Coarctation of yeropa - chii ichi? Coarctation pakati yeropa muvana

Coarctation of yeropa - mwoyo chirwere, izvo kubatana aienda pamusoro lumen makurusa mudziyo ari mumuviri womunhu. Kutaura zvazviri, haisi chirwere mumwoyo, sezvo zvokurwara iri mupasi kunze miganhu yacho myocardium. Most kazhinji chirwere coarctation yacho yeropa iri vacheche, kunyange dzimwe nguva maperembudzi dzakaonekwa atova varwere akura. Kakawanda, chirwere panobviswa ne kuvhiyiwa.

Chokwadi, chirwere ichi hachisi zvachose pachena varwere uye chikonzero kuti tidzikame. Saka munofanira kudzidza zvakawanda pamusoro chii chirwere ichi uye chii yematambudziko ungasangana murume airwara.

Coarctation pakati yeropa, chii ichi?

Chokutanga, ngationei kubata zvinoreva izwi. Coarctation of yeropa - a vachiberekwa urema, izvo kubatana aienda pamusoro yeropa. In maumbirwo ichi komoyo varwere zvakajairika. Kunyange zvakadaro, yeropa iri kupfuura mudziyo munhu uye kutyora ropa riyerere munzvimbo ino isakarurama zvarinoita basa kwete chete mwoyo nemidziyo ropa, asiwo yose muviri.

Kazhinji, varambidzwe kudya achiumbwa Panourayirwa kutsemuka chematenga rinopfuura iri pasi chikamu. muenzaniso akadaro explainable, nekuti pano panova chakaipa vasiri aienda. Panzira, nguva yokutanga hosha paakarondedzerwa 1791 ne D. Morgagni (Italian pathologist). Maererano Statistical umboo kakawanda kuti zvokurwara zviri 15% vachiberekwa malformations. Chimwe dzinonakidza Chokwadi ndechokuti chirwere kunoitika munguva vakomana 3-5 nguva kazhinji pane varwere vechikadzi.

The Mhando chikuru zvokurwara

Zvichienderana unhu, coarctation yacho yeropa rinogona mhando mbiri:

• "Adult" coarctation kunoratidzwa kuderedza pamusoro lumen pakati yeropa pazasi pfungwa kwainobva ngaubve kuruboshwe subclavian tsinga; nepo kuvhara zviri ductus arteriosus;
• infantile mhando zvokurwara iri pamwe hypoplasia pakati yeropa panzvimbo yaigara subclavian tsinga, asi zvisinei, kuerera, chinoramba yakazaruka.

Anatomical zviri zvokurwara

Vachiberekwa coarctation pakati yeropa vangava chokuita comorbidities siyana. Zvichienderana kuremara ichi inogona kupatsanurwa muzvikwata zvitatu.

Zvokurwara anogona insulated - muchiitiko ichi isina zvimwe zvikanganiso kukura kumwoyo. Kakawanda, coarctation pakati yeropa muvana anogona chokuita nedzimwe pathologies - ichi vanogona kuva aneurysm, kutsemuka stenosis, septal kuremara pakati ventricles uye atria, transposition midziyo kukuru.

The boka rechitatu - coarctation, umo ropa riyerere iri kuchengetwa kuwanikidza. Muzviitiko zvakadaro, mashoko zvokurwara anogona kuva:

• postduktalnoy (aienda riri pazasi pokuti anoendazve bvumidzwa ductus arteriosus;
• yukstaduktalnoy (coarctation rinongova kuzarura kuerera chechetere);
• preduktalnaya (arterial mutsinga dzinofamba nemukaka anovhura pasi constriction).

Chokwadi, zviratidzo zvikurukuru kunotsamira chaiyo pamusoro mhando uye unhu coarctation.

Chii chinokonzera dzezvakaipa?

Kazhinji anovandudza coarctation pakati yeropa iri mudumbu. Nei izvi zvichiitika? Zvinozivikanwa kuti panguva fetus mumuviri mwana kutoitwa arterial mutsinga dzinofamba nemukaka, iro rinobatanidza yeropa uye rworuboshwe pulmonary tsinga. Chivako ichi chete kudiwa kwechinguva. Aberekwa uye kutanga pulmonary afemeruke mutsinga dzinofamba nemukaka anovhara.

Pane dzidziso kuti chimwe chikonzero kana mumwe mwana muduku chikamu zvinyama zviri kuerera inofamba munzvimbo yeropa, saka kana iwe vanza mutsinga dzinofamba nemukaka pakuitika kunosanganisira uye kutsemuka rusvingo, zvichitungamirira ayo marwadzo.

