Tetralogy of Fallot (TOF) ndi mtundu wodwala mtima wamtundu umene umakhudza pafupifupi ana asanu mwa ana khumi alionse, omwe amachititsa pafupifupi 10 peresenti ya matenda onse a mtima. Ngakhale TOF nthawi zonse imakhala vuto lalikulu lomwe limafuna chithandizo cha opaleshoni, kuuma kwake kumatha kusiyana pang'ono. Nthawi zina zimatulutsa zizindikiro zoopsa zowonongeka kwa mwana wakhanda, ndipo zimafuna chithandizo mwamsanga.
Nthawi zina, TOF ikhoza kusonyeza zizindikiro zazikulu (ndipo zingakhale zosadziwika) kwa zaka zingapo. Koma posachedwa, TOF nthawi zonse imayambitsa mavuto oopsa a moyo, ndipo imafuna kukonza opaleshoni.
Kodi Tetralogy ya Wonyenga Ndi Chiyani?
Tetralogy of Fallot ndi ophatikizidwa anayi a mtima wamathambo, monga momwe Dr. Etienne-Louis Arthur Fallot anafotokozera mu 1888. Awa ndiwo:
- mitsempha yamatumbo ya stenosis (kupopera kwa mitsempha ya pulmonary)
- chotupa chachikulu chotchedwa septal defect (dzenje pakhoma pakati pa ma ventricles akumanja ndi kumanzere)
- Kupatuka kwa aorta ku ventricle yoyenera
- bwino ventricular hypertrophy (minofu thickening)
Ophunzira zachipatala nthawi zambiri amalakwitsa kuyesa kumvetsa TOF mwa kukumbukira mndandanda wa zilema zinayi. Pochita zimenezi kungawathandize kuyankha mafunso, siwathandiza kwambiri kumvetsa momwe TOF ikugwirira ntchito, kapena chifukwa chake anthu omwe ali ndi TOF amasiyana kwambiri ndi zizindikiro zawo.
Ntchito Yoyamba Mtima
Kuti "mutenge" TOF, ndiyothandiza koyamba kuti muwone momwe mtima umagwirira ntchito. ( Werengani apa za zipinda za mtima ndi valve .) Oxygen-osauka, "yogwiritsidwa ntchito" magazi kuchokera mthupi lonse amabwereranso pamtima kupyola mitsempha, ndipo imalowa muyeso yolondola, ndiyeno cholowera choyenera. Mpweya wabwino umapopera magazi kudzera mu mitsempha ya pulmonary kupita m'mapapu, kumene amabweretsedwa ndi mpweya.
Mwazi wamakono woterewu umabwerera pamtima kudzera m'mitsempha ya pulmona ndipo imalowa m'mzere wa kumanzere, ndiyeno kumapeto kwa ventricle. Vutoli lakumanzere (chipinda chachikulu chopopera) ndiye kumapopera magazi okosijeni mu mitsempha yambiri (aorta) ndi kunja kwa thupi. Komanso kumbukirani kuti kawirikawiri, ventricles zolondola ndi zamanzere zimasiyanirana wina ndi mzake ndi khoma lamtundu wotchedwa septric ventricular.
Chifukwa Tetralogy of Fallot Amayambitsa Mavuto
Kuti mumvetse TOF, mumayenera kumvetsetsa zochitika ziwiri (osati zinayi) zofunika za chikhalidwe ichi. Choyamba, gawo lalikulu la vesi la ventricular likusowa TOF (chomwe chimatchedwa ventricular septal defect). Chotsatira cha vutoli la septal ndi kuti ma ventricles abwino ndi omanzere sakuchita ngati zipinda ziwiri zosiyana; mmalo mwake, zimagwira ntchito mozama ngati chida chimodzi chachikulu. Oxygen-osauka magazi obwerera kuchokera ku thupi, ndi magazi olemera okosijeni ochokera mmapapo, kusakanikirana mu ventricle iyi.
Chachiwiri, chifukwa kugwira ntchito kumeneko kwenikweni ndi chimango chimodzi chokha chachikulu, pamene mgwirizano wa ventricle, mitsempha ya pulmonary ndi aorta imakhala "yopambana" pamagazi. Ndipo chifukwa mu TOF pali kuchuluka kwa stenosis (kupopetsa) kwa mitsempha ya pulmonary, aorta nthawi zambiri imalandira zambiri kuposa gawo lake.
Ngati mwakhala mukufotokozera apa, ziyenera kukhala zomveka kwa inu kuti fungulo la TOF ndi mlingo wa stenosis yomwe ilipo mu mitsempha ya pulmonary. Ngati pali mankhwala ochuluka omwe amatha kutsekemera, ndiye kuti pokhapokha ngati mgwirizano "wosakwatira" umalowa m'magazi a aorta, ndipo pang'onopang'ono sangalowe mu mitsempha ya pulmonary. Izi zikutanthauza kuti magazi ochepa amapita kumapapo ndikukhala okosijeni; magazi ozungulira ndiyeno okosijeni-osauka, matenda owopsa otchedwa cyanosis . Choncho, mavuto aakulu a TOF ndiwo omwe mapiritsi a stenosis ndi akulu kwambiri.
