitral stenosis, timapepala timene timagwiritsira ntchito mankhwala otsekemera (otsekemera omwe amatseguka komanso otsekedwa ngati mtima wathunthu) amagwirizanitsa pamodzi, kuteteza kuti valve isatsegulidwe kwathunthu. PMBV amayesera kulekanitsa timapepala kuchokera kwa wina ndi mzake kuti athetse vutoli.
Mu PMBV, chubu, yaitali, chofewa (catheter) ndi bulloon yomwe ili pambali yake imadutsa pamtunda wa mitral. Bhaluni ndiye ikufutukulidwa. Cholinga chake ndichotseketsa zomangiriza zomwe zatsutsana ndi mitral valve leaftlets kwa wina ndi mzake.
Chifukwa PMBV ndi ndondomeko yothandizira odwala komanso osati opaleshoni ya mtima , ndizovuta kwa odwala kusiyana ndi machitidwe ena opaleshoni ya mitral. Zovuta zimakhala zochepa, ndipo nthawi zambiri zimakhala zophweka.
PMBV imakhalanso yothandiza kwambiri pochitidwa pa anthu osankhidwa bwino.
Kawirikawiri, PMBV ndi njira yopaleshoni dokotala wanu angakulimbikitseni kuthana ndi mitration stenosis, pokhapokha mutakhala:
- khungu lakuda lamanzere (magazi clot)
- Kalisiyamu yapamwamba imayika pamtunda wanu kapena pafupi ndi mitral yanu
- Kupitirira malire a mitral kuthamanga - pamene mitral valve siimitsekera bwino, kulola magazi kuti alowe kupyolera mu valve
Kuonjezera apo, PMBV nthawi zambiri sizotheka ngati mitral stenosis ikutsatizana ndi zina zovuta mtima.
Pambuyo pa njira ya PMBV, ndizotheka mitral stenosis kuyamba kuyamba kuwonjezereka pang'onopang'ono kachiwiri. Pachifukwa ichi, ngakhale mutatha kuchita izi, ndikofunika kuti muyesetse kupenda nthawi zonse ndi mafilimu . Odwala 21 peresenti omwe ali ndi PMBV amafunika kuchipatala kachiwiri.
Mitral Commissurotomy
Cholinga cha mgwirizano wa mitral ndi chimodzimodzi ndi PMBV-kupatula timapepala timene timagwirana. Chosiyana ndi kusintha kwa mitral, komabe, ndi njira yotsegulira mtima yomwe ikukwaniritsira cholinga ichi pogwiritsa ntchito tsamba lapadera lopaleshoni.
Kawirikawiri nthawi zambiri zimapereka zotsatira zabwino kwambiri. Komabe, mukudziwidwa ndi zoopsa za opaleshoni yayikulu komanso nthawi yowonjezereka yopuma kusiyana ndi PMBV, ndicho chimene chimaletsa madokotala kuti ayambe kuwavomereza ngati chisankho choyamba.
Kawirikawiri ndibwino kuti anthu omwe akufuna kukhala a PMBV kupatulapo kukhalapo kwa thribusti, kuwerengera kwa valve, kapena kubwerera kwa mitral.
Mofanana ndi njira ya PMBV, mitral stenosis ikhoza kubwereza pang'onopang'ono kutsatizana ndi chiyambi. Anthu omwe ali ndi ndondomekoyi amafunikanso kupitiliza kuunika kwa mtima.
Mitral Valve m'malo mwake
Mitral valve m'malo mwake ndikutsiriza, chifukwa imakhala ndi chiopsezo chachikulu kuposa ma PMBV kapena commissurotomy. Kugwiritsa ntchito valve n'kofunika pamene mitral stenosis yachititsa kuti valve mitral iwonongeke kwambiri kapena kuwerengedwa, ndikupanga njira ziwirizo zosatheka.
M'malo otchinga mmagetsi, valve imalowetsedwa ndi valve yopangira (prosthetic) valve . Mavavu opangidwira akhoza kukhala opangidwa 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 wanu komanso ngati mungathe kutenga coumadin wochepa magazi.
Magetsi onse opangira mtima amakula kwambiri kuti apange magazi. Komabe, kutseka magazi sikungakhale kovuta ndi bioprosthetic kusiyana ndi ma valve opangira, kotero anthu omwe ali nawo kale sangathe 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. Ngati mukufuna mpikisano wa mitral, ali ndi zaka zoposa 65, ndipo mukhoza kutenga Coumadin, dokotala wanu angakonzekere valavu yamagetsi. Ngati ndinu wamkulu kuposa 65, kapena ndinu wamng'ono koma simungatenge Coumadin, bivrosthetic valve nthawi zambiri amalimbikitsa.
Opaleshoni Yanu ya Opens Stenosis Chisankho
Ngati muli ndi mitral stenosis, muyenera kugwira ntchito mwakhama ndi katswiri wanu wamaganizo kuti muwone ngati pakufunika opaleshoni komanso opaleshoni, ndikusankha njira yopangira opaleshoni yomwe ikugwirizana ndi zosowa zanu. Pozindikira kuti atha kusamalidwa komanso kusamalidwa mtima, anthu ambiri omwe ali ndi mitra stenosis masiku ano amatha kukhala ndi moyo wamba.
Zotsatira:
Bonow, RO, Carabello, BA, Chatterjee, K, ndi al. 2008 Kuwonetseratu kwapadera kumene kunaphatikizidwa ndi malangizo a ACC / AHA 2006 otsogolera odwala matenda a mtima wa valvular: lipoti la American College of Cardiology / American Heart Association Ntchito Yogwiritsa Ntchito Malangizo Othandizira (Komiti Yolemba Kukonzekera Malangizo a 1998 a Ulamuliro Odwala Amene Ali Ndi Matenda a Mtima wa Valvular): Ovomerezedwa ndi Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, ndi Society of Thoracic Surgeons. Kuyendayenda kwa 2008; 118: e523.
Ben Farhat M, Ayari M, Maatouk F, et al. Pulogalamu yowonongeka potsata opaleshoni yotsekedwa ndi yotseguka ya mitral commissurotomy: zotsatira za zaka zisanu ndi ziwiri zotsatila zotsatira za mayesero angapo. Circulation 1998; 97: 245.