I-aortic stenosis uhlobo lwesifo se- valve senhliziyo esibangelwa ukuvinjelwa okuyingxenye yesiphakamiso se-aortic. Nge-stenosis ye-aortic, kuba nzima kakhulu enhliziyweni ukupompa igazi ngaphandle kwezitho zomzimba. I-aortic stenosis ingaba nomthelela omkhulu ekusebenzeni kwenhliziyo, ikhiqize izimpawu ezibalulekile, futhi ingase iholele ekufeni ngaphandle kokuthi iphathwe.
Kuyini i-Aortic Stenosis?
Abaqaphi be-aortic valve ukuvula phakathi kwe-ventricle kwesokunxele ne-aorta. Njengoba i-ventricle engakwesokunxele iqala ukuvumelanisa, i-valve ye-aortic ivuleka ukuze ivumele igazi engxenyeni engakwesokunxele ukuba ixoshwe enhliziyweni , ibe yi-aorta, iphinde nayo yonke emzimbeni. Ngokushesha lapho i-ventricle yesokunxele iqedile ukuthenga, i-valve ye-aortic ivala ukugcina igazi ekubuyiseni emuva kwi-ventricle.
Uma umuntu edala i-aortic stenosis, i-aortic valve yabo ihluleka ukuvula ngokuphelele uma i-ventricle iqala ukushaya, ngakho-ke inhliziyo kufanele isebenze kanzima ukuze ixoshe igazi nge-valve engavaliwe. Lokhu ukucindezeleka okungaphezu kwenhliziyo kungaholela ekuhlulekeni kwenhliziyo nezinye izinkinga ezibalulekile zenhliziyo.
Yiziphi Izimbangela Ze-Aortic Stenosis?
Kunezinkinga eziningana ezingaveza i-aortic stenosis, kuhlanganise:
- Ukwenziwa kabusha kanye nokubalwa : Kubantu abaneminyaka engaphezu kwengu-70 ubudala, imbangela evame kakhulu ye-aortic stenosis "ukugqoka nokuphuka." Ngokuhamba kwesikhathi, i-valve ye-aortic ingaqala ukuguquka, okwenza ukuba i-calcium deposits iqoqwe ku-valve. Lezi zinhlayiya ze-calcium ziphula umthetho wokuvulwa kwe-valvular, okwenza i-aortic stenosis.
- I-valor i-aortic i-bicuspid : Isizathu esivame kakhulu se-aortic stenosis kubantu abasha kuyisivunguvungu esinobubele bicuspid. Kulesi simo umuntu uzalwa nge-valve e-aortic ehlanganisa "izibhamu" ezimbili (isib., Ama-flaps) esikhundleni sesithathu evamile. Ama-valve e-bicuspid aictic ahloswe kakhulu ekwakhiweni kwe-calcium deposits-futhi ngaleyo ndlela, ku-aortic stenosis. Abantu abane-aictic stenosis bicuspid ngokuvamile baqala izimpawu ema-40s no-50s.
- Isifo senhliziyo : Akukhona ukuthi amashumi eminyaka adlule, isifo senhliziyo esisodwa sasiyisifo esiyinhloko se-aortic stenosis ezweni elithuthukile. Kodwa ngokuthuthukiswa kwama-antibiotics okuphumelelayo nama- bacteria e-streptococcus , futhi ukunciphisa okulandelayo ezinkingeni ze- rheumatic fever , isifo se-heart rheumatic sesiyinto engavamile.
- I-aortic stenosis yama- congenital: Izinkinga eziningana zokubeletha ngaphezu kwe-valve bicuspid zingaveza i-aortic stenosis. Lezi zihlanganisa ukuhlukumeza okuhlukahlukene kwe-valve ye-aorti ngokwayo, kanye nokuhlelwa okungavamile kokuvimbela isisu senhliziyo ngaphezu noma ngaphansi kwe-valve yangempela ye-aortic. Lezi zindlela ezingavamile kakhulu ze-aortic stenosis zivame ukubonakala ezinganeni.
Iziphi Izinkinga Ezibangelwa I-Aortic Stenosis?
Nge-storosis ye-aortic, ukuphuma kwegazi kusuka nge-ventricle kwesokunxele kuyavinjelwa kancane, ngakho kuba nzima ngenhliziyo ukulahla igazi. Lo msebenzi we-cardiac owedlule ubeka ukucindezeleka okuphawulekayo emisipha ye-ventricular engakwesokunxele, okubangela ukuthi kuqhume, noma "ukuxuba."
