Ubuhinduka Bw’imitsi Y’amaraso mu Mitima (TAPVR): Ibimenyetso, Intandaro, n’Ubuvuzi

Ubuhinduka bw’imitsi y’amaraso mu mitima (Total anomalous pulmonary venous return, TAPVR) ni uburwayi bwo mu mutima buhoraho, aho imitsi itwara amaraso yuzuye umwuka uva mu mwijima ihura n’igice kitari cyo cy’umutima. Aho gusubira mu gice cy’umutima cyo ibumoso nk’uko bikwiye, iyi mitsi ihura n’igice cy’umutima cyo iburyo cyangwa andi mitsi y’amaraso.

Ubu burwayi bugera kuri 1 kuri abana 15.000, kandi busaba kubagwa, akenshi mu mwaka wa mbere w’ubuzima. Nubwo byumvikana nkibintu bigoye kandi biteye ubwoba, ubuvuzi bw’umutima bugezweho bufite ibyiza byinshi mu gukosora ubu burwayi, kandi abana benshi bakura bakaba bafite ubuzima bwiza kandi bukora.

Ubuhinduka bw’imitsi y’amaraso mu mitima (TAPVR) ni iki?

TAPVR ibaho iyo imitsi y’amaraso iva mu mwijima idakora neza mu gihe cy’inda. Ubusanzwe, iyi mitsi ine ikwiye guhura n’igice cy’umutima cyo ibumoso, itwara amaraso yuzuye umwuka ava mu mwijima asubira kugenda mu mubiri.

Muri TAPVR, iyi mitsi ine yose ihura n’ahandi hatariho. Ibi bivuze ko amaraso yuzuye umwuka avangwa n’amaraso adafite umwuka mbere yo kugera mu gice cy’umutima cyo ibumoso. Ibi bituma umubiri w’umwana atabona umwuka uhagije, ibyo bishobora gutera ibimenyetso bikomeye.

Tekereza nk’aho imitsi y’amazi meza yahuriye n’igice kitari cyo cy’ububiko bw’amazi. Umutima ukora cyane kugira ngo ubone uko wihanganira, ariko utabagwa, ubu burwayi bushobora kuba bwangiza ubuzima.

Ni ubuhe bwoko bw’ubuhinduka bw’imitsi y’amaraso mu mitima (TAPVR)?

Abaganga bagabanya TAPVR bitewe n’aho imitsi y’amaraso ihuriye nabi. Hari ubwoko bune nyamukuru, buri bwoko bufite ibimenyetso n’uburemere butandukanye.

Ubwoko bwa supracardiac ni bwo bugaragara cyane, bugera kuri 45% by’ababwanduye. Aha, imitsi y’amaraso ihura hejuru y’umutima ku mitsi nka superior vena cava. Abana bafite ubu bwoko bakunze kugira ibimenyetso buhoro buhoro mu byumweru cyangwa amezi.

Ubwoko bwa cardiac bugera kuri 25% by’ababwanduye, aho imitsi ihura n’igice cy’umutima cyo iburyo cyangwa coronary sinus. Aba bana bashobora kugira ibimenyetso byoroheje mu ntangiriro ariko bagomba kuvurwa vuba.

Ubwoko bwa infracardiac bugera kuri 25% by’ababwanduye kandi ni bwo bukomeye cyane. Imitsi y’amaraso ihura munsi y’umutima, akenshi ku mwijima cyangwa andi mitsi yo mu nda. Ubu bwoko busanzwe butera ibimenyetso bikomeye hakiri kare, rimwe na rimwe mu minsi mike nyuma yo kuvuka.

Ubwoko buvangiye ni ubwo buke cyane, bugera kuri 5% by’ababwanduye. Imitsi itandukanye ihura n’ahantu hatandukanye hatariho. Ibimenyetso n’igihe bituruka ku mitsi ihuriye hamwe.

Ni ibihe bimenyetso by’ubuhinduka bw’imitsi y’amaraso mu mitima (TAPVR)?

Ibimenyetso bya TAPVR bigaragara mu mezi make ya mbere y’ubuzima, nubwo igihe bituruka ku bwoko runaka. Ibimenyetso bya mbere bikunze kugaragara ni uko umwana atabona umwuka uhagije kandi umutima ukora cyane.

