Coarctation le-aorta - Iyini? Coarctation le-aorta ezinganeni

Coarctation le-aorta - isifo senhliziyo, okuyinto kuhambisana ukuvaleka mafutha anciphisa isikhala esingaphakathi bomkhumbi ngobukhulu emzimbeni womuntu. Eqinisweni, akuyona isifo senhliziyo, njengoba zokugula itholakala ngaphandle kwemingcele myocardium. Iningi ngokuvamile kutholakala ukuthi uphethwe yini coarctation le-aorta ezinsaneni, nakuba ngezinye izikhathi lesi sifo itholwa kakade iziguli omdala. Ngokuvamile, ukugula siqedwa by ukuhlinzwa.

Yiqiniso, lokhu ngokushesha ukuthi uphethwe yini ngokuphelele esicacile iziguli kanye kubenze ukwethuka. Ngakho-ke kufanele ufunde kabanzi mayelana Siyini ngempela lesi sifo futhi yini yezinkinga ungase uhlangane umuntu ogulayo.

Coarctation le-aorta: Iyini?

Okokuqala, ake ukubhekana ne lisho ukuthini igama elithi. Coarctation le-aorta - isici azalwa naso, okuyinto kuhambisana ukuvaleka le-aorta. Kulendlela yokubhala wenhliziyo iziguli kuyinto ejwayelekile. Noma kunjalo, aorta isitsha elikhulu umuntu kanye nokwephula ukugeleza kwegazi kule ndawo Uphatha kabi umsebenzi hhayi kuphela inhliziyo nemithambo yegazi, kodwa futhi wonke umzimba.

Njengomthetho, kwakheka Umkhawulo endaweni lapho lwaleli yomthambo i-aorta sihamba endaweni phansi ingxenye. iphethini njalo is explainable, ngoba lapha kunendawo encane evamile bokuphila ukuvaleka. By the way, okokuqala lesi sifo achazwa 1791 by D. Morgagni (sezifo Italian). Ngokusho idatha izibalo imvamisa zokugula isesikhathini 15% kombungu esizalweni. Kuvela elinye iqiniso elithakazelisayo ukuthi isifo kwenzeka abafana izikhathi 3-5 maningi amathuba kuneziguli zesifazane.

Izinhlobo ezinkulu zokugula

Kuye izici, coarctation le-aorta kungaba ezimbili zama:

• "Kwabantu abadala" coarctation libhekene omncane mafutha anciphisa isikhala esingaphakathi le-aorta ngezansi iphuzu lapho isuka kwesokunxele Umthambo subclavian; ngenkathi kukhona kuvalwe ductus arteriosus;
• uhlobo kwezinsana zokugula kuhambisana hypoplasia le-aorta endaweni efanayo umsuka Umthambo subclavian, kodwa Nokho, ukugeleza, uvuliwe.

izici yokwakheka zokugula

coarctation azalwa naso le-aorta lingaphathelaniswa ne comorbidities ahlukahlukene. Kuye le nkinga zingahlukaniswa ngamaqembu amathathu.

Pathology kungenzeka ngci - kuleli cala khulula yimuphi omunye yokulimala ukuthuthukiswa uhlelo senhliziyo nemithambo yegazi. Ngokuvamile, coarctation le-aorta ezinganeni kungenzeka ukuthi umataniswe nezinye pathologies - lokhu kungaba useshonile, stenosis yomthambo i-aorta, isici septal phakathi ventricles futhi Atria, transposition izitsha ezinkulu.

Iqembu lesithathu - coarctation, lapho ukugeleza kwegazi siyenzeka ukutholakala. Ezimweni ezinjalo, i-pathology kungaba:

• postduktalnoy (ukuvaleka itholakala ngezansi iphuzu lapho isuka ductus patent arteriosus;
• yukstaduktalnoy (coarctation nje ukuvula ukugeleza ezingeni);
• preduktalnaya (imbobo lwemithambo kuvula ngezansi constriction).

Yiqiniso, izimpawu ixhomeke ngokunembile ngohlobo kanye nezici coarctation.

