Coarctation kwa msempha - ndi chiyani ichi? Coarctation wa msempha ana

Coarctation wa msempha - matenda mtima, amene anatsagana ndi kuchepetsa wa lumen wa chotengera waukulu mu thupi la munthu. Ndipotu, si matenda a mtima, monga kudwala ndi isanafalikire malire a myocardium lapansi. Ambiri zambiri matenda coarctation wa msempha makanda, ngakhale kuti nthawi zina matenda ndi wapezeka kale odwala wamkulu. Nthawi zambiri, matenda likuchotsedwa ndi opaleshoni.

Kumene, matenda izi si kwathunthu bwino odwala ndi chifukwa iwo mantha. Choncho muyenera kudziwa zambiri zimene ndi matenda ndi zimene mavuto nalo munthu wodwala.

Coarctation kwa msempha: ndi chiyani ichi?

Choyamba, tiyeni kuthana ndi mawu akuti. Coarctation wa msempha - ndi kobadwa nako chilema, omwe limodzi ndi kuchepetsa kwa msempha. Mu dongosolo ili za mtima odwala ndi zabwinobwino. Komabe, msempha ndi chotengera waukulu wa munthu ndi kuphwanya magazi mderali zoipa zokhudza ntchito ya mtima osati ndi mitsempha, komanso lonse chamoyo.

Monga ulamuliro, chiletso cha aumbike mwa kumene Chipilala kung'ambika akudutsa mu gawo kunsi. Chotero chitsanzo ndi explainable, chifukwa apa pali ang'ono yachibadwa thupi kuchepetsa. Mwa njira, nthawi yoyamba matenda limafotokonzera 1791 ndi D. Morgagni (Italy dokotala wodziwa za vutoli). Malinga ndi kafukufuku zowerengera pafupipafupi kudwala ndi 15% wa malformations kobadwa nako. Ndipotu ina chidwi ndi matenda kumachitika anyamata nthawi 3-5 zambiri kuposa odwala wamkazi.

The mitundu ikuluikulu ya kudwala

Malinga makhalidwe, coarctation kwa msempha angakhale mitundu iwiri:

• "Wamkulu" coarctation amakhala ndi kuchepetsa wa lumen kwa msempha pansipa poti izo imasiyana kumanzere mtsempha wamagazi subclavian; pamene pali kutsekedwa kwa ductus arteriosus;
• infantile mtundu wa kudwala limodzi ndi hypoplasia wa msempha mu malo omwewo a chiyambi cha mtsempha wamagazi ndi subclavian, koma otaya Komabe, wotseguka.

mbali anatomical wa kudwala

Kobadwa nako coarctation kwa msempha likhoza kulumikizidwa ndi comorbidities zosiyanasiyana. Malinga chilema yonseyi ikhonza kuikidwa mu magulu atatu.

Kudwala akhoza amalimata - Pankhaniyi ufulu vuto lina lililonse chitukuko cha dongosolo mtima. Nthawi zambiri, coarctation wa msempha ana akhoza kugwirizana ndi pathologies ena - imeneyi kungakhale aneurysm, kung'ambika stenosis, septal chilema pakati pa ventricles ndi atria, transposition ziwiya kwambiri.

Gulu lachitatu - coarctation, imene magazi zimawonedwa anapeza. Zikatero, ndi kudwala angathe kukhala:

• postduktalnoy (kuchepetsa ili pansipa poti inyamuka setifiketi ductus arteriosus;
• yukstaduktalnoy (coarctation chabe kutsegula mlingo otaya);
• preduktalnaya (wolumikizira ritsa akutsegula pansipa constriction kwa).

Kumene, zizindikiro kwakukulukulu zimatengera ndendende pa mtundu ndi makhalidwe a coarctation.

ndi zimayambitsa wachiwiri chiyani?

Nthawi zambiri akufotokozera coarctation wa msempha mu mwana wosabadwayo. Zachitikiranji zimenezi? Amadziwika kuti pa chitukuko yoopsa mu thupi la mwanayo ukugwirira ntchito wolumikizira ritsa, zomwe zikugwirizana ndi msempha ndi kumanzere mtsempha wamagazi m'mapapo mwanga. nyumba imeneyi chofunika chokha mongoyembekezera. Atabadwa ndipo chiyambi cha m'mapapo mwanga kutseka kupuma ritsa.

Pali maganizo amenewa zifukwa zina mwana gawo laling'ono la minofu ya otaya upita ku msempha, pamene inu kutseka ritsa mu ndondomeko amatenda ndi khoma kung'ambika, zikubweretsa chidule chake.