Ushobora kubona ibi bimenyetso byo mu myanya y’ubuhumekero no mu kurya uko umwana aharanira gukora ibintu by’ibanze:

• Guhumeka cyane cyangwa bigoye, cyane cyane mu gihe cyo kurya cyangwa kurira
• Kurya nabi no gukura buhoro
• Kunyara cyane mu gihe cyo kurya cyangwa gukora ibintu bisanzwe
• Indwara nyinshi z’ubuhumekero cyangwa pneumonia
• Kuruha cyane mu gihe cyo kurya cyangwa gukina

Ihinduka ry’amabara akenshi ritanga ibimenyetso byumvikana ko hari ikibazo. Ushobora kubona ibara ry’ubururu ku minwa y’umwana, iminwa, cyangwa uruhu, cyane cyane iyo ari gukora cyangwa ari kubabara. Ibi bibaho kuko amaraso ye adafite umwuka uhagije.

Ibimenyetso bijyanye n’umutima bishobora kuza uko uburwayi bugenda buzamuka:

• Umutima ukubita cyane, nubwo umwana aruhutse
• Umuvuduko w’umutima muganga yumva mu gihe cyo gusuzuma
• Ibimenyetso byo kunanirwa kw’umutima nko kubyimba mu maguru cyangwa mu nda
• Kubabara cyane cyangwa kugira ubunebwe bidasanzwe

Mu bihe bidasanzwe by’ubwoko bwa infracardiac, abana bashobora kugira ibimenyetso bikomeye mu masaha cyangwa mu minsi mike nyuma yo kuvuka. Ibi bishobora kuba harimo ubururu bukabije, ibibazo bikomeye byo guhumeka, cyangwa ibimenyetso bisa no gucika intege bisaba ubuvuzi bwihuse.

Ni iki gitera ubuhinduka bw’imitsi y’amaraso mu mitima (TAPVR)?

TAPVR itera mu byumweru umunani bya mbere by’inda iyo umutima w’umwana n’imitsi y’amaraso biri gukora. Intandaro nyayo ntiyamenyekanye neza, ariko isa n’aho iterwa no kudakora neza kw’iterambere ry’umutima muri icyo gihe cy’ingenzi.

Mu iterambere risanzwe, imitsi y’amaraso iva mu mwijima itangira nk’urusobe rw’imitsi mito mito buhoro buhoro ihura n’igice cy’umutima cyo ibumoso kiri gukura. Muri TAPVR, uyu mukino uhinduka, kandi imitsi irangira ihuriye n’ibindi bice bitari byo.

Ibintu by’umuzuko bishobora kugira uruhare mu bihe bimwe na bimwe, nubwo byinshi bibaho ubusa nta mateka y’uburwayi mu muryango. Bamwe mu bana bafite TAPVR bafite izindi ndwara z’umuzuko cyangwa uburwayi bw’umutima, bigaragaza ko ibibazo by’iterambere rusange bishobora kuba birimo.

Ibintu by’ibidukikije mu gihe cy’inda bishobora kugira uruhare, ariko abashakashatsi ntibigeze bamenya ibintu byihariye bibitera. Ababyeyi benshi ntibakore ikibi, kandi nta buryo bwo kuburiza ubu burwayi kubaho.

Ni ryari ukwiye kujya kwa muganga kubera ubuhinduka bw’imitsi y’amaraso mu mitima (TAPVR)?

Hamagara muganga wawe wa mbere ubonye ibimenyetso byo kugira ibibazo byo guhumeka cyangwa kurya nabi ku mwana wawe mushya. Kumenya hakiri kare bishobora kugira uruhare rukomeye mu mibereho, rero wizeye impuhwe zawe niba hari ikintu kidahagaze neza.

