Stenosis ʻaʻano

ʻO ke aorta ka aʻa nui e lawe i ke koko mai ka puʻuwai i ke koena o ke kino. Kahe ke koko mai ka puʻuwai a i loko o ke aorta ma o ka aortic valve. I nā stenosis aortic, ʻaʻole wehe hāmole ākea. Hoʻoemi kēia i ke kahe o ke koko mai ka puʻuwai.

E like me ka hoʻopili ʻana o ka kiwikā aortic, pono ka ventricle hema e hana ʻoi aku ka ikaika e hoʻokahe i ke koko ma o ka va. E hana i kēia hana keu, ʻoi aku ka mānoanoa o nā mākala i nā paia ventricle. Hiki i kēia ke alakaʻi i ka ʻeha o ka umauma.

Ke piʻi nei ke kaomi, piʻi paha ke koko i loko o nā māmā. Hiki i nā stenosis aortic koʻikoʻi ke kaupalena i ka nui o ke koko i hiki i ka lolo a me ke koena o ke kino.

Aia paha kahi stenosis aortic mai ka hānau ʻana (congenital), akā pinepine ka ulu ʻana ma hope i ke ola. Loaʻa i nā keiki me ka stortosis aortic nā kūlana ʻē aʻe i hānau ʻia mai ka wā hānau.

Hana ʻia ka stortosis aortic ma muli o ke kūkulu ʻia ʻana o nā waihona calcium e hoʻoliʻiliʻi ai ka pahu. Kapa ʻia kēia ʻo ka stenosis aortic calcific. Hoʻopilikia ka pilikia i ka poʻe kahiko.

ʻO ka paʻa ʻana o ka vaipō o ka nohona ma mua koke i ka poʻe i hānau ʻia me nā valves aortic a i ʻole bicuspid valves. I nā hihia maʻamau, hiki i ka buildup calcium ke ulu wikiwiki aʻe ke loaʻa i ke kanaka ka radiation radiation (e like me ka mālama ʻana i ka maʻi ʻaʻa.

ʻO kekahi kumu ke kuni rumatika. Hiki i kēia ʻano ke ulu ma hope o ka ʻāʻī strep a i ʻole ke kuni ʻulaʻula. ʻAʻole hoʻomohala nā pilikia Valve no 5 a 10 mau makahiki a ʻoi paha ka lōʻihi ma hope o ka loaʻa ʻana o ka maʻi rumatika. Ke hele a lahilahi nei ke kuni Rheumatic ma United States.

Hana ʻia ka stortosis aortic ma kahi o 2% o ka poʻe ma mua o 65 mau makahiki. Kū pinepine ia i nā kāne ma mua o nā wahine.

ʻO ka hapa nui o ka poʻe me nā stenosis aortic ʻaʻole hoʻomohala i nā hōʻailona a hiki i ka wā e holo nui ai ka maʻi. Ua hana ʻia paha ke kuhi a lohe ka mea mālama ola i kahi ʻōhumu o ka puʻuwai a hana i nā hoʻokolohua.

Nā hōʻailona o ka stortosis aortic pū me:

• Hōʻoluʻolu o ka umauma: E ʻoi aku paha ka ʻeha o ka umauma me ka hana a hiki i ka lima, ka ʻāʻī, a me ka ʻāʻā. Pīpī paha ka umauma i ka umauma a ʻomi ʻia paha.
• Cough, he koko paha.
• Nā pilikia hanu ke hana ʻoe.
• Luhi maʻalahi.
• ʻIke i ka puʻuwai (palpitations).
• Ka palu ʻana, nāwaliwali, a i ʻole ka puʻupuʻu me ka hana.