Ziyini izimbangela zobubi?

Ngokuvamile eba coarctation le-aorta ku-fetus. Kungani lokhu kwakwenzeka? Kuyaziwa ukuthi phakathi kwengane esiswini emzimbeni wengane siyasebenza lwemithambo imbobo, okuyinto uxhuma le-aorta ne kwesokunxele Umthambo yamaphaphu. Lesi sakhiwo idingeka kuphela okwesikhashana. Ngemva kokuzalwa ekuqaleni yamaphaphu kwezimila imbobo Kuvalwa.

Kukhona umbono ngezizathu ezithile ingane ingxenye encane izicubu ukugeleza uhamba ku le-aorta, ngakho lapho uvala imbobo kule nqubo ihlanganisa futhi odongeni yomthambo i-aorta, okuholela ukusikwa yayo.

Izizathu zalokhu inqubo, maye, akwaziwa. Ososayensi kuphela wathola ukuthi lesi sifo iziguli babonakala bethambekele kakhulu nge chromosomal Turner Syndrome (khona eyodwa kuphela ubulili ifana ne-chromosome). Cishe zonke izingane yeshumi nge sitholakele le nkinga kutholwa.

Coarctation le-aorta (IBC) akanayo ukuba azalwa nako. Akwaziwa Ezimweni ezingavamile lapho vasoconstriction selwenzekile kakade lapho usukhulile. Ezimweni ezinjalo kubangela coarctation balimala futhi izilonda yomthambo i-aorta atherosclerotic, isifo sokuvuvukala omsakazo engaziwa semithambo izindonga (Takayasu Syndrome).

Ukwephula coarctation hemodynamic

Yiqiniso, yomthambo i-aorta constriction umphumela kulo lonke uhlelo senhliziyo nemithambo yegazi, ngisho noma izenzo ezimbi isikhonzi azitholakali. Ukuba khona coarctation Imiphumela kwetinhlavu ezimbili ezihlukene ukugeleza Imibuso of.

Olugcwele esikhaleni ngezansi wegazi luyanda, okuholela ukunwetshwa mafutha anciphisa isikhala esingaphakathi imithambo yegazi. Ngenxa sindisa systolic eba kwesokunxele ventricular hypertrophy. Kodwa kwendawo coarctation ngesimo okuphambene - behlisa ukugeleza kwegazi, umfutho wegazi lehliselwa. Njengoba umzimba wengane oyenza izindlela compensatory - ekuthuthukiseni izitsha eseduze amaningi anikeza igazi ligeleze dlula.

Uma kuziwa uhlobo omdala icala, iziguli waphawula kwesokunxele ventricular hypertrophy, umfutho wegazi ophakeme kakhulu, ukwanda afundwa umthamo wegazi. Lapho coarctation kwezinsana lapho le arteriosus ductus evulekile, ukwephula ngenhla akachaziwe ngokucace kangaka. Kodwa kunezinye pathologies. Ngokwesibonelo, lapho uhlobo zokugula postduktativnom igazi elikuyi-aorta ngaphansi kwengcindezi okusezingeni eliphezulu ilethwa ngqo Umthambo yamaphaphu, okuholela ekwandeni kwengcindezi izitsha yokujikeleza kwegazi eliya emaphashini.

Kunoma ikuphi kukhona ukwephulwa ezibucayi hemodynamics, okuyinto kunoma yiliphi icala akufanele anganakwa, ngoba imiphumela ingaba ebuhlungu.

Ayini izimpawu zesifo kuhambisana?

Izimpawu coarctation yomthambo i-aorta kakhulu kuxhomeke ngezinga elithile ukuvaleka umkhumbi, kanye ukuba khona noma ukungabi sesimweni concomitant. coarctation Ezintsha yazo zonke ayinakuboniswa.

