Arterial Switch Operation

Ndani Akufunika Opaleshoni ya Arterial Switch?

ASO zikuwonetsedwa kwa makanda omwe ali ndi Transposition of the Great Arteries (TGA), omwe pafupifupi nthawi zonse amapezeka mu nthawi ya neonatal. 

Zizindikiro za ASO: 

• D-Transposition of Great Arteries (d-TGA)
• TGA yokhala ndi ventricular septum (IVS)
• TGA yokhala ndi ventricular septal defect (VSD)
• TGA yokhala ndi zovuta zina zamtima zobadwa nazo 

Nthawi yokonzekera ndiyofunikira pakukhazikitsa zopulumutsa moyo, Khola kumayenda kwa magazi okosijeni m'thupi.               

Mitundu ya Njira Zogwiritsira Ntchito Arterial Switch

Njira ya ASO kwa anthu omwe ali ndi TGA imakhalabe chimodzimodzi mosasamala kanthu za njira yopangira opaleshoni zimachitika. Komabe, njira za opaleshoni zingasiyane malinga ndi kubadwa kogwirizanako zopindika. Zina mwa njira izi amapatsidwa pansipa: 

Njira Yokhazikika

izi zimachitika pamene TGA ndi yosavuta (d-TGA) popanda chilema chachikulu.

Pankhaniyi, mtsempha wamagazi ndi mtsempha wamagazi amasinthidwa, ndipo mitsempha yapamtima imabwezeretsedwa kuchokera ku aorta kupita ku mitsempha ya m'mapapo. 

Kusintha kwa Arterial ndi Ventricular Septal Defect (VSD) Kutseka

VSD, kuwonjezera pa TGA, imafuna kutsekedwa in chimodzimodzi kukonza opaleshoni ya VSD nditero kawirikawiri kuyankhidwa pakusintha kwa arterial. 

Arterial Switch Operation yokhala ndi Complex Congenital Heart Defect

Kukonza uku kumafuna kuwunika kowonjezera kwa TGA ndikuwonjezera zolakwika zamapangidwe ngati pulmonary stenosis. Kukonza zovuta kumakhala kovuta kwambiri ndipo kumafuna nthawi yayitali yogwirira ntchito. 

Komabe, kaya ndi yosavuta kapena yovuta, cholinga cha opaleshoni ndi kukhazikitsa zachibadwa, kuyenda kofanana ndi kugwira ntchito kwa mitsempha ya m'mitsempha yamagazi ku myocardium.

Pre-Surgery Evaluation ndi Diagnostics

Kuzindikira kolondola komanso kuwunika kwatsatanetsatane ndikofunikira musanayambe ndi ASO. Kukonzekera koyambirira kumaphatikizapo:

• Echocardiography (2D ndi Doppler)
• Cardiac MRI/CT Scan
• Cardiac Catheterization
• Pulse Oximetry
• Pesi X-ray
• Mayesero a Magazi

Kwa ana obadwa kumene omwe ali ndi cyanosis yoopsa, kulowetsedwa kwa prostaglandin E1 mulole kuyamba asanayambe opaleshoni kuti ductus arteriosus ikhale yotseguka mpaka opaleshoni.

Kusankha ndi Kukonzekera Opaleshoni

Gulu la opaleshoni limawunika mosamala:

• Zaka ndi kulemera kwa khanda
• Zowonongeka zamtima (mwachitsanzo, VSD, pulmonary stenosis)
• Malo ndi mapangidwe a mitsempha yam'mitsempha
• Kukhazikika kwa khanda lonse ndi oxygenation isanachitike opaleshoni

Nthawi Yabwino

ASO nthawi zambiri imachitika mkati mwa masabata awiri oyambirira a moyo kuletsa ventricle yakumanzere kuti isataye mphamvu yake yopopa magazi mumayendedwe othamanga kwambiri.

