Ingabe Ukuvala I-Patent Foramen Ovale Ukuvimbela Izibhamu?
Sonke sasiba nomgodi enhliziyweni yethu. Igazi ligeleza ngokuhluke kakhulu ngomzimba wesisu esingakazalwa uma kuqhathaniswa nomuntu omdala. Ngenye, igazi ligeleza phakathi kokuvula phakathi kwesobunxele nangakwesokudla senhliziyo ngevulo elibizwa nge-foramen ovale.
Nokho, ngokuphefumula kwethu kokuqala emoyeni, i-gradient yokucindezela phakathi kohlangothi lwesobunxele nangakwesokudla senhliziyo iyashintsha, futhi i-flap of tishu igcina uphawu lwe-foramen ovale.
Kusukela ngaleso sikhathi kuya phambili, igazi ligeleza kuphethini evamile cishe bonke abantu abadala.
Nokho, ngezinye izikhathi, i-foramen ovale ayigcinanga ngokuphelele, ishiya lokho okubizwa ngokuthi i-patent foramen ovale, noma i- PFO. Lokhu empeleni kuhle kakhulu futhi kuthiwe kuthinta umuntu oyedwa kwabahlanu.
Njengoba kuyabonakala njengoba kuzwakala ukuba nalokhu kuxhumana phakathi kwezinhlangothi zombili zenhliziyo, ucwaningo oluningi lubonisa ukuthi PFOs ayinabungozi isikhathi esiningi. Abanye odokotela bakholelwa ukuthi i-PFO ingandisa ingozi yokushaya isifo.
Isebenza kanjani?
Le mbono iyahamba kanje: amafomu e-clot egazi emilenzeni bese ehamba ngesistimu enobuchopho kuze kube enhliziyweni. Igazi livame ukuthunyelwa ukusuka ohlangothini lwesokudla lwenhliziyo ukuya emaphashini ukuze kukhishwe i-carbon dioxide bese ilayisha umoya. Izindwangu zegazi lapho lokhu kukhishwa kwegesi kwenzeka khona kuncane kakhulu, futhi noma yiziphi izindwangu ezihamba emithanjeni ( emboli ) cishe zizohlungwa emaphashini.
Lesi sihlungi esingokwemvelo singase sidlule, uma igazi likwazi ukuhamba ukusuka ngakwesokudla kuya ohlangothini lwesobunxele lwenhliziyo ngaphandle kokuhamba emaphashini. Kungenza lokhu uma kukhona imbobo phakathi kwezinhlangothi zenhliziyo ezifana ne-PFO, futhi uma i-gradient ingcindezi ngezinye izikhathi iphakama ngakwesokunene senhliziyo kunokungakwesokunxele (okuvamile).
Ngaphansi kwalezi zimo, i-clot yegazi ingaya enhlangothini lwesobunxele senhliziyo, lapho iqhutshelwa khona emzimbeni, kuhlanganise nobuchopho, lapho i-clot ivula khona ukugeleza kwegazi futhi iholela ekushayweni kwe- embolic . I-clot ehamba ngaleyo ndlela ibizwa ngokuthi i-paradoxical embolus, kusuka epulasini (emibili) kanye ne- doxical (emaceleni).
Izinketho
Kunezigaba ezimbili zesenzo lapho othile onenhlangano ye-PFO enesifo esingenaso isizathu esicacile. Indlela yokuqala, njengoba kunconywe imihlahlandlela ka-2012 yaseMelika College of Chest Physicians (ACCP), ukusebenzisa i-antiplatelet therapy njenge-aspirin. Uma i-thrombus ikhona emilenzeni, i-anticoagulation ne-ejenti efana ne-heparin noma i- warfarin iyathandwa.
Indlela yesibili ukuqinisa iPOO. Lokhu kuyathinta kakhulu iziguli ezivele zine-stroke futhi zithola izindaba ezesabekayo ukuthi kukhona "imbobo enhliziyweni yabo." Ngaphansi kwalezo zimo, umuntu angase afune ukwenza konke okusemandleni ukuze angabi nenye, okungenzeka ibe yingozi nakakhulu.
Inkinga yukuthi ngenkathi ukufaka uphawu lwe-PFO kubonakala kuyinto enengqondo ukuyenza, ucwaningo olunzulu alubonisi inzuzo ephelele kule nqubo engavamile.