Hamagara ubuvuzi bwihuse niba umwana wawe agaragaza ibimenyetso byo kuburira ibi bikurikira:

• Ibara ry’ubururu ku minwa, mu maso, cyangwa ku iminwa
• Ibibazo bikomeye byo guhumeka cyangwa guhumeka cyane mu gihe aruhutse
• Kwanka kurya cyangwa kugira ibibazo bikomeye byo kurya
• Ubunebwe budasanzwe cyangwa kugorana gukanguka
• Ibimenyetso byo gucika amazi nko kugira imyenda mike y’amazi

Ku bana bafite ubwoko bwa infracardiac, ibimenyetso bishobora kuba bibi cyane vuba cyane. Niba umwana wawe mushya agize ubururu bukabije, ibibazo byo guhumeka, cyangwa asa n’umurwayi cyane, hamagara serivisi z’ubutabazi ako kanya aho gutegereza gupanga kuvugana na muganga.

Gusuzuma abana buri gihe ni ingenzi kugira ngo hamenyekane hakiri kare. Muganga wawe azumva umutima w’umwana wawe kandi azareba ibimenyetso byo gukura nabi cyangwa iterambere rishobora kugaragaza ikibazo cy’umutima.

Ni ibihe bintu byongera ibyago by’ubuhinduka bw’imitsi y’amaraso mu mitima (TAPVR)?

Byinshi mu bihe bya TAPVR bibaho ubusa, ariko hari ibintu bimwe na bimwe bishobora kongera ibyago gato. Gusobanukirwa ibi bintu bishobora kugufasha wowe na muganga wawe kuba maso ku bimenyetso bishoboka.

Ibintu by’umuzuko bigira uruhare mu miryango imwe na imwe, nubwo byinshi bibaho nta mateka y’uburwayi bw’umutima mu muryango. Niba ufite umwana umwe ufite TAPVR, ibyago ku bana bawe bazakurikira ni byinshi kurusha ubusanzwe, ariko biracyari bike cyane.

Hariho ibyago by’indwara z’umuzuko bifitanye isano n’ibipimo byinshi bya TAPVR:

• Heterotaxy syndrome, ihindura imiterere y’imigongo
• Ihinduka rimwe na rimwe ry’ibice by’umubiri
• DiGeorge syndrome mu bihe bidasanzwe
• Scimitar syndrome, ubundi burwayi bw’imitsi y’amaraso

Ibintu by’umubyeyi mu gihe cy’inda bishobora kugira uruhare mu bihe bimwe na bimwe, nubwo ibimenyetso bitari byo. Ibi birimo diyabete idakozwe neza, imiti imwe na imwe, cyangwa indwara z’ibyorezo mu gihe cy’inda.

Ibintu by’ibidukikije byaranzwe ariko ntibyagaragaje isano isobanutse n’ibyago bya TAPVR. Byinshi bibaho mu miryango idafite ibintu by’ibyago bizwi, bigaragazako ubu burwayi busanzwe butera ubusa mu gihe cy’iterambere ry’umutima.

Ni ibihe bibazo bishoboka by’ubuhinduka bw’imitsi y’amaraso mu mitima (TAPVR)?

Utabagwa, TAPVR ishobora gutera ibibazo bikomeye uko umutima w’umwana aharanira kohereza umwuka uhagije mu mubiri we. Inkuru nziza ni uko kubagwa hakiri kare birinda byinshi muri ibyo bibazo kubaho.

Kunanirirwa kw’umutima ni ikibazo gikunze kubaho iyo TAPVR idavuwe. Umutima ukora cyane kurusha ubusanzwe, amaherezo ukaba munini kandi unanutse. Ushobora kubona ibimenyetso nko kurya nabi, guhumeka cyane, cyangwa kubyimba.

Ibibazo byo mu myanya y’ubuhumekero bishobora kuza uko imiterere y’amaraso ihinduka:

• Umuvuduko w’amaraso mu myanya y’ubuhumekero ukomoka ku muvuduko mwinshi mu mitsi y’amaraso yo mu mwijima
• Indwara nyinshi z’ubuhumekero kubera imiterere y’amaraso yahindutse
• Pulmonary edema, aho amazi yubakira mu mwijima
• Kunanirirwa guhumeka mu bihe bikomeye

Gukura no gutinda kw’iterambere bikunze kubaho kuko umubiri w’umwana atabona umwuka uhagije kugira ngo ukure neza. Abana bashobora kuba bato kurusha ibyo bateganya kandi bagera ku ntambwe z’iterambere buhoro kurusha bagenzi babo.