I nā pēpē a me nā keiki, hoʻopili ʻia nā ʻōuli me:

• Luhi maʻalahi me ka hoʻoikaika ʻana (i nā hihia maʻalahi)
• ʻO ka loaʻa ʻole o ke kaupaona
• ʻAi hānai maikaʻi ʻole
• Nā pilikia hanu nui e hoʻomohala i loko o nā lā a i ʻole mau pule hānau (i nā hihia koʻikoʻi)

ʻO nā keiki me ka stenosis aortic akahai a kaulike paha e ʻoi aku ka maikaʻi i ko lākou wā ʻelemakule. Kūpono pū kekahi lākou no kahi maʻi puʻuwai i kapa ʻia he endocarditis bacteria.

ʻO kahi ʻōhumu o ka puʻuwai, kaomi a i ʻole ke kani ʻano ʻē aʻe e lohe pinepine ʻia ma o kahi stethoscope. Hiki paha i ka mea hāʻawi ke ʻike i kahi haʻalulu a i ʻole neʻe ke kau ʻana i kahi lima ma luna o ka puʻuwai. Maliʻa paha he pulse pulupulu a hoʻololi paha i ka maikaʻi o ka lāʻau i ka ʻāʻī.

Haahaa paha ke koko.

ʻIke pinepine ʻia ʻo Aortic stenosis a laila ukali me ka hoʻohana ʻana i kahi hōʻike i kapa ʻia he transthoracic echocardiogram (TTE).

E hana ʻia paha nā hōʻike aʻe:

• ECG
• Hōʻike hoʻohaʻahaʻa hoʻoikaika kino
• ʻO ka catheterization puʻuwai hema
• MRI o ka puʻuwai
• Echocardiogram Transesophageal (TEE)

ʻO nā hōʻoia maʻamau ʻana e kahi mea hoʻolako i nā mea e pono ai inā ʻaʻole koʻikoʻi kāu mau ʻōuli. Pono e nīnau ka mea hāʻawi e pili ana i kāu mōʻaukala olakino, hana i kahi hoʻokolohua kino, a hana i kahi echocardiogram.

ʻ belelo ʻia paha ka poʻe me nā stenosis aortic koʻikoʻi ʻaʻole e pāʻani i nā haʻuki hoʻokūkū, ʻoiai inā ʻaʻohe o lākou hōʻailona. Inā kū nā ʻōuli, pono e kaupalena ʻia ka hana ikaika.

Hoʻohana ʻia nā lāʻau e mālama ai i nā ʻōuli o ka puʻuwai puʻuwai a i ʻole nā ​​puʻuwai puʻuwai maʻamau (ʻo ka fibrillation atrial pinepine). Hoʻopili kēia i nā diuretics (nā wai wai), nā nitrates, a me nā beta-blockers. Pono e mālama ʻia ke koko kiʻekiʻe. Inā koʻikoʻi ka stortosis aortic, pono e hana pono ʻia kēia mālama ʻana no laila ʻaʻole e hāʻule ke kaomi koko ma kahi lōʻihi.

I ka wā ma mua, ʻo ka hapa nui o ka poʻe me nā pilikia o ka puʻuwai puʻuwai i hāʻawi ʻia i nā lāʻau antibiotic ma mua o ka hana niho ʻana a i ʻole ke kaʻina hana e like me ka kolone. Hāʻawi ʻia nā antibiotic i mea e pale aku ai i ka maʻi o ka puʻuwai i hōʻino ʻia. Eia nō naʻe, hoʻohana ʻia nā antibiotic i kēia manawa ma mua o ka hana niho a me nā kaʻina hana ʻē aʻe. E hōʻoia me kāu mea mālama ola e ʻike inā makemake ʻoe i nā antibiotic.

ʻO ka poʻe me kēia a me nā ʻano puʻuwai ʻē aʻe e pono e hoʻōki i ka puhipaka a hoʻāʻo ʻia no ka kiʻekiʻe o ke kō.