Ezimweni ezimbi kakhulu, izimpawu kakade ebonakalayo onyakeni wokuqala wokuphila. Izingane ngokuvamile uhlushwa ukuvuvukala amaphaphu Ukuphinda njalo. Izingane ukuphaphatheka isikhumba kanye ukuphefumula izinkinga - dyspnea livela phakathi ukudla, imidlalo noma ngisho uphumule. Ngokuvamile, izingane nale Ihlahlubo ngokwenyama zithuthuka kancane kuka ontanga yabo.

Usola khona okuphambene ngangokunokwenzeka kuyilapho ukulalela inhliziyo imisindo, kanye ekutholweni ishayela ku imithambo yegazi wemikhawulo yasenhla nemithombo yasenzansi. Imithambo ku ulnar emphethweni kungabonwa voltage yezwakala, kuyilapho ngesikhathi ishayela femoral ibuthakathaka kakhulu.

Lapho preduktalnoy coarctation waphawula cyanosis heterogeneous - isikhumba kwengane ngezinyawo iba luhlaza cyanotic, kuyilapho isikhumba engxenyeni engaphezulu kuphela yomzimba kubuyise umbala zemvelo.

Kaningi kuyenzeka ukuthi zokugula isivele kutholakala ukuthi uphethwe yini zisencane amadala - babe izingane zesikole, intsha, abadala. Izimpawu kulokhu zibandakanya kukhuphuke blood pressure. Iziguli esekhala ukukhathala, ukuphathwa ikhanda, isiyezi njalo, ubuhlungu enhliziyweni okungapheli, umongozima ukukhathala. Ngokuvamile umuntu angabona ligcine ukuthuthukiswa ongalingani imisipha yomzimba engenhla nengezansi ngesikhathi luhlolo. Izimpawu zihlanganisa ukuba buthakathaka emilenzeni, amajaqamba njalo, ukuzwela izinyawo abandayo. Abesifazane zingabuka menstrual cycle sifo, futhi ngezinye izikhathi inkinga yokungabi nenzalo.

Coarctation le-aorta: Ihlahlubo

Usola khona udokotela okuphambene ungakwazi kuyilapho ukulalela inhliziyo umsindo. Ngaphezu kwalokho olwenziwa nezinye izinyathelo zokuxilonga, ezisiza hhayi kuphela ukusungula khona coarctation we-fax, kodwa futhi ukuthola amanye zikhubazeke futhi kutholakale umsuka wendaba yesihluku kokunqotshwa yisimiso senhliziyo nemithambo yegazi:

• Enye indlela elula kakhulu futhi kufinyeleleke iyona electrocardiogram. Akukona inqubo kakhulu ulwazi, kusukela ukuvaleka lolingene aorta we electrocardiogram nesineke angabukeka ngokuphelele evamile. Izingane onyakeni wokuqala wokuphila kungabonwa displacement we-eksisi kagesi wenhliziyo phakathi naleyo nqubo. The guys amadala Ungasavele ukubona izimpawu kwesokunxele ventricular hypertrophy. In iziguli omdala, eksisi kagesi wenhliziyo kugudlukela ngakwesobunxele, futhi ngezinye izikhathi kukhona akuphelele nokuvinjelwa kwesokunxele besigaxa block legatsha.
• iziguli evame ukunikezwa phonocardiography. Le nqubo ikuvumela ukuba alobe imisindo nokudludliza okubangelwa umsebenzi izitsha inhliziyo negazi. Ephambi kwezinduna coarctation ungase uphawule nzuzo ithoni le-aorta yesibili, kanye ukubukeka nokububula systolic ngemuva nasesikhathini yesibili intercostal isikhala onqenqemeni sternum (sokunene nesobunxele).
• Ulwazi kuyinto ultrasound inhliziyo, okuyinto ingakusiza ukuthola ukuvaleka le-aorta. Futhi, uchwepheshe ungabona ukwanda inhliziyo isisindo. Doppler echocardiography usetshenziselwa ukukhomba izimpawu nobuntu zokugula, ikakhulukazi, umfutho wegazi umehluko ku izingxenye nangaphezulu constriction, khona zeziyaluyalu systolic ukugeleza.
• emaphashini Ngaphezu kwalokho esimweni futhi inhliziyo. Ngokuvamile, ubukhulu inhliziyo ijwayelekile, kodwa uzophawula ukwanda okukhulu le-aorta unyuka. umdwebo yamaphaphu bungathuthukiswa embhedeni lwemithambo, nakuba lokhu waphawula ngaso sonke isikhathi.
• Aortography - inqubo enikela yethula elikuyi-aorta yalokho kuqhathanisa umphenyi okhethekile, balandela ngokuqaphela nokusakazwa kwayo isitsha. Lolu cwaningo ungakwazi ukunquma ngokunembile ubukhulu ezingeni ukuvaleka le-aorta.
• catheterization senhliziyo - inqubo kunalokho xaka. Noma kunjalo, ngokwethula ipayipi ekhethekile ku mafutha anciphisa isikhala esingaphakathi bomkhumbi lingalinganiswa ngokunembile blood pressure.