Multidisciplinary Team

Madokotala ochita opaleshoni yamtima mwa ana, ogonetsa, akatswiri amtima, ndi akatswiri osamalira odwala kwambiri akhanda amagwirira ntchito limodzi kukonzekera ndikuchita njirayi.

Njira ya Arterial Switch Operation

ASO ndi opaleshoni yovuta yamtima yotseguka yomwe imachitidwa pansi pa anesthesia wamba ndipo imafuna kugwiritsa ntchito a cardiopulmonary bypass (makina a mtima-mapapo).

Pang'onopang'ono Njira Yopangira Opaleshoni

1. Anesthesia ndi Kudulidwa - General opaleshoni zimachitika, ndi chocheka amapangidwa kuyamba mankhwala. 
2. Cardiopulmonary Bypass Initiation - Wodwalayo amaikidwa ndi cardiopulmonary bypass, yomwe imatenga malo mapapo ndi moyo Nchito pa ntchito yonse. 
3. Great Artery Transection - Mitsempha ya m'mapapo ndi aorta achotsedwa kuchokera ku malo awo oyambirira pansi pa mtima. 
4. Kusintha kwa Mitsempha Yapamtima - Mitsempha yama coronary ang'ambika kuchokera ku msempha woyambirira pamodzi ndi minofu yozungulira. Mtsempha wamagazi zakonzedwa kukhala msempha watsopano, ndipo wapachiyambi umakhala mtsempha watsopano wa m'mapapo. 
5. Kulumikizananso kwa Mitsempha - Mabatani a mtsempha wamtima amaikidwanso mu msempha watsopano. 
6. Kukonza Zowonjezera - Mtsempha wamagazi imamangidwanso ndi chigamba, ndi kugwirizana kwa msempha ndiye analengedwa. 
7. Kutseka - Chifuwa pamapeto pake chimatsekedwa kuti amalize ndondomekoyi. 

Zowopsa & Zovuta Zomwe Zingachitike pa Arterial Switch Operation

ASO ndi njira yapadera kwambiri yokhala ndi chiwongola dzanja chabwino m'malo akatswiri, koma zoopsa zina zikadalipo.

• Kutuluka magazi kapena matenda
• Kutsekeka kwa mtsempha wa coronary kapena kutsekeka
• Low cardiac output syndrome
• Arrhythmias (kugunda kwa mtima kosakhazikika)
• Zovuta za kupuma
• Pulmonary artery stenosis
• Neoaortic valve regurgitation
• Mavuto a mtsempha wamagazi (osowa)
• Zowonongeka zamtima zotsalira zomwe zimafuna kulowererapo kwamtsogolo

Ngakhale zoopsa izi, zovuta zambiri zitha kuyendetsedwa bwino ndi opaleshoni yamakono ndi pambuyo opaleshoni chisamaliro.

Zomwe Muyenera Kuyembekezera Pambuyo pa Kusintha kwa Arterial?

Nthawi yomweyo postoperative nthawiyi ndi yofunika kwambiri ndipo imaphatikizapo kuyang'anitsitsa mosamala Pediatric cardiac intensive care unit (PCICU).

Ntchito Yotumiza Chisamaliro

• Thandizo lamakina mpweya wabwino kwa masiku 2-5
• Kuwunika kwamtima kosalekeza
• IV madzi, mankhwala othandizira mtima, ndi maantibayotiki
• Kusamalira ululu ndi kuyambitsa kudyetsa pang'onopang'ono
• Kuchotsa kukhetsa pachifuwa patatha masiku angapo

Kukhala Pachipatala

• Childs 2-3 milungu, kutengera kuchira liwiro ndi kusowa kwa zovuta.

Londola:

• Kutsata pafupipafupi ndi akatswiri amtima wa ana kuti awone momwe mtima umagwirira ntchito, mtsempha wamagazi thanzi, ndi kuyang'anira zovuta za nthawi yayitali.

