Dextrocardia

ʻO Dextrocardia kahi ʻano i kuhikuhi ʻia ka naʻau i ka ʻaoʻao ʻākau o ka umauma. ʻO ka maʻamau, kuhikuhi ka puʻuwai i ka hema. Aia ke ʻano i ka wā hānau (congenital).

I loko o nā pule mua o ka hāpai ʻana, ulu ka puʻuwai o ka pēpē. I kekahi manawa, huli ia e kuhikuhi i ka ʻaoʻao ʻākau o ka pahu ma kahi o ka ʻaoʻao hema. ʻAʻole maopopo nā kumu o kēia.

Aia kekahi mau ʻano dextrocardia. Pili nā ʻano he nui i nā kīnā ʻē aʻe o ka puʻuwai a me ka ʻōpū.

I ke ʻano maʻalahi o ka dextrocardia, he aniani ke ʻano o ka puʻuwai a ʻaʻohe pilikia ʻē aʻe. Kākaʻikahi kēia ʻano. Ke kū kēia, e hoʻonohonoho pinepine ʻia nā mea o ka ʻōpū a me nā māmā i kahi kiʻi aniani. ʻO kahi laʻana, ma ke ʻaoʻao hema ke akepaʻa ma kahi o ka ʻākau.

ʻO kekahi poʻe me ke aniani-kiʻi dextrocardia he pilikia me nā lauoho maikaʻi (cilia) e kānana i ka ea e hele ana i ko lākou ihu a me nā ala ea. Kapa ʻia kēia ʻano ʻo Kartagener Syndrome.

I nā ʻano dextrocardia i ʻike nui ʻia, aia pū kekahi nā kīnā o ka puʻuwai. ʻO ka maʻamau o kēia mau mea:

• Pālua ventricle ʻākau puka (hoʻohui ka aorta i ka ventricle ʻākau ma kahi o ka ventricle hema)
• Hewa endocardial cushion (ʻo nā paia e hoʻokaʻawale ana i nā keʻena 4 āpau o ka puʻuwai e hana maikaʻi ʻole ʻia a hele ʻole paha)
• Pulmonary stenosis (hoʻoliʻiliʻi o ka pulmonary valve) a i ʻole atresia (ʻaʻohe kūpono kūpono ka pulmonary valve)
• Single ventricle (ma kahi o ʻelua ventricle, aia kahi ventricle hoʻokahi)
• Transposition o nā moku nui (ua hoʻololi ʻia ke aorta a me ke aʻa puaʻa)
• Ventricular septal defect (puka i ka paia e hoʻokaʻawale i nā ventricle ʻākau a hema o ka puʻuwai)

ʻO nā ʻōpū a me nā ʻōpū o ka umauma i nā pēpē me ka dextrocardia he mea kūpono ʻole a ʻaʻole holo pono paha. ʻO kahi maʻi koʻikoʻi koʻikoʻi e kū me ka dextrocardia i kapa ʻia heterotaxy. I kēia kūlana, ʻaʻohe o nā mea nui i ko lākou mau wahi maʻamau a ʻaʻole paha e hana pono. ʻO kahi laʻana, nalowale paha ka ʻōpala. ʻO ka pelupelu kahi ʻāpana nui o ka ʻōnaehana pale, no laila ke makaʻu nei nā pēpē i hānau ʻia me ka ʻole o kēia ʻōpū i nā maʻi bacteria a koʻikoʻi a me ka make. I kekahi ʻano o ka heterotaxy, aia kekahi mau spleens liʻiliʻi, akā ʻaʻole holo pono paha lākou.

Hoʻokomo pū ʻia ʻo Heterotaxy:

• ʻŌnaehana gallbladder maoli
• Nā pilikia me nā ake māmā
• Nā pilikia me ka hanana a i ʻole ke kūlana o nā ʻōpū
• Nā kīnā kīnā ʻole
• Nā kūpono ʻole o nā kīʻaha koko

ʻO nā kumuhana kūpono no ka dextrocardia me kahi moʻolelo ʻohana o kēia ʻano.

ʻAʻohe hōʻailona o ka dextrocardia inā maʻamau ka puʻuwai.

Hiki i nā kūlana ke komo pū me dextrocardia ke kumu i kēia mau ʻōuli:

• ʻIli polū
• Hanu paʻakikī
• ʻAʻole e ulu a loaʻa ka kaumaha
• Ka luhi
• Jaundice (ʻili melemele a me nā maka)
• ʻO kaʻili pale (pallor)
• ʻO nā maʻi sinus a i ʻole nā ​​maʻi māmā

E hana ka mea mālama ola i kahi hoʻokolohua kino a nīnau e pili ana i nā ʻōuli.

ʻO nā hoʻokolohua e kuhikuhi ai i ka dextrocardia me:

• Pākuʻi x-ray
• CT scan o ka puʻuwai
• Uila uila
• MRI o ka puʻuwai
• ʻEchocardiogram

ʻO kahi dextrocardia kiʻi aniani piha ʻole me nā puʻuwai puʻuwai e pono ʻole ai kahi lāʻau. He mea nui naʻe, e hoʻomaopopo i ka mea mālama ola o ke keiki ʻike ka puʻuwai ma ka ʻaoʻao ʻākau o ka umauma. Hiki ke lilo kēia ʻike i mea nui i kekahi mau hoʻokolohua a me nā hoʻokolohua.

