Hewa septal Atrial (ASD)

Atrial septal defect (ASD) kahi kīnā o ka naʻau i loaʻa i ka wā hānau (congenital).

Ke ulu a pēpē i loko o ka ʻōpū, hana ʻia kahi paia (septum) e hoʻokaʻawale i ke keʻena kiʻekiʻe i atrium hema a ʻākau. Ke kū pololei ʻole kēia pā, hiki i ka hopena i kahi kīnā i koe ma hope o ka hānau ʻana. Kapa ʻia kēia he hemahema septial atrial, a i ʻole ASD.

ʻO ka maʻamau, ʻaʻole hiki i ke koko ke kahe ma waena o nā keʻena puʻuwai ʻelua o luna. Eia naʻe, ʻae kahi ASD i kēia e kū.

Ke kahe ke koko ma waena o nā keʻena puʻuwai ʻelua, ua kapa ʻia kēia he shunt. E kahe pinepine ke koko mai ka hema a i ka ʻaoʻao ʻākau. Ke hana kēia i ka ʻaoʻao ʻākau o ka puʻuwai e hoʻonui. Ma luna o ka manawa kaomi i nā akemāmā e kūkulu paha. Ke hiki mai kēia, hele ke koko i loko o ka kīnā mai ka ʻākau a ka hema. Inā kū kēia, e emi ana ka oxygen ma ke koko e hele i ke kino.

Hoʻomaopopo ʻia nā hemahema septtr attrial ma ke ʻano he primum a secundum paha.

• Hoʻopili ʻia nā hemahema maikaʻi i nā kīnā ʻole o ka naʻau o ka septum ventricular a me ka mitral valve.
• Hiki i nā kīnā Secundum ke puka hoʻokahi, liʻiliʻi a nui paha. ʻOi aku paha lākou i hoʻokahi puka liʻiliʻi ma ka septum a i ʻole ka paia ma waena o nā keʻena ʻelua.

ʻO nā kīnā liʻiliʻi loa (ʻoi aku ma mua o 5 millimeter a i ʻole ¼ inch) ka mea liʻiliʻi i nā pilikia. ʻIke pinepine ʻia nā kīnā liʻiliʻi ma hope o ke ola ma mua o nā mea nui.

Me ka nui o ka ASD, kahi o ka hemahema e hoʻokani ai i ke kahe o ke koko a me nā pae oxygen. ʻO ka hiki ʻana o nā kīnā o ka puʻuwai kekahi mea nui.

ʻAʻole maʻamau ka ASD.

ʻO ke kanaka me ke kīnā ʻole o ka puʻuwai ʻē aʻe, a i ʻole kahi kīnā ʻuʻuku (ma lalo o 5 millimeter) ʻaʻole i loaʻa kekahi mau ʻōuli, a ʻaʻole paha e loaʻa nā hōʻailona a hiki i ka makahiki waena a i ʻole ma hope.

E hoʻomaka paha nā ʻōuli e hana ʻia i kēlā me kēia manawa ma hope o ka hānau ʻana ma o ka wā kamaliʻi. Hiki iā lākou ke hoʻopili:

• Ka hanu paʻakikī (dyspnea)
• ʻO nā maʻi hanu pinepine i nā keiki
• Manaʻo ka puʻuwai (palpitations) i nā mākua
• Ka hanu ʻana me ka hana

E nānā ka mea mālama ola i ka nui a me ke koʻikoʻi o ka ASD e pili ana i nā ʻōuli, ka hoʻāʻo kino, a me nā hopena o nā hoʻāʻo ʻana o ka puʻuwai.

Lohe paha ka mea hāʻawi i nā kani naʻau kūpono ʻole ke hoʻolohe i ka umauma me kahi stethoscope. E lohe wale ʻia kahi ʻōhumu i kekahi mau kūlana o ke kino. I kekahi manawa, ʻaʻole lohe ʻia ka namunamu. ʻO kahi ʻōhumu ʻaʻole ke kahe o ke koko ma waena o ka puʻuwai.

Hōʻike paha ka hoʻokolohua kino i nā hōʻailona o ka holo pono ʻole o ka puʻuwai i kekahi mau mākua.

ʻO kahi echocardiogram kahi ho'āʻo e hoʻohana i nā nalu kani e hana i kahi kiʻi neʻe o ka puʻuwai. ʻO ka manawa pinepine ka hōʻike mua i hana ʻia. Hana ʻia kahi noiʻi Doppler ma ke ʻāpana o ka echocardiogram i ka mea mālama ola e loiloi i ka nui o ka shunting o ke koko ma waena o nā keʻena puʻuwai.

Nā hoʻokolohua ʻē aʻe i hana ʻia e hoʻopili ʻia:

• ʻO ka catheterization Cardiac
• Angiography coronary (no nā mea maʻi ma mua o 35 mau makahiki)
• ECG
• Heart MRI a i ʻole CT
• Echocardiography Transesophageal (TEE)

ʻAʻole pono ka ASD i ka mālama inā he kakaikahi a ʻaʻohe paha o nā ʻōuli, a i ʻole inā liʻiliʻi ka hemahema a ʻaʻole pili i nā mea ʻē aʻe ʻē aʻe. Paipai ʻia ke ʻoki ʻana e pani i ka hemahema inā kumu ka hemahema i kahi nui o ka shunting, pehu ka puʻuwai, a i ʻole hanana ʻia nā ʻōuli.

