ʻOki kino Aortic - invasive minimally

Kahe ke koko mai kou puʻuwai a i loko o kahi kīʻaha koko nui i kapa ʻia ʻo aorta. Hoʻokaʻawale ka valve aortic i ka puʻuwai a me ke aorta. Wehe ka kiwikā aortic i hiki i ke kahe ke kahe i waho. Pani ia no ka mālama ʻana i ke koko mai ka hoʻi ʻana i ka puʻuwai.

Pono ʻoe i kahi ʻoki aorta aorta e hoʻololi i ka kiwikā aortic i loko o kou puʻuwai inā:

• ʻAʻole pani paʻa kāu kōwaha aortic i nā ala āpau, no laila kahe hou ke koko i loko o ka puʻuwai. Kapa ʻia kēia a regurgitation aortic.
• ʻAʻole wehe hāmama kāu ākea aorta, no laila e hoʻemi ʻia ke kahe o ke koko mai ka puʻuwai. Kapa ʻia kēia aortic stenosis.

Hiki ke pani i ka kiwikā aortic i ka hoʻohana ʻana:

• ʻO ke kahakaha kiwikā liʻiliʻi hoʻōla liʻiliʻi, hana ʻia me ka hoʻohana ʻana i hoʻokahi a ʻoi paha o nā ʻoki liʻiliʻi
• Wehe i ke kīpoki aorta pani, hana ʻia i kahi ʻoki nui i kou umauma

Ma mua o kou ʻoki ʻana, e loaʻa iā ʻoe ka anesthesia ākea.

E hiamoe ʻoe a ʻaʻohe ʻeha.

Nui a hewahewa nā ala e hana ai i ke kahakaha kiwikā aortic invasive minimally invasive. Loaʻa i nā ʻenehana nā min-thoracotomy, min-sternotomy, ʻoki lāʻau i kōkua ʻia e ka lopako, a me ke ʻoki perkutaneus. E hana i nā kaʻina hana ʻokoʻa:

• Hiki paha i kāu kaukipoki ke hana i kahi ʻiniha 2 a 3 ʻīniha (5 a 7.6 kenimika) ʻokiʻoki i ka ʻaoʻao ʻākau o kou umauma kokoke i ka sternum (ka umauma). E māhelehele ʻia nā mākala ma ia wahi. Hāʻawi kēia i ke kauka i ka puʻuwai a me ka aorta.
• Hiki i kāu kaukipoki ke mahele wale i ka hapa luna o kou iwi iwi, a ʻae ʻia i ka pewa aorta.
• No ka ʻoki poepoe i kōkua ʻia me ka lopako, hana ke kauka iā 2 a i ʻehā mau ʻoki liʻiliʻi i kou umauma. Hoʻohana ka lāʻau lapaʻau i kahi kamepiula kūikawā e kāohi i nā lima robotic i ka wā o ke ʻoki. Hōʻike ʻia kahi nānā 3D o ka puʻuwai a me ka aorta ma ka kamepiula i loko o ka lumi lumi.

Pono paha ʻoe ma ka mīkini puʻuwai puʻuwai no kēia mau hana āpau.

Ke hōʻino loa ke kiwikā aortic no ka hoʻoponopono hou ʻana, hoʻokomo ʻia kahi kiwikā i kahi. E lawe aku kāu kauka lāʻau i kāu kiwikā aortic a humuhumu i kahi hou i kahi. Aia he ʻano nui ʻelua o nā kiwikā hou:

• Mīkini, hana ʻia i nā mea i hana ʻia e ke kanaka, e like me ka titanium a i ʻole ke kalapona. ʻO ka lōʻihi loa o kēia mau valves. Pono ʻoe e lawe i nā lāʻau lapaʻau koko, e like me warfarin (Coumadin), no ke koena o kou ola inā loaʻa iā ʻoe kēia ʻano kiwikā.
• ʻO Biological, i hana ʻia e nā kānaka a holoholona paha. He 10 a 20 mau makahiki paha ka lōʻihi o kēia mau valves, akā ʻaʻole pono ʻoe e lawe i nā mea lahilahi no ke ola.