Zvikonzero izvi, nhamo, asingazivikanwi. Masayendisiti chete akaona kuti hosha kupfuura asingatani varwere chromosomal Turner kwakaita syndrome (kuvapo zvepabonde chromosome imwe chete). Chinenge mwana ose chegumi pamwe nechirwere kuremadza uku dzakaonekwa.

Coarctation pakati yeropa (IBC) hakurevi kuva vachiberekwa. Rizivikanwe zvisingawanzoitiki zviitiko apo vasoconstriction kwakaitika kare vakura. Muzviitiko zvakadaro kunokonzera coarctation vakakuvadzwa uye kutsemuka atherosclerotic maronda, anogumbura chirwere vasingazivikanwi etiology vascular masvingo (Takayasu kuti urwere).

Kutyora hemodynamic coarctation

Chokwadi, kutsemuka constriction zvainoita yose kumwoyo, kunyange kana mushandi zvakaipa havasi kuwanika. Kuvapo coarctation zvabuda pakugadzirwa mbiri dzakasiyana chokubuda neChikomonisiti.

Kuderedza nzvimbo pamusoro BP rwuchiwanzwa, iyo inotungamirira pakuwedzera lumen rwengarava ropa. Nokuda systolic zadzisa hwapedyo rworuboshwe ventricular hypertrophy. Asi pasi nzvimbo coarctation zvinhu ndicho - kufambira ropa aibuda, BP iri ashaye. Sezvo muviri wemwana zvaanopa simba compensatory zvigadziriswe - nekukudziridza vakawanda rubatso midziyo kuti anopa ropa riyerere yokunzvenga.

Kana totaura vakuru mhando kuremara, varwere vakachengeta rworuboshwe ventricular hypertrophy, BP yakakwirira zvikuru, uye kuwedzera achiparadzira rwakapetwa ropa. Kana infantile coarctation apo ari ductus arteriosus rakavhurika, pamusoro apa kutyorwa vasiri zvakajeka kudaro kunorondedzerwa. Asi pane dzimwe pathologies. Somuenzaniso, kana mhando zvokurwara postduktativnom ropa kubva yeropa pasi kumusoro kumanikidzwa uchakumikidzwa zvakananga kupinda pulmonary tsinga iya inosvitsa kuwedzera nevamwe nhumbi pulmonary riparadzirwe.

Chero zvazvingava pane chakakomba pakakuvara hemodynamics, izvo chero zvazvingava havafaniri kungosiyiwa, nokuti migumisiro yacho inogona kuva nemigumisiro.

Chii zviratidzo maperembudzi pamwe?

Zviratidzo kutsemuka coarctation zvikuru kuvimba ukuru aienda pamusoro mudziyo, uyewo kuvapo kana kusavapo concomitant kuremara. Munyoro coarctation zvose hazvigoni kuratidzwa.

Muzviitiko zvakaipisisa, zviratidzo vatova kuoneka mugore upenyu rokutanga. Nendumure vanowanzotambura kubva kuzvimba mapapu uye kugara dzokororo. Vana hapana ganda uye kufema matambudziko - dyspnea sokuti munguva kudya, mitambo kana kunyange zororo. Kazhinji, vana vane chirwere ichi muviri kuva zvishoma nezvishoma pane vezera ravo.

Chifungidziro kuvapo mutevedzeri sezvinobvira apo kuteerera mwoyo mitinhimira, uyewo kutsunga kurova kwemwoyo muropa nemidziyo okumusoro migumo. The arteries pamusoro ulnar pazvirugu zvinogona kuonekwa ripple voltage, panguva femoral kupomba simba chaizvo.

Kana preduktalnoy coarctation vakachengeta heterogeneous cyanosis - ganda hwemwana netsoka inova cyanotic Hue, ukuwo ganda iri repamusoro chikamu muviri kuramba yepanyama ruvara.

It zvinowanzoitika kuti zvokurwara ratova chirwere panguva mukuru zera - vane chikoro-zera vana, kuyaruka, vakuru. Zviratidzo muchiitiko ichi zvinosanganisira kwakawedzera BP. Varwere vanotsutsumwa nokuneta, kutemwa nomusoro, kakawanda dzungu, kurwadziwa mumwoyo, nosebleeds uye kuneta. Kazhinji munhu anogona kuchengeta munhu disproportionate kuvandudzika tsandanyama ose okumusoro muviri panguva kuongorora. Zviratidzo zvinosanganisira utera makumbo, kakawanda chinyamunhari chinorwadza, aikanganiswa tsoka inotonhora. Vakadzi vanogona kuchengeta kuenda kumwedzi chirwere, uye dzimwe nguva kushaya mbereko.

