ʻOki kino mitral - invasive minimally

ʻO ka ʻoki ʻana o ka mitral valve kahi ʻoki e hoʻoponopono a i ʻole hoʻololi i ka valve mitral i kou puʻuwai.

Kahe ke koko mai nā akemāmā a komo i kahi lumi pumping o ka puʻuwai i kapa ʻia ʻo atrium hema. E kahe ana ke koko i loko o ka lumi pauma hope loa o ka puʻuwai i kapa ʻia ka ventricle hema. Aia ka pahū mitral ma waena o kēia mau keʻena ʻelua. Mālama ia i ka neʻe ʻana o ke koko i mua ma o ka puʻuwai.

Hiki paha iā ʻoe ke ʻoki ma kāu kiwikā mitral inā:

• Hoʻopaʻa ʻia ka pahu mitral (helu ʻia). Pale kēia i ke koko mai ka neʻe ʻana i mua ma o ka nohona.
• Lohe ka valve mitral. Kolo ke kahe o ke koko i hope ke kū kēia.

Hana ʻia ke kahakaha mitral invasive liʻiliʻi ma o nā ʻoki liʻiliʻi. ʻO kekahi ʻano o ka hana, wehe i ka ʻoki ʻana o ka mitral valve, koi i kahi ʻoki nui.

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

E hiamoe ʻoe a ʻaʻohe ʻeha.

Nui a hewahewa nā ala like ʻole e hana ai i ke kaha ʻana o ka mitral invasive liʻiliʻi loa.

• Hiki paha i kāu mea hōʻeha puʻuwai ke hana i kahi ʻiniha 2 a ʻekolu ʻīniha (5 a 7.5 kenimika) ʻokiʻoki i ka ʻaoʻao ʻākau o kou umauma kokoke i ka sternum (umauma). E māhelehele ʻia nā mākala ma ia wahi. Hāʻawi kēia i ke kauka i ka puʻuwai. Hana ʻia kahi ʻoki liʻiliʻi ma ka ʻaoʻao hema o kou puʻuwai i hiki i ke kaukipō ke hoʻoponopono a hoʻololi paha i ka nohona mitral.
• I ke kahakaha endoscopic, hana kāu kauka lāʻau iā 1 i 4 mau puka liʻiliʻi i kou umauma. Hana ʻia ke kaha ma o nā ʻoki e hoʻohana ana i kahi kāmela a me nā pono hana ʻoki kūikawā. No ka ʻoki poepoe i kōkua ʻia me ka lopako, hana ke kauka iā 2 a i ʻehā mau ʻoki liʻiliʻi i kou umauma. ʻO nā ʻoki ma kahi o 1/2 a 3/4 ʻīniha (1.5 a 2 kenimika) o kēlā me kēia. 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 mitral kiwila ma ke kamepiula i ka lumi hana.

Pono ʻoe i mīkini mīkini puʻuwai no kēia ʻano ʻoki. E hoʻopili ʻoe i kēia hāmeʻa ma o nā ʻoki liʻiliʻi o ke aʻa a i ʻole ma ka umauma.

Inā hiki i kāu kauka lāʻau ke hoʻoponopono i kāu kiwikā mitral, loaʻa iā ʻoe:

• Annuloplasty ke komo lima - Hoʻopili ke kauka i ka nohona ma o ka humuhumu ʻana i ke apo o ka hao, ka lole, a i ʻole nā ​​mea a puni ka nohona.
• Hoʻoponopono Valve - Hoʻokiʻoki ke kahu lāʻau, nā kinona, a kūkulu hou i hoʻokahi a i ʻole o nā pale i hāmama a pani i ka puka.