Ngati mitsempha yamatumbo ya stenosis siivutitsa kwambiri, ndiye kuti magazi ambiri amatha kuponyedwa m'mapapo ndikukhala okosijeni. Anthuwa ali ndi cyanosis yocheperako, ndipo kupezeka kwa TOF kungasokonezeke pakubadwa.
Gawo lofotokozedwa bwino lomwe la TOF, lomwe likuwonedwa mwa ana ambiri omwe ali ndi vutoli, ndilokuti mlingo wa mapiritsi a stemosis amatha kusinthasintha. Zikatero, cyanosis ikhoza kubwera ndi kupita. Zithunzi zapanyumba zingathe kuchitika, mwachitsanzo, pamene mwana yemwe ali ndi TOF akugwedezeka kapena ayamba kulira, kapena mwana wachikulire ali ndi TOF. Izi "zamatsenga" za cyanosis nthawi zambiri amatchedwa "tet spells" kapena hypercyanotic spells. Mankhwalawa a cyanosis angakhale aakulu kwambiri, ndipo angafunike kuchipatala mwamsanga.
Zizindikiro za Tetralogy Wonyenga
Zizindikiro zimadalira kwambiri, monga momwe tawonera, pokhapokha ngati chitetezo chimapezeka m'mapiritsi. Pamene chitetezo cha mitsempha chokhazikika chimakhala chachikulu, cyanosis yaikulu imawoneka mwa khanda (chomwe chimatchedwa "buluu"). Ana amenewa amakhala ndi nkhawa komanso amatha kupatsidwa chithandizo mwamsanga.
Ana omwe amachititsa kuti mitsempha ya pulmonary iwonongeke nthawi zambiri imapezeka nthawi ina. Dokotala akhoza kumva mtima akudandaula ndi kuyesa mayesero; kapena makolo angayang'ane za hypercyanotic pamene mwanayo akung'ung'udza. Zizindikiro zina za TOF zingaphatikizepo kuvutika kudya, kulephera kukula bwino, ndi dyspnea .
Ana okalamba omwe ali ndi TOF nthawi zambiri amaphunzira kuchepetsa zizindikiro zawo. Kuwombera kumawonjezera kukaniza m'mitsempha ya mitsempha, yomwe imayambitsa kukana magazi mu aorta, motero imatsogolera magazi ambiri m'magazi. Izi zimachepetsa cyanosis kwa anthu omwe ali ndi TOF. Nthawi zina ana omwe ali ndi TOF amayamba kudziwika ngati makolo awo akunena kuti nthawi zambiri amapita kwa dokotala.
Zizindikiro za TOF-cyanosis, kulephera kuchita masewera olimbitsa thupi, kutopa, ndi dyspnea-zimakhala zoipira ngati nthawi ikupita. Kwa anthu ambiri omwe ali ndi TOF, matendawa amapangidwa kuyambira ali mwana ngakhale atadziwika pa kubadwa.
Mwa anthu omwe TOF imaphatikizapo mitsempha yaing'ono yokha ya pulmonary stenosis, maselo a cyanosis sangathe kuchitika nkomwe, ndipo zaka zingadutse asanatuluke. Nthawi zina, TOF ikhoza kupezeka mpaka mutakula. Ngakhale kuti alibe cyanosis yoopsa, anthuwa akufunikiranso kuchiritsidwa, chifukwa nthawi zambiri amakhala ndi vuto lalikulu la mtima kuyambira ali wamkulu.
Kodi Chimachititsa Bwanji Tetralogy of Fallot?
Monga momwe ziliri ndi mitundu yambiri ya ubongo wa mtima, chifukwa cha TOF sichidziwika. TOF imachitika kawirikawiri kwa ana omwe ali ndi matenda a Down syndrome komanso ndi zina zosawerengeka. Komabe, maonekedwe a TOF nthawi zonse amakhala ochepa komanso saulandira. TOF yakhala ikugwirizananso ndi amayi achiberekero, amayi osowa zakudya, kumwa mowa, komanso zaka za amayi a zaka 40 kapena kuposa. Komabe, nthawi zambiri, palibe zifukwa izi zomwe zimakhalapo pamene mwana wabadwa ndi TOF.
Kuzindikira Tetralogy ya Wonyenga
Pomwe pali vuto la mtima, chidziwitso cha TOF chikhoza kupangidwa ndi echocardiogram kapena MRI ya mtima , yomwe imasonyeza kuti thupi lachilendo lachilendo ndilosazolowereka. Catheterization ya mtima imathandizanso pofotokozera kutengera kwa mtima kusanayambe kukonza.