Chifukwa ndondomeko imeneyi, tsoka, osadziwika. Asayansi yekha anapeza kuti matenda odwala ambiri sachedwa ndi matenda chromosomal Turner a (pamaso pa chimodzi chokha kugonana khromozomu). Pafupifupi mwana chakhumi ndi matenda a chilema izi wapezeka.

Coarctation wa msempha (IBC) alibe kukhala kobadwa nako. Mumadziwika nthawi zina pamene vasoconstriction zinachitika kale mu mukadzakula. Zikatero amachititsa coarctation anavulala ndi kung'ambika zotupa atherosclerotic, yotupa matenda a osadziwika etiology mtima makoma (syndrome Takayasu a).

Kulakwila coarctation hemodynamic

Kumene, kung'ambika constriction zotsatira pa dongosolo lonse mtima, ngakhale makhalidwe mtumiki palibe. Pamaso pa zotsatira coarctation mu mapangidwe awiri ankhanza osiyana otaya.

Kuchepetsa mpata pamwamba kuthamanga kwa magazi ndi kuchuluka, imbaenda yowonjezera lumen Mitsempha. Chifukwa zimamuchulukira systolic akufotokozera kumanzere yamitsempha yamagazi hypertrophy. Koma pansipa dera coarctation wa zinthu zosiyana - mochedwa magazi, magazi ndi adatchithisira. Monga thupi la mwanayo imayendetsa njira compensatory - osauka ziwiya ina angapo kuti kupereka magazi kulambalala.

Pankhani mtundu wamkulu wa chilema, odwala anaona kumanzere yamitsempha yamagazi hypertrophy, matenda oopsa kwambiri, ndi kuwonjezeka mu kufalitsidwa magazi buku. Pamene infantile coarctation pamene a ductus arteriosus lotseguka, ndi kuyan'anila pamwamba sali zodziwika bwino. Koma pali pathologies ena. Mwachitsanzo, pamene mtundu wa magazi kudwala postduktativnom ku msempha pansi kuthamanga aperekedwa mwachindunji mu mtsempha wamagazi m'mapapo mwanga, imbaenda ndi kuwonjezeka mu kuthamanga ziwiya kufalitsa m'mapapo mwanga.

Mulimonsemo pali kusagwirizana kwakukulu kwa hemodynamics, amene Mulimonsemo sayenera ananyalanyaza, chifukwa zotsatira zake zingakhale aakulu.

Kodi zizindikiro za matenda limodzi ndi?

Zizindikiro za coarctation kung'ambika kwakukulukulu kudalira pa mlingo wa kuchepetsa a chotengeracho, komanso pamaso kapena kusapezeka vuto concomitant. Wofatsa coarctation onse sangathe wasonyeza.

Zikavuta kwambiri, zizindikiro ndi kale kuonekera chaka choyamba cha moyo. Ana zambiri amadwala kutupa kwa mapapu ndi zisadzachitikenso zonse. Ana wotumbululuka khungu ndi kupuma mavuto - dyspnea limapezeka pa chakudya, masewera kapena ngakhale pa mpumulo. Nthawi zambiri, ana ndi matenda uku kwathupi kukhala pang'onopang'ono kusiyana ndi anzawo.

Akuganiza pamaso pa wachiwiri ngati n'kotheka pamene kumvetsera phokoso mtima, komanso mtima wa zimachitika mu mtsempha wa malekezero chapamwamba ndipo m'munsi. Mitsempha pa makutu ulnar Tingaone ripple voteji, pamene pa zimachitika femoral ndi ofooka kwambiri.

Pamene preduktalnoy coarctation anati sakanikira cyanosis - khungu mwana pa mapazi amakhala cyanotic hue, pamene khungu mu kumtunda kwa thupi nawobe mtundu achilengedwe.

Nthawi zambiri zimachitika kuti kudwala kale anapezeka ali wamkulu - ndi sukulu ana, achinyamata, achikulire. Zizindikiro Pankhaniyi monga kuthamanga magazi. Odwala amadandaula kutopa, kupweteka kwa mutu, kawirikawiri chizungulire, kupweteka mtima, nosebleeds ndi kutopa. Nthawi zambiri munthu angaone akanagwiritsa chitukuko cha minofu ya thupi chapamwamba ndipo m'munsi pa kumupima. Zizindikiro monga kufooka mu miyendo, omangana pafupipafupi, kudziwa mapazi ozizira. Akazi akhoza kusunga kusamba mkombero matenda, ndi zina osabereka.

