Ciwon zuciya na haihuwa - tiyata gyara

Cutar cututtukan zuciya da ke tattare da gyaran tiyata na gyara ko magance cututtukan zuciya da aka haifi yaro da su. Yarinyar da aka haifa da lahani ɗaya ko fiye na zuciya yana da cututtukan zuciya na haihuwa. Ana buƙatar yin aikin tiyata idan lahani zai iya cutar da lafiyar yaron na tsawon lokaci ko ƙoshin lafiya.

Akwai tiyatar zuciya ta yara da yawa.

Hanyar Patent ductus arteriosus (PDA):

• Kafin haihuwa, jariri yana da jijiyoyin jini wanda yake gudana tsakanin aorta (babban jijiyoyin jiki) da jijiyoyin huhu (babban jijiyoyin huhu), ana kiransa ductus arteriosus. Wannan ƙaramin jirgin ruwa galibi yana rufewa jim kaɗan bayan haihuwa lokacin da jaririn ya fara numfashi da kansa. Idan bai rufe ba. An kira shi patent ductus arteriosus. Wannan na iya haifar da matsaloli daga baya a rayuwa.
• A mafi yawan lokuta, likita zai rufe buɗewar ta amfani da magani. Idan wannan ba ya aiki, to ana amfani da wasu fasahohi.
• Wani lokaci ana iya rufe PDA tare da hanyar da ba ta haɗa da tiyata ba. Ana yin aikin sau da yawa a cikin dakin gwaje-gwaje wanda ke amfani da hasken rana. A wannan tsarin, likitan ya yi karamin yanka a cikin durin. An saka waya da bututu da ake kira catheter a cikin jijiya a kafa kuma a miƙa shi zuwa zuciya. Bayan haka, ana wucewa da karamin karfe ko wata na’ura ta hanyar catheter a cikin jijiyar jaririn. Kebul ko wata naura tana toshe magudanar jini, kuma wannan yana gyara matsalar.
• Wata hanyar ita ce yin karamin tiyatar a gefen hagu na kirji. Likitan likita ya sami PDA sannan ya ɗaura ko ya ɗauka ductus arteriosus, ko kuma ya raba shi. Ana kiran ɗaure bakin bututu. Ana iya yin wannan aikin a cikin sashin kulawa mai kulawa mai ƙarfi (NICU).

Coarctation na gyaran aorta:

• Coarctation na aorta yana faruwa a lokacin da wani ɓangare na aorta yana da kunkuntar sashe. Siffar ta yi kama da mai sa'a ɗaya. Theuntataccen yana da wahala ga jini ya ratsa ta ƙananan ƙasan. Bayan lokaci, yana iya haifar da matsaloli kamar su hawan jini ƙwarai da gaske.
• Don gyara wannan lahani, mafi yawan lokuta ana yin yanki a gefen hagu na kirji, tsakanin haƙarƙarin. Akwai hanyoyi da yawa don gyara kwatankwacin aorta.
• Hanyar da ta fi dacewa a gyara shi ita ce yanke yanki kunkuntar kuma a kara girma tare da facin da aka yi da Gore-tex, kayan da mutum ya yi (roba).
• Wata hanyar da za a iya gyara wannan matsalar ita ce cire matsatsiyar sashin aorta tare da haɗa sauran ƙarshen. Ana iya yin wannan mafi yawanci a cikin manyan yara.
• Hanya ta uku don gyara wannan matsalar ita ce ake kira subclavian flap. Da farko, ana yin yankan a cikin kunkuntar sashin aorta. Bayan haka, ana ɗaukan faci daga jijiyar ƙaramar hagu (jijiyar zuwa hannu) don faɗaɗa kunkuntar sashin aorta.
• Hanya ta huɗu don gyara matsalar ita ce haɗa bututu zuwa sassan al'ada na aorta, a kowane ɓangaren ɓangaren kunkuntar. Jini yana gudana ta cikin bututun kuma yana ratsa kunkuntar sashi.
• Sabuwar hanyar ba ta buƙatar tiyata. Ana sanya ƙaramin waya ta cikin jijiyar cikin duwawu kuma har zuwa aorta. Ana buɗe ƙaramin balan-balan a cikin kunkuntar yankin. Stent ko ƙaramin bututu an barshi a can don taimakawa buɗe jijiyar. Ana yin aikin a cikin dakin gwaje-gwaje tare da hasken rana. Ana amfani da wannan hanya sau da yawa lokacin da coarctation ya sake faruwa bayan an gyara shi.

