Zaka zaposachedwapa, anthu ambiri omwe ali ndi zolemba zamakono akudabwa ndi chidziwitso chakuti ali ndi matenda a mtima wamba omwe amatchedwa "patent foramen ovale," kapena PFO.
Malangizo omwe anthuwa amapatsidwa atapatsidwa mankhwalawa amasiyana mosiyana. Madokotala ena amafuna kuwachitira ndi warfarin kapena aspirin kuti ayese kuteteza magazi.
Ena angalimbikitse ndondomeko ya mtima yowonongeka pofuna kukhazikitsa chipangizo chapadera kuti atseke PFO. Komabe, madokotala ena amawauza kuti PFO ilibe phindu lenileni komanso kuti palibe mankhwala omwe amafunikira.
Nkhaniyi ikufotokozera mwachidule zomwe zimadziwika ponena za PFO ndikuyesa kutsutsana pazochitika zake.
PFO ndi chiyani?
M'mimba yomwe ikukula, mphutsi ya foramen ovale ndi yotsegulira yomwe imakhalapo pamtundu wa atrial (chimbudzi chochepa chomwe chimasiyanitsa cholowa kuchokera kumanzere a atrium), chomwe chimalola kuti magazi azitha kutuluka momasuka kuchoka kumalo abwino kupita kumanzere. Kuthamanga kwa magazi kuchokera ku tolium yoyenera mpaka ku atrium kumanzere n'kofunika pa nthawi ya kukula kwa mwana, chifukwa zimathandiza kuti magazi azizungulira kwambiri m'mapapo. (Kamwana kamene kamalandira magazi ake okosijeni kuchokera kwa mayi ake, kupyolera mu pulasitiki.)
Pa kubadwa, pamene mwana ayamba kupuma, kupanikizika kumanzere kumanzere kumawonjezeka ndipo kupanikizika kumalo otsika kumachepa.
Mpweya woterewu umayambitsa minofu kuti idzipangitse kuti ikhale yodula pamtunda, motsekemera bwino. Panthawiyi, magazi satha kuyendayenda pamtundu wa foramen ovale, kuyambira kumanja kupita kumanzere.
Kwa anthu ambiri, minofu imeneyi yotsekemera mthunzi wa foramen imasindikizidwa, motero mphulupulu ya olambula imakhala ilibenso.
Komabe, pafupifupi munthu mmodzi mwa anthu anayi (100%) omwe ali ndi kachilombo kawiri (25 peresenti), chovalacho sichimasindikizidwa kwathunthu ndipo chimadalira pazitsulo zapamwamba ku atrium kuti zitsekedwa. Pamene kuponderezedwa kwa atrium kumakhala kochepa kwambiri kusiyana ndi kumanzere kumanzere (monga momwe zingathere, mwachitsanzo, mukakokera), pafupikitsa nthawiyi theamen ovale ikhoza kutseguka, ndipo, mwadzidzidzi, magazi amatha kutuluka kuchokera kumbali yolondola kupita ku atrium kumanzere. Anthu awa amanenedwa kuti ali ndi patent foramen ovale. Kuyang'anitsitsa momwe mtima ulili komanso mmene umagwirira ntchito kumapangitsa kumvetsa bwino njirayi.
Kodi PFO Imapezeka Bwanji?
Madokotala amadziwa kuti PFOs ndi zojambulajambula. Sikuti PFOs zonse ndi zofanana, ndipo zina zimakhala zovuta kuzizindikira kuposa zina. Nthawi zingapo, PFO imakhala yoonekeratu ndipo idzawonetsedwa ndi aliyense wa echocardiographer. Kaŵirikaŵiri, kuyendetsa mwapadera ndikofunikira kuti tipeze PFO, kuphatikizapo zojambula zojambula m'matumbo, kujambula zinthu zosiyana siyana m'magazi (" kuphunzirira "), komanso kugwiritsa ntchito njira yabwino yopuma kupyolera podutsa mpweya wapadera. Chovuta kwambiri kuti katswiri wa echocardiographer agwire ntchito kuti azindikire PFO, makamaka kuti awone imodzi.
Kwa anthu ena, ziphuphu zomwe zimaphatikizapo mthunzi wa foramen ukhoza kukhala ndi bulloon-like bulge, yomwe imatchedwa septal aneurysm (ASA). Nthawi zambiri ASA ikuphatikizidwa ndi PFO, choncho zinthu ziwirizi zimagwirizanitsidwa ndi wina ndi mzake. Momwe ASA ndi PFO zilili ofanana kwambiri, ndipo mwina sizolondola kuganiza kuti ASA ndi yowonjezereka (ndipo mwinamwake yofunika kwambiri) ya PFO.
Kodi Phindu la PFO N'chiyani?
Cryptogenic sitiroko. Chifukwa chomwe madokotala akudera nkhawa za PFOs ndi chakuti, pazigawo zochepa zomwe zimakhala zochepa kwambiri pamene vuto lapachilombo lapamwamba ndilopamwamba kusiyana ndi kukanika kwa magazi, magazi amatha kuyenda kuchokera ku right torium kupita kumanzere.
Ngati chigoba (mwazi wamagazi womwe ukuyenda kupyola mu mitsempha ya mitsempha) imakhala ikuyenda kudzera pa malo oyenerera pa nthawi yomweyo, iyenso ikhoza kulowa m'mbali mwamanzere. Kuchokera kumanzere kumanzere kotsekemera kumatha kudutsa mu ventricle ya kumanzere, ndipo kuchokera pamenepo alowetsani dongosolo lozungulira, kumbali iliyonse ya thupi. Ngati chovalacho chikapita ku ubongo, chikhoza kuchititsa sitiroko . Choncho, vuto lalikulu lokhudzana ndi PFO ndiloti lingapangitse ngozi yowonongeka.