Mu bihe bidasanzwe, cyane cyane ubwoko bwa infracardiac, abana bashobora kugira ibibazo bikomeye by’ubuzima vuba cyane. Ibi bishobora kuba harimo gucika intege bikabije, ibibazo by’impyiko, cyangwa kunanirwa kw’umutima bikabije bisaba ubutabazi bwihuse.

Nyuma yo kubagwa neza, ibibazo byinshi bikemuka burundu. Ariko, bamwe mu bana bakeneye gukurikiranwa kugira ngo barebe ibibazo bishoboka nko kudakora neza kw’umutima cyangwa amahirwe make yo kugira imitsi y’amaraso y’umwijima ihindagurika aho babagwe.

Ubuhinduka bw’imitsi y’amaraso mu mitima (TAPVR) bupimwa gute?

Kumenya uburwayi akenshi bitangira iyo muganga wawe wa mbere abonye ibimenyetso nko kurya nabi, guhumeka cyane, cyangwa umuvuduko w’umutima mu gihe cyo gusuzuma. Kumenya hakiri kare ni ingenzi, bityo muganga wawe azategeka ibizamini niba akeka ko hari ikibazo cy’umutima.

Echocardiogram ni bwo buzaminisho bwa mbere kandi bw’ingenzi. Ubu buryo bwo gusuzuma umutima hakoreshejwe amajwi bwerekana imiterere n’imikorere y’ibice by’umutima w’umwana wawe n’imitsi y’amaraso. Bishobora kugaragaza neza aho imitsi y’amaraso ihuriye n’aho amaraso ari kugenda.

Ibizamini by’amashusho byongeyeho bishobora kuba bikenewe kugira ngo hamenyekane neza:

• X-ray yo mu kifuba kugira ngo harebwe ubunini bw’umutima n’imiterere y’imwijima
• Electrocardiogram (ECG) kugira ngo harebwe umuvuduko w’umutima n’imikorere y’amashanyarazi
• Cardiac catheterization mu bihe bigoye kugira ngo harebwe umuvuduko n’amashusho arambuye
• CT cyangwa MRI scans kugira ngo harebwe imiterere mbere yo kubagwa

Ibizamini by’amaraso bifasha kumenya neza uko imyanya y’umubiri w’umwana ikora niba iboneye umwuka uhagije. Ibi bishobora kuba harimo urugero rw’umwuka mu maraso n’ibizamini by’imikorere y’impyiko n’umwijima.

Rimwe na rimwe TAPVR iboneka mbere y’uko umwana avuka mu gihe cyo gusuzuma inda. Niba bikekwa mbere y’uko umwana avuka, uzoherezwa kwa muganga wita ku mitima y’abana kugira ngo asuzume neza kandi ategure ukuvuka mu bitaro bifite ubushobozi bwo kubaga.

Ni ubuhe buvuzi bw’ubuhinduka bw’imitsi y’amaraso mu mitima (TAPVR)?

Kubagwa ni bwo buvuzi bwonyine bwo gukosora TAPVR, kandi busanzwe bukorwa mu mwaka wa mbere w’ubuzima. Igihe bituruka ku bimenyetso by’umwana wawe n’ubwoko bwa TAPVR afite.

Ubu buvuzi burimo guhindura imitsi y’amaraso iva mu mwijima kugira ngo ihure neza n’igice cy’umutima cyo ibumoso. Umuganga wawe azahanga inzira nshya y’amaraso yuzuye umwuka asubira mu gice cy’umutima cyo ibumoso aho akwiye.

Mbere yo kubagwa, itsinda ry’abaganga bazakora ibishoboka byose kugira ngo bakomeze ubuzima bw’umwana wawe:

• Imiti ifasha umutima gukora neza
• Imiti igabanya amazi
• Umwuka w’inyongera niba bikenewe
• Ubufasha mu kurya kugira ngo ukure
• Kuvura indwara z’ubuhumekero

Uburyo bwo kubaga butandukanye bitewe n’ubwoko bwa TAPVR. Kubwoko bwa supracardiac na cardiac, ubu buvuzi busanzwe bworoshye kandi bufite ibyiza byinshi. Ubwoko bwa infracardiac bushobora gusaba kubagwa bigoye ariko bugifite ibyiza byinshi.