Hana pinepine ʻia ke kīʻaha no ka hoʻoponopono ʻana a pani ʻana paha i ka nohona. ʻOiai ʻaʻole maikaʻi ʻole nā ​​ʻōuli, e paipai paha ke kauka i ke ʻoki ma muli o nā hopena hōʻike.

ʻO kahi kaʻina hana hoʻowahāwahā i kapa ʻia he balloon valvuloplasty e hana ʻia ma kahi o a i ʻole ma mua o ke ʻoki ʻana.

• Hoʻokomo ʻia kahi pāluna i loko o ke aʻa i loko o ke aʻa, wili ʻia i ka puʻuwai, kau ʻia ma o ka ākea, a hoʻonui ʻia. Eia nō naʻe, hana hou ka hoʻopili ʻana ma hope o kēia kaʻina hana.
• ʻO kahi hana hou i hana ʻia i ka manawa like i hiki i ka valvuloplasty ke hoʻokomo i kahi kiwikā hana (transcatheter aortic valve replacement a i ʻole TAVR). Hana pinepine ʻia kēia hana i nā mea maʻi ʻaʻole hiki ke loaʻa i ke ʻoki, akā ke lilo nei ia i mea maʻamau.

Pono paha i kekahi mau keiki e hoʻoponopono a pani hou paha i ka vaʻa aorta. Hiki i nā keiki me nā stenosis aortic akahai ke komo i ka hapa nui o nā hana.

Hoʻololi ka hopena. Māmā paha ka maʻi a ʻaʻole hana i nā ʻōuli. I ka hala ʻana o ka manawa, e mikiʻiki paha ka aorta aʻa. ʻO kēia ka hopena i nā pilikia puʻuwai ʻoi aku ka nui e like me:

• Aibrial fibrillation a me atrial flutter
• Hoʻopili ke koko i ka lolo (hahau), ʻōpū, nā puʻupaʻa, a i ʻole nā ​​wahi ʻē aʻe
• Pāheoheheʻe maikaʻi (sinkope)
• Hewa puʻuwai
• ʻO ke koko kiʻekiʻe i nā aʻa o nā akemā (hypertension pulmonary)

ʻO nā hopena o ke pani pani pani maikaʻi ʻoi aku ka maikaʻi. No ka loaʻa ʻana o ka lāʻau maikaʻi loa, e hele i kahi kikowaena e hana maʻamau i kēia ʻano ʻoki.

Kāhea i kāu mea hāʻawi inā ʻo ʻoe a ʻo kāu keiki paha nā ʻōuli o aorta stenosis.

E kāhea koke aku i kāu kauka inā ua ʻike ʻia ʻoe me kēia maʻi a hele a ʻoi aku ka maikaʻi o kāu mau hōʻailona a i ʻole e ulu nā hōʻailona hou.

Stenosis kiwikā Aortic; Stenosis aorta Rheumatic; Calcific aortic stenosis; Stenosis ʻaʻa puʻuwai; Valvular aortic stenosis; Puʻuwai hānau - stenosis aortic; Rumatika fiva - aorta stenosis

• Stenosis ʻaʻano
• Nā nohona puʻuwai

ʻO Carabello BA. Maʻi maʻi valvular. I: Goldman L, Schafer AI, eds. ʻO ka lāʻau lapaʻau Goldman-Cecil. 26th ed. Piladelapia, PA: Elsevier; 2020: chap 66.

Hermann HC, Mack MJ. Nā lāʻau Transcatheter no nā maʻi puʻuwai valvular. 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 72.

ʻO Lindman BR, Bonow RO, Otto CM. Maʻi maʻi aorta. 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 68.

Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA / ACC nānā i ka hoʻohou o ka 2014 AHA / ACC alakaʻi no ka mālama ʻana i nā mea maʻi me ka maʻi puʻuwai valvular: kahi hōʻike o ka American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines. Kaapuni. 2017; 135 (25): e1159-e1195. PMID: 28298458 pubmed.ncbi.nlm.nih.gov/28298458/.