Indlela evelele kakhulu yokusungula i-patent foramen ovale inenqubo yesikhashana.
Udokotela oqeqeshwe uhlanganisa umcengezi emithanjeni yomzimba enhliziyweni, lapho kusetshenziselwa khona ukufaka uphawu lwe-PFO. Enye indlela ihilela ukuhlinzwa okungajwayelekile.
Izifundo ezinkulu zokuvalwa kwe-PFO ekuboniseni isisindo akusizi inzuzo noma inqubo. Esinye sezivivinyo ezinhle kakhulu, esibizwa ngokuthi i-CLOSE 1, sibheke abantu abangaphansi kweminyaka engama-60 abanenhlangano ye-PFO abaye babhekana nokuhlaselwa kwesisindo noma isicikichi esincane . Akukhona nje kuphela ukuthi kwakungekho nzuzo emva kweminyaka emibili, kodwa abantu abenza inqubo okwenzekile cishe babe nezinkinga ezinkulu ze-vascular noma fibrillation ye-atrial kunelabo abasanda kuthola ukwelashwa kwezokwelapha.
Imiphumela yabo yayikhungathekisa abantu abaye babona ukuthi kwamanye, izifundo ezibuthakathaka ukuvala idivayisi kwakubonakala kusebenza. Njenganoma yisiphi isilingo, ukuvalwa 1 kunamaphutha. Abaphikisi basikisela ukuthi mhlawumbe idivayisi engcono inganciphisa ingozi yezinkinga, noma ukuthi ubungakanani besampula abukwanele. Lokho kusho ukuthi, UKUKHALA 1 kunobunye ubufakazi obuhle kunoma yikuphi ukuhlolwa kwangaphambilini, futhi imiphumela iphelele kakhulu. kanti abanye baye bathi ukuthuthukiswa kwamasu asetshenziselwa ukuvalwa kwe-PFO kungase kulungise ukusetshenziswa kwayo, ukuphikisana okuwukuthi ukuphathwa kwezokwelapha kuyaqhubeka futhi kungasaphumelela ukuphoqeleka ukuvalwa kwe-PFO.
Iziphetho
I-American Academy of Neurology kanye nezinye ziye zaphetha ukuthi ayikho inzuzo enkambisweni ye PFO, nakuba ukuvalwa komuntu ngamunye kungase kutholakale ngendlela ejwayelekile futhi eqinile yokuxhumana phakathi kwezinhlangothi ezingakwesokunxele nezingakwesokudla zenhliziyo. Amacala anjalo afaka iphutha elikhulu le-atrial septal.
Kukhona odokotela abakuzungezile abazimisele ukwenza le nqubo kulabo abaphikelela ekubeni ne-patent foramen ovale ivaliwe. Abanye abantu abakwazi ukucabanga ukuthi kukhona imbobo enhliziyweni, noma ngabe imbobo sonke esinakho, futhi abantu abaningi bayaqhubeka bengenazo izinkinga. Kulabo abahlala benesithakazelo naphezu kokuntuleka kokuhlomula okuqinisekisiwe, kubalulekile ukuthola umbono ovela kudokotela ongenazo izinkinga zemali ekwenzeni inqubo.
Imithombo:
Furlan AJ, Reisman M, Massaro J, et al. Ukuvalwa noma ukwelapha kwezokwelapha ukushaywa kwe-cryptogenic ne-patent foramen ovale. N Engl J Med 2012; 366: 991.
UHagen PT, uScholz DG, u-Edwards WD. Isilinganiso nobukhulu be-patent foramen ovale emashumini ayishumi okuqala okuphila: isifundo se-autopsy sezinhliziyo ezingu-965 ezijwayelekile. I-Mayo Clin Proc. 1984; 59: 17-20.
ULansberg MG, O'Donnell MJ, uKhatri P, et al. Ukwelashwa kwe-Antithrombotic kanye ne-thrombolytic ye-ischemic stroke: I-Antithrombotic Therapy nokuvimbela i-Thrombosis, 9th: I-American College of Chest Physicians Imihlahlandlela yokuSebenza ngokuMtholampilo. I-Chest 2012; 141: e601S.