Coarctation pakati yeropa: zvokuongorora

Chifungidziro kuvapo mutevedzeri chiremba apo anogona kuteerera mwoyo kurira. Uyezve vakaperekedza vamwe chirwere matanho, izvo kubatsira kwete chete kuti kumisa pamberi coarctation pamusoro Fax, asi pane dzimwe zvikanganiso uye kuona kukura kwakaita kukundwa kumwoyo:

• Chimwe chezvinhu nyore uye dzive nyore kupinda nzira ndiyo kwemwoyo unonzi, electrocardiograph. Haisi zvikuru anodzidzisa unyanzvi, sezvo usinganyanyi aienda pamusoro yeropa murwere unonzi, electrocardiograph vangatarira zvakakwana chakaipa. Vana mugore upenyu rokutanga zvinogona kuona misha electric akabatana mwoyo panguva nzira. Vakomana vakura kare kuziva zviratidzo rworuboshwe ventricular hypertrophy. In varwere mukuru, yemagetsi akabatana mwoyo iri zvava kuruboshwe, uye dzimwe nguva pane kukwana blockade kuti misa kuruboshwe masumbu bazi.
• Varwere kazhinji ushandiswe phonocardiography. nzira iyi kunoita kuti vanyore mitinhimira uye vibrations kunokonzerwa nebasa mwoyo uye ropa midziyo. In pamberi coarctation ungacherechedza kubiridzira mataurire yeropa wechipiri, uyewo chitarisiko systolic kutsutsumwa shure uye yechipiri intercostal nzvimbo pedyo sternum pamucheto (kurudyi uye kuruboshwe).
• Inodzidzisa ndiyo Ultrasound mwoyo, izvo zvinogona kukubatsira kuona aienda pamusoro yeropa. Uyewo, nyanzvi kuona kuwedzera mumwoyo uremu. Doppler echocardiography rinoshandiswa kuziva maitiro zviratidzo zvokurwara, zvikurukuru, BP kusiyana pazvikamu kumusoro uye pasi constriction, kuvapo kugadzikana systolic kuyerera.
• Uyezve radiography mapapu uye mwoyo. Kazhinji, kukura komoyo kuipa, asi uchaona kuchikosha pakuwedzera vachikwira yeropa. Pulmonary mufanidzo inogona dzinowedzerwa arterial mubhedha, kunyange zvazvo izvi vakachengeta kwete nguva dzose.
• Aortography - muitiro kuti anopa sumo kupinda yeropa munhu anokosha akasiyana mumiriri, zvichiteverwa nokucherechedza kuparadzirwa kwayo pamusoro mudziyo. Kudzidza uku kunogona kuona zvakarurama papi uye pachiyero aienda pamusoro yeropa.
• Cardiac catheterization - a panzvimbo yakaoma muitiro. Kunyange zvakadaro, nokusuma chaiyo anobudisa mushonga zvishoma nezvishoma kunyika lumen ari mudziyo zvinogona zvakarurama kuyerwa BP.

Chete pashure mufananidzo rakakwana chiremba anogona kupa for uye kusarudza zvakakodzera nzira yokubvisa ichi dzezvakaipa.

Ndinofanira kuvhiyiwa?

Zvakadini kana murwere akawanikwa coarctation yacho yeropa? Mukushanda, Chokwadi, ndiyo chete inoshanda yokuparadza zvakaipa. Asi chisarudzo kubata kuvhiyiwa anogona kuitwa chete kuvarapi avo vanoziva nhoroondo uye mharidzo zvekuchipatara.

Mune zvimwe zviitiko (kana paine chete zvishoma aienda, ine zvokuti hapana zvazvinoita hemodynamics), kuvhiyiwa zvirege inodiwa. The murwere chete neapo akapfuura bvunzo.

Kana musiyano systolic arterial aomerwa okumusoro Mbabvu mukuru 50 mm HG. Art., Vanachiremba kakawanda zvinoratidza kuitisa kuvhiya. Kana kutsemuka coarctation mu vacheche kwave nechirwere, kuvhiyiwa (zvashata) iri kuitwa nyaya muvarwere vaduku chipo BP yakakwirira uye cardiac decompensation. Muzviitiko apo chirwere achiri zvakanaka, uye mukuru ngozi upenyu mwana asipo, muitiro anogona kumbosiyiwa makore mashanu kana matanhatu zera kusvikira.

Kuvhiya mabatiro chemwoyo

To musi, pane nzira dzakawanda kubvisa ichi dzezvakaipa. Selection kuvhiya chidobi kunoenderana ezvinhu omurwere, chimiro chirwere uye coarctation saizi.