Nyuma yo kubagwa, abana benshi barakira neza kandi bakura bafite ubuzima bwiza. Igihe cyo kuba mu bitaro gisanzwe ari icyumweru kimwe cyangwa bibiri, harimo igihe cyo kuba mu cyumba cy’ubutabazi kugira ngo umwana wawe akurikiranwe hafi uko ari gukira.

Uko witwara mu rugo mu gihe cy’ubuhinduka bw’imitsi y’amaraso mu mitima (TAPVR)

Mu gihe utegereje kubagwa cyangwa mu gihe cyo gukira, hari uburyo butandukanye bwo gufasha umwana wawe kumva aruhutse no kumufasha gukura. Itsinda ry’abaganga bazakugira inama yihariye ijyanye n’ibyo umwana wawe akeneye.

Kurya akenshi bisaba kwitabwaho cyane kuko abana bafite TAPVR baruhukira vuba mu gihe cyo kurya. Ushobora gukenera gutanga ibiryo bike, byinshi, kandi ugatanga igihe cyinshi kuri buri gihe cyo kurya.

Dore imwe mu ngamba zo kurya zishobora gufasha:

• Koresha ifu ifite ibinure byinshi niba muganga wawe abikubwiye
• Gerageza imyanya itandukanye yo kurya kugira ngo ugabanye imbaraga zo guhumeka
• Fata ibiruhuko byinshi mu gihe cyo kurya kugira ngo umwana wawe aruhuke
• Kureba neza uko umwana wawe ari gukura nk’uko muganga wawe abikubwiye
• Kureba ibimenyetso byo kudakunda kurya nko kuruka cyangwa umunaniro ukabije

Kurema ahantu hatuje kandi heza bifasha kugabanya umunaniro ku mutima w’umwana wawe. Komereza ahantu hashyushye, gabanya ibintu byinshi bitera umunaniro, kandi ushyireho imigenzo myiza yo kuryama no kurya.

Kureba umwana wawe neza kugira ngo harebwe impinduka z’ibimenyetso. Kanda ibyo kurya, imiterere yo guhumeka, n’imbaraga rusange. Menyesha itsinda ry’abaganga bawe impinduka zose ziteye impungenge, cyane cyane ubururu bwongereye cyangwa ibibazo byo guhumeka.

Uko witegura kujya kwa muganga

Kwitunganya kujya kwa muganga wawe wa mbere cyangwa kwa muganga wita ku mitima y’abana bifasha guhamya ko ubona amakuru n’ubuvuzi byiza ku mwana wawe. Za imbere n’ibibazo n’ibintu byinshi wibonye ku bimenyetso by’umwana wawe.

Kora urutonde rw’ibintu by’umwana wawe byo kurya, kuryama, n’ibimenyetso. Andika ibyo arya, igihe cyo kurya, n’impinduka zo guhumeka wibonye. Aya makuru afasha abaganga kumenya uko umwana wawe ari gukora no gutegura igihe cyo kuvurwa.

Zana ibi bintu by’ingenzi mu gihe ugiye kwa muganga:

• Urutonde rw’imiti yose ukoresha n’ingano zayo
• Urutonde rw’ibyo kurya n’ibimenyetso
• Amakuru y’ubwisungane n’ibizamini byakozwe mbere
• Urutonde rw’ibibazo ushaka kubaza
• Amakuru y’abandi baganga bafasha kuvura umwana wawe

Tegura ibibazo mbere kugira ngo utibagiwe ibibazo by’ingenzi. Ushobora kubaza igihe cyo kubagwa, icyo witeze mu gihe cyo gukira, uko bizagenda mu gihe kirekire, cyangwa uko wamenya ibimenyetso by’ubukorikori.

Tekereza kuzana umuntu ugushakira inkunga kugira ngo afashe kwibuka amakuru no gutanga inkunga yo mu mutima. Gusura kwa muganga bishobora kuba bibi, cyane cyane iyo uganira ku burwayi bw’umutima w’umwana wawe n’ubuvuzi buzakurikira.

