Idivaysi yokusiza nge-ventricular (LVAD) yenziwe ngokuhlinzwa, ipompo eqhutshwe ngamabhethri eyenzelwe ukunyusa isenzo sokuqhuma kwesifo se-ventricle esesibunxele esesibuthakathaka kakhulu ekuhlulekeni kwenhliziyo ukusebenza ngokusebenzayo ngokwakho.
Ama-LVAD asebenza kanjani?
Izinhlobo eziningana zamadivayisi e-LVAD asethuthukile. Abaningi babo badonsela igazi ebhukwini elifakwe engxenyeni engakwesobunxele, bese bepompa igazi ngokusebenzisa elinye ithini elifakwe e-aorta.
Umhlangano wokumisa ngokwawo uvame ukufakwa ngaphansi kwenhliziyo, engxenyeni engenhla yesisu. Ukuhola kagesi (ikhebula elincane) elivela ku-LVAD lingena esikhunjeni. Ukuhola kufaka i-LVAD ibe yilawunithi yokulawula yangaphandle kanye namabhethri enza amandla epompo.
Ama-LVAD aphelele ngokuphelele. Amabhethri adingekayo namadivayisi alawulwayo agqoke ibhande noma isifuba sekhanda. Ama-LVAD avumela iziguli ukuba zisekhaya futhi zihlanganyele emisebenzini eminingi evamile.
Ukuguquka kwe-LVADs
Ubuchwepheshe be-LVAD buguquke kakhulu ngoba la madivaysi asetshenziswe okokuqala ngawo-1990. Ekuqaleni, i-LVADs yazama ukukhiqiza ukugeleza kwegazi okwakusakazwa ngoba kwakucatshangwa ukuthi ukushaywa komzimba kungadingeka kumzimba ojwayelekile womzimba.
Noma kunjalo, noma yikuphi i-LVAD eyenza i-pulse eqondile idinga izingxenye eziningi ezihambayo, isebenzisa amandla amaningi, futhi idala ithuba elihle lokuhluleka komshini. Isizukulwane sokuqala se-LVAD sibhekene nazo zonke lezi zinkinga.
Ngokushesha kwaqaphela ukuthi abantu benza kahle ngokugeleza kwegazi okuqhubekayo njengokungqubuzana kwe-pulsatile. Lokhu kwavumela ukuthi isizukulwane sesibili se-LVAD sithuthukiswe esincane, sineyingxenye eyodwa kuphela eshukumisayo, futhi sidinga amandla angaphansi kakhulu. Lawa ma-LVAD amasha ahlala isikhathi eside futhi athembekile kunamadivaysi esizukulwane sokuqala.
I-HeartMate II noJarvik 2000 ziyisizukulwane sesibili, i-LVAD eqhubekayo yokugeleza.
Isizukulwane sesithathu se-LVAD siza emgqeni esincane kakhulu futhi senzelwe ukuhlala iminyaka emihlanu kuya kweyishumi. I-HeartWare ne-Heartmate III LVADs amadivaysi esizukulwane sesithathu.
Ngabe i-LVAD isetshenziswa nini?
Ama-LVADS asetshenziswa ezimweni ezintathu zemitholampilo. Kuzo zonke izimo, i-LVAD igcinelwe iziguli ezenza kahle naphezu kokwelapha okudinga ukwelapha.
1) Ibhuloho Yokutshala. I-LVAD ingasetshenziswa ukusekela iziguli ezinezinkinga ezinzima ezingapheliyo zenhliziyo ezilindele ukufakelwa kwenhliziyo.
2) Ukwelashwa Kwendawo. Ama-LVAD angasetshenziswa njengendlela "yokwelashwa okuya endaweni" kubantu abanokuhluleka kwenhliziyo ekupheleni kwesiteleka abangabhalwanga ukufakelwa kabusha (ngenxa yezinye izici ezifana nobudala, isifo sezinso, noma isifo samaphaphu), futhi abanokuhlushwa okubi kakhulu ngaphandle kwemishini ukwesekwa. Kulezi ziguli, i-LVAD yilashwa; kukhona ukulindela okungenangqondo ukuthi i-LVAD ingasuswa.
