Coarctation le aorta - yintoni na le nto? Coarctation le aorta ebantwaneni

Coarctation le aorta - isifo sentliziyo, nto leyo sikhatshwa licuthe le mithambo benqanawa inkulu emzimbeni womntu. Eneneni, akukho sisifo sentliziyo, njengoko ngezifo yenzelwe ngaphandle imida myocardium. Kakhulu sivame ukuxilongwa coarctation le aorta kwiintsana, nangona ngamanye amaxesha sifo ukubonakala sele kwizigulana abadala. Kaninzi, ngenxa yokugula iyapheliswa yi uqhaqho.

Kakade ke, lo uphethwe akucacanga ngokupheleleyo kwizigulana yaye kubangele ukuba ukothuka. Ngoko ke kufuneka ufunde ngakumbi malunga nokuba yintoni na esi sifo yaye ziintoni ezinobuzaza usenokudibana indoda egulayo.

Coarctation le aorta; yintoni na le nto?

Okokuqala, makhe ukumelana intsingiselo kota. Coarctation le aorta - onesiphene awazalwa enaso, nto leyo sikhatshwa licuthe le aorta. Kwesi sakhiwo wentliziyo izigulane Kuyinto eqhelekileyo. Noko ke, le aorta na isitya likhulu umntu kuchasene igazi ukuhamba kule ndawo echaphazela kakubi umsebenzi kuphela intliziyo kunye nempahla negazi, kodwa yonke eziphilayo.

Njengoko umthetho, isithintelo senziwa kwindawo apho arch aortic udlula kwi inxenye ezantsi. Loo Ipateni explainable, kuba apha kukho exineneyo encinane oluqhelekileyo nokomzimba. Hi ndlela leyi, okokuqala esisifo echazwe Ngo1791 ngu D. Morgagni (sezifo Italian). Ngokutsho kwedatha yeenkcukacha-manani nezihlandlo leengxaki kukuba ukuya kwi-15% of malformations bekhubazekile. Okunye okunika umdla kukuba esi sifo livela emakhwenkweni amaxesha 3-5 kukhangaleka kakhulu izigulane ababhinqileyo.

Eyona eziphambili ze zokugula

Kuxhomekeka kwiimpawu, coarctation le aorta unokuba kweentlobo ezimbini:

• coarctation "abadala" ubonakala ukuvala le mithambo le aorta ngezantsi kwindawo apho isuka ekhohlo umfula subclavian; lo gama kukho yokuvalwa ductus arteriosus;
• uhlobo bobusana leengxaki sikhatshwa hypoplasia le aorta kwindawo enye imvelaphi kwemithambo subclavian, kodwa ukuhamba, kunjalo, uvuliwe.

iimpawu yokwakheka leengxaki

coarctation azalwa le aorta esinxulunyaniswa kunye comorbidities ezahlukeneyo. Kuxhomekeka kule isiphene zingahlulwa zibe ngamaqela amathathu.

Pathology ukuze ngerabha - kule meko azinazo naziphi na iziphene kuphuhliso kwenkqubo sentliziyo. Ngokufuthi, coarctation le aorta ebantwaneni ingadityaniswa nezinye ezimbi - oku kuba kwemithambo, stenosis aortic, isiphako septal phakathi ventricles kunye nomthambo, transposition iimpahla ezinkulu.

Iqela lesithathu - coarctation, apho ukuhamba kwegazi uyabonakala izovela. Kwiimeko ezinjalo, i ngezifo ingaba:

• postduktalnoy (ukuvala ibekwe ngezantsi kwindawo apho isuka lomenzi ductus arteriosus;
• yukstaduktalnoy (coarctation nje ukuvula inqanaba flow);
• preduktalnaya (duct esimbaxa ivula ngezantsi constriction).

Kakade ke, iimpawu ixhomeke kanye kuhlobo kunye iimpawu coarctation.

Zintoni izinto ezibangela vice?

Ngokufuthi iphuhlise coarctation le aorta kwi olungekazalwa. Kutheni le nto isenzeka? Yinto eyaziwayo ukuba ngexesha Palsy kumzimba lo mntwana liyasebenza esimbaxa bile, leyo inxulumanisa aorta kunye pulmonary ekhohlo. Esi sakhiwo efunekayo okwexeshana kuphela. Emva kokuzalwa kunye ekuqaleni iphetha nokuphefumla duct miphungeni.

Kukho ingcamango yokuba esinye isizathu okanye omnye umntwana inxenye encinane esiqwini ye-flow lihamba kungena aorta, ngoko xa uvala bile kule nkqubo ibandakanya kwaye udonga aortic, ekhokelela nokuncipha yayo.