Icyo ukwiye kumenya cyane ku buhinduka bw’imitsi y’amaraso mu mitima (TAPVR)

Ikintu cy’ingenzi cyo kwibuka ni uko TAPVR ivurwa neza hakoreshejwe ubuvuzi, kandi abana benshi bakura bafite ubuzima bwiza nyuma yo kubagwa. Nubwo kumenya uburwayi bishobora kuba bibi, ubuvuzi bw’umutima bw’abana bugezweho bufite ibyiza byinshi kuri ubu burwayi.

Kumenya no kuvura hakiri kare bigira uruhare rukomeye mu mibereho. Niba ubona ibimenyetso by’ubukorikori ku mwana wawe nko kugira ibibazo byo kurya, guhumeka cyane, cyangwa ibara ry’ubururu, ntutinye kuvugana na muganga wawe wa mbere.

Abana benshi babagwe neza TAPVR bashobora gukora ibikorwa byabo bya buri munsi, harimo imikino na siporo. Basanzwe bakeneye gukurikiranwa n’umuganga wita ku mitima ariko ntibakenera kugira imipaka ku mikorere yabo.

Wibuke ko ubu burwayi buva ubusa mu gihe cy’inda, kandi nta kintu wakoreye kuburiza kubaho. Shyira imbaraga zawe mu gukorana n’itsinda ry’abaganga bawe kugira ngo umwana wawe abone ubuvuzi n’inkunga byiza.

Ibibazo byakunze kubaho ku buhinduka bw’imitsi y’amaraso mu mitima (TAPVR)

Q.1 Kubagwa kwa TAPVR bisanzwe bimamara igihe kingana iki?

Kubagwa kwa TAPVR bisanzwe bimamara amasaha 3 kugeza kuri 6, bitewe n’uburyo bugoranye bw’umubiri w’umwana wawe. Itsinda ry’abaganga bazakumenyesha uko ibintu byagenda mu gihe cyo kubagwa, kandi uzahura n’umuganga nyuma yo kubagwa kugira ngo muganire uko byagenze.

Q.2 Umwana wanjye azakenera kubagwa inshuro nyinshi?

Abana benshi bafite TAPVR bakenera kubagwa rimwe gusa kugira ngo bakemure ikibazo. Ariko, umubare muto ushobora gukenera ubundi buvuzi niba hari ibibazo nko kugira imitsi y’amaraso y’umwijima ihindagurika nyuma. Muganga wita ku mitima azakurikirana umwana wawe asuzumwa buri gihe kugira ngo amenye ibibazo hakiri kare.

Q.3 Abana babagwe TAPVR bashobora gukina siporo?

Yego, abana benshi babagwe neza TAPVR bashobora gukora ibikorwa byabo bya buri munsi, harimo imikino ya siporo. Muganga wita ku mitima azasuzumira imikorere y’umutima w’umwana wawe kandi ashobora kugutegeka gukora ikizamini cyo gukora siporo mbere yo kumwemerera gukora ibikorwa bikomeye, ariko imipaka ni mike.

Q.4 Ni ayahe mahirwe yo kubyara undi mwana ufite TAPVR?

Ibyago byo kubyara undi mwana ufite TAPVR ni byinshi kurusha abandi ariko biracyari bike cyane, bisanzwe biri hagati ya 2-3%. Muganga wawe ashobora kugutegeka kugisha inama umuganga wita ku mibanire y’abantu n’umuzuko no gusuzuma umutima w’umwana mu gihe cy’inda kugira ngo harebwe iterambere ry’umutima.

Q.5 Umwana wanjye azakenera gusuzumwa kenshi gute nyuma yo kubagwa?

Igihe cyo gukurikirana gitandukanye, ariko abana benshi babona muganga wita ku mitima buri mezi 6-12 nyuma yo kubagwa neza. Mu gihe cy’ubwangavu n’ubukure, gusuzuma buri mwaka bisanzwe bihagije keretse hari ibibazo byihariye. Ibi bisura bifasha guhamya ko umutima w’umwana wawe ukomeza gukora neza uko ari gukura.