Maganin Stenosis na Pulmonary

Kiyasta lokacin karantawa: 8 minti daya

Idan ya dace, PBV (BVP/Balloon valvuloplasty), Jiyya na farko don stenosis pulmonic (PS) An yarda da shi azaman dabara. Yaduwar wannan fasaha ta duniya ta haifar da mutuwar karnuka da yawa tare da PS. ya karu sosai tsawon rai.

Bugu da ƙari, godiya ga ci gaba da ci gaba da kayan aikin da aka yi amfani da su, wannan hanyar ita ce yanzu Karnuka masu nauyin kasa da 2 kg ko Cats Ya zama mai amfani ga gungun marasa lafiya da yawa, kamar Hanya ce mai sauri, aminci da nasara sosai lokacin da ƙwararrun likitocin suka yi..

Restenosis (sake raguwa)yana faruwa a ƙasa da kashi 20% na lamuran da aka yi magani. A irin wadannan marasa lafiya, An tabbatar da hanyar PBV ta biyu mai aminci da inganciSakamakon jiyya ya dogara ba kawai akan tsananin stenosis ba amma har ma siffofi na morphological na na'urar bawul na huhu kuma ya dogara.

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Alamomi da Pre-Procedure Evaluation

Sharuɗɗan Aikace-aikacen BPV

Mafi mahimmancin ma'auni na ƙayyade wajibcin BPV shine, matsakaicin gradient na huhu shine darajar.

• Nazarin da aka gudanar, matsakaicin gradient na huhu fiye da 60 mmHg da marasa lafiya marasa lafiya, masu alaƙa da cututtuka hadarin tasowa bayyanar cututtuka na asibiti tare da, tsawon rai ya ragu ya nuna.

•Saboda, dabbobi tare da matsakaicin matsakaicin girma fiye da 60 mmHg, koda kuwa asymptomatic ne ana la'akari da hadarin. A cikin waɗannan marasa lafiya, don hana haɓakar ventricular dama da gazawa, don hana bayyanar cututtuka na asibiti da kuma tsawaita rayuwa Ana ba da shawarar sa baki da wuri sosai.

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Sharuɗɗan Nasara

• Rage madaidaicin gradient na huhu da 50%, gabaɗaya ana ɗaukar ma'amala mai nasara.

• A cikin marasa lafiya da high preoperative gradient, wannan raguwar na iya zama mai bayyanawa.

• Wannan raguwa, kai tsaye alaka da canji a cikin stenotic bawul yankin.

• Nau'in A PS marasa lafiya, ita ce ƙungiyar da ke ba da mafi kyawun amsa tare da annulus na al'ada da fused da ɗan kauri kaɗan.

• Nau'in B PS marasa lafiya Ba shi da ƙarancin amsawa ga BPV saboda annulus na hypoplastic da alamun bawul masu kauri.

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Zaɓin Balloon da Ma'aunin Annulus

Aunawa annulus na huhuyana da mahimmanci don tabbatar da daidaiton diamita na balloon.

• Rabon Balloon-Annulus: Rabon diamita na balloon zuwa diamita annulus yawanci 1.3 zuwa 1.5 Wannan rabo ya kamata ya kasance tsakanin yana ba da ingantaccen buɗewa na yankin murfi.

• Dabarun Aunawa:

• Transthoracic echocardiography (TTE)ana amfani dashi don auna diamita na annulus, amma a cikin karnuka masu zurfin ƙirji wannan ma'aunin diamita na annulus ya bayyana karami fiye da yadda yake me zai iya zama.

• Saboda haka, a lokacin hanya. 2D ko 3D transesophageal echocardiography (TEE) ko angiography Ana bada shawara don maimaita ma'auni tare da .

• Angiography, yana ba da damar mafi kyawun kimantawa game da ilimin halittar jini na arteries na huhu.

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Nagartattun Dabaru

• Dabarun Balloon Biyu:

• A cikin marasa lafiya tare da diamita na annulus na huhu na ≥20 mm amfani.

• Wannan dabara tana ba da damar buɗe sararin valvular mafi girma.

• Shuka stent:

• Nau'in B PS a cikin marasa lafiya, hypoplastic annulus ve leaflets na farko An san BPV baya tasiri a lokuta inda

• A irin wannan yanayi, sanya stent ta hanyar annulus na huhu shawarar. Wannan hanyar ita ce har abada yana faɗaɗa yankin stenotic ve yana ƙara ƙarar bugun jini na dama.