Pono ʻoe i kahi kiwikā hou inā nui ka nui o nā pōʻino i kāu kiwikā mitral. Kāhea ʻia kēia mea he keʻoki pani. Hiki i kāu kaukoki ke kāʻili i kekahi a i ʻole o kāu āpau mitral 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 titanium a me carbon. ʻO ka lōʻihi loa o kēia mau valves. Pono ʻoe e ʻai i ka lāʻau lapaʻau koko, e like me warfarin (Coumadin), no ke koena o kou ola.
• ʻO Biological - Hana ʻia i ke kino kanaka a holoholona paha. He 10 a 15 mau makahiki paha a keu paha ka lōʻihi o kēia mau valves, akā ʻaʻole paha ʻoe e pono e lawe i nā mea lahilahi no ke ola.

Hiki ke ʻokiʻoki i 2 a 4 mau hola.

Hiki ke hana i kēia ʻoki ʻana i kekahi manawa ma o ke aʻa koko, me ka ʻoki ʻole o kou umauma. Hoʻouna ke kauka i kahi catheter (Tube Tube) me kahi pāluna i hoʻopili ʻia ma ka hopena. Hoʻoulu ka pāluna e hoʻolōʻihi i ka wehe o ka puka. Kapa ʻia kēia kaʻina hana i ka valvuloplasty percutaneus a hana ʻia no kahi kiwikā mitral i ālai ʻia.

ʻO ke kaʻina hana hou e pili ana i ke kau ʻana i ka catheter ma o ka aʻa o ke aʻa a me ka ʻoki ʻana i ka pahu i mea e pale ʻole ai ka paipu.

Pono ʻoe i ke ʻoki inā ʻaʻole holo pono kāu valve mitral no ka mea:

• Loaʻa iā ʻoe ka registitation mitral - Ke pani ʻole ka valve mitral i nā ala āpau a ʻae i ke kō e hoʻi hou i ke atria hema.
• Loaʻa iā ʻoe kahi stenosis mitral - Ke wehe ʻole kahi kīwī mitral a hoʻopaʻa i ke kahe o ke koko.
• Ua hoʻomohala ʻia kāu kiwikā i kahi maʻi (endocarditis infectious).
• Loaʻa iā ʻoe ka prolaps valve mitral koʻikoʻi i kāohi ʻole ʻia me ka lāʻau.

Hiki ke hana ʻia i kahi ʻoki hōʻoki liʻiliʻi no kēia mau kumu:

• ʻO nā loli i kāu kiwikā mitral ke kumu nei i nā ʻōuli nui o ka puʻuwai, e like me ka hanu ʻana, ka pehu ʻana o ka wāwae, a i ʻole ka puʻuwai puʻuwai.
• Hōʻike nā hoʻokolohua ke hoʻomaka nei nā loli i kāu kiwikā mitral e hōʻeha i kāu hana puʻuwai.
• Poino i kou kiwikā puʻuwai mai ka maʻi (endocarditis).

ʻO ke kaʻina hana invasive minimally he nui nā keu. Aia ka liʻiliʻi o ka ʻeha, ke kahe o ke koko, a me ka makaʻu o ka maʻi. E ola wikiwiki nō hoʻi ʻoe ma mua o ke kahakaha puʻuwai hāmama. Eia nō naʻe, ʻaʻole hiki i kekahi poʻe ke loaʻa i kēia ʻano hana.

Hiki ke hana ʻia i nā valvuloplasty Percutaneile i ka poʻe maʻi nui a ʻaʻohe anesthesia. ʻAʻole lōʻihi nā hopena o kēia kaʻina hana.

ʻO nā pōʻino no kēlā me kēia ʻoki kino:

• Hoʻopaʻa ke koko i nā wāwae e hele paha i nā akemāmā
• Lilo ke koko
• 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

ʻOi aku ka nui o nā pōpilikia o nā ʻōnaehana hōʻoki minimally ma mua o ke kaha ākea.ʻO nā pilikia i hiki ke hōʻemi ʻia mai ke kaha ʻana o ke kiwikā liʻiliʻi.