Lokhu kushiywe kwe-ventricular hypertrophy kungabangela ukungasebenzi kahle kwe-diastolic nokuhluleka kwenhliziyo ye-diastolic , lapho imisipha ekhuni "igxilile" i-ventricle, futhi yenza kube nzima kakhulu ukuthi ama-ventricles agcwalise igazi phakathi kwezinyosi zenhliziyo.
Izimpawu ekugcineni ziphumela. Lezi zimpawu ngokuvamile zihlanganisa i- dyspnea (ukuphefumula), ukukhathala okulula nokunciphisa ukubekezelela ukuvivinya umzimba, futhi ingozi eyengeziwe yokuthuthukisa i-fibrillation ye-atrial .
Njengoba i-aortic stenosis ikhula, i-angina ingenzeka, kanye neziqephu zokuphefumula noma ngisho nokuvumelanisa (ukulahlekelwa kwesazi) ngesikhathi sokuzama.
Nge-aortic stenosis enamandla kakhulu, imisipha ye-ventricle engakwesokunxele ingaguqukela ekubeni yinyene kakhulu futhi ibe nzima ukuze ibe buthakathaka futhi ihlanjululwe-isimo esibizwa ngokuthi i-cardiomyopathy ehlanjululwe . Uma i-aortic stenosis ikhiqiza i-cardiomyopathy, i-heart failure ingenakuguqulwa.
Ukufa okungazelelwe kuyabonakala ngokuqina okukhulu kwe-aortic stenosis.
I-Aortic Stenosis Ithola Kanjani?
Ngenxa yokuthi i-aortic stenosis engasetshenzisiwe ivame ukubulala, okwenza ukuthi ukuxilongwa okulungile kubaluleke kakhulu. Ngenhlanhla, ukuhlolisisa i-aortic stenosis namuhla ngokuvamile akulula.
Odokotela basolisa i-aortic stenosis lapho iziguli zabo zikhononda ngezibonakaliso "ezivamile" (ukuphefumula, ukunciphisa ukuvivinya umzimba, ukunciphisa isifuba, isizungu noma i-syncope). Okungcono kakhulu, udokotela uzobe esolisa i-aortic stenosis ngaphambi kokuba izimpawu zikhule lapho bezwa inhliziyo ikhononda ejwayelekile yalesi simo. Ukuxilongwa kungaqinisekiswa noma kugwetshwe yi- echocardiogram .
Ukwelapha i-Aortic Stenosis
Ukwelashwa kwe-aortic stenosis yi-valve yokufakelwa esikhundleni. Ukwelapha izidakamizwa kungathuthukisa izimpawu okwesikhashana, kepha ekugcineni akusebenzi ngoba inkinga iyisithiyo se-aortic. Ngakho uma umuntu ene-aortic stenosis, umbuzo uvame ukuthi awukwenzi ukuhlinzwa, kodwa nini.
Njengomthetho ojwayelekile, ukuguqulwa kwesiphakamiso se-aortic kufanele kwenziwe maduzane ngemuva kokuba i-aortic stenosis yomuntu iqala ukuveza izimpawu-ukuphefumula, ubuhlungu besifuba, isizungu noma i-syncope. Uma noma iyiphi yalezi zimpawu ivela ku-aortic stenosis, ukuhlala okujwayelekile isilinganiso sokuphila ngaphandle kwe-valve esikhundleni se-2 noma 3 iminyaka. Ukuguqulwa kwe-valve ngesikhathi esifanele kuthuthukisa kakhulu lesi sibikezelo. Uma umuntu ethola ukuthi une-aortic stenosis, kubalulekile ukuba aqashwe ngokucophelela nganoma yisiphi isibonakaliso sokuthuthukisa lezo zimpawu.
Ngenxa yokuthi ukuhlinzeka ngokuzumayo kunciphisa ukuvinjelwa kanzima ukugeleza kwegazi komzimba, ezimweni eziningi umsebenzi we-cardiac uthuthuka ngendlela ephawulekayo ngemuva kokuguqula i-valve. Ngakho-ke ngisho nabantu asebekhulile futhi abanamahloni kakhulu bangase benze kahle ngemva kokuhlinzwa kwe-aortic stenosis.