• Wannan tsari, huhu regurgitation Koyaya, ventricle na dama yawanci yana jure wa wannan yanayin.

• A cikin dogon lokaci, juzu'in ventricle na dama kuma wasu rashin aiki na iya tasowa.

• A madadin, jeri na bawul stent Koyaya, irin waɗannan na'urori a halin yanzu ana amfani dasu kawai a cikin marasa lafiya na ɗan adam kuma kawai a cikin manyan karnuka girman mai amfani ne. Duk da haka, saurin ci gaba a fasaha, yana nuna cewa nan ba da jimawa ba za a iya samun waɗannan na'urori cikin ƙananan girma kuma.

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Nau'ikan Stenosis na Musamman

• Hourglass stenosis:

• A cikin irin wannan nau'in stenosis. daidai gwargwado na annulus diamitashi ne abin da ke ƙayyade diamita na balloon.

• Diamita na kunkuntar yanki, ba abu ne mai ƙima ba a zaɓin diamita na balloon.

• Diamita na rassan jijiya na huhu, ana iya bincika tare da TTE, amma don ƙarin ma'auni daidai zabin angiography shawarar.

• Hypoplasia na jijiyoyin bugun jini:

• Matsalolin prognostic mara kyau Ana la'akari.

• A wasu lokuta, segmental stenosis idan akwai endovascular stent za a iya sanyawa.

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Ƙimar Ƙarfafawa

• Ƙimar fasalin jiki da na aiki yana da mahimmanci.

• Tsayi mai ƙarfi, Gabaɗaya beta blockers amsa da kyau.

• Idan wani gagarumin stenosis na subvalvular outflow fili idan haka ne, a wannan yanayin, patch graft tiyata ko Dama ventricular outflow fili jeri stent jeri Waɗannan hanyoyin sun fi tasiri fiye da BPV.

• Subvalvular zobe toshewaya kamata a yi la'akari da hankali tare da launi Doppler.

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Cutar cututtuka

• Nau'in R2A anomaly na jijiyoyin jini, don BPV wani dangi contraindications Ana la'akari.

• Wannan rashin hankali, ta hanyar matsewar jijiyoyin bugun jini na gefen hagu na iya haifar da rikitarwa kwatsam.

• A irin wannan yanayi, tare da ƙananan balloon-to-annulus rabo Ana iya ba da shawarar rigakafin valvuloplasty. Duk da haka, tasirin wannan hanya yana da iyakacin iyaka, kuma restenosis na kowa.

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Ragewar Zuciya

• Nagewar hagu na cranial vena cava (PLCC)Anomaly ne na jijiyoyin jini akai-akai hade da PS.

• Wannan jijiya yawanci located tare da dama cranial vena cava.

• Wannan jirgin ruwa mara kyau yana magudawa zuwa cikin atrium na dama ta hanyar sinus na jijiyoyin jini, amma baya haifar da canji a wurare dabam dabam.

• Kasancewar PLCC, musamman hanyoyin shiga tsakani da za a yi ta jijiyar jugular hagu dole ne a ƙayyade tukuna.

• Echocardiography lokacin, kara girman sinus na jijiyoyin jini Ana iya zargin kasancewar PLCC.

• Don tabbatar da PLCC, lissafta tomography (CT) ko bambanci echocardiography za a iya bincika tare da.

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Kimanta Ayyukan Haihuwar Dama

A cikin kimantawa kafin tsari, Dole ne a bincika aikin ventricular na dama.

• Auna ma'auni da sigogin aikiyana ba da bayani game da aikin ventricle na dama.

• TAPSE (Tarcuspid annular jirgin systolic balaguro), peak S' gudun ve auna nakasar tsayin daka (danniya). Sigogi irin su ana tantance su.

• Mai tsanani hypertrophy idan akwai raguwar ventricular dama raguwa na radial yana taka muhimmiyar rawa.

• Girman ventricle na dama, dilation na tricuspid annulus, ƙananan saurin gudu ve dadewar lokacin fitarwa, rage aikin systolic nuna.