• 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
• ʻO ke kuʻi puʻuwai ʻole e pono e mālama ʻia me nā lāʻau a i ʻole ka mea mālama maʻi
• Hewa ʻole nā ​​hakuʻala
• Hoʻōla maikaʻi ʻole i nā ʻeha

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.

Inā puhi ʻoe, pono ʻoe e hoʻokū. E noi i kāu mea hāʻawi mai i kōkua.

I nā lā ma mua o kou ʻoki kino:

• No ka manawa hebedoma 1 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 kēia mau lāʻau e laʻa me 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.
• E nīnau i nā lāʻau āu e lawe ai i ka lā o kou ʻoki ʻana.
• 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 ke kaha:

• 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.

Manaʻo e lilo 3 a 5 mau lā i ka haukapila ma hope o ke kaha ʻana. E ala ʻoe i loko o ka hale mālama nui (ICU) a ola ma laila no 1 a i ʻole 2 mau lā. E nānā pono nā kahu hānai i nā mea nānā e hōʻike i kāu mau hōʻailona koʻikoʻi (pulse, ka mahana, a me ka hanu).

ʻElua a ʻekolu paha mau paipu i loko o kou umauma e hoʻokahe i ka wai mai a puni kou puʻuwai. Lawe pinepine ʻia lākou 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. Hiki paha iā ʻoe ke loaʻa i nā laina intravenous (IV) e loaʻa ai nā wai.

E hele ʻoe mai ka ICU a i kahi lumi hōkele maʻamau. E kiaʻi ʻia kou puʻuwai a me nā hōʻailona koʻikoʻi a mākaukau ʻoe e hoʻi i ka home. E loaʻa iā ʻoe ka lāʻau ʻeha no ka ʻeha ma kou umauma.

E kōkua kāu kahu hānai i ka hoʻomaka ʻana o ka hana. E hoʻomaka paha ʻoe i kahi papahana e hoʻoikaika i kou puʻuwai a me kou kino.

Hoʻokomo ʻia kahi pacemaker i loko o kou puʻuwai inā lohi loa kāu puʻuwai ma hope o ke kahakaha ʻana. He manawa pōkole paha kēia a pono paha ʻoe i pacemaker mau ma mua o kou haʻalele ʻana i ka haukapila.

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 o ke kahe o ke koko, akā kūleʻa ʻole i kahi manawa lōʻihi.

ʻO nā hopena o ka hoʻoponopono mitral valve maikaʻi loa. No nā hopena maikaʻi loa, koho e hana i kahi ʻoki ma ke kikowaena e hana i kēia mau kaʻina hana. Ua hoʻomaikaʻi maikaʻi loa ke kīpoki puʻuwai invasive liʻiliʻi i nā makahiki i hala iho nei. Palekana kēia mau loea no ka hapa nui o ka poʻe, a hiki ke hoʻemi i ka manawa hoʻōla a me ka ʻeha.

Hoʻoponopono i ka nohona kiwikā - pono mini-thoracotomy; Hoʻoponopono i nā kiwikā Mitral - sternotomy ma luna a ma lalo paha; Hoʻoponopono kōkua kōkua endoscopic Robotically-kōkua; ʻO valvuloplasty mitral liʻiliʻi

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

ʻO Bajwa G, ʻo Mihaljevic T. Hoʻokiʻoki liʻiliʻi mitral invasive: he hoʻokokoke ʻana sternotomy. I: Sellke FW, Ruel M, eds. ʻO Atlas o nā hana ʻoki lāʻau Cardiac. ʻElua ed. Piladelapia, PA: Elsevier; 2019: chap 20.

ʻO Goldstone AB, Woo YJ. Lapaʻau lapaʻau o ka mitral kiwikā. I: Sellke FW, del Nido PJ, Swanson SJ, eds. ʻO Sabiston lāua ʻo Spencer Surgery o ka umauma. 9th ed. Piladelapia, PA: Elsevier; 2016: chap 80.

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.

ʻO Thomas JD, Bonow RO. Maʻi maʻi mitral. 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 69.