Coarctation o ka aorta

Lawe ke aorta i ke koko mai ka puʻuwai i nā kīʻaha e hāʻawi i ke kino i ke koko. Inā ʻikiʻoki kahi hapa o ke aorta, paʻakikī ka hele ʻana o ke koko ma waena o ke aʻa. Kāhea ʻia kēia ʻo coarctation o ka aorta. He ʻano hānau kīnā ʻole ia.

ʻAʻole ʻike ʻia ke kumu kūpono o ka coarctation o ka aorta. Nā hualoaʻa mai nā mea kūpono ʻole i ka hoʻomohala ʻana o ka aorta ma mua o ka hānau ʻana.

ʻOi aku ka maʻamau o ka coortctort aortic i ka poʻe me kekahi maʻi genetics, e like me Turner Syndrome.

ʻO ka coortctort aortic kekahi o nā ʻano puʻuwai maʻamau e kū nei i ka wā hānau (nā kīnā o ka naʻau congenital). Loaʻa kēia abnormalities ma kahi o 5% o nā kīnā o ka naʻau hānau āpau. Hoʻomaopopo pinepine ʻia i nā keiki a i ʻole nā ​​mākua ma lalo o 40 mau makahiki.

ʻO ka poʻe i loaʻa kēia pilikia me kā lākou aorta e loaʻa paha kahi wahi nāwaliwali i ka paia o nā kīʻaha koko i ko lākou lolo. Kuhi kēia nāwaliwali i ka ipu koko e ʻōhū a i waho paha. ʻIke ʻia kēia ma ke ʻano he aneurysm berry. Hiki ke hoʻonui i ka makaʻu no ka hahau.

ʻIke ʻia ka hui ʻana o ka aorta me nā kīnā o ka naʻau congenital, e like me:

• ʻO ke kiwikā ākea Bicuspid
• Stenosis ʻaʻano
• Hewa septal ʻo Ventricular
• Patent ductus arteriosus

Pili nā ʻōuli i ka nui o ke kahe e hiki ai ke kahe ma waena o ke aʻa. Hiki i nā hemahema puʻuwai ʻē aʻe ke hoʻokani.

Ma kahi o ka hapalua o nā keiki hānau hou me kēia pilikia e loaʻa ai nā ʻōuli i nā lā mua o ke ola. Hiki i kēia ke hoʻopili i ka hanu wikiwiki, nā pilikia e ʻai, hoʻonui i ka huhū, a me ka hoʻonui ʻana i ka hiamoe a i ʻole lilo i ka pane maikaʻi ʻole. I nā hihia koʻikoʻi, hiki i ke pēpē ke hoʻomohala i ka puʻuwai a me ka haʻalulu.

I nā hihia momona, ʻaʻole paha e ulu nā ʻōuli a hiki i ke keiki i ka wā ʻōpio. ʻO nā hōʻailona me:

• ʻEha ʻeha
• Nā wāwae anuanu a mau wāwae paha
• Pōpō a maule paha
• Hoʻoemi i ka hiki ke hoʻoikaika kino
• Ka holomua ʻole ʻana
• Pākuʻi ka wāwae me ka hoʻoikaika kino
• Nosebleed
• Piʻi maikaʻi ʻole
• Uku poʻo ʻeha
• Pokole o ka hanu

ʻAʻohe paha ʻōuli.

E hana ka mea mālama ola i kahi hoʻokolohua kino a nānā i ke kahe o ke koko a me ka pulse i nā lima a me nā wāwae.

• E palupalu ka lāʻau i ka ʻūlū (femoral) a i ʻole nā ​​wāwae ma mua o ka lāʻau i loko o nā lima a i ʻole ʻāʻī (carotid). I kekahi manawa, ʻaʻole paha e ʻike ʻia ka puʻuwai wahine.
• ʻO ke kahe o ke koko i nā wāwae he ʻoi aku ka nāwaliwali ma mua o nā lima. ʻOi aku ke kiʻekiʻe o ke kaomi koko i nā lima ma hope o ka wā pēpē.

E hoʻohana ka mea hāʻawi i kahi stethoscope e hoʻolohe i ka puʻuwai a nānā i nā ʻōhumu. ʻO ka poʻe me ka coarctation aortic pinepine ka namunamu kani kani hiki ke lohe ʻia ma lalo o ka iwi iwi hema a i ʻole ka hope. Aia pū kekahi mau ʻano ʻōhumu ʻē aʻe.

ʻIke pinepine ʻia ka coarctation i ka wā o ka hōʻike mua a kahi keiki hānau hou a i ʻole kahi hōʻike pēpē maikaʻi. ʻO ka lawe ʻana i ka lāʻau i loko o ka pēpē kahi mea nui ia o ka hōʻike, no ka mea ʻaʻohe paha he hōʻailona ʻē aʻe a hiki i ka nui ʻana o ke keiki.

Hiki i nā hoʻokolohua ke kuhikuhi i kēia ʻano ke:

• ʻO ka catheterization Cardiac a me ka aortography
• Pākuʻi x-ray
• ʻO ka Echocardiography kahi hōʻike maʻamau e ʻike ai i kēia ʻano, a hoʻohana ʻia ʻia paha e nānā i ke kanaka ma hope o ke kaha ʻana
• Pono paha ka CT CT i nā keiki makua
• Pono e MRI a i ʻole MR angiography o ka umauma i nā keiki makua

Hiki ke hoʻohana ʻia i ka ultrasound Doppler a me ka catheterization puʻuwai e ʻike ai inā aia kekahi ʻokoʻa i ke kahe o ke koko ma nā wahi like ʻole o ka aorta.