3) Ibhuloho Ekubuyiseleni. Kwezinye iziguli ezinokuhluleka kwenhliziyo, ukufakwa kwedivaysi ye-LVAD kungavumela i-ventricle engakwesobunxele esonakele ukuba "iphumule" futhi ivuselele ngokwayo "ngokulungisa kabusha ." Izibonelo lapho inkinga yomshoshaphansi ekhona ngezinye izikhathi ingathuthuka ngokuphumula ihlanganisa ukwehluleka kwenhliziyo ngemuva kokuhlinzwa komzimba izinqubo, noma ngokuhlasela okukhulu kwenhliziyo , noma nge- myocarditis ephawulekayo.
Ezigulini eziwela kwelinye lalezi zigaba, ama-LVAD avame ukuphumelela kakhulu ekubuyiseni inani legazi inhliziyo iqhuma emuva emazingeni aseduze-avamile. Lokhu ngcono ngokuvamile kunciphisa izimpawu zokuhluleka kwenhliziyo , ikakhulukazi i- dyspnea kanye nobuthakathaka obunzima, ngokuphawulekayo. Kungabuye kuthuthukise umsebenzi wezinye izitho ezivame ukusebenza ngokuhluleka kwenhliziyo, njengezinso nesibindi.
Izinkinga Nge-LVAD
Ukuphepha kwama-LVAD kuye kwathuthukiswa kakhulu eminyakeni edlule, futhi izinkampani eziziklamile zisebenze kanzima ukunciphisa usayizi wazo ukuze zibenze zifanele abantu abadala. Kodwa kusekhona izinkinga eziningi ezihlobene nama-LVAD.
Lokhu kufaka:
- Ama-LVAD adinga ukugcinwa kwansuku zonke ngokucophelela, nokuqapha ngokucophelela ukuqinisekisa ukuthi bahlale benamathele kumthombo omuhle wamandla. Ngakho isiguli - noma amalungu omndeni - kumele akwazi ukubhekana nezidingo ezingapheli ezizobekwa phezu kwazo.
- Izifo ezingathí sina zegazi zenzeka namaphesenti angama-25 e-LVAD, futhi lezi zifo zivame ukubulala.
- Izinkinga ezibalulekile zokuphuma kwegazi zenzeka ezincane zeziguli.
- Ingozi yokushaya isisu (kusuka emaqenjini egazi) iphakathi kuka-10% no-15% ngonyaka.
Lezi zinkinga ngokusobala zinzima kakhulu, ngakho-ke isinqumo sokufaka i-LVAD siyisimangaliso ngempela. Lesi sinqumo kufanele sithathwe kuphela uma ukufa kusencane kubonakala sengathi kungumphumela omkhulu ngaphandle komunye.
Kungakhathaliseki ukusebenzisa i-LVAD ngokuthi "ukwelapha okuya endaweni" kuyisinqumo esiyinkimbinkimbi kakhulu, ngoba kuleso simo, akukho nethemba elincane lokukwazi ukususa le divayisi. Esivivinyweni esikhulu somtholampilo esenziwe kuze kube yimanje besebenzisa i-LVAD njengesiphakamiso sokuya khona, abamukeli abangu-46% kuphela be-LVAD abamukeli bobabili bephila futhi behlulekile ngengozi eminyakeni emibili.
Ngisho nezinkinga eziseLVADS, la madivaysi anikeze ithemba eliqinisekile ezigulini eziningi ezinezinkinga zokuphelelwa yinhliziyo okungapheli okungeke kube nethemba eminyakeni embalwa eyedlule.
Birks EJ, George RS, Hedger M, et al. Ukuguqulwa kokuhluleka kwenhliziyo enomshini oqhubekayo wokuhamba nge-ventricular kanye nokwelashwa kwemithi: isifundo esingaba khona. Ukujikeleza ngo-2011; 123: 381.
Imithombo:
Rose, EA, Gelijns, AC, Moskowitz, AJ, et al. Ukusetshenziswa kwesikhathi eside kwesidingo sokusiza nge-ventricular kwesokunxele sokuhluleka kwenhliziyo ekugcineni. N Engl J Med 2001; 345: 1435.
Birks EJ, George RS, Hedger M, et al. Ukuguqulwa kokuhluleka kwenhliziyo enomshini oqhubekayo wokuhamba nge-ventricular kanye nokwelashwa kwemithi: isifundo esingaba khona. Ukujikeleza ngo-2011; 123: 381.