Kwaze kwaba yilapho sebeshiye isithombe esiphelele udokotela anganika umhlahlo bese ukhetha izindlela ezifanele ukuqeda lo mkhuba omubi.

Ingabe ngidinga ukuhlinzwa?

Kuthiwani uma isiguli kutholakala coarctation le-aorta? Ukusebenza Yiqiniso, iyona kuphela indlela ephumelelayo yokuqeda okubi. Kodwa kungenzeka isinqumo ukubamba ukuhlinzwa kwenziwe kuphela odokotela abazi umlando kanye isethulo emtholampilo.

Kwezinye izimo (uma kukhona ukuvaleka okuncane kuphela, okuyinto has cishe akunamthelela hemodynamics), ukusebenza kungenzeka kudingeke. Isiguli kuphela ngezikhathi ezithile lidlule izivivinyo.

Uma umehluko systolic lwemithambo yokucindezela nemilenze yasenhla nemithombo yasenzansi mkhulu kuka-50 mm HG. Art., Odokotela bavame iphakamise ukuthi ukuqhuba phakathi nenqubo yokuhlinzwa. Uma coarctation yomthambo i-aorta ezinsaneni uye kwatholakala, ukusebenza (eziphuthumayo) wenziwa umcimbi ukuthi uma seziguli ezisencane ukwethula wegazi vele ophakeme kakhulu futhi decompensation inhliziyo. Ezimweni lapho isifo kuqhathaniswa evumayo, futhi ingozi ephezulu impilo wengane alikho, inqubo ingase selihlehliselwa kweminyaka emihlanu noma eyisithupha ubudala.

ukuphathwa Steel yesifo senhliziyo

Kuze kube manje, zikhona izindlela eziningana ukuze kuqedwe lokhu okuphambene. Ukukhethwa amasu kuhlinzwa kuncike ngezimo zesiguli, uhlobo sifo coarctation ngosayizi.

• Kwezinye izimo, odokotela resection (excision) wesabelo ayisesemikhulu le-aorta, bese ubunye emikhawulweni esitsheni, ukusebenzisa anastomosis. Le nqubo kungenzeka kuphela uma coarctation has ngezinga elincane.
• Uma kwenzeka ukuthi ingxenye mkhawulo eside, futhi abeke anastomosis akunakwenzeka, besebenzisa sokwenziwa. Ngesikhathi inqubo udokotela ohlinzayo kususa ingxenye abathintekayo le-aorta whereupon amachopho amabili isitsha zihlangene nge sokwenziwa ekhethekile eyenziwe zokwenziwa izinto.
• Aortoplastika - omunye ezihlukahlukene imisebenzi, kodwa kulokhu ngoba nokuvulwa obuphelele yomthambo i-aorta zokwenziwa sokwenziwa alisetshenziswa, futhi ingxenye kwesokunxele Umthambo subclavian isiguli.
• Ngezinye izikhathi odokotela unqume ukuchitha dlula yomthambo i-aorta. Ezimweni ezinjalo, i-sokwenziwa zokwenziwa, ogama imiphetho ithungwe nangaphezulu ingxenye ayisesemikhulu bomkhumbi - ngaleyo ndlela kudale indlela dlula ngoba ukugeleza kwegazi.
• Kunenye Inqubo ebizwa ngokuthi i ibhaluni angioplasty. It wenziwa kulezo zimo, uma emva kokuhlinzwa okwenzile ngokudlule reappeared vasoconstriction. Ngesikhathi inqubo, udokotela ifaka ngokusebenzisa izitsha neuropathy e mafutha anciphisa isikhala esingaphakathi yomthambo i-aorta ibhaluni ekhethekile, ogama izivimbelo ubalekela lapho ulele. Kwezinye izimo, isethi okhethekile stents ezengeziwe kanzima ukuthi ubambe Usayizi inesikhala yomthambo i-aorta.