Kuchira Pambuyo pa Opaleshoni & Kusamalira Kwanthawi Yaitali

Kuchira Mwamsanga

• Makanda ambiri amawonetsa kusintha kwakukulu kwa okosijeni ndi zochitika zonse mkati mwa masabata angapo atatha opaleshoni.

Kusamalira Nthawi Yaitali

• Kutsata kwa moyo wonse wa cardiology ndi periodic echocardiograms, ECGs, komanso kuyesa kupsinjika kwa ana okulirapo.
• Kuwunika koyambirira kwachitukuko amagwiritsidwa ntchito kuonetsetsa kukula bwino ndi chitukuko cha chidziwitso.
• Kuwunika kosalekeza kwa coronary artery patency, neoaortic valve function, komanso thanzi la mitsempha yam'mapapo.
• Kuchita nawo masewera olimbitsa thupi oyenera zaka zambiri kumalimbikitsidwa pokhapokha ngati pali zovuta.

Ana ambiri akhoza kutsogolera a zachibadwa, moyo wokangalika kutsatira ASO bwino ndi zochepa zoletsa yaitali.

Kupambana kwa Arterial Switch Operation ku India

Malo otsogola kwambiri okhudza mtima wa ana ku India amapereka zotsatira zomwe zimagwirizana ndi zizindikiro zapadziko lonse lapansi.

Malipoti Opambana:

• Mlingo Wopulumuka Koyambirira: Oposa 95% m'zipatala zodziwika bwino
• Kupulumuka Kwa Nthawi Yaitali: Zabwino kwambiri, ndi odwala ambiri omwe akukula bwino
• Moyo Wabwino: Ana ambiri amakula moyandikana ndi thupi
• Mtengo Wobwezeretsanso: Osakwana 10% angafunike njira zowonjezera pakapita nthawi

Kuzindikira koyambirira, kutumizidwa panthawi yake, komanso ukadaulo wapadera wa opaleshoni ndizofunikira kwambiri zomwe zimapangitsa kuti chipambano chikhale chokwera.

Mtengo wa Arterial Switch Operation ku India

Mtengo wa Arterial Switch Operation ku India nthawi zambiri umachokera USD 5,000 mpaka USD 15,000, malingana ndi zinthu zosiyanasiyana monga malo a chipatalacho ndi mbiri yake, ukatswiri wa dokotala wa opaleshoni, ndi kucholoŵana kwa mlanduwo. Mizinda ikuluikulu monga Mumbai, Delhi, ndi Bengaluru imakhala ndi mitengo yokwera chifukwa chazipatala zapamwamba komanso kupezeka kwa akatswiri. Kuphatikiza pa opaleshoni yokha, odwala ayeneranso kuganizira zoyankhulana asanakhalepo, chisamaliro cha pambuyo pa opaleshoni, ndi chithandizo china chilichonse chomwe chingakhale chofunikira, chomwe chingathandize kuti ndalama zonse ziwonongeke. 

Chifukwa Chiyani Musankhire India Kuti Mugwire Ntchito Yosinthira Arterial?

India ndi malo omwe amakondedwa padziko lonse lapansi kuti apange maopaleshoni ovuta a mtima a ana, kuphatikiza maopaleshoni osinthika a arterial, chifukwa cha zida zapamwamba komanso chisamaliro chotsika mtengo.

Ubwino Ofunika:

• Madokotala odziwa bwino kwambiri opaleshoni yamtima omwe ali ndi chidziwitso chambiri cha ASO
• Kupezeka kwa ma ICU apamwamba a neonatal cardiac
• Phukusi la opaleshoni yotsika mtengo poyerekeza ndi mayiko akumadzulo
• Nthawi zochepa zodikirira maopaleshoni ovuta obadwa nawo
• Thandizo lathunthu labanja ndi pambuyo opaleshoni ntchito zothandizira

Zolemba Zofunikira kwa Odwala Opita ku India Kuti Akagwire Ntchito Yosintha Zinthu

