M'mapapo mwanga Vienna. Anomalous mitsempha m'mapapo mwanga

M'mapapo mwanga Vienna (chithunzi pansipa) - chotengera umene umabweretsa magazi wolumikizira limayenda ndi mpweya m'mapapo kwa atrium kumanzere.

Kuyambira capillaries m'mapapo mwanga kuphatikiza mu zotengera mitsempha zambiri wotumidwa kwa bronchi, ndiye zigawo tuzigawo twa, m'mapapo makungwa lalikulu chipata anapanga (iwiri iliyonse mizu) kuti akuuzidwa horizontally mu kumtunda kwa atrium kumanzere. Komanso, aliyense wa mbiya ya kudutsa mu kutsegula osiyana: kumanzere - kumanzere kwa atrium anachoka ndi ufulu kumanja. Pomwe m'mapapo mwanga mitsempha, izi matenda (kumanzere) transversely intersect ndi atrium bwino (kumbuyo kwake).

Akunja m'mapapo mwanga (kumanja) Vienna

Anapanga mtsempha zigawo segmental pakati ndi chapamwamba lobes m'mapapo.

• R.apicalis (nthambi apical) - ankaimira lalifupi venous thunthu, limene lili pa Lobe chapamwamba (mediastinal padziko) ndipo amanyamula magazi kuchokera gawo kwenikweni. Asanalowe mu bwino kuposa m'mapapo mwanga mtsempha pafupipafupi pamodzi segmental (kumbuyo) nthambi.
• R. zapambuyo (kumbuyo nthambi) amanyamula magazi chopereka kuchokera gawo kumbuyo. Izi nthambi - kwambiri ndi chachikulu Vienna mitsempha onse (segmental), zomwe zili Lobe chapamwamba. Mu chotengera ichi ndi akutali magawo angapo: vnutrisegmentarny poddolevoy gawo ndi gawo kuti amatenga magazi interlobar m'dera padziko slits oblique.
• R.anterior (kutsogolo nthambi) amanyamula magazi chapamwamba yosonkhanitsa gawo (kapena gawo zapambuyo). Nthawi zina, nkotheka kuti kuphatikiza kutsogolo ndi kumbuyo nthambi (ngati iwo kugwera mu thunthu wamba).
• R.lobi medii (pakati Lobe nthambi) amalandira magazi kwa zigawo pomwe m'mapapo (gawo pa avareji). Nthawi zina, izi zimachitika mawonekedwe a munthu Vienna mbiya ndipo amalowa chapamwamba pomwe m'mapapo mwanga mtsempha, koma nthawi cholandirira aumbike mwa mbali ziwiri: medial ndi lateral kuti kukhetsa ankalemekeza zigawo medial ndi lateral.

M'munsi m'mapapo mwanga (kumanja) Vienna

chotengera ichi amatenga magazi kuchokera m'munsi Lobe (zigawo zake 5) ndipo ali awiri inflow chachikulu: woyambira mtsempha ndi wamba chapamwamba nthambi.

Nthambi chapamwamba

Uli pakati pa woyambira ndi zigawo chapamwamba. Aumbike kwa mitsempha zina ndi waukulu, ayenera kukhala patsogolo ndi pansi kudutsa kuseri kwa apical segmental bronchus. nthambi Izi pamwamba pa zonse kanthu mu m'munsi pomwe m'mapapo mwanga mtsempha.

Choncho chifuwa Vienna limapangidwa inflow zitatu: lateral, chapamwamba medial ili ambiri intersegmental koma ukhoza kuthamanga ndi vnutrisegmentarno.

Chifukwa cha zina magazi outflow mtsempha ikuchitika ndi gawo chapamwamba (pamwamba ake) mu dera poddolevuyu segmental mtsempha kumbuyo chapamwamba Lobe (zapambuyo ake gawo).

Woyambira okwana Vienna

Tinanyamuka venous thunthu, anapanga pamphambano ya m'munsi ndi chapamwamba mitsempha woyambira nthambi zikuluzikulu zomwe kugona chozama kutsogolo wamba pamwamba.

Woyambira pamwamba Vienna. Popangidwa ndi pophatikizana a yaikulu mitsempha woyambira segmental ndi mitsempha kuti kunyamula magazi kuchokera medial, zapambuyo ndi zigawo lateral.

Woyambira pansi Vienna. Mayina wonse woyambira mtsempha kuchokera pamwamba pake otsika kumbuyo. The inflow waukulu chidebe - woyambira zapambuyo nthambi amatenga magazi woyambira zapambuyo gawo. Nthawi zina, m'munsi woyambira Vienna angafikemo pamwamba m'mitsempha woyambira.

ADLV

Ndi kobadwa nako matenda a mtima pa zomwe yatsoka ndi wapezeka neanatomichnoe mitsempha m'mapapo mwanga kwa atrium (kumanja), kapena m'mayina atsopano a vena cava.

kudwala Izi limodzi ndi chibayo pafupipafupi, kutopa, kufupika kwa mpweya, kuchedwa ya kukula, kupweteka mtima. Monga diagnostics ntchito: ECG, Kujambula, X-ray, mtima catheterization, ultrasound, ndi ventrikulo- atriografiyu, angiopulmonography.

Opaleshoni chithandizo chilema zimadalira mtundu wake.

mwachidule

ADLV - kobadwa nako chilema ndi za 1.5-3.0% ya zopindika mtima. Ambiri anaona odwala wamwamuna.

Nthawi zambiri chilema izi pamodzi ndi chowulungika (lotseguka) zenera ndi zilema septum pakati ventricles lapansi. Pang'ono zochepa (20%) - kuchokera thunthu magazi wamba, hypoplastic kumanzere mbali za mtima, VSD, dextrocardia, tetralogy wa Fallot, ndi transposition ziwiya chachikulu, ambiri ventricle mtima.

Kuwonjezera zopindika awa, nthawi zambiri limodzi ADLV extracardiac kudwala: hernias umbilical, zopindika fupa mapangidwe ndi machitidwe endocrine, matumbo diverticula, horseshoe impso, matenda polycystic impso ndi hydronephrosis.

Gawo anomalous m'mapapo mwanga venous ngalande (ADLV)

Mu nkhani ya confluence ya mitsempha kufalitsa zokhudza zonse kapena mu atrium lamanja, chilema uyu akutchedwa zonse anomalous ngalande, ngati mu dongosolo pamwamba amalowa m'modzi kapena mitsempha ochepa, chotero chilema amatchedwa tsankho.

Mogwirizana ndi mlingo wa confluence kuonetsetsa ena options cirema;

• zosinthika Choyamba: nadserdechny (suprakardialny). Mitsempha m'mapapo mwanga (monga thunthu wamba kapena kupatukana) kuyenda mu chapamwamba vena cava kapena nthambi zake.
• Njira ziwiri: mtima (intracardiac). mitsempha m'mapapo mwanga chatsanulidwa mu nkusani inatsekeratu kapena atrium bwino.
• Chachitatu chimake: podserdechny (infuraredi kapena subcardial). mitsempha m'mapapo mwanga kulowa chipata kapena vena cava m'munsi (anaiwononga mu ritsa lymphatic).
• Njira chachinayi: osokonezeka. mitsempha m'mapapo mwanga m'gulu nyumba osiyana ndi mbali zosiyanasiyana.

Features hemodynamics

Mu utero yogwira chilema nthawi sanaone, chifukwa cha peculiarities wa kufalitsidwa yoopsa. Atabadwa mwana mawonetseredwe hemodynamic anafotokozedwa kwa chilema ichi ndi osakaniza ake ndi anomalies ena kobadwa nako.

Pankhani ya okwana anomalous ngalande matenda hemodynamic anasonyeza hypoxemia, hyperkinetic zimamuchulukira wa mtima wabwino ndi matenda oopsa m'mapapo mwanga.

Pankhani ya hemodynamics tsankho ngalande ofanana kuti ndi ASD. The otsogolera wa kuyan'anila za nthenda arteriovenous shunt, imbaenda ndi kuwonjezeka mu buku magazi bwalo laling'ono.

Zizindikiro za anomalous m'mapapo mwanga venous ngalande

Kids ndi chilema kawirikawiri zowawa pachimake matenda kobwereza kupuma tizilombo chibayo, iwo amati chifuwa, otsika kunenepa, tachycardia, kufupika kwa mpweya, kupweteka mtima, kuwala cyanosis ndi kutopa.

Pankhani ya matenda oopsa m'mapapo mwanga zimaoneka mu m'badwo yaing'ono kuoneka mtima kulephera, anasonyeza cyanosis ndi mtima hump.

diagnostics

Chithunzi auscultation pa ADLV ofanana ASD, ndiye amapanga wosakhazikika auscultated systolic phokoso mu zolosera za mitsempha mitsempha (mitsempha m'mapapo mwanga) ndi akuwaza wa kamvekedwe 2.

• The ECG zizindikiro za zimamuchulukira mtima lamanja, zopatuka mbo pomwe anatseka misewu (chosakwanira), pomwe mtolo chipika nthambi.
• Pamene phonography zizindikiro za ASD.
• Mu radiography apeze chitsanzo kuwala oumbidwa mtsempha wamagazi m'mapapo mwanga (Arc ake), kuwonjezera lamanja mtima malire, "Turkey saber" chizindikiro.
• Echocardiography.
• Poona cavities mtima.
• Venography.
• Atriografiya (kumanja).
• Angiography.
• Ventriculography.

Masiyanidwe matenda a chilema zimenezi ziyenera kuchitidwa:

• Lymphangiectasia.
• Kung'ambika atresia / mitral valavu.
• ziwiya transposition.
• Mitral stenosis.
• Stenosis ya kumanja / kumanzere mitsempha m'mapapo mwanga.
• Trehpredserdnym mtima.
• Wakutali ASD.

chithandizo

Mitundu ya opaleshoni tsankho ngalande anatsimikiza mtima umodzi chilema, kukula ndi malo ASD.

uthenga matenda kuthetsa ntchito pulasitiki kapena suturing ASD. Ana kwa zaka zitatu kuti ali mwakayakaya yovuta