Pili ke ʻano o ka mālama ʻana i ka pilikia o ka puʻuwai a i ʻole ke kino i ka pēpē me ka dextrocardia.

Inā loaʻa nā kīnā ʻole o ka naʻau me dextrocardia, pono paha ka pēpē e ke ʻoki. ʻO nā pēpē e maʻi nui nei pono e lawe i nā lāʻau i mua o ka hiki ʻana iā lākou ke ʻoki. Kōkua kēia mau lāʻau i ka pēpē e ulu nui aʻe no laila maʻalahi ka hana ʻana i ke ʻoki.

Loaʻa i nā lāʻau:

• Pila wai (diuretics)
• Nā lāʻau i kōkua i ka puʻuwai puʻuwai puʻupuʻu me ka ikaika (inotropic agents)
• Nā lāʻau e hoʻohaʻahaʻa i ke kaomi koko a hoʻomāmā i ka ukana o ka hana ma ka puʻuwai (ACE inhibitors)

Pono paha ka pēpē i ke kaha ʻana e hoʻoponopono i nā pilikia i loko o nā ʻōpū o ka ʻōpū.

Pono nā keiki me Kartagener Syndrome e hana hou me nā lāʻau ʻalopika no nā maʻi sinus.

ʻO nā keiki me kahi spleen nalo a i ʻole pono ʻole e pono ai nā antibiotic wā lōʻihi.

Pono paha nā keiki āpau me nā kīnā o ka puʻuwai e lawe i nā lāʻau ʻaloʻalo ma mua o nā ʻoki ʻana a i ʻole nā ​​mālama niho.

Loaʻa i nā pēpē me ka dextrocardia maʻalahi kahi ola maʻamau a ʻaʻohe pilikia e pili ana i ka wahi o ka puʻuwai.

Ke hōʻike ʻia ka dextrocardia me nā kīnā ʻē aʻe i ka puʻuwai a me nā wahi ʻē aʻe o ke kino, pehea ka maikaʻi o ka pēpē i ka paʻakikī o nā pilikia ʻē aʻe.

Loaʻa pinepine nā maʻi i nā pēpē a me nā keiki me ka ʻala ʻole. Hiki ke pale hapa ʻia kēia me nā antibiotic i kēlā me kēia lā.

Pili nā pilikia ma muli o ka dextrocardia kahi ʻāpana o kahi maʻi nui, a inā he mau pilikia ʻē aʻe i loko o ke kino. Komo pū nā pilikia:

• ʻO nā ʻōpū i ālai ʻia (ma muli o kahi kūlana i kapa ʻia ʻo ka huhū ʻōpū)
• Hewa puʻuwai
• Maʻiʻaʻai (heterotaxy me ka spleen)
• Hoʻokomoʻole i nā kāne (Kartagener Syndrome)
• Pākuʻi hou i hana hou ʻia
• Nā maʻi sinus sinus hou (Kartagener Syndrome)
• Make

Kāhea i kāu mea hāʻawi inā kāu pēpē:

• ʻIke ʻia e loaʻa pinepine i nā maʻi
• ʻAʻole paha e loaʻa ke kaupaona
• Pākuʻi maʻalahi

E ʻimi i ka mālama kūpilikiʻi inā loaʻa i kāu pēpē:

• ʻO kahi kala bluish i ka ʻili
• Hī pilikia
• ʻIli melemele (jaundice)

Hiki paha i kekahi mau syndrome ke komo pū me dextrocardia ke holo i loko o nā ʻohana. Inā loaʻa iā ʻoe ka moʻolelo ʻohana o ka heterotaxy, e kamaʻilio me kāu mea hoʻolako ma mua o ka hāpai ʻana.

ʻAʻohe ala i ʻike ʻia e pale aku ai i ka dextrocardia.Eia nō naʻe, ke hōʻalo nei i ka hoʻohana ʻana i nā lāʻau kū ʻole (keu hoʻi i ka cocaine) ma mua a i ka wā o ka hāpai ʻana e hoʻoliʻiliʻi paha i ka pilikia o kēia pilikia

E kamaʻilio me kāu mea hāʻawi inā loaʻa ka maʻi diabetes. Hiki i kēia ʻano ke hāʻawi i kāu pilikia i ka loaʻa ʻana o kahi keiki me kekahi ʻano dextrocardia.

Maʻi kīnā ʻole Cyanotic - dextrocardia; ʻIno puʻuwai Congenital - dextrocardia; Hema hānau - dextrocardia

• Dextrocardia

Park MK, Salamat M. Chlo localization a me ka naʻau malposition. I: Pākuʻi MK, Salamat M, eds. Park's Pediatric Cardiology no nā mea hoʻomaʻamaʻa. ʻEpekema 7 Piladelapia, PA: Elsevier; 2021: chap 17.

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.