Izizathu yale nkqubo, yeha, engaziwayo. Oosonzululwazi bafumanisa kuphela ukuba esi sifo izigulane ezininzi ezithandwa kunye syndrome chromosomal Turner lowo (ubukho chromosome sex elinye kuphela). Phantse wonke umntwana yeshumi kunye uxilongo kule isiphene ibanjiwe.

Coarctation le aorta (IBC) Akunyanzelekanga ukuba ube naso. Eyaziwa Kwiimeko ezinqabileyo apho vasoconstriction kwenzeka sele umdala. Kwiimeko ezinjalo ebangela coarctation benzakala nangokujaduka aortic atherosclerotic, isifo yokukrala umyalezo engaziwayo iindonga semithambo (Takayasu kaThixo syndrome).

Ukophulwa of coarctation hemodynamic

Kakade ke, isiphumo constriction aortic kwi yonke yegazi, nokuba ngaba ezimbi umlindi ayifumaneki. Ubukho iziphumo coarctation kukwenziwa kolawulo ukuhamba ezimbini ezahlukeneyo.

indawo ukuvala ngaphezu uxinzelelo lwegazi inyuswe, nto leyo ekhokelela ekubeni ukwanda kwale mithambo kwemithambo yegazi. Ngenxa omninzi iSystolic iphuhlise ventricular hypertrophy ngasekhohlo. Kodwa ngaphantsi kwendawo coarctation le meko okwahlukileyo - wehlisa flow kwegazi, uxinzelelo lwegazi uvikivwa. Njengoko umzimba somntwana iyazingenela iindlela zembuyekezo - ukuphuhlisa izitya akananto ezininzi ezibonelela ukuhamba kwegazi bypass.

Xa kufikwa uhlobo omdala isiphako, izigulana baphawula ventricular hypertrophy ngasekhohlo, lwegazi kakhulu, kunye nokwanda elijikeleza umthamo wegazi. Xa coarctation bobusana xa le arteriosus ductus evulekileyo, ezi ukunyhashwa ngasentla alithathwanga ichazwe ngokucacileyo. Kodwa kukho nezinye izinto ezimbi. Ngokomzekelo, xa uhlobo wegazi ngezifo postduktativnom ukusuka aorta phantsi koxinzelelo oluphezulu unikelwa ngqo kwi-pulmonary, nto leyo ekhokelela ukuba ukwanda koxinzelelo izitya ejikeleza miphungeni.

Kuyo nayiphi na imeko kukho ukutyeshelwa ngokunzulu hemodynamics, nto leyo nayiphi na imeko akufuneki ukuba zingahoywa, kuba imiphumo inokuba emibi.

Zeziphi iimpawu zesi sifo ihamba?

Iimpawu coarctation aortic ubukhulu becala kuxhomekeka iqondo licuthe le nqanawa, kwakunye ubukho okanye ukungabikho iziphene ezihamba. coarctation mnene bonke ayikwazi bangaboniswa.

Kwiimeko kakhulu ngakumbi, iimpawu sele ibonakale kunyaka wabo wokuqala bezelwe. Abantwana badla bayahlupheka ukusuka ukudumba imiphunga kunye ukuphinda rhoqo. Abantwana mhlophe ulusu nokuphefumla iingxaki - dyspnea ivela ngexesha esidlweni, imidlalo okanye ukuphumla. Amaxesha amaninzi, abantwana kunye nale kwesifo emzimbeni elicothayo ngaphezu noontanga babo.

Ukrokrela ubukho vice kangangoko kunokwenzeka ngoxa uphulaphule izandi ngentliziyo, kwakunye nokumiselwa ubume kwimikhumbi yegazi kweqondo eliphezulu nengasezantsi. Kwemithambo on nezibaya ulnar zingabonakala ombane yama- nzi, ngoxa kwi ubume femoral ibuthathaka kakhulu.

Xa preduktalnoy coarctation waphawula cyanosis owahlukeneyo - isikhumba lomntwana ngeenyawo iba nombala cyanotic, ngoxa kwesikhumba nakumphezulu umzimba awuthintele umbala yendalo.

Kudla ukuba ngezifo sele unesifo at an ubudala nangaphezulu - baye-isikolo abantwana, elivisayo, abadala. Iimpawu kulo mzekelo ziquka noxinzelelo lwegazi. Izigulane ezikhala ukudinwa, intloko ebuhlungu, isiyezi rhoqo, iintlungu entliziyweni, nokopha nokudinwa. Ngokufuthi umntu bagcine uphuhliso esibi lwe izihlunu umzimba ephezulu nesezantsi ngethuba loviwo. Iimpawu zihlanganisa ubuthathaka imilenze, amahlaba rhoqo, uvakalelo ezinyaweni ezibandayo. Abafazi agcine sexesheni kumjikelo sifo, kwaye maxa wambi ukungachumi.

