He aha ka maʻi o ka puka puʻuwai? Nā hōʻailona, nā kumu, a me ka lāʻau

Hana ʻia ka maʻi o ka puka puʻuwai i ka wā e hana pono ʻole ai ka puka ma waena o ka ventricle ʻākau o kou puʻuwai a me ka artery pulmonary. Hana kēia puka e like me ka puka hoʻokahi wale nō, e ʻae ana i ke koko e kahe mai kou puʻuwai i kou mau māmā akā ke pale aku nei i ka kahe ʻana ma hope.

Ke lilo kēia puka i ka liʻiliʻi loa (stenosis) a i ʻole ka leaki (regurgitation), pono e hana nui kou puʻuwai e pūpū pono i ke koko. ʻO ka ʻoiaʻiʻo maikaʻi, he nui nā kānaka me ka maʻi māmā o ka puka puʻuwai e ola ana i nā ola maʻamau, olakino, a loaʻa nā lāʻau lapaʻau maikaʻi ke pono.

He aha nā hōʻailona o ka maʻi o ka puka puʻuwai?

ʻAʻohe hōʻailona o ka maʻi māmā o ka puka puʻuwai i nā kānaka he nui. He mea hoʻololi maikaʻi loa kou puʻuwai a hiki ke hoʻokō pinepine i nā pilikia liʻiliʻi o ka puka me ka ʻike ʻole ʻoe.

Ke hōʻike ʻia nā hōʻailona, hoʻomohala mālie lākou i ka holomua ʻana o ka pilikia o ka puka. Eia nā mea āu e ʻike ai:

• Pōkole o ka hanu, ʻoi aku hoʻi i ka wā o ka hana kino a i ʻole ka hoʻoikaika kino
• Luhi a i ʻole ka manaʻo luhi maʻamau i ka wā o nā hana o kēlā me kēia lā
• ʻEha umauma a i ʻole ka ʻoluʻolu ʻole, ʻoi aku hoʻi me ka hoʻoikaika kino
• Nāwaliwali a i ʻole ka māmā ke kū koke
• ʻEhu i kou mau kuʻekuʻe wāwae, nā wāwae, a i ʻole nā wāwae
• Nā palpitations puʻuwai a i ʻole nā manaʻo o ka puʻuwai kūpono ʻole
• Nā hiʻohiʻona ʻānai, ʻoiai ʻaʻole pinepine kēia

I nā hihia kakaikahi, hiki i ka maʻi koʻikoʻi o ka puka puʻuwai ke hoʻokumu i nā hōʻailona koʻikoʻi e like me ka maʻi ʻōhū mau, ka hoʻonui wikiwiki o ke kaumaha mai ka wai e mālama ʻia, a i ʻole nā pilikia hanu koʻikoʻi ʻoiai i ka hoʻomaha. Pono koke kēia mau hōʻailona i ka nānā ʻana o ke kauka.

He aha nā ʻano o ka maʻi o ka puka puʻuwai?

ʻElua mau ʻano nui o ka maʻi o ka puka puʻuwai, ʻo kēlā me kēia e hoʻopilikia ana i ke kahe ʻana o ke koko ma kou puʻuwai. Hiki i ka hoʻomaopopo ʻana i kēia mau ʻano ke kōkua iā ʻoe e hoʻomaopopo maikaʻi i ka mea e hana nei i kou kūlana kikoʻī.

Ke hiki mai ka stenosis pulmonary, e lilo ana kāu valve i mea ʻāpana a paʻakikī paha, e ʻoi aku ka paʻakikī o ke kahe ʻana o ke koko mai kou naʻau a i kou māmā. E noʻonoʻo e like me ka ho'āʻo ʻana e kāʻili i ka wai ma o kahi faucet i pani ʻia hapa - pono kāu naʻau e pūʻiwa me ka ikaika hou aku e kipaku i ke koko ma o ka puka ʻāpana.

Ke hiki mai ka regurgitation pulmonary, ʻaʻole e pani pono kāu valve, e ʻae ana i ke koko e kahe hou i loko o kou naʻau. ʻO ia hoʻi, kekahi koko e pono ke hele i kou mau māmā e kahe hou i loko o ka lumi o kou naʻau, e koi ana iā ia e hana ikaika e mālama i ka holo koko kūpono.