Ua hoʻomohala ʻia kahi hana e pani ai i ka hemahema (inā ʻaʻohe ʻano ʻē aʻe ʻē aʻe) me ka ʻole o ka ʻoki ʻana o ka puʻuwai.

• Hoʻopili ke kaʻina hana i ke kau ʻana i kahi hāmeʻa pani ASD i loko o ka puʻuwai ma o nā paipu i kapa ʻia he catheters.
• Mālama ka mea mālama ola i kahi ʻoki liʻiliʻi i ke aʻa, a laila hoʻokomo i nā catheters i loko o kahi kīʻaha koko a i loko o ka puʻuwai.
• Hoʻonoho ʻia ka hāmeʻa pani ma o ka ASD a pani ʻia ka hemahema.

I kekahi manawa, pono ke ʻoki puʻuwai puʻuwai e hoʻoponopono i ka kīnā. ʻOi aku ka makemake o ke ʻano o ke kaha ʻana inā aia kekahi mau maʻi kīnā ʻole o ka naʻau.

Hiki i kekahi poʻe me nā hemahema septial atrial ke loaʻa i kēia kaʻina hana, kaukaʻi ʻia i ka nui a me kahi o ka hemahema.

ʻO ka poʻe i loaʻa kahi kaʻina hana a kāʻoki paha e pani i kahi ASD pono e loaʻa nā lāʻau ʻaloʻalo ma mua o nā kaʻina hana niho i loaʻa iā lākou i ka wā ma hope o ke kaʻina hana. ʻAʻole pono nā lāʻau lapaʻau ma hope.

I nā pēpē, ʻaʻole liʻiliʻi nā ASD liʻiliʻi (ma lalo o 5 mm) i nā pilikia, a i ʻole pani ʻia me ka ʻole o ka lapaʻau. Nā ASD nui (8 a 10 mm), ʻaʻole pili pinepine a pono paha i kahi kaʻina hana.

ʻO nā mea nui e pili ana i ka nui o ka kīnā, ka nui o ke kahe o ke koko e kahe ana ma o ka wehe, ka nui o ka ʻaoʻao ʻākau o ka puʻuwai, a inā he mau hōʻailona ko ke kanaka.

Loaʻa i kekahi poʻe me ASD nā kūlana puʻuwai congenital ʻē aʻe. Hiki i kēia mau mea ke komo i kahi kīwī leaky a i ʻole kahi puka ma kahi ʻē aʻe o ka puʻuwai.

ʻO ka poʻe me ka ASD ʻoi aku ka paʻakikī a ʻoi paha ka paʻakikī i ka hoʻomohala ʻana i nā pilikia ʻē aʻe, e like me:

• Nā ritme naʻau maʻamau, ʻo ia hoʻi ka fibrillation atrial
• Hewa puʻuwai
• Maʻi maʻiʻaʻai (endocarditis)
• ʻO ke koko kiʻekiʻe ma nā aʻa o nā akemāmā
• Hahau

Kāhea i kāu mea hāʻawi inā loaʻa iā ʻoe nā hōʻailona o ka hemahema septial atrial.

ʻAʻohe ala i ʻike ʻia e pale ai i ka kīnā. Hiki ke pale ʻia kekahi o nā pilikia me ka ʻike mua ʻana.

Hewa naʻau Congenital - ASD; Naʻau kīnā hānau - ASD; Palena ASD; Secundum ASD

• ʻOki puʻuwai Pediatric - hoʻokuʻu

• Hewa septal Atrial

ʻO Liegeois JR, Rigby ML. Hewa septal Atrial (kamaʻilio interatrial). I: Gatzoulis MA, Webb GD, Daubeney PEF, eds. ʻIke a me ka mālama ʻana i nā maʻi puʻuwai makua makua. ʻEkolu huaʻōlelo. Piladelapia, PA: Elsevier; 2018: chap 29.

ʻO Silvestry FE, Cohen MS, Armsby LB, et al. Nā ʻōkuhi no ka loiloi echocardiographic o ka hemahema septal atrial a me ka patent foramen ovale: mai ka American Society of Echocardiography and Society for Cardiac Angiography and Intervensional. ʻO J Am Soc Echocardiogr. 2015; 28 (8): 910-958. PMID: 26239900 pubmed.ncbi.nlm.nih.gov/26239900/.

Sodhi N, Zajarias A, Balzer DT, Lasala JM. ʻO ka panunu ʻana o ka patent formen ovale a me ka hemahema atrial septal. I: Topol EJ, Teirstein PS, eds. Puka o ka Cardiology Interventional. 8th ed. Piladelapia, PA: Elsevier; 2020: chap 49.

Webb GD, Smallhorn JF, Therrien J, Redington AN. ʻO ka maʻi puʻuwai Congenital i ke kanaka makua a me ka mea maʻi pediatric. I: Zipes DP, Libby P, Bonow RO, Mann DL, Tomaselli GF, Braunwald E, eds. ʻO ka maʻi puʻuwai ʻo Braunwald: He puke aʻo no ka lāʻau Cardiovascular. 11th hua. Piladelapia, PA: Elsevier; 2019: chap 75.