ʻO ka hapa nui o nā keiki hānau hou me nā ʻōuli e loaʻa i ka pāʻoki ma hope pono o ka hānau ʻana a ma hope koke paha. E loaʻa mua iā lākou nā lāʻau e hoʻokūpaʻa iā lākou.

ʻO nā keiki i ʻike ʻia ke ʻelemakule lākou e pono ke ʻoki. I ka hapanui o nā hihia, ʻaʻole koʻikoʻi nā ʻōuli, no laila hiki ke lawe ʻia i manawa hou aku e hoʻolālā no ke ʻoki kino.

I ka wā o ke kaha ʻana, e hoʻoneʻe a wehe ʻia paha ka ʻāiki o ka aorta.

• Inā liʻiliʻi ka wahi pilikia, e hoʻopili hou ʻia nā wēlau manuahi o ka aorta. Kapa ʻia kēia he anastomosis hopena-a-hope.
• Inā hoʻoneʻe ʻia kahi ʻāpana nui o ke aorta, hiki ke hoʻohana ʻia kahi graft a i ʻole kekahi o nā aʻa ponoʻī o ka mea maʻi e hoʻopiha i ka hakahaka. Hana ʻia ke graft e kahi kanaka a i ʻole kahi cadaver.

I kekahi manawa, e hoʻāʻo nā kauka e hāmama i ka ʻāiki o ka aorta ma o ka hoʻohana ʻana i kahi baluna e hoʻonui ʻia i loko o ke kīʻaha koko. Kapa ʻia kēia ʻano hana he angioplasty balloon. Hana ʻia paha ma kahi o ke kahakaha, akā ʻoi aku ke kiʻekiʻe o ka holo pono ʻole.

Pono nā keiki makua i nā lāʻau e mālama i ke koko kiʻekiʻe ma hope o ke kahakaha ʻana. Pono kekahi i ka mālama ola no kēia pilikia.

Hiki ke hoʻōla ʻia ke kōkō ʻana o ke aorta me ke kaha. ʻOi aku ka maikaʻi o nā ʻōuli ma hope o ke kaha ʻana.

Eia nō naʻe, nui aʻe ka makaʻu no ka make ma muli o nā pilikia puʻuwai i waena o ka poʻe i hoʻoponopono i kā lākou aorta. Paipai ʻia ke alualu ʻana me ke ola holoʻokoʻa me ka cardiologist.

Me ka ʻole o ka lapaʻau ʻana, make ka hapa nui o ka poʻe ma mua o ka makahiki 40. No kēia kumu, koi pinepine nā kauka e ʻokiʻoki ke kanaka ma mua o ka makahiki 10. ʻO ka hapanui o ka manawa, hana ʻia ke ʻoki e hoʻoponopono ai i ka coarctation i ka wā kamaliʻi.

Hiki ke hoʻihoʻi a i ʻole ke kūkaʻa ʻana o ke aʻa ma hope o ke kahakaha ʻana. ʻOi aku paha kēia i ka poʻe i loaʻa i ka ʻokiʻoki ma ke ʻano he keiki hānau.

Nā pilikia i hiki mai ma mua, i ka wā, a i ʻole ma hope koke o ke kaha ʻana.

• Lilo kahi ʻāpana o ka aorta i nui a i ʻole nā ​​pāpale i waho
• Haehae i ka paia o ke aorta
• ʻO ka rupture o ke aorta
• Kahe i ka lolo
• Hoʻomohala mua ʻana i ka maʻi o ke aʻa coronary (CAD)
• Endocarditis (maʻi i loko o ka puʻuwai)
• Hewa puʻuwai
• Hoarseness
• Nā pilikia ʻiʻo
• Lōlō o ka hapalua o ke kino (kahi pilikia laha o ke ʻoki ʻana e hoʻomaikaʻi i ka coarctation)
• Kaumaha kiʻekiʻe loa
• Hahau

ʻO nā pilikia lōʻihi lōʻihi me:

• Hoʻomau a hoʻomau pinepine paha i ka aorta
• Endocarditis
• Piʻi koko kiʻekiʻe

Kāhea i kāu mea hāʻawi inā:

• ʻO ʻoe a ʻo kāu keiki paha he mau ʻōuli o ka coarctation o ka aorta
• Hoʻomohala ʻoe i ka ʻeha a ʻeha paha o ka umauma (ʻo kēia paha nā hōʻailona o kahi pilikia koʻikoʻi)

ʻAʻohe ala i ʻike ʻia e pale ai i kēia maʻi. Eia nō naʻe, ke hoʻomaopopo nei i kāu pilikia e alakaʻi i ka hōʻailona mua a me ka lāʻau.

Hoʻohālikelike aortic

• ʻOki puʻuwai Pediatric - hoʻokuʻu

• Coarctation o ka aorta

Fraser CD, Kane LC. Maʻi maʻi ʻōpū. I: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. ʻO Sabiston Textbook of Surgery: Ke kumu kumu olaola o ka hana ʻoki ʻana o kēia ao. 20 ouk. Piladelapia, PA: Elsevier; 2017: chap 58.

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 Saunders; 2019: chap 75.