• Mune zvimwe zviitiko, vanachiremba vanoita resection (excision) ari mugove kujekesa kuti yeropa, uye ipapo kubatanidza kumigumo mudziyo, kushandisa anastomosis. nzira Izvi zvinogoneka chete kana coarctation ane diki pamwero.
• Kuri kuti mutemo mugove hwakareba uye kumanikidza anastomosis hazvibviri, kushandisa prosthesis. Munguva nzira chiremba anobvisa njodzi chikamu yeropa, dzakatsigira miromo miviri mudziyo vari ane prosthesis chaiyo yakagadzirwa chakaita zvokugadzirwa nezvinhu akabatanidzwa.
• Aortoplastika - mumwe siyana remapazi, asi muchiitiko chino kuti kudzorera urefu yeropa haina ashandisa chakaita zvokugadzirwa prosthesis, sezvo chikamu kuruboshwe subclavian tsinga murwere.
• Dzimwe nguva vanachiremba vanosarudza kupedzera kutsemuka yokunzvenga. Muzviitiko zvakadaro, murume chakaita zvokugadzirwa prosthesis, ane micheto vasonanidza pamusoro uye nechepasi mugove kujekesa ari mudziyo - nokudaro kutanga yokunzvenga nzira ropa riyerere.
• Pane imwe nzira inonzi chibharuma angioplasty. Voitakura muna Muzviitiko, kana pashure kare akaita oparesheni chakamukazve chava Sangano vasoconstriction. Munguva nzira, chiremba inoisa kuburikidza midziyo peripheral iri kutsemuka lumen chaiwo chibharuma, ane mutemo nokupera kana inflated. Mune zvimwe zviitiko, mamwe yakatarwa anokosha stents kwakaoma vanobatisisa ukuru kutsemuka lumen.

Ndizvo gwapa kururamiswa anonzi "coarctation yacho yeropa." Pashure pokuvhiyiwa, murwere, Chokwadi, ndiko kuti vanoomerera dzimwe nhungamiro. Zvikurukuru, unofanira kudya zvakanaka, tisanyanyozvidya wenyama nesimba nokusarovedza muviri, kuti kunyatsoongorora kuongorora mamiriro utano uye kumbotambudzika dzose kunoonekwa nachiremba panguva kupinda cardiologist.

Ndezvipi yematambudziko zvinobvira?

Coarctation of yeropa - chirwere ane ngozi, izvo chero zvazvingava havafaniri kungosiyiwa. Kana vanoshorwa kosi kuremara kungaita kuti zviome chaizvo ngozi:

• Nokuda aienda pamusoro mudziyo , varwere zvingamuka BP yakakwirira.
• Kazhinji, mwoyo kuremara ichi - kutsemuka coarctation - uyewo aine paumbwe imwe aneurysm wayo unozotevera atsamwira.
• Matambudziko zvinosanganisirawo sitiroko uye subarachnoid effusion ropa.
• On pakanyorwa chirwere ichi mu varwere kazhinji kuva mwoyo kukundikana, icho pamwe inonzi cardiac asima uye pulmonary edema.
• Kuderedza of kutsemuka lumen kunokanganisa yose vascular hurongwa. Nokuda inorema giperenzii kungaita duku renal arteries.
• Apo neapo varwere kuva kwemabhakitiriya endocarditis. kuomesa kwakadaro kazhinji rikaitika chiitiko kuti coarctation yacho yeropa Rinobatanidzwa ne abnormalities yacho kutsemuka vharuvhu. Zvinosuruvarisa kazhinji, izvi mwoyo chirwere kwemabhakitiriya nemishonga inouraya mabhakitiriya.

Sezvaunogona kuona, coarctation pakati yeropa muvana uye vakuru vanogona kuva kuurayisa. Ndokusaka zvichikosha kuti nenguva chirwere uye zvakakwana kurapa.

The fungidziro varwere vane coarctation

Most kazhinji chirwere coarctation yacho yeropa iri vacheche. Chii riro varwere vaduku uye chii chinofanira vabereki kutarisira? Kutaura zvazviri, zvose zvinoenderana ukuru aienda rwengarava ropa. Mune zvimwe zviitiko, chirwere kunoda pakarepo kuvhiya kupindira. Kana zviri usinganyanyi dhigirii dzezvakaipa, kunyange kana zvose chiremba kunenge varwere kurarama makore 30-35 chete, uye mhaka rufu, somunhu mutemo, ndiwo sitiroko kana aneurysm atsamwira.

Munyoro aienda dzimwe nguva zvinoda kuvhiyiwa - chiremba chete anokurudzira nenguva vanosangana nemiedzo kuziva matambudziko. Muzviitiko zvakadaro, kuvapo mwoyo chirwere kazhinji zvarinoita ya murwere upenyu.