ʻO kekahi ʻenehana kahi transcatheter aortic valve replacement (TAVR). Hiki ke hana i ke kahakaha kiwikā ʻo TAVR ma o kahi incision liʻiliʻi i hana ʻia i ke ana a me ka umauma hema. Hoʻoholo ʻia ka pahu pani i loko o ke kīʻaha koko a i ʻole ka puʻuwai a neʻe i luna i ka nohona aorta. He baluna kā ka catheter ma ka hopena. Hoʻonui ʻia ka pāluna e hoʻonui i ka wehe o ka puka. Kapa ʻia kēia hana he valvuloplasty percutaneile a ʻae ʻia e waiho i kahi kiwikā hou i kēia wahi. Hoʻouna ka mea hoʻopukapuka i kahi catheter me kahi kiwikā paʻa a hoʻokaʻawale i ka nohona kiwikā e lawe i ka wahi o ke kiwikā aortic i hōʻino ʻia. Hoʻohana ʻia kahi kiwikā olaola no TAVR. ʻAʻole pono ʻoe e noho ma ka mīkini puʻuwai puʻuwai no kēia kaʻina hana.

I kekahi mau hihia, loaʻa iā ʻoe ke kīpoki bypass coronary (CABG), a i ʻole ke ʻoki e pani i kahi ʻāpana o ka aorta i ka manawa like.

Ke hana nei ke kiʻikuhi hou, e hana kāu mea kauka.

• Pani i ka ʻoki liʻiliʻi i kou puʻuwai a aorta paha
• E kau i nā catheters (nā paipu maʻalahi) a puni kou puʻuwai e hoʻokahe i nā wai e kūkulu
• Pani i ka ʻokiʻoki i loko o kou mauʻiʻo a me kou ʻili

Hiki ke ʻoki kino i 3 a 6 mau hola, akā naʻe, ʻoi aku ka pōkole o kahi kaʻina TAVR.

Hana ʻia ke kahakaha kiwikā Aortic inā ʻaʻole holo pono ka valve. Hana ʻia ke kaha no kēia mau kumu:

• ʻO nā loli i kāu kiwikā ākea ke kumu nei i nā ʻōuli nui o ka puʻuwai, e like me ka ʻeha o ka umauma, ka pōkole o ka hanu, nā haʻalulu nāwaliwali, a i ʻole nā ​​puʻuwai ʻole.
• Hōʻike nā hōʻike i nā loli i kāu kiwikā aortic e hōʻino ana i ka hana o kou puʻuwai.
• Poino i kou kiwikā puʻuwai mai ka maʻi (endocarditis).

Hiki i ke kaʻina hana hoʻouka minimally ke loaʻa nā keu pono he nui. Aia ka liʻiliʻi o ka ʻeha, ke kahe o ke koko, a me ka makaʻu no ka maʻi. E ola wikiwiki nō hoʻi ʻoe ma mua o ke kahakaha puʻuwai hāmama.

ʻO ka valvuloplasty a me ka catheter-based valve replacement e like me TAVR e hana wale ʻia i ka poʻe maʻi nui a i ʻole ka pilikia nui no ka ʻoki puʻuwai nui. ʻAʻole lōʻihi ka hopena o nā valvuloplasty percutaneus.