Panopa akukhulupirira kuti PFO ndi imodzi mwa " cryptogenic stroke " - ndiko, stroke yomwe chifukwa chake sichitha kudziwika patatha kafukufuku wathunthu wa zachipatala. Komabe, chifukwa kufalikira kwa PFOs ndikokwera kwambiri, makamaka ngati mumawafuna mozama, kupeza PFO mwa munthu amene adagwidwa ndi matenda osagwira ntchito mosatsimikiziridwa kuti palibe PFO yomwe imayambitsa matendawa.
Kafukufuku waposachedwapa akuti, mwa anthu osapitirira zaka 60 omwe ali ndi vuto la cryptogenic, komanso omwe ali ndi PFO (kapena PFO yokhudzana ndi ASA), kutseka PFO kumakhala ndi chiopsezo chochepa cha kupwetekedwa kanthawi kochepa . (PFOs ikhoza kutsekedwa ndi mpangidwe wapadera womwe ukhoza kuikidwa mwa kathete.)
Komabe, kutsegulidwa kwa PFO si njira yopanda ngozi, ndipo kupindula pochita zimenezi kwawonedwa kokha mwa odwala osamala kwambiri. Izi zili choncho chifukwa zikwapu zambiri zopwetekedwa sizinayambidwe ndi PFOs, ngakhale PFO imazindikiritsidwa. Kutsekedwa kwa PFO kuyenera kuganiziridwa pa opulumuka miyoyoyo pokhapokha atayang'aniridwa bwinobwino ndi katswiri wamaganizo ndi wazamagulu.
Migraines. Kafukufuku wina wasonyeza kuti mutu wa mutu wa migraine umakhala wofala kwambiri kwa anthu omwe ali ndi PFOs. Koma kafukufuku wina wasonyeza kuti palibe mgwirizano pakati pa PFOs ndi migraines. Ndiye ngakhale mgwirizano pakati pa migraines ndi PFO ndi wokayikitsa. Kuwonjezera apo, palibe zifukwa zomveka zogwiritsira ntchito physiologic zokhudzana ndi momwe PFO ingawonetsere migraines.
Kulephera kwa chiphunzitso chotero sikulepheretsa madotolo ena kuti atsimikizire zipangizo zotsekemera za PFO mwa odwala migraine. Ena omwe adachita zimenezi adanena kuti anthu omwe ali ndi migraine amachepetsa zizindikiro. Chifukwa cha izi, mayesero amodzi adakonzedwa kuti aphunzire ngati kutseka kwa PFO kuli koyenera. Kusanthula kumeneku, kofalitsidwa mu 2008, sikunapindule konse ndi kutseka kwa PFO.
Panthawi imeneyi palibe chifukwa chokhulupirira kuti PFOs ndizo zimayambitsa mutu wa mutu wa migraine. Kupereka PFO kutsekedwa ndi odwala migraine ndiko kugwiritsa ntchito mosayenera kuti onse ali-komanso-nthawi zambiri amayembekezera chilichonse chimene wina anganene kuti angawathandize. Anthu ambiri omwe ali ndi migraines angathe kuthandizira kuthetsa mavuto awo ngati angapeze dokotala wosamalira ndikugwira ntchito limodzi naye.
Matenda a Platypnea-orthodeoxia. Matenda a Platypnea-orthodeoxia ndi osowa kwambiri omwe munthu amalephera kupuma ndipo amavutika ndi mpweya wotsika wa magazi pamene ali pamalo oyenera. Matendawa sasowa PFO chabe, komanso chikhalidwe china cha mtima chimene chimapangitsa PFO kutseguka pamene munthu aima. Kawirikawiri, "chikhalidwe china" ndi chinthu chodabwitsa m'mtima chomwe chimalimbikitsa magazi kutuluka kuchokera pa malo oyenerera kupita ku atrium kumanzere. Kutseka PFO ndi imodzi mwa njira zoyenera kuthandizira matendawa.
Mawu Ochokera
Patent foramen ovale ndi matenda a "zamakono" omwe amachitidwa kale kwambiri m'zaka makumi angapo zapitazo ndi kufika kwa mafilimu ojambula zithunzi. Ngakhale kuti PFO imalingalira kuti ndizovuta chifukwa cha kupweteka kwa cryptogenic, anthu ambiri omwe amapezeka kuti ali ndi PFO, palibe vuto lililonse la mankhwala.
> Zotsatira:
> Dowson A, Mullen MJ, Peatfield R, et al. Kulimbana ndi Migraine ndi Starflex Technology (Mist) Mayesero: Cholinga, Multicenter, Double-Blind, Sham-Controlled Trial Kuti Azindikire Mphamvu ya Patent Foramen Ovale Kutsekedwa ndi Starflex Septal Kukonzekera Kukonzekera Kuthetsa Opractory Mutu wa mutu wa Migraine. Kuyendayenda kwa 2008; 117: 1397.
> Mas JL, Derumeaux G, Guillon B, et al. Patent Foramen Ovale Kutsekedwa kapena Anticoagulation vs. Antilatelateletseni pambuyo pa kupweteka. N Engl J Med 2017; 377: 1011.
> Wopulumutsa JL, Carroll JD, Thaler DE, et al. Zotsatira za Nthawi Zakale za Patent Foramen Ovale Kutsekedwa kapena Chithandizo chachipatala pambuyo pa kupweteka. N Engl J Med 2017; 377: 1022.
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