Hiki i kekahi poʻe ke loaʻa nā kūlana ʻelua i ka manawa hoʻokahi, ka mea i kapa ʻia ʻo ka maʻi valve hui. E hoʻoholo kāu kauka i ke ʻano āu e loaʻa ai ma o ka nānā pono ʻana a me ka ho'āʻo ʻana.

He aha ka mea e hoʻokumu ai i ka maʻi valve pulmonary?

Hiki i ka maʻi valve pulmonary ke ulu mai nā hemahema hānau a loaʻa paha ma hope o ka manawa ma muli o nā kumu like ʻole. ʻO ka hapa nui o nā hihia mai nā hemahema naʻau hānau, ʻo ia hoʻi, ʻaʻole i hana pono ka valve i kou ulu ʻana i loko o ka ʻōpū.

Eia nā kumu nui āu kauka e kūkākūkā ai me ʻoe:

• Nā hemahema naʻau hānau, me ka bicuspid pulmonary valve a i ʻole tetralogy of Fallot
• Ka maʻi naʻau rheumatic mai nā maʻi ʻāʻī strep i mālama ʻole ʻia
• Ka maʻi carcinoid, kahi kūlana maʻamau e pili ana i nā tumors e hana ana i nā hormone
• Ka infective endocarditis, kahi maʻi o ka papa o loko o ka naʻau
• Nā pilikia o ka ʻoki naʻau ma mua
• Ka hypertension pulmonary e kau ana i ka ukana hou aku ma ka valve
• Ka radiation therapy i ka ʻāpana umauma

ʻOi aku ka liʻiliʻi, hiki i kekahi mau lāʻau lapaʻau, nā kūlana autoimmune, a i ʻole ka hōʻeha umauma ke hōʻino i ka valve pulmonary ma hope o ka manawa. ʻO ka ʻelemakule a me ka haʻalulu he mea maʻamau loa ia me kēia valve kūikawā, ʻaʻole e like me kekahi mau valves naʻau ʻē aʻe.

I ka wā e ʻike ai i ke kauka no ka maʻi valve pulmonary?

E pono ʻoe ke hoʻokaʻaʻike aku i kāu mea mālama ola inā ʻike ʻoe i nā hōʻailona mau loa e hoʻopilikia ana i kāu mau hana o kēlā me kēia lā. Mai kali inā ke ʻike nei ʻoe i ka pōkole o ka hanu e hoʻonui nei, ʻoi aku hoʻi inā ke ʻino nei ia ma luna o ka manawa.

Hoʻonohonoho i kahi kūkā koke inā loaʻa iā ʻoe ka ʻeha umauma me ka hana, ka luhi pinepine, a i ʻole ka pehu ʻana o kou mau wāwae ʻaʻole e hoʻomaikaʻi me ka hoʻomaha a me ka hoʻokiʻekiʻe. Ke hōʻike nei kēia mau hōʻailona e hana nui paha kāu naʻau ma mua o ka mea e pono ai.

E ʻimi i ka mālama olakino koke inā loaʻa iā ʻoe nā hanana hiolo, ka ʻeha umauma nui, a i ʻole nā pilikia hanu nui koke. ʻOiai he mea maʻamau ʻole kēia mau kūlana me ka maʻi valve pulmonary, pono lākou i ka loiloi koke e hōʻoia i kou palekana.

He aha nā kumu pilikia no ka maʻi valve pulmonary?

Hiki i kekahi mau mea ke hoʻonui i kou hiki ke loaʻa i ka maʻi valve pulmonary, ʻoiai ʻaʻole ʻo ka loaʻa ʻana o nā kumu pilikia e manaʻo ai e loaʻa maoli iā ʻoe ke kūlana. Ke kōkua nei ka hoʻomaopopo ʻana i kēia mau mea iā ʻoe a me kāu kauka e nānā pono aku i kou olakino naʻau.