Yilokho izilungiso angelasici ibizwa ngokuthi "coarctation le-aorta." Ngemva kokuhlinzwa, isiguli, Yiqiniso, ukuba banamathele nemihlahlandlela ethize. Ikakhulukazi, udinga ukudla ngendlela efanele, gwema ngokweqile ukuzikhandla ukungawuvivinyi umzimba, ukuqapha ngokucophelela isimo sempilo kanye ibhekane njalo bayohlolwa ngesikhathi wenhliziyo bayahlanganyela.

Yini yezinkinga zingenzeka?

Coarctation le-aorta - isifo esiyingozi, okuyinto kunoma yiliphi icala akufanele ishalazelwe. Lapho ezingezinhle Yiqiniso isici kungaholela yezinkinga eziyingozi kakhulu:

• Ngenxa ukuvaleka bomkhumbi , iziguli zingase ziqale wegazi vele ophakeme kakhulu.
• Ngokuvamile, le nkinga inhliziyo - coarctation yomthambo i-aorta - futhi ephelezelwa ukwakheka useshonile futhi ukudabuka kwalo okwalandela.
• Izinkinga futhi zihlanganisa isifo sohlangothi kanye effusion subarachnoid kwegazi.
• On ngemuva kwalesi sifo ngo iziguli kaningi ukuthuthukisa ukumelwa inhliziyo, okuyinto kuhambisana okuthiwa somoya zenhliziyo edema yamaphaphu.
• Omncane mafutha anciphisa isikhala esingaphakathi yomthambo i-aorta kuthinta lonke uhlelo semithambo. Ngenxa giperenzii esindayo kungaholela kwemithambo emincane kwezinso.
• Ngezikhathi ezithile iziguli ziba endocarditis virus. inkinga enjalo ngokuvamile kwenzeka uma kwenzeka ukuthi coarctation le-aorta lihlotshaniswa kwezinso of valve yomthambo i-aorta. Ngeshwa, ezimweni eziningi, lezi webhaktheriya isifo senhliziyo anenkani.

Njengoba ubona, coarctation le-aorta ezinganeni nakubantu abadala kungaba yingozi. Yingakho kuba ukuxilongwa zibaluleke kangaka ngesikhathi esifanele futhi ukwelashwa ezanele.

Onalesi sifo iziguli coarctation

Iningi ngokuvamile kutholakala ukuthi uphethwe yini coarctation le-aorta in izinsana. Uyini umbono seziguli ezisencane futhi yini abazali kufanele balindele? Empeleni, konke kuncike degree of ukuvaleka imithambo yegazi. Kwezinye izimo, ukugula edinga ngokushesha kuhlinzwa. Uma ngezinga ngokulinganisela okuphambene, ngisho noma izincomo iziguli zonke udokotela uhlala iminyaka 30-35 kuphela, kanti imbangela yokufa kwalo, njengoba umthetho, kuba unhlangothi noma isifo sokuvuvukala kwemithambo ukudabuka.

ngezinye izikhathi ukuvaleka Ezintsha kudinga ukuhlinzwa - kudokotela uncoma ngezikhathi kuphela avivinywe ukuthola izinkinga. Ezimweni ezinjalo, khona isifo senhliziyo akuvamile kuthinta bungakanani ubude bokuphila lesiguli.