Kune vanhu vane chirwere chakakomba chinonzi valve aortic, kushandiswa kwevhavha yekugadzirisa inowanzova kurapwa chete kunopa rubatsiro rukuru. Zvisinei, chirwere chinonzi aortic valve chinosanganisira ngozi dzakawanda. Transcatheter aortic valve implantation (TAVI) yakagadzirwa sechiedza kuronga nzira isingasviki yekusvitsa zvirwere zvearwere aortic.
Muna TAVI, rimwe remagetsi anogadzira aortic rinoshandiswa nenzira yepamusoro yekugadzirisa catheterization.
Kunyange zvazvo TAVI ichiri kuonekwa sechitsva, inogamuchirwa muUnited States uye neEuropean Union kuitira kurapwa kwevamwe vanhu vane ngozi yakawanda vane chakanyanya aortic stenosis. MuEurope, inobvumirwawo kuitira kurapa vamwe vanhu vane aortic yakanyanya kudzokera zvakare.
Pamusoro peAortic Valve Disease
Mune aortic stenosis, the aortic valve inowanzovharidzirwa, iyo inoita kuti moyo ushande zvakaoma kupompa ropa kumuviri. Mune aortic kudzokera zvakare , aortic valve inokundikana kuvhara zvachose, zvichiita kuti ropa riyerere zvakare mumwoyo apo valve inofanirwa kuvharwa. Pakupedzisira, chimwe chezviitiko izvi zveaortic zvinogona kufambira mberi kumoyo kusakundikana , zvichikonzera edema (kuzvimba), dyspnea , uye (kazhinji) kufa.
Nepo zviratidzo zveaortic valve chirwere zvinogona kutarisirwa kwekanguva uchishandiswa kurapa kurapa kwekushaya mwoyo , hapana mushonga unogona kubvisa chinetso chemagetsi ne aortic valve.
Imwe chete inobatsira kurapwa ndeyekugadzira chigadzirwa chinonzi aortic valve ane chirwere chevhavha yekugadzira.
Zvinosuruvarisa, nzira yakakwana yeaortic valve inoshandiswa inoda kushanda kwepfungwa huru yekuvhiya, uye, kunyanya kune vakwegura varwere avo vanowanzogadzira aortic stenosis, iyo inomira iyo ine ngozi yakawanda.
Nzira yaTATVI yakagadziriswa senzira inogona kuisa pangozi yekutsvaga aortic valve.
Ndeapi maTV Devices Akaiswa?
Zvinhu zviviri zveTVI zvinowanikwa FDA inobvumirwa muUnited States - muvharo weEdwards SAPIEN, uye Medtronic CoreValve. Zvimwe zvakawanda zveTATVI zvigadzirwa zvinobvumirwa muEurope. Zvose izvi zvinoshandiswa zvakafanana zvakafanana: Ivhavha yekugadzirira inowanikwa kune firamu yakakoromoka, iyo inowanikwa kune catheter. Iyo catheter inowanikwa muropa remudziyo (kazhinji, chikadzi chechikadzi chiri pedyo nekugomera), uye inosvika kune imwe nzvimbo ye aortic valve. Painenge pachigaro, firimu inowedzera kuburikidza nokuputira bhoron. Izvi zvinobvumira vheji yekugadzirira kuvhura, uye kutanga kushanda.
Ndezvipi Zvinoguma NaTavi?
Zvidzidzo zvepakutanga neTATVI zvaive zvishoma kune vanorwara vane aortic stenosis yakaoma avo vaifungidzirwa kuti vanorwara zvikuru kuti vave nekuvhiyiwa kwemoyo wakadikanwa kudiwa kuti "standard" aortic valve ishandiswe. Mune vashandi ava vanorwara zvikuru, avo avo vakanga vasingagoni kuwana TAVI vakanga vakaderedza zvakanyanya kufa kwehuwandu uye zvakanyanya kuwedzera zviratidzo pashure pegore rimwe, zvichienzaniswa nevaya vakagamuchira kurapwa kwechirwere chete.
Zvisinei, varwere vakashandurwa kuTATVI vaiva nezvikamu 5 muzana zvekurohwa kukuru, vachienzanisa ne1% chete muvanorapwa varwere.
TAVI-yakabatana nesroro is embolic strokes .
Imwe yedzidzo yakazotevera yakaenzaniswa naTATVI kusvika pakugadzirisa aortic valve kushandiswa muna 690 varwere vane zvakanyanya aortic stenosis. Kufa kwehuwandu, hutachiona hwehuwandu, uye kuvandudza zviratidzo zvaive zvakafanana kune rimwe gore mumapoka maviri acho.
Vaya vaibatwa neTATVI vaiva nezvimwe zvinetso zvakakura mumidziyo yeropa, uye avo vanorapwa nekuvhiya kwepfungwa yakazara vaiva nematambudziko akawanda ekubuda ropa uye akawanda mushure mekushanda kwepayidi yefridhi .
Matambudziko
Kunyange zvazvo TAVI inonyanya kusvibisa pane kuvhiyiwa kwepfungwa yakasununguka, inoramba iine ngozi huru. Izvo zviitiko zviviri zvakanyanya uye zvakakomba zvinokonzera kukanganisa kwakanyanya kumidziyo midzi yeropa nekurohwa.
Zvose izvi zvinetso zvinokonzerwa nekushungurudzika kusingadzivisiki kunokonzerwa nokuisa mamiriro ekugadzirisa uye anogadzikana mumagetsi. Somugumisiro wezvinetso zvakadaro, njodzi yekufa ne TAVI inenge 6% mukati memazuva makumi matatu ekugadzirisa.
Uchapupu huchangobva kuratidza hunoratidza kuti pane "mwedzi wakadzidza" unoenderana nekuita mutambo we TAVI. Kunyanya, njodzi yezvinetso zvakakomba inoratidzika kuva yakakosha munguva yekutanga 30 TAVI nzira iyo chiremba anoita.
Makambani aya ari kuwedzera maTAT devices anoenderera mberi achishanda pakuvandudza teknolojia, mukuedza kuderedza njodzi dzinobatanidza nekushandiswa kwavo. Nokuda kwezvino, zvisinei, njodzi dzinoramba dzakakosha.
Iko Ino State State TAVI
Parizvino muU.S., TAVI inobvumidzwa neRDA chete kune varwere vane aortic stenosis yakaoma iyo inonzi inonyanya kukonzerwa nehutachiona, yakasununguka-chest aortic valve replacement.
Kana TAVI inokurudzirwa iwe iwe kana munhu waunoda, unofanirwa kuve nechokwadi kuti nzira ichazoitwa nechiremba uyo ave ane ruzivo rwakakura nemhando iyi.
Mune ramangwana, zvinenge zvichiitika kuti TAVI ichava nzira yakagamuchirwa yekuvhiya moyo yemwoyo kune vamwe varwere vane aortic stenosis inokosha vasati "vanorwara" nokuda kwekushanda kwemwoyo wose. Asi kupa zvipingamupinyi izvo, kusvika ikozvino, zvinobatanidzwa neTATVI, hatisipo ikozvino.
> Sources:
> Zajarias A, Cribier AG. Migumisiro nekuchengetedzwa kwePascutaneous Aortic Valve Replacement. J Am Coll Cardiol 2009; 53: 1829.
> Leon MB, Smith CR, Mack M, et al. Transcatheter Aortic Valve Kugadzirwa kweAortic Stenosis Muvarwere Vasingagoni Kuvhiyiwa. N Engl J Med 2010; 363: 1597.
> Smith CR, Leon MB, Mack MJ, et al. Transcatheter Inoshandiswa Nokutsvaga Valvheti yeAortic Kudzorerwa muHurumende Dzakanyanya Kungozi. N Engl J Med 2011; 364: 2187.
> Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA / ACC Nhungamiro yekutarisira varwere neValvular Heart Disease: Nyaya yeAmerican College yeCardiology / American Heart Association Task Force pamusoro pekushandisa mazano. J Am Coll Cardiol 2014; 63: e57.