Coarctation kwa msempha: matenda

Akuganiza pamaso pa wachiwiri dokotala pamene kumvetsera mtima zikumveka. Komanso imachitika njira zina matenda, zomwe zimathandiza osati kukhazikitsa pamaso pa coarctation a fax, komanso kupeza zilema zina ndi kudziwa mmene anagonjetsera dongosolo mtima:

• Imodzi mwa njira kwambiri ophweka ndi Kufikika ndi electrocardiogram. Izo siziri njira kwambiri nkhani, kuyambira zolimbitsa kuchepetsa wa msempha wa electrocardiogram mtima ungaoneke n'kwachibadwa. Ana mu chaka choyamba cha moyo Tingaone wa kusamuka kwa olamulira magetsi a mtima pa ndondomeko. The anyamata achikulire sangathe kale kudziwa zizindikiro za kumanzere yamitsempha yamagazi hypertrophy. Odwala wamkulu, olamulira magetsi a mtima ali ankatembenukira lamanzere, ndipo nthawizina pali chosakwanira anatseka misewu ya kumanzere chipika mtolo nthambi.
• odwala zambiri zotchulidwa phonocardiography. Ndondomeko imeneyi zimathandiza inu kulemba phokoso ndi Phokoso chifukwa cha ntchito zipangizo mtima ndi magazi. Pamaso pa coarctation kuzindikira phindu la kamvekedwe wachiwiri kwa msempha, komanso kuoneka kudandaula systolic kumbuyoko ndi danga chachiwiri intercostal pafupi sternum m'mphepete (lamanja ndi lamanzere).
• Nkhani ndi ultrasound a mtima, zimene zingakuthandizeni kudziwa kuchepetsa kwa msempha. Komanso, katswiri kuwona kuwonjezeka mu thupi mtima. Doppler echocardiography ntchito kuzindikira zizindikiro khalidwe la kudwala, makamaka magazi kusiyana pa mbali pamwamba ndi pansi constriction, ndi pamaso pa chipwirikiti systolic otaya.
• mapapo Komanso radiography ndi mtima. Childs, kukula kwa mtima ndi wabwinobwino, koma muona ka kufutukuka yofunika kwambiri akwera msempha. chojambula m'mapapo mwanga akhoza kumatheka chifukwa cha wolumikizira bedi, ngakhale zimawonedwa nthawi zonse.
• Aortography - ndondomeko yomwe imapereka kwa oyamba mu msempha wa wapadera wothandizira Mosiyana, kenako kuona kugawa ake pa chotengeracho. phunziro ili molondola kudziwa mmene ndi mlingo wa kuchepetsa kwa msempha.
• Mtima catheterization - ndondomeko m'malo zovuta. Komabe, mwa kuyambitsa catheter wapadera mu lumen chotengera akhoza molondola anayeza magazi.

Pokhapokha chithunzi thunzi chokwanira cha dokotala akhoza kupereka Mapa ndi kusankha njira yoyenera kuthetsa kuonera zolaula.

Kodi ndikufunika opaleshoni?

Kodi ngati wodwalayo opezeka coarctation kwa msempha? opareshoni, ndithudi, ndi yodalirika njira kuchotsa zoipa. Koma kusankha kukachititsa opaleshoni akhale yekha madokotala amene amadziŵa bwino mbiri ndi ulaliki matenda.

Nthawi zina (ngati pali chabe kuchepetsa pang'ono, amene ali pafupifupi ziribe mphamvu pa hemodynamics), opaleshoni mwina kuchita. The wodwala nthaŵi mayeso.

Ngati kusiyana systolic wolumikizira kuthamanga wa miyendo chapamwamba ndipo m'munsi ndi wamkulu kuposa 50 mm Hg. Art. Nthawi zambiri madokotala amati kuchititsa opaleshoni. Ngati kung'ambika coarctation makanda wakhala matenda, ntchito (mwadzidzidzi) ikuchitika choncho odwala wamng'ono pano aakulu oopsa ndi decompensation mtima. Pa nthawi imene matenda zimakhalanso yabwino, ndi chiopsezo pa moyo wa mwana palibe, ndondomeko akhoza kulephereka mpaka zaka zisanu kapena zisanu ndi chimodzi zakubadwa.

Opaleshoni mankhwala a matenda a mtima

Pakali pano, pali njira zingapo kuthetsa kuonera zolaula. Kusankha njira opaleshoni zimadalira mmene wodwalayo, mtundu wa matenda ndi coarctation kukula.