Ama-valve esithombeni asetshenziselwa ukufaka esikhundleni se-valve e-aortic enezifo angase ahlanganise ngokuphelele izinto ezenziwe ngumuntu (ama-valve mechanical), noma angenziwa kusukela ku-valve yenhliziyo yesilwane, ngokuvamile ingulube (i-valve ye-bioprosthetic). Ukunquma ukuthi yiluphi uhlobo lwe-valve yokufakelwa okufanele lusetshenziswe kuncike eminyakeni yobudala bomuntu, nokuthi ngabe bangathatha igazi elincane njengoCoumadin .
Zonke izivinji zenhliziyo ezinamandla zinezikhukhula ezengeziwe zokwenza ama-clots egazi. Kodwa-ke, ukuguqa kwegazi akuncane kunenkinga nge-valve ye-bioprosthetic kunokuthi i-valve yomshini, ngakho-ke abantu abanokuqala bangadingeki ukuthi bathathe ukwelapha okungapheli kwe-Coumadin; labo abaneziphazamisi zemishini benza. Ngakolunye uhlangothi, ama-valve kagesi ngokuvamile abonakala ehlala isikhathi eside kunama-valve e-bioprosthetic.
Ngakho kubantu abane-aortic stenosis abangaphansi kweminyaka engama-65 abangathatha i-Coumadin, ama-valve yenhliziyo avamile avunyelwe. Kubantu abangaphezu kuka-65, noma abangakwazi ukuthatha i-Coumadin, i-valve ye-bioprosthetic ivame ukuphakanyiswa.
Izindlela Ezincane Ezibalulekile Zokuphatha Ukwelula Kwe-Aortic
Ukwelapha okungenasidingo esingaphansi kokuthuthwa kwe-valve yokuhlinzwa kuthuthukiswa.
E- valvulotomy ye-aortic , i-catheter ibhaluni idluliselwa ku-valve ye-aortic futhi ibhaluni ihlanjululwe ukuze kuphulwe ezinye ze-calcium deposits ku-valve. Lokhu kuvame ukuvumela i-valve ukuba ivule ngokugcwele, futhi ikhulule ezinye ze-aortic stenosis. Ngeshwa, i-valvulotomy ayinikezi imiphumela ewusizo, futhi ingabangela izinkinga ezinkulu.
Enye indlela yokwelapha i -catheter yokuphatha i-aortic stenosis yi- trans-catheter aortic valve implantation (TAVI) . Amadivayisi amaningana we-TAVI aphansi kokuthuthukiswa okusebenzayo, futhi ezimbalwa ziye zavunyelwa ukusetshenziselwa ukwelashwa ezigulini ezisengozini enkulu yokuhlinzwa okwenziwa ngokujwayelekile. Noma kunjalo, izinkinga nge-TAVI kule ndawo ziyisici esinqande. Kokubili i-TAVI ne-valvulotomy ngalesi sikhathi zigcinelwe abantu abane-aortic stenosis abangenakwenzeka ukuba basinde esikhundleni sokuguqula i-valve.
Izwi elivela
I-aortic stenosis uhlobo lwe-valvular isifo senhliziyo esivimbela ukugeleza kwegazi ngaphakathi kwenhliziyo. I-aortic stenosis ephakeme iveza izimpawu ezibalulekile, futhi inciphise kakhulu isikhathi sokuphila. Ngenhlanhla, ngokuhlinzeka ngokuhlinzekwa kahle, abantu abane-aortic stenosis bangenza kahle.
> Imithombo:
> U-Eveborn GW, uSchirmer H, uHeggelund G, et al. I-Evolving Epidemiology yeValvular Aortic Stenosis. ucwaningo lwaseTromsø. Inhliziyo ka-2013; 99: 396.
> Leon MB, Smith CR, Mack M, et al. I-Transcatheter i-Aortic-valve Implantation ye-Aortic sSenosis kubantu abagulayo abangakwazi ukuhlinzwa. N Engl J Med 2010; 363: 1597.
> Nishimura RA, Otto CM, Bonow RO, et al. Umhlahlandlela we-AHA / ACC we-2014 we-Management of Patients With Valvular Heart Disease: Umbiko we-American College of Cardiology / American Heart Association Task Force on Guidelines Practice. J Am Coll Cardiol 2014; 63: e57.