Nā pilikia o kekahi ʻoki kino:

• Kahena
• Hoʻopaʻa ke koko i nā wāwae e hele paha i nā akemāmā
• Nā pilikia hanu
• ʻO ka maʻi, e komo pū ana me nā akemāmā, nā puʻupaʻa, ka ʻai, ka umauma, a i ʻole nā ​​kīʻaha puʻuwai
• Nā hopena i nā lāʻau

Hoʻololi nā pilikia ʻē aʻe i ka makahiki o ke kanaka. ʻO kekahi o kēia mau pilikia:

• Ka hōʻino i nā ʻōpala ʻē aʻe, nā aʻa, a iwi paha
• Kaʻi puʻuwai, hahau ʻana, a i ʻole make
• ʻO ka maʻi o ka nohona hou
• Hewa ʻole nā ​​hakuʻala
• ʻO ke kuʻi puʻuwai ʻole e pono e mālama ʻia me nā lāʻau a i ʻole ka mea mālama maʻi
• Hoʻōla maikaʻi ʻole i ka ʻokiʻoki
• Make

E haʻi mau i kāu mea mālama ola:

• Inā ʻoe a hāpai paha
• He aha nā lāʻau āu e lawe nei, a ʻo nā lāʻau paha, nā mea hoʻopili, a i ʻole nā ​​mea kanu āu i kūʻai ai me ka ʻole o ka lāʻau

Hiki paha iā ʻoe ke mālama i ke koko i ka panakō koko no nā transfusions i ka wā a ma hope o kou ʻoki ʻana. E nīnau i kāu mea hāʻawi e pili ana pehea e hāʻawi ai ʻoe a me nā lālā o kou ʻohana i ke koko.

No hoʻokahi pule ma mua o ke kahakaha ʻana, e noi ʻia paha ʻoe e haʻalele i ka lawe ʻana i nā lāʻau e paʻakikī ai i ke kō ʻana o kou koko. Hiki paha i kēia ke hoʻonui i ke kahe i ka wā o ke ʻoki.

• ʻO kekahi o lākou he aspirin, ibuprofen (Advil, Motrin), a me naproxen (Aleve, Naprosyn).
• Inā ʻoe e lawe ana i warfarin (Coumadin) a i ʻole clopidogrel (Plavix), e kamaʻilio me kāu kauka lā ma mua o ke kū a hoʻololi ʻana paha i kāu lawe ʻana i kēia mau lāʻau.

I nā lā ma mua o kou ʻoki kino:

• E nīnau i nā lāʻau āu e lawe ai i ka lā o kou ʻoki ʻana.
• Inā puhi ʻoe, pono ʻoe e hoʻokū. E noi i kāu mea hāʻawi mai i kōkua.
• E hoʻomaopopo mau i kāu mea hāʻawi inā loaʻa ʻoe i ke anu, flu, fever, breakout herpes, a i ʻole nā ​​maʻi ʻē aʻe i ka manawa e kū mua i kāu ʻoki.

E hoʻomākaukau i kou hale no ka wā e hoʻi mai ana ʻoe mai ka haukapila.

E holoi a holoi i kou lauoho i ka lā ma mua o ke ʻoki ʻana. Pono ʻoe e holoi i kou kino ma lalo o kou ʻāʻī me kahi kopa kūikawā. E ʻānai i kou umauma i 2 a i ʻole 3 mau manawa me kēia kopa. E noi ʻia paha ʻoe e lawe i kahi antibiotic e pale aku ai i ka maʻi.

I ka lā o kou ʻoki kino:

• Nonoi ʻia ʻoe ʻaʻole e inu a ʻai paha i kekahi mea ma hope o ke aumoe i ka pō ma mua o kou ʻoki ʻana. Hoʻopili kēia i ka hoʻohana ʻana i ka nau a me nā ʻūlū. E holoi i kou waha me ka wai inā maloʻo. E akahele o ale.
• E lawe i nā lāʻau i kauoha ʻia iā ʻoe e lawe me kahi wahi wai ʻuʻuku.
• E haʻi ʻia ʻoe i ka wā e hōʻea ai i ka haukapila.

Ma hope o kāu hana, lilo ʻoe i 3 a 7 mau lā i ka haukapila. E hoʻolilo ʻoe i ka pō mua ma kahi keʻena mālama nui (ICU). Mālama nā kahu hānai i kou kūlana i nā manawa āpau.