Atrial septal flapt (ASD) gyara:

• Tsarin atrial shine bango tsakanin hagu da dama atria (ɗakunan sama) na zuciya. Ana kiran rami a cikin wannan bangon ASD. A gaban wannan lahani, jini tare da ba tare da oxygen ba na iya cakuɗe kuma a kan lokaci, yana haifar da matsalolin likita da arrhythmias.
• Wani lokaci, ana iya rufe ASD ba tare da tiyatar zuciya ba. Da farko dai, likitan ya yi yanka kadan a makwancinsa. Sannan likita mai fiɗa ya saka waya a cikin jijiyoyin jini wanda ke zuwa zuciya. A gaba, an sanya ƙananan na'urori masu kama da "clamshell" masu laima a gefen dama da hagu na septum. Wadannan na'urori guda biyu suna hade da juna. Wannan yana rufe ramin a cikin zuciya. Ba duk cibiyoyin likita suke yin wannan aikin ba.
• Hakanan ana iya yin aikin tiyata a buɗe don gyara ASD. A wannan aikin, ana iya rufe septum ta amfani da ɗinka. Wata hanyar rufe ramin ita ce tare da faci.

Defectaramar ƙwanƙwasa mara kyau (VSD) gyara:

• Ptunƙarar ƙyama ita ce bango tsakanin hagu da dama (ƙananan ɗakuna) na zuciya. Ana kiran rami a cikin septum mai kwakwalwa VSD. Wannan ramin yana ba da damar jini tare da iskar oxygen haɗuwa da jinin da aka yi amfani da shi ya koma huhu. Bayan lokaci, bugun zuciya da ba na doka ba da sauran matsalolin zuciya na iya faruwa.
• Da shekara 1, yawancin ƙananan VSDs suna rufe kansu. Koyaya, waɗancan VSD ɗin da suke buɗe bayan wannan zamanin na iya buƙatar rufe su.
• Manyan VSDs, kamar ƙananan waɗanda ke wasu sassan ɓangaren sashin, ko waɗanda ke haifar da gazawar zuciya ko endocarditis, (kumburi) suna buƙatar tiyata a buɗe. Ramin a cikin septum an fi rufe shi da faci.
• Wasu lahani na septal ana iya rufe su ba tare da tiyata ba. Hanyar ya hada da wucewa karamar waya zuwa cikin zuciya da sanya wata karamar na'ura don rufe lahani.

Tetralogy na Fallot gyara:

• Tetralogy na Fallot nakasar zuciya ce wacce ta kasance tun daga haihuwa (haifuwa). Yawanci ya haɗa da lahani guda huɗu a cikin zuciya kuma yana sa jariri ya canza launi mai laushi (cyanosis).
• Ana buƙatar tiyata a buɗe, kuma ana yin hakan sau da yawa lokacin da yaron ya kasance tsakanin watanni 6 zuwa shekara 2.

Yin aikin ya haɗa da:

• Rufe raunin ɓarkewar zuciya tare da faci.
• Bude bawul na huhu da cire tsoka mai kauri (stenosis).
• Sanya faci a ƙasan dama da babban jijiyoyin huhu don haɓaka gudan jini zuwa huhu.

Yaron na iya samun aikin shunt da farko. Shunt yana motsa jini daga wani yanki zuwa wani. Ana yin wannan idan ana buƙatar jinkirin yin tiyata a buɗe domin yaron ba shi da lafiya ta yadda za a yi masa tiyata.

• Yayinda ake gudanar da aikin shunt, likitan yana yin tiyatar a gefen hagu na kirji.
• Da zarar yaro ya girma, ana rufe shuntar kuma ana yin babban gyara a cikin zuciya.

Canjin manyan jiragen ruwa:

• A cikin zuciya ta yau da kullun, aorta yana fitowa daga gefen hagu na zuciya, kuma jijiyoyin huhu na zuwa daga gefen dama. A cikin jujjuyawar manyan tasoshin, wadannan jijiyoyin suna zuwa daga kishiyar zuciya. Yaron kuma na iya samun wasu lahani na haihuwa.
• Gyara jigilar manyan jiragen ruwa yana buƙatar tiyata a buɗe. Idan za ta yiwu, ana yin wannan aikin jim kaɗan bayan haihuwa.
• Gyara da aka fi sani ana kiransa sauyawar jijiya. Aorta da jijiyoyin jini sun kasu kashi biyu. Hanyar jijiyar huhu an haɗa ta da kafar dama, inda yake. Bayan haka, aorta da jijiyoyin jijiyoyin jini suna haɗuwa da jijiyar hagu, inda suke.

Truncus arteriosus gyara:

• Truncus arteriosus yanayi ne wanda ba kasafai yake faruwa ba yayin da aorta, jijiyoyin jijiyoyin jini, da jijiyoyin jini duk suka fito daga cikin akwati daya. Rashin lafiyar na iya zama mai sauƙin gaske, ko kuma mai sarkakiya. A kowane hali, ana buƙatar tiyata a buɗe don gyara lahani.
• Gyara yawanci ana yin sa ne a fewan kwanakin farko ko makonnin farko na rayuwar jariri. Jijiyoyin huhu sun rabu da akwatin jijiyoyin jiki, kuma duk wani lahani an toshe shi. Yawancin lokaci, yara ma suna da raunin ɓarna, kuma wannan ma a rufe yake. Daga nan sai a sanya haɗi tsakanin jijiyar dama da jijiyoyin huhu.
• Yawancin yara suna buƙatar ƙarin tiyata ɗaya ko biyu yayin da suke girma.