• Nthawi zina, madokotala kuchita resection (excision) wa gawo mwapang'ono kwa msempha, kenako ndikulilumikizanso malekezero a chidebe, kugwiritsa ntchito anastomosis. njirayi zimatheka ngati coarctation ali pati yaing'ono.
• Kukachitika kuti chiletso gawo yaitali, ndi amalowerera anastomosis sizingatheke ntchito prosthesis. Pa ndondomeko ya dokotalayo amachotsa gawo akhudzidwa kwa msempha, inatuluka malekezero awiri chidebe likugwirizana ndi prosthesis wapadera zopangidwa angapange.
• Aortoplastika - zosiyanasiyana wina wa ntchito, koma mu nkhani iyi kubwezeretsa kutalika kwa msempha si ntchito prosthesis kupanga, monga mbali ya kumanzere subclavian mtsempha wamagazi wodwala.
• Nthawi zina madokotala kusankha nthawi kulambalala kung'ambika. Zikatero, ndi prosthesis kupanga, amene m'mbali sewn pamwamba ndi pansi pa gawo mwapang'ono chombocho - motero kupanga kulambalala njira otaya magazi.
• Pali ndondomeko china chotchedwa zibaluni angioplasty. Iwo ikuchitika zonsezi ngati pambuyo kale opaleshoni anapezeka vasoconstriction. Pa ndondomeko, dokotala amaika kudzera ziwiya zotumphukira mu kung'ambika lumen zibaluni wapadera, amene chiletso Mwamsanga pamene mpweya. Nthawi zina, zina amaika wapadera molimba stents akugwira kukula kwa lumen kung'ambika.

Ndicho chimene chilema kudzudzulidwa amatchedwa "coarctation kwa msempha." Pambuyo pa opaleshoni, wodwala, ndithudi, ndi kutsatila malangizo ena. Makamaka, muyenera kudya bwino, kupewa kwambiri thukuta, thupi ndi moyo wongokhala, mosamala kuyan'ana ukupeza ndi kubatizidwa zonse cheke akuluakulu pa cardiologist nawo.

Kodi mavuto ndi zotheka?

Coarctation kwa msempha - matenda oopsa, amene Mulimonsemo sayenera ananyalanyaza. Pamene akumane Inde chilema kungachititse kuti mavuto oopsa kwambiri:

• Chifukwa kuchepetsa chombocho , odwala akhoza kuyamba matenda oopsa kwambiri.
• Nthawi zambiri imeneyi chilema mtima - kung'ambika coarctation - komanso motsogozedwa ndi mapangidwe aneurysm ndi chotupa wake wotsatira.
• Zovuta mulinso sitiroko ndi subarachnoid effusion magazi.
• Pa maziko a matenda odwala zambiri mtima kulephera, amene anatsagana ndi otchedwa mtima mphumu edema m'mapapo mwanga.
• Kuchepetsa wa lumen kung'ambika amakhudza dziko lonse la mtima. Chifukwa cha giperenzii katundu angachotsedwe mitsempha yaing'ono aimpso.
• Nthawi zina odwala kukhala endocarditis bakiteriya. Vuto amenewa kawirikawiri amapezeka kukachitika kuti coarctation kwa msempha amagwirizana ndi kuvutika kwa vavu kung'ambika. Mwatsoka, nthawi zambiri, awa toyambitsa matenda a mtima ndi kugonjetsedwa ndi mankhwala.

Monga mukuonera, coarctation wa msempha ana ndi akulu akhoza chakupha. Ndicho chifukwa chake ndi chofunika yake matenda ndi mankhwala okwanira.

Kuti madokotala ananena zawo odwala ndi coarctation

Ambiri zambiri matenda coarctation wa msempha makanda. Kodi maganizo achinyamata amene akudwala ndipo kodi makolo zotani? Ndipotu, izo zonse zimadalira mlingo wa kuchepetsa Mitsempha. Nthawi zina, matenda amafuna yomweyo alowererepo pa opaleshoni. Ngati ndi digiri zolimbitsa a khalidwe lonyansa, ngakhale dokotala onse ayamikira odwala moyo zaka 30-35 yekha, ndi chifukwa cha imfa, monga ulamuliro, ndi sitiroko kapena aneurysm chophukacho.

Wofatsa kuchepetsa nthawi zina pamafunika opaleshoni - dokotala akuonetsa kokha nthawi kukumana ndi mayesero kudziwa zosokonezeka. Zikatero, pamaso pa matenda a mtima kawirikawiri zimakhudza nthawi ya moyo wodwalayo.