ʻO nā kumu pilikia nui loa e komo pū ana:

• Mōʻaukala ʻohana o nā hemahema naʻau i hānau ʻia
• Ka maʻi rheumatic ma mua a i ʻole nā maʻi strep i mālama ʻole ʻia
• Mōʻaukala o nā kūlana naʻau i hānau ʻia ʻē aʻe
• Ka ʻoki naʻau ma mua, ʻoi aku ka pili ʻana i ka valve pulmonary
• Nā ʻaʻai carcinoid a i ʻole ka carcinoid syndrome
• Ka maʻi puʻupaʻa lōʻihi e pono ai ka dialysis
• Kekahi mau syndrome genetic e hoʻopilikia ana i ka hoʻomohala ʻana o ka naʻau

Hiki i kekahi mau mea ola a me nā mea kūlohelohe ke pāʻani pū kekahi, e komo pū ana ka hōʻike ʻia ʻana i kekahi mau lāʻau lapaʻau, ka radiation umauma, a i ʻole ka hoʻohana ʻana i nā lāʻau intravenous. Eia naʻe, nui nā kānaka me kēia mau kumu pilikia ʻaʻole loa e loaʻa i nā pilikia valve, a loaʻa i kekahi poʻe me nā kumu pilikia ʻole ke kūlana.

He aha nā pilikia hiki ke loaʻa i ka maʻi valve pulmonary?

ʻO ka hapa nui o nā kānaka me ka maʻi palupalu o ka puʻupuʻu, ʻaʻole lākou e ʻike i nā pilikia nui, ʻoiai me ka nānā pono a me ka mālama. Eia naʻe, ʻo ka hoʻomaopopo ʻana i nā pilikia hiki ke kōkua iā ʻoe e ʻike i ka wā e ʻimi ai i ka mālama lapaʻau hou aku.

Ke holomua a i ʻole ke mālama ʻole ʻia ka maʻi valve, hiki i kēia mau pilikia ke ulu:

• Ka hāʻule ʻana o ka naʻau ʻākau, kahi hiki ʻole i kou naʻau ke pūpū i ke koko me ka maikaʻi
• Nā ʻano naʻau kūpono ʻole (arrhythmias) e hiki ai ke hoʻoulu i nā palpitations
• ʻO nā clots koko e hana ana i loko o nā keʻena naʻau
• Ka hahau mai nā clots koko e hele ana i ka lolo
• Ka make naʻau koke, ʻoiai he mea maʻamau loa kēia
• Infective endocarditis, ʻoi aku inā loaʻa iā ʻoe nā ʻāpana valve hana
• ʻO ka hypertension pulmonary e hoʻonui nei i ka manawa

ʻO ka mea maikaʻi, ʻo ka nānā mau a me ka mālama koke e hiki ke pale aku i ka hapa nui o kēia mau pilikia. E hana pū kāu hui olakino me ʻoe e loiloi i kou pilikia pilikino a hana i kahi hoʻolālā e mālama i kou naʻau olakino.

Pehea e hiki ai ke pale ʻia ka maʻi valve pulmonary?

ʻOiai ʻo ka hapa nui o ka maʻi valve pulmonary mai nā hemahema naʻau congenital, ʻaʻole hiki ke pale ʻia mau. Eia naʻe, hiki iā ʻoe ke lawe i nā ʻanuʻu koʻikoʻi e pale aku i kou olakino naʻau a pale aku i nā pilikia.

ʻO ka hana pale nui loa ka mālama koke ʻana i nā maʻi ʻāʻī strep me nā antibiotics e pale aku i ka maʻi rheumatic. Hiki i kēia hana hoʻokahi ke hoʻemi nui i kou pilikia o ka loaʻa ʻana o ka maʻi naʻau rheumatic ma hope i ke ola.

ʻO ka mālama ʻana i ka maʻemaʻe niho maikaʻi a me ka loaʻa ʻana o ka mālama niho maʻamau e kōkua i ka pale ʻana i ka infective endocarditis, ʻoi aku inā loaʻa iā ʻoe nā pilikia valve. Hiki i kāu kauka niho a me ka cardiologist ke ʻōlelo aku i ka prophylaxis antibiotic ma mua o kekahi mau kaʻina hana niho.

ʻO ke ola kino olakino naʻau ke kākoʻo i kou olakino cardiovascular holoʻokoʻa. Hoʻopili kēia i ka ʻai ʻana i ka ʻai kaulike, ka hoʻoikaika kino mau e like me ka ʻāpono ʻana a kāu kauka, ka pale ʻana i ka puhipaka, a me ka mālama ʻana i nā kūlana e like me ka maʻi diabetes a me ke koko kiʻekiʻe.

Pehea ka hōʻoia ʻana o ka maʻi valve pulmonary?