Tricuspid atresia gyara:

• Ana samun bawul din tricuspid tsakanin manya da ƙananan ɗakuna a gefen dama na zuciya. Tricuspid atresia na faruwa lokacin da wannan bawul din ya zama mara kyau, kunkuntar, ko ɓacewa.
• Yaran da aka haifa da tricuspid atresia suna shuɗi saboda ba sa iya samun jini zuwa huhu don ɗaukar iskar oxygen.
• Don isa zuwa huhu, jini dole ne ya ratsa wata ɓarkewar ɓarna (ASD), ɓoyayyiyar ɓarna (VSD), ko kuma jijiyoyin bugun gini (PDA). (Waɗannan yanayi an bayyana su a sama.) Wannan yanayin yana matuƙar takurawar jini zuwa huhu.
• Ba da daɗewa ba bayan haihuwa, ana iya ba wa jaririn wani magani da ake kira prostaglandin E. Wannan maganin zai taimaka wajen buɗe patent ductus arteriosus a buɗe don jini ya ci gaba da gudana zuwa huhu. Koyaya, wannan zaiyi aiki ne na ɗan lokaci. Yaron zai ƙarshe bukatar tiyata.
• Yaron na iya buƙatar jerin tsere da tiyata don gyara wannan lahani. Manufar wannan tiyatar ita ce a bar jini daga jiki ya gudana zuwa huhu. Dole ne likitan likita ya gyara bawul ɗin tricuspid, sauya bawul din, ko sanya shi a cikin wani ƙwanƙwasa don jini ya sami huhu.

Jimlar komowar kwata-kwata na huhu (TAPVR):

• TAPVR na faruwa ne lokacin da jijiyoyin huhu suka kawo jini mai wadataccen oxygen daga huhu zuwa gefen dama na zuciya, maimakon gefen hagu na zuciya, inda galibi yake zuwa ga masu lafiya.
• Dole ne a gyara wannan yanayin tare da tiyata. Za'a iya yin aikin tiyatar a lokacin haihuwa idan jariri yana da alamun rashin lafiya. Idan ba a yi shi daidai bayan haihuwa ba, ana yi a watanni 6 na farkon rayuwar jariri.
• TAPVR gyara yana buƙatar tiyata a buɗe. An juya jijiyoyin huhu zuwa gefen hagu na zuciya, inda suke, kuma duk hanyoyin haɗi sun kasance a rufe.
• Idan PDA ta kasance, tana ɗaure kuma an raba ta.

Hypoplastic hagu gyara zuciya:

• Wannan nakasar zuciya ce mai tsananin gaske wanda ya samu ta hanyar hagu mara kyau sosai. Idan ba a yi magani ba, yana haifar da mutuwa ga yawancin jariran da aka haifa da ita. Ba kamar jarirai masu sauran lahani na zuciya ba, waɗanda ke da zuciyar hagu ba su da wata lahani. Ana gudanar da ayyuka don magance wannan lahani a cibiyoyin kiwon lafiya na musamman. Yawancin lokaci, tiyata na gyara wannan lahani.
• Jerin ayyukan zuciya sau uku galibi ana buƙata. Aikin farko ana yin sa a makon farko na rayuwar jariri. Wannan tiyata ce mai rikitarwa inda aka halicci jijiya ɗaya daga jijiyoyin huhu da aorta. Wannan sabon jirgi yana ɗaukar jini zuwa huhu da sauran jiki.
• Aiki na biyu, ana kiran shi aikin Fontan, galibi ana yin sa ne lokacin da jariri ya kai watanni 4 zuwa 6.
• Aiki na uku ana yi ne shekara guda bayan aiki na biyu.

Yin aikin tiyatar zuciya; Patent ductus arteriosus ligation; Hypoplastic gyaran zuciya na hagu; Tetralogy na gyaran Fallot; Coarctation na gyaran aorta; Atrial septal flapt gyara; Defectaramar ƙwanƙwasa mara kyau; Truncus arteriosus gyara; Jimlar gyaran jijiyoyin ciki mara kyau; Canza wurin gyara manyan jiragen ruwa; Tricuspid atresia gyara; Gyara VSD; ASD gyara

• Tsaron gidan wanka - yara
• Kawowa yaronka ziyara dan uwansa mara lafiya
• Yin aikin tiyatar zuciya na yara - fitarwa
• Kula da rauni na tiyata - a buɗe

• Zuciya - sashi ta tsakiya
• Cardiac catheterization
• Zuciya - gaban gani
• Duban dan tayi, tayi na al'ada - bugun zuciya
• Duban dan tayi, nakasar sashin hanji - bugun zuciya
• Patent ductus arteriosis (PDA) - jerin
• Jariri ya buɗe tiyatar zuciya

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Webb GD, Smallhorn JF, Therrien J, Redington AN. Cutar cututtukan zuciya.A cikin: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. Braunwald na Ciwon Zuciya: Littafin rubutu na Magungunan zuciya da jijiyoyin jini. 11th ed. Philadelphia, PA: Elsevier; 2019: babi na 75.