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• A cikin dabbobi tare da matsakaicin matsakaicin sama da 60 mmHg, ana bada shawarar sa baki da wuri.

• Ƙayyade madaidaicin diamita na balloon yana da mahimmanci ga nasara.

• Hypoplasia na jijiyoyin bugun jini ve R2A ciwon zuciya Yanayi na musamman irin waɗannan suna haifar da ƙarin ƙalubale ga BPV.

• Haɓaka fasaha na iya ba da damar aiwatar da tsarin akan ƙananan dabbobi.

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Ƙimar Bayan Yin aiki

Marasa lafiya waɗanda suka yi aikin BPV (Balloon Pulmonic Valvuloplasty), nan da nan bayan hanya sai me A watanni 1, 6 da 12 yakamata a tantance. Bayan wannan lokaci, haɗarin restenosis yana raguwa sosai ve gyare-gyaren baya a cikin ventricle na dama (RV) ya kusan kammala.

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Duba Tsarin Farko na Farko (Nan da nan Bayan)

• Canje-canjen Rufin Tsarin: A cikin kima na farko. canje-canje a tsarin bawul ve canje-canje a cikin girma da motsi na ɗakunan zuciya abin lura.

• Rage Fusion na Leaflets Valve: Bayan an yi nasarar dilatation. raguwa a cikin digiri na fusion na bawul leaflets iya ganewa.

• Edema a Gefen Leaflet: A wasu marasa lafiya, matsananciyar rauni na balloon dangane da, gagarumin edema da kauri na gefuna na leaflet na iya faruwa.

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Canje-canje na Hemodynamic

• Ingantawa a cikin Gudun Anterograde: Ingantawa a buɗe bawul, ƙarar diastolic ventricle na hagu haddasawa.

• Hannun Hannun Dama na iya zama Hyperkinetic: Nan da nan bayan hanya, Dama ventricular (RV) hyperkinetic kuma wannan na iya zama, gagarumin toshewar hanyar fita mai ƙarfi me zai iya zama.

• Wannan m sabon abu, Gabaɗaya Yana warware ba zato ba tsammani a cikin sa'o'i 24 na farko..

• A cikin Marasa lafiya Masu Karɓan Magungunan Beta-Blocker: irin wadannan jihohin hyperkinetic, Yana da wuya a cikin marasa lafiya da ke shan beta-blockers..

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Bin Dogon Tsawon Lokaci (Kimanin Watanni 1, 6, da 12)

• Kiyaye Ragewa a Matsakaicin Gradient:

• An samu a farkon kimantawa saukowa gradient, gabaɗaya ana kiyaye shi na dogon lokaci.

• Saboda haka, a cikin bincike na gaba. ya kamata a yi ma'auni na gradient kuma yakamata a sanya ido akan kowane karuwa.

• Juya Gyaran Halin Halin Dama na Dama:

• A cikin marasa lafiya tare da raguwa mai mahimmanci a cikin gradient, cikin lokaci sannu a hankali juyewar hawan jini na dama abin lura.

• Wannan yana bayyana azaman raguwa a kaurin bangon ventricular dama, yana nuna ingantaccen aikin ventricular na dama.

Bayan BPV, marasa lafiya saka idanu na yau da kullun da kimantawa yana da mahimmanci.

• Dubawa na farko, nan da nan bayan hanya ana yi sannan A watanni 1, 6 da 12 ana binsa.

• Kiyaye saukar gradient ve jujjuyawar hypertrophy na ventricular damasune mafi mahimmancin alamomin nasarar ciniki.

• Hyperkinetic yanayin ventricle na dama, yawanci yana warwarewa a cikin sa'o'i 24 da wannan yanayin da wuya a cikin marasa lafiya da ke shan beta-blockers.

• Hadarin restenosisBayan wata na 12, yana da ƙasa sosai kuma ventricle na dama yana kammala aikin gyaran sa.

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Wasu Labarun Kuna iya Sha'awarsu

• Tsarin Jarrabawar Zuciyar ku
• Rufe Patent Ductus Arteriosus (PDA)
• TEER Mitral Valve Gyara (V-Clamp)
• Huhun Stenosis
• Mai Saitin Irish (Jan Saitin Irish)

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"Kada ku ji tsoron hargitsi, domin ana haihuwar taurari a lokacin hargitsi."

Charlie Chaplin

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