ʻO ka hapanui o ka manawa, hoʻoneʻe ʻia ʻoe i kahi lumi maʻamau a i kahi keʻena mālama hoʻololi i ka haukapila ma waena o 24 mau hola. E hoʻomaka lohi ʻoe i ka hana. E hoʻomaka paha ʻoe i kahi papahana e hoʻoikaika i kou puʻuwai a me kou kino.

ʻElua a ʻekolu paha mau paipu i kou umauma e hoʻokahe i ka wai mai a puni kou puʻuwai. ʻO ka hapanui o ka manawa, lawe ʻia kēia i 1 a 3 mau lā ma hope o ke kaha ʻana.

Loaʻa paha iā ʻoe kahi catheter (Tube Tube) i loko o kāu pēpē e hoʻokahe i ka mimi. Loaʻa paha iā ʻoe nā laina intravenous (IV) no nā wai. E nānā pono nā kahu hānai i nā mea nānā e hōʻike i kāu mau hōʻailona koʻikoʻi (pulse, ka mahana, a me ka hanu). E loaʻa iā ʻoe nā hoʻokolohua koko i kēlā me kēia lā a me nā ECG e hoʻāʻo i kāu hana puʻuwai a hiki i kou wā e hoʻi pono ai i ka home.

Hoʻokomo ʻia kahi pacemaker manawa ʻole i loko o kou puʻuwai inā lohi loa kou puʻuwai ma hope o ke kahakaha ʻana.

Aia a pau i ka home, lawe ka manawa i ke ola. E hoʻomāmā, a hoʻomanawanui me ʻoe iho.

ʻAʻole hāʻule pinepine nā valves puʻuwai mīkini. Eia nō naʻe, hiki i nā kōkō koko ke hoʻomohala ma luna o lākou. Inā kū kahi kōpē koko, loaʻa paha ʻoe i ka maʻi hahau. Hiki ke hele i ke kahe ʻana, akā kākaʻikahi kēia.

ʻO nā valves biological i kahi makaʻu haʻahaʻa no ka huehue o ke koko, akā kūleʻa ʻole i ka holo ʻana o ka manawa. Ua hoʻomaikaʻi maikaʻi ʻia ke kīpoki puʻuwai minamina liʻiliʻi i nā makahiki i hala iho nei. Palekana kēia mau loea no ka hapanui o ka poʻe a hiki ke hōʻemi i ka manawa hou a me ka ʻeha. No nā hualoaʻa maikaʻi loa, koho e loaʻa i kāu ʻoki aorta i kahi kikowaena e hana i kēia mau kaʻina hana.

Mini-thoracotomy aortic pani pani pani a hoʻoponopono paha; ʻOki kino Cardiac; Mini-sternotomy; Robotically-kōkua aortic pani pani pani; Transcatheter aortic pani pani

• Nā lāʻau Antiplatelet - nā mea kūpaka P2Y12
• ʻO ka aspirin a me ka maʻi puʻuwai
• ʻO ke kīpoki puʻuwai puʻuwai - hoʻokuʻu
• ʻOki puʻuwai Pediatric - hoʻokuʻu
• Lawe iā warfarin (Coumadin)

Herrmann 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.

Hoʻokomo ʻo Lamelas J. Minimally invasive, pani mini-thoracotomy aortic pani pani. I: Sellke FW, Ruel M, eds. ʻO Atlas o nā hana ʻoki lāʻau Cardiac. ʻElua ed. Piladelapia, PA: Elsevier; 2019: chap 10.

Reiss GR, Williams MR. ʻO ke kuleana o ke kauka lāʻau ʻōpū. I: Topol EJ, Teirstein PS, eds. Puka o ka Cardiology Interventional. ʻEpekema 7 Piladelapia, PA: Elsevier; 2016: chap 32.

Rosengart TK, Anand J. Loaʻa nā maʻi puʻuwai: valvular. I: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. ʻO Sabiston Textbook of Surgery. 20 ouk. Piladelapia, PA: Elsevier; 2017: chap 60.