Kuchiza Tetralogy wa Wonyenga
Mankhwala a TOF ndi opaleshoni. Ntchito yamakono ndiyo kuchita opaleshoni yokonzekera chaka choyamba cha moyo, makamaka pakati pa miyezi itatu ndi isanu ndi umodzi. "Opaleshoni yokonzekera" mu TOF amatanthauza kutseka chivundikiro cha septal (kotero kulekanitsa mbali yeniyeni ya mtima kuchokera kumanzere kwa mtima) ndikuthandizira kutsekemera kwa mitsempha. Ngati zinthu ziwirizi zikhoza kukwaniritsidwa, magazi akudutsa mkati mwa mtima akhoza kukhala ovomerezeka.
Pomwe pali vuto lalikulu pakuberekera, ayenera kuchitidwa opaleshoni yopatsa mphamvu, kuti athetse mwanayo mpaka atakhala ndi mphamvu yokwanira opaleshoni. Kuchita opaleshoni yowonongeka kumaphatikizapo kupanga kupanga shunt pakati pa imodzi mwa mitsempha yamagetsi (kawirikawiri mitsempha ya subclavia) ndi imodzi mwa mitsempha ya pulmonary, pofuna kubwezeretsa kuchuluka kwa magazi m'mapapo.
Kwa anthu achikulire omwe amapezeka ndi TOF, opaleshoni yokonzanso ikulimbikitsidwanso, ngakhale kuti chiopsezo cha opaleshoni chiposa akuluakulu kusiyana ndi ana aang'ono.
Ndi njira zamakono, opaleshoni yokonza TOF ingakhoze kuchitidwa ndi chiopsezo chakufa kwa azimayi ndi ana okha. Komabe, kuchuluka kwa opaleshoni ya TOF yokonzekera akuluakulu, ikhoza kukhala yoposa 10. Mwamwayi si zachilendo kuti TOF "iwonongeke" lero kukhala wamkulu.
Kodi Zotsatira Zakale za Tetralogy of Fallot ndi Ziti?
Popanda kukonza opaleshoni, pafupifupi theka la anthu omwe ali ndi TOF amafa patangotha zaka zochepa chabe, ndipo owerengeka (ngakhale omwe ali ndi vuto loipa) amakhala 30.
Pambuyo popanga opaleshoni yoyamba, kupulumuka kwa nthawi yaitali tsopano ndibwino kwambiri. Ambiri mwa anthu omwe adakonzedwe TOF amakhala moyo mpaka wamkulu. Chifukwa masiku ano opanga opaleshoni ali ndi zaka makumi angapo zakubadwa, sitikudziwa chomwe chiwerengero chawo chokhalitsa chidzakhalapo. Koma zimakhala zofala kuti akatswiri a cardiologists aziwona odwala omwe ali ndi TOF m'zaka makumi asanu ndi chimodzi kapena zisanu ndi ziwiri za moyo wawo.
Komabe, mavuto a mtima ndi ofanana kwambiri kwa akuluakulu omwe anakonza TOF. Mphuno yamadzimadzi yowonongeka , mtima wosalimba, ndi mtima wamagayimu (makamaka atrial tachycardia ndi ventricular tachycardia ) ndi mavuto omwe amakumana nawo nthawi zambiri. Pachifukwa ichi, aliyense yemwe wasintha TOF ayenera kusamaliridwa ndi katswiri wa zamoyo yemwe angathe kuwayesa nthawi zonse, kotero kuti mavuto alionse a mtima omwe amayamba kukhalapo angathe kuthandizidwa mwaukali.
Mawu Ochokera
Ndi chithandizo chamakono, tetralogy of Fallot yasinthidwa kuchokera mu thupi lachibadwa lomwe nthawi zambiri limapangitsa imfa muunyamata, kuti pakhale vuto loyenera kwambiri, lomwe liri ndi chithandizo chabwino ndi chokhalitsa, limagwirizana ndi kukhala ndi moyo mpaka atakula. Lero, makolo a makanda obadwa ndi matendawa ali ndi zifukwa zomveka zoyembekezera kukhala ndi chimwemwe chofanana ndi chomwe amatha kuchiyembekezera ndi mwana wina aliyense.
> Zotsatira:
> Khairy P, Aboulhosn J, Gurvitz MZ, et al. Arrhythmia Burden mu Akuluakulu ndi Kukonzekera mwachidule Tetralogy wa Fallot: Multi-institutional Study. Kuthamanga kwa 2010; 122: 868.
> Park CS, Lee JR, Lim HG, et al. Zotsatira Zomwe Zatha Zonse Zokonzera Tetralogy Wonyenga. Eur J Cardiothorac Surg 2010; 38: 311.
> Amachenjeza CA, Williams RG, Bashore TM, et al. ACC / AHA 2008 Malangizo Othandizira Otsogolera Aakuluakulu Odwala Matenda a Mtima Wodzichepetsa: Lipoti la American College of Cardiology / American Heart Association Task Force on Practice Guidelines (Komiti Yolemba Kupanga Malangizo Otsogolera Akuluakulu Odwala Ndi Matenda a Mtima Wokhazikika). Anakhazikitsidwa mu mgwirizano ndi American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, ndi Society of Thoracic Surgeons. J Am Coll Cardiol 2008; 52: e143.