Kwa odwala apadziko lonse omwe akuganizira za ASO ku India, ndikofunikira kuwonetsa zolemba zina kuti mukhale ndiulendo wosavuta wachipatala. Izi zikuphatikizapo:

• Pasipoti Yovomerezeka: Ndilovomerezeka kwa miyezi isanu ndi umodzi kuchokera tsiku lomwe mwayenda.
• Medical Visa (M Visa): Zoperekedwa ndi Embassy / Consulate waku India pazifukwa zachipatala.
• Kalata Yoyitanira kuchokera ku Chipatala cha India: Kalata yodziwika bwino yofotokoza njira yamankhwala komanso kutalika kwake.
• Zolemba Zaposachedwa Zachipatala: Ma X-ray, ma MRIs, kuyezetsa magazi, ndi zolemba zotumizidwa ndi dotolo wakudziko lakwawo.
• Fomu Yofunsira Visa Yomalizidwa: Ndi zithunzi za kukula kwa pasipoti malinga ndi momwe zimakhalira.
• Umboni wa Njira: Malipoti aku banki a miyezi ingapo yapitayo kapena inshuwaransi yazaumoyo.
• Visa Wachipatala: Ndikofunikira kwa woyenda naye kapena womusamalira amene akuyenda ndi wodwalayo.

Ndibwino kuti mutumize kwa kazembe waku India kapena wotsogolera wanu zachipatala kuti mudziwe zaposachedwa komanso kukuthandizani pakulemba.

Akatswiri Apamwamba Ogwiritsa Ntchito Arterial Switch ku India

Nawa otsogolera arterial kusintha ntchito akatswiri m'dziko. 

1. Dr. Krishna S Iyer, Fortis Escorts Heart Institute, New Delhi
2. Dr. Suresh Joshi, Jaslok Hospital & Research Center, Mumbai
3. Dr. KR Balakrishnan, MGM Healthcare, Chennai
4. Dr. Rajesh Sharma, Chipatala cha Jaypee, Noida
5. Dr. Devi Prasad Shetty, Narayana Health, Bangalore

Zipatala Zabwino Kwambiri Zogwiritsa Ntchito Arterial Switch ku India

Nazi zina mwa zipatala zapamwamba za njirayi ku India. 

1. Fortis Escorts Heart Institute, New Delhi
2. Chipatala Padziko Lonse, Chennai
3. Chipatala cha Apollo, Chennai
4. Medanta - The Medicity, Gurgaon
5. Chipatala cha Jaslok & Research Center, Mumbai

Mafunso Ofunsidwa Kawirikawiri (FAQs)

Kodi opareshoni ya arterial switch imachitika ali ndi zaka zingati?

Momwemo, mkati masabata awiri oyambirira a moyo, koma mungathe kuchitidwa kwa miyezi ingapo yakubadwa muzochitika zinazake.

Kodi ASO ndi mankhwala ochiritsira?

Inde, ASO imawongolera bwino momwe mtima umakhalira, koma kutsata mtima kwa moyo wonse ndikofunikira kuti muwone momwe mtima umagwirira ntchito komanso thanzi la mitsempha yamagazi.

Kodi mwayi wopulumuka pambuyo pa ASO ndi wotani?

Kupulumuka kumaposa 95% m'malo odziwa zambiri, ndipo ana ambiri amatsogolera zachibadwa amakhala.

Kodi mwanayo adzafunika maopaleshoni ena amtima pambuyo pake? 

Ana ena angafunike kuthandizidwanso kuti athe kuthana ndi vuto la kuchepa kwa mitsempha ya m'mapapo kapena ma valve, ngakhale ambiri safuna maopaleshoni ena.

Ana omwe ali ndi ASO angakhale moyo zachibadwa moyo? 

Inde, ndi opaleshoni yopambana ndi kutsatiridwa koyenera, ana ambiri angathe kuchita nawo zachibadwa ntchito, maphunziro, ndi masewera.