Kwa anthu omwe ali ndi matenda aakulu a valve aortic, malo opangira opaleshoni nthawi zambiri ndiwo mankhwala okha omwe amapereka chithandizo chachikulu. Komabe, opaleshoni ya valve ya aortic imaphatikizapo zoopsa zazikulu. Kupanga mavitamini a Transcatheter aortic (TAVI) anapangidwa pofuna kuyesa njira yochepetsetsa yochotsera valve aortic .
Mu TAVI, chophimba chotchedwa aortic valve chimapangidwira mwa njira yodabwitsa yothandizira.
Ngakhale kuti TAVI idakali njira yatsopano, imavomerezedwa ku United States ndi European Union kuti athe kuchiritsa odwala ena omwe ali ndi vuto lalikulu la aortic stenosis. Ku Ulaya, amavomerezedwa kuti athe kuchiritsa anthu ena.
Za matenda a Aortic Valve
Mu aortic stenosis, valve ya aortic imalepheretsedwa pang'ono, zomwe zimalimbikitsa mtima kugwira ntchito molimbika kwambiri kupopera magazi ku thupi. Mu aortic kubwezeretsa , valve ya aortic imalephera kutseka kwathunthu, kulola kuti magazi alowe mmbuyo mu mtima pamene valve imayenera kutsekedwa. Potsirizira pake, zina mwazirombo za aortic zikhoza kupweteka mtima , kuchititsa edema (kutupa), dyspnea , ndi (nthawi zambiri) imfa.
Ngakhale kuti zizindikiro za matenda a aortic valve zimatha kuyendetsedwa kwa kanthawi pogwiritsa ntchito mankhwala ochiritsa mtima , palibe mankhwala omwe angathetse vuto la makina ndi valve ya aortic.
Njira yokhayo yothandiza kwambiri ndiyo kupaleshoni opaleshoni ya aortic valve ndi valve yopangira.
Mwamwayi, njira yowonongeka ya aortic valve imafuna njira yayikulu yotsegulira opaleshoni, ndipo makamaka odwala okalamba amene ambiri amakhala ndi aortic stenosis, ndi njira yomwe ili ndi chiopsezo chachikulu.
Ndondomeko ya TAVI yakhazikitsidwa ngati njira yowopsa yochotsera valavu ya aortic.
Kodi Zida za TAVI Zimayikidwa Bwanji?
Zipangizo ziwiri za TAVI ndizovomerezedwa ndi FDA ku United States - valve SAPIEN valve, ndi Medtronic CoreValve. Zida zambiri za TAVI zimavomerezedwa ku Ulaya. Zipangizo zonsezi zimagwira ntchito mofanana: Valavu yopangira imagwiritsidwa ntchito pazitsulo zowonongeka, zomwe zimamangiriridwa ku kathete. Catheter imalowetsedwa m'ziwiya zamagazi (kawirikawiri, mitsempha ya chikazi pafupi ndi kuphulika), ndipo imapita patsogolo pa valavu ya aortic. Pamene ali pa malo, mawonekedwe a waya amatambasulidwa mwa kuwomba buluni. Izi zimapangitsa kuti valve yopangidwira ikatsegule, ndikuyamba kugwira ntchito.
Kodi zotsatirapo ndi TAVI ndi ziti?
Maphunziro oyambirira ndi TAVI anali ochepa okha kwa odwala aortic stenosis amene ankawoneka odwala kwambiri kuti apite opaleshoni yamtima yofunikira kuti athe "aormous valve" m'malo mwake. Kwa odwala omwe akudwala kwambiri, omwe adalandira kachilombo ka TAVI adachepetsereka kwambiri chiwerengero cha anthu omwe amwalira komanso amatha kukhala ndi zizindikiro zambiri pambuyo pa chaka chimodzi, poyerekeza ndi omwe adalandira mankhwala okhaokha.
Komabe, odwala omwe anadwala matendawa ndi 5% omwe amavutika kwambiri ndi matendawa , poyerekeza ndi 1% pa odwala omwe amachiritsidwa.
Sitiroko zokhudzana ndi TAVI ndizokwapulika .
Kafukufuku wina anayerekezera TAVI ndi malo otsika a valtic m'malo odwala 690 odwala aortic stenosis. Kufa kwa chiwerengero cha anthu, kufala kwa ziwalo, ndi kusintha kwa zizindikiro kunali kofanana chaka chimodzi m'magulu awiriwa.
Anthu omwe ankadwala ndi TAVI anali ndi mavuto akuluakulu m'mitsempha ya mitsempha, ndipo omwe amachitira opaleshoni yamtima anali ndi mavuto ochulukirapo kwambiri m'magazi komanso operewera kwambiri .
Mavuto
Ngakhale kuti TAVI ndi yovuta kwambiri kusiyana ndi opaleshoni yotseguka, imakhalabe yoopsa kwambiri. Mavuto awiri omwe amapezeka mobwerezabwereza ndi oopsa kwambiri amakhala owonongeka ku mitsempha yambiri yamagazi ndi sitiroko.
Zovuta zonsezi zimakhala chifukwa cha nthawi zambiri-zovuta zomwe sichitha kupezeka chifukwa choyika mitsempha yodalirika komanso yolimba mu mitsempha yowonongeka. Chifukwa cha mavutowa, chiopsezo cha imfa ndi TAVI chiri pafupifupi 6% mkati mwa masiku makumi atatu.
Umboni wam'mbuyo umasonyeza kuti pali "mphunzitsi wophunzira" wokhudzana ndi kupanga njira ya TAVI. Makamaka, chiopsezo cha mavuto aakulu chikuwoneka kukhala chapamwamba pa njira 30 zoyambirira za TAVI zomwe dokotala amachita.
Makampani omwe akupanga zipangizo za TAVI akupitirizabe kugwira ntchito yopititsa patsogolo luso lamakono, poyesera kuchepetsa ngozi zomwe zimakhudzana ndi ntchito yawo. Koma pakalipano, zoopsazo zimakhalabe zofunikira.
TAVI Yamakono
Pakalipano ku US, TAVI imavomerezedwa ndi FDA kokha kwa odwala aortic stenosis omwe amawoneka kuti ali pangozi yaikulu yowonongeka, yokhotakhota aortic valve m'malo.
Ngati TAVI ikulimbikitsidwa kwa inu kapena wokondedwa wanu, muyenera kutsimikiza kuti njirayi idzachitidwa ndi dokotala yemwe wakhala ndi chidziwitso chochuluka ndi njira iyi.
M'tsogolo, mwinamwake kuti TAVI idzakhala njira yabwino yochitidwa opaleshoni ya mtima kwa odwala ena omwe ali ndi aortic stenosis omwe sali "odwala" chifukwa cha opaleshoni ya mtima wowonekera. Koma chifukwa cha zovuta zomwe, mpaka pano, zimayanjanitsidwa ndi TAVI, sitidakali pano.
> Zotsatira:
> Zajarias A, Wolakwa Cribier AG. Zotsatira ndi Chitetezo cha m'malo ochotsera Aortic Valve. J Am Coll Cardiol 2009; 53: 1829.
Leon MB, Smith CR, Mack M, et al. Transcatheter Aortic Valve Kukonzekera kwa Aortic Stenosis kwa Odwala Amene Sakanatha Kuchita Opaleshoni. N Engl J Med 2010; 363: 1597.
Smith CR, Leon MB, Mack MJ, et al. Transcatheter Potsutsa Opaleshoni ya Aortic Yopangika M'malo Odwala Oopsa. N Engl J Med 2011; 364: 2187.
> 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.