Coarctation le aorta: isifo

Ukrokrela ubukho vice ugqirha ngoxa uphulaphule entliziyweni izandi. Eminye olwenziwe amanye amanyathelo diagnostic, ezinceda nje kuphela ukumisa ubukho coarctation le fax, kodwa ubone ezinye iziphene ukuze ligqibe ngobungakanani ngokoyiswa nemithambo yegazi:

• Enye indlela elula kakhulu futhi zifikeleleke ke electrocardiogram. Yinto na ubuchule kakhulu ulwazi, ekubeni licuthe eziphakathi malunga aorta le electrocardiogram nomonde ukuze ubukeka eqhelekileyo. Abantwana kunyaka wokuqala wobomi kungabonwa ukubana ahlangene zombane kwentliziyo ngexesha le nkqubo. Le guys abadala sele ukubona iimpawu ventricular hypertrophy ngasekhohlo. Xa izigulane abadala, i-axis zombane intliziyo ishenxiselwe ekhohlo, kwaye maxa wambi kukho i engaphelelanga kuvalwe iindlela ngasekhohlo bundle kwibloko yesebe.
• izigulane zidla emiselweyo phonocardiography. Le nkqubo ikuvumela ukuba abhale izandi intlokoma ezivela umsebenzi iimpahla sentliziyo kunye negazi. Phambi coarctation ukuze uqaphele inzuzo isandi yesibini aorta, kwakunye yimbonakalo bambombozela iSystolic ngasemva kwaye kwisithuba intercostal yesibini kufuphi ngohlangothi kwentamo (ekunene ekhohlo).
• Enengcombolo na ultrasound intliziyo, nto leyo enokukunceda ukubona licuthe le aorta. Kwakhona, i ingcali angabona ukwanda ubunzima entliziyweni. Doppler echocardiography isetyenziselwa ukuchonga iimpawu uphawu ngezifo, ingakumbi, umahluko uxinzelelo lwegazi iinxalenye ngasentla ngezantsi constriction, ubukho iSystolic flow lesiphithiphithi.
• imiphunga Ngaphezu ray nentliziyo. Ngokuqhelekileyo, ubungakanani intliziyo eziqhelekileyo, kodwa wena uya kuqaphela nokongezwa ebalulekileyo aorta inyuka. umzobo pulmonary kungenziwa ngcono kwebhedi esimbaxa, nangona oku waphawula akusoloko.
• Aortography - inkqubo obonelela kokukhutshelwa aorta ye arhente ezikhethekileyo koko, kulandele ngokondela ukusasazwa yayo isitya. Olu phando unako ukugqiba ngokuchanileyo ubungakanani kunye nenqanaba licuthe le aorta.
• catheterization senhliziyo - inkqubo kunokuba nzima. Sekunjalo, ngokuthi unike catheter okukhethekile le mithambo benqanawa ukuba ngokuchanekileyo kulinganiswa uxinzelelo lwegazi.

Kuphela emva kokuba umfanekiso opheleleyo ugqirha ukunika uqikelelo kwaye akhethe iindlela ezifanelekileyo ukuphelisa lo mkhwa.

Ngaba kusafuneka ndenze uqhaqho?

Kuthekani ukuba isigulane wafumana coarctation le aorta? Utyando, Kakade, yeyona ndlela kuphela zokususa ububi. Kodwa isigqibo ukubamba usebenzela kunokwenziwa kuphela amagqirha aziyo kwimbali ntetho clinical.

Kwezinye iimeko (ukuba kukho exineneyo nje kancinane, nto leyo eye phantse akukho alunasiphumo kwi hemodynamics), loo msebenzi akavumelekanga ukuba kufuneka. Le isigulane kuphela wambi kudlule iimviwo.

Ukuba umahluko kuxinzelelo esimbaxa iSystolic le imilenze ephezulu nesezantsi mkhulu kwe-50 mm HG. Art., Oogqirha ukucebisa ukuqhuba etyandwa. Ukuba coarctation aortic kwiintsana kuye kwafunyaniswa, lo msebenzi (likaxakeka) oluqhutywa kwityala izigulane abaselula lwegazi langoku kakhulu kunye decompensation intliziyo. Kwiimeko apho isifo zangaphakath, kunye nomngcipheko eliphezulu ubomi bomntwana ayikho, le nkqubo ukuze elinye ixesha de emihlanu okanye emithandathu ubudala.

unyango zoqhaqho nesifo sentliziyo

Ukuza kuthi ga ngoku, kukho iindlela ezininzi ukuphelisa lo mkhwa. Ukhetho ubuchule ngotyando kuxhomekeke kwimeko yomguli, uhlobo lwe ubukhulu izifo coarctation.

• Kwezinye iimeko, oogqirha benza resection (Ukusikwa) yenxalenye iingqameko le aorta, uze ubunye iziphelo isingxobo, ukusebenzisa anastomosis. Le nkqubo kungenzeka kuphela xa coarctation unalo kangangoko encinane.
• Kwimeko yokuba inxalenye isithintelo inde, abeke anastomosis akwenzeki, esebenzisa afakelweyo. Ngexesha inkqubo ugqirha lususa inxalenye uchaphazelekayo womGaqo-aorta, ebezikuyo emancamini omabini container aba kunye sokwenziwa ekhethekileyo eyenziwe zokwenziwa.
• Aortoplastika - elinye iintlobo ngeentlobo zemisebenzi, kodwa kulo mzekelo ukubuyisela ubude aorta ayisetyenziselwanga sokwenziwa zokwenziwa, njengenxalenye kwemithambo ekhohlo subclavian malunga nesigulane eso.
• Ngamanye amaxesha oogqirha isigqibo tirhisa bypass aortic. Kwiimeko ezinjalo, sokwenziwa zokwenziwa, ogama ezinemiphetho athungwe ngasentla nangasezantsi inxalenye iingqameko benqanawa - oko kudala kwindlela bypass ukuba ukuhamba kwegazi.
• Kukho nenye inkqubo ebizwa ngokuba ibhaloni angioplasty. Kuliwa kwezo meko, ukuba emva kokuba enze ngaphambili utyando walilungisa vasoconstriction. Ngexesha inkqubo, ugqirha ifaka ngokusebenzisa iimpahla peripheral kwi sayo aortic ibhaloni ezizodwa, ogama isithintelo liyalahleka xa dlame. Kwezinye iimeko, umntu stents nzima ezongezelelweyo ekhethekile unabayibambe ubungakanani sayo aortic.

Yiloo nto ukulungiswa eligqibeleleyo ubizwa ngokuba 'coarctation le aorta. " Emva kotyando, umguli, Kakade ke, kukuba ukubambelela izikhokelo ezithile. Ngokukodwa, kufuneka ukuba nidle okulungileyo, kuphephe amandla ngokugqithiseleyo ngokomzimba yokungasebenzi ngokwasemzimbeni, ukuba esweni ngenyameko imeko yempilo bathole rhoqo-ups kule cardiologist khona.

Ziintoni ezinobuzaza xa kunokwenzeka na?

Coarctation le aorta - isifo esiyingozi, nto leyo kuyo nayiphi na imeko akufuneki ngoyaba. Xa ikhosi siphene ezimbi kungakhokelela kubunzima kakhulu yingozi:

• Ngenxa licuthe le nqanawa , izigulane ukuphuhlisa lwegazi kakhulu.
• Ngokufuthi, le siphene intliziyo - coarctation aortic - kwakhona sikhatshwe ekumiseni kwemithambo kunye komsipha kwayo okwalandela.
• Ezinobuzaza ziquka stroke kunye effusion subarachnoid igazi.
• Kwisiqalo kwesi sifo izigulane badla ukuphuhlisa ukusilela intliziyo, nto leyo sikhatshwa ebizwa ngokuba yi-isifuba ezesifuba nokudumba nezengekho miphungeni.
• Licuthe le mithambo aortic luchaphazela olujikeleza lonke. Ngenxa giperenzii enzima kungabangela imithambo ezincinane sezintso.
• Ngamanye amaxesha izigulane ukuphuhlisa endocarditis yebhaktiriya. ingxaki enjalo ngokuqhelekileyo kwenzeka xa kuthe coarctation le aorta lu dityanisiwe ezingaqhelekanga ze ivalve aortic. Ngelishwa, kwiimeko ezininzi, ezi isifo sentliziyo yebhaktiriya abanganyangekiyo antibiotics.

Njengoko ubona, coarctation le aorta abantwana nabantu abadala lunokubulala. Kungenxa yoko le nto diagnosis kubaluleke kangaka ngexesha kunye nonyango ngokwaneleyo.

I-ALS izigulana coarctation

Kakhulu sivame ukuxilongwa coarctation le aorta kwiintsana. Yintoni na uqikelelo kwizigulana abaselula yintoni kufuneka ukuba abazali? Enyanisweni, bonke kuxhomekeke iqondo licuthe imithambo yegazi. Kwezinye iimeko, ngenxa yokugula kufuna ukungenelela yotyando. Ukuba iqondo ngokulinganisela vice, kwanokuba zonke kagqirha izigulane izindululo ubomi iminyaka 30-35 kuphela, yaye unobangela wokufa, njengoko umthetho, oko istroke okanye kwemithambo komsipha.

maxa wambi ukuvala onomoya kufuneka utyando - ugqirha lithethelela kuphela ngamaxesha athile enziwe uvavanyo ukubona iingxaki. Kwiimeko ezinjalo, ubukho nesifo sentliziyo akufane kuchaphazela ixesha lobomi yesigulane.