ʻO ka hōʻoia ʻana i ka maʻi valve pulmonary e hoʻomaka pinepine me kāu kauka e hoʻolohe ana i kou naʻau me ka stethoscope. Hana nui nā pilikia valve i nā murmurs naʻau kūikawā e hiki i nā limahana ola kino akamai ke ʻike i nā loiloi maʻamau.

Inā manaʻo kāu kauka i ka maʻi valve, e kauoha paha lākou i kahi echocardiogram ma mua. Hana kēia hoʻokolohua ultrasound ʻole ʻeha i nā kiʻi kikoʻī o kou naʻau, e hōʻike ana i ka maikaʻi o ka wehe ʻana a me ka pani ʻana o kāu mau valves a me ka nui o ke koko e kahe ana ma o lākou.

Hiki i nā hoʻokolohua hou ke komo pū me ka electrocardiogram (ECG) e nānā i kou rhythm naʻau, nā X-ray umauma e ʻike i ka nui o kou naʻau a me ke kūlana o ka māmā, a me nā hoʻokolohua kaumaha hoʻoikaika e ʻike i ka hana ʻana o kou naʻau i ka wā o ka hana. I kekahi manawa, hāʻawi nā hoʻokolohua kūikawā e like me ka MRI naʻau a i ʻole ka catheterization naʻau i ka ʻike kikoʻī hou aku.

E nānā pū kāu kauka i kou mōʻaukala lapaʻau a me nā hōʻailona me ka mālama, ʻoiai kōkua kēia ʻike iā lākou e hoʻomaopopo i ke ʻano o ka maʻi valve i ka hoʻopili ʻana i kou ola i kēlā me kēia lā a me kou olakino holoʻokoʻa.

He aha ka lāʻau lapaʻau no ka maʻi valve pulmonary?

ʻO ka lāʻau lapaʻau no ka maʻi valve pulmonary e hilinaʻi ana i ka nui o kou kūlana a me ke ʻano o kona hoʻopili ʻana i kou ola i kēlā me kēia lā. Nui nā kānaka me ka maʻi māmā e pono wale nō ka nānā mau ʻana me ka ʻole o ka hoʻopili koke.

No nā hihia māmā, e ʻōlelo paha kāu kauka i ka

• Lāʻau lapaʻau e kōkua ai i kou naʻau e pāʻani hou aku ai a i ʻole e kaohi i nā hōʻailona
• Balloon valvuloplasty, kahi e wehe ai kahi pōpō liʻiliʻi i kahi valve i kuʻi ʻia
• Transcatheter pulmonary valve replacement me ka hoʻohana ʻana i kahi ala catheter-based
• ʻO ka ʻoki naʻau ākea e hoʻoponopono ai a i ʻole e pani i ka pulmonary valve
• Nā hana hybrid e hoʻohui ana i nā ʻano like ʻole

E hana pū kāu cardiologist me ʻoe e hoʻoholo i ke ala maikaʻi loa ma muli o kou kūlana kūikawā, olakino holoʻokoʻa, makahiki, a me nā makemake pilikino. ʻO ka pahuhopu mau loa ke hoʻomaikaʻi i kou ola maikaʻi ʻoiai e hoʻemi ana i nā pilikia.

Pehea e mālama ai i ka maʻi pulmonary valve ma ka home?

ʻO ka mālama ʻana i ka maʻi pulmonary valve ma ka home e kau nui ana i ke kākoʻo ʻana i kou olakino naʻau a me ka ʻike ʻana i ka wā e pono ai ʻoe i ka nānā ʻana o nā kauka. ʻO ka hapa nui o ka mālama ʻana i kēlā me kēia lā e pili ana i nā koho ola maʻalahi e pōmaikaʻi i kou ʻōnaehana cardiovascular holoʻokoʻa.

E noho ikaika i loko o kou pae ʻoluʻolu, akā e hoʻolohe i kou kino. Hiki i ka hoʻoikaika kino māmā a waena paha e like me ka hele wāwae, ka ʻauʻau, a i ʻole ka holo paikikala ke hoʻoikaika i kou naʻau, akā e pale i ka hoʻoikaika nui ʻana i kahi e hiki ai i ka hanu pōkole nui a i ʻole ka ʻeha umauma.

E nānā mau i kou mau hōʻailona a mālama i kahi moʻolelo maʻalahi o kou manaʻo. E hoʻomaopopo i nā loli i kou pae ikehu, hanu, a i ʻole pehu, no ka mea, kōkua kēia ʻike i kāu hui mālama ola e hana i nā hoʻoholo naʻauao e pili ana i kāu mālama.

E hahai i ka ʻai olakino naʻau me ka nui o nā hua, nā huaʻai, a me nā huaola holoʻokoʻa ʻoiai e kaupalena ana i ka paʻakai inā ʻoe e ʻeha ana i ka pehu. E lawe i nā lāʻau lapaʻau āpau i kuhikuhi ʻia e like me ke kuhikuhi ʻia, a mai haʻalele i nā doses inā ʻoe e ʻoluʻolu ana.

E hoʻomaʻamaʻa i ka mālama niho maikaʻi a e haʻi aku i nā mea mālama ola a pau e pili ana i kou kūlana valve, no ka mea, pono paha ʻoe i ka antibiotic prophylaxis ma mua o kekahi mau kaʻina hana. E noho hou i nā lāʻau inoa, ʻoi aku hoʻi nā pana flu, e pale aku i nā maʻi e hiki ke hoʻoikaika i kou naʻau.

Pehea ʻoe e hoʻomākaukau ai no kāu hālāwai me ke kauka?

ʻO ka hoʻomākaukau ʻana no kāu kūkā ʻana e kōkua i ka hōʻoia ʻana e loaʻa iā ʻoe nā ʻike waiwai loa a me ke alakaʻi mai kāu kipa. E hoʻomaka ma ka kākau ʻana i kāu mau hōʻailona a pau, me ka wā e kū mai ai a me nā mea e hoʻomaikaʻi ai a ʻoi aku ka ʻino paha.

E lawe mai i ka papa inoa piha o nā lāʻau lapaʻau, nā mea hoʻohui, a me nā wikamina āu e lawe nei, me nā nui. E hoʻomākaukau pū i ka papa inoa o nā nīnau āu e makemake ai e nīnau i kāu kauka, ʻoiai he maʻalahi ke poina i nā manaʻo nui i ka wā o ke kūkā ʻana.

E hōʻiliʻili i nā hopena hoʻokolohua ma mua, ʻoi aku hoʻi nā echocardiograms a i ʻole nā ​​hoʻokolohua pili i ka naʻau mai nā mea mālama ola ʻē aʻe. Inā ʻoe e ʻike ana i kahi loea no ka manawa mua, e lawe mai i kahi hōʻuluʻulu o kāu mōʻaukala lapaʻau a me kekahi mōʻaukala ʻohana o ka maʻi naʻau.

E noʻonoʻo e lawe mai i kahi lālā ʻohana hilinaʻi a hoaaloha paha e kōkua iā ʻoe e hoʻomanaʻo i ka ʻike i kūkākūkā ʻia i ka wā o ke kūkā ʻana. Mai kānalua e noi i kāu kauka e hana hou a wehewehe paha i kekahi mea āu ʻaʻole i maopopo loa.

He aha ka lawe nui e pili ana i ka maʻi valve pulmonary?

ʻO ka maʻi valve pulmonary kahi kūlana hiki ke hoʻokele ʻia e hoʻopilikia i nā kānaka ma nā ʻano like ʻole ma muli o kona koʻikoʻi. Nui nā kānaka me ka maʻi māmā e ola ana i nā ola maʻamau loa me ka nānā mau ʻana a me ka mālama kūpono ke pono.

ʻO ka mea nui loa e hoʻomanaʻo ai, ʻo ka ʻike mua ʻana a me ka hoʻokele kūpono e hana i kahi ʻokoʻa nui i nā hopena. ʻO nā nānā maʻamau e hiki ai i kāu hui mālama ola ke nānā i nā loli a komo kūpono inā holomua kāu kūlana.

He kiʻekiʻe loa ka pono o nā lāʻau lapaʻau hou, mai nā lāʻau lapaʻau a hiki i nā kaʻina hana liʻiliʻi invasive a hiki i nā koho ʻoki ke pono. ʻO ke kī, ʻo ia ka hana pili loa me kāu hui mālama ola e hana i kahi hoʻolālā pilikino e kūpono i kāu mau pono a me ke ʻano ola.

E hoʻomanaʻo ʻaʻole ke ʻano o ka maʻi valve e hoʻomaopopo iā ʻoe a i ʻole e kaupalena i kou hiki ke ola i kahi ola piha. Me ka mālama pono a me ka nānā pono, nui ka poʻe me ka maʻi valve pulmonary e hoʻomau i ka leʻaleʻa i kā lākou mau hana maʻamau a mālama i ka maikaʻi o ke ola.

Nā nīnau pinepine e pili ana i ka maʻi valve pulmonary

Hiki iaʻu ke hoʻoikaika kino me ka maʻi valve pulmonary?

Hiki i ka hapa nui o nā kānaka me ka maʻi valve pulmonary māmā a waena paha ke hoʻoikaika kino me ka palekana a pono e noho ikaika no ke olakino o ka naʻau. E hāʻawi kāu kauka i nā kuhikuhi kikoʻī ma muli o ke koʻikoʻi o kou ʻano a me nā hōʻailona. Ma ke ʻano laulā, he pono nā hana haʻahaʻa a waena paha e like me ka hele wāwae, ka ʻauʻau, a i ʻole ka holo paikikala māmā, ʻoiai nā haʻuki hoʻokūkū kiʻekiʻe e pono ai ka ʻae mai kāu cardiologist.

E pono anei iaʻu ka ʻoki kino no kaʻu maʻi valve pulmonary?

ʻAʻole pono ka ʻoki kino no kēlā me kēia kanaka me ka maʻi valve pulmonary. Nui nā kānaka me ka maʻi māmā e pono wale nō ka nānā mau, ʻoiai ʻē aʻe e pōmaikaʻi mai nā kaʻina hana liʻiliʻi e like me ka balloon valvuloplasty. E paipai kāu kauka i ka ʻoki kino wale nō inā ke hoʻopilikia nui nei kāu mau hōʻailona i kou maikaʻi o ke ola a i ʻole inā hōʻike nā hoʻokolohua ua hoʻoikaika ʻia kou naʻau e ka pilikia valve.

He hoʻoilina anei ka maʻi valve pulmonary?

ʻO kekahi mau ʻano o ka maʻi valve pulmonary, ʻoi aku ka pili i nā hemahema naʻau congenital, hiki ke loaʻa kahi ʻāpana genetic. Inā loaʻa iā ʻoe ka mōʻaukala ʻohana o ka maʻi naʻau congenital, hiki i kāu mau keiki ke loaʻa kahi pilikia kiʻekiʻe iki. Eia naʻe, nui nā hihia e kū mai me ka ʻole o ka mōʻaukala ʻohana, a ʻo ka loaʻa ʻana o ke kūlana ʻaʻole e hōʻoia e ulu kāu mau keiki.

Pehea pinepine wau e pono ai i nā hālāwai hoʻomau?

ʻO ka pinepine o ka hahai ʻana ma hope mai e hilinaʻi ana i ka nui o kou maʻi valve a me nā hōʻailona. ʻO ka poʻe me ka maʻi māmā, maʻamau lākou e pono ai i ka nānā ʻana i kēlā me kēia makahiki 1-2, ʻoiai ʻo ka poʻe me ka maʻi waena paha e pono ai nā kūkākūkā i kēlā me kēia mahina 6-12. Inā loaʻa iā ʻoe ka maʻi nui a i ʻole ua loaʻa iā ʻoe nā kaʻina hana valve, e pono paha iā ʻoe ka nānā pinepine ʻana. E hana kāu kauka i ka papa hana pilikino e pili ana i kou kūlana kūikawā.

Hiki i ka maʻi valve pulmonary ke ʻoi aku ka ʻino ma mua o ka manawa?

Hiki i ka maʻi valve pulmonary ke holomua i ka manawa, akā hana mālie kēia i ka hapanui o nā hihia. Nui nā kānaka e noho kūpaʻa no nā makahiki me ka ʻole o nā loli nui, ʻoiai ʻo kekahi poʻe e ʻike i ka holomua mālie. Ke kōkua nei ka nānā mau ʻana i kāu hui olakino e ʻike i nā loli koke a hoʻoponopono i kāu papa hana lapaʻau e like me ia. ʻO ka nui o ka holomua e ʻokoʻa loa ma waena o nā kānaka a hilinaʻi ia i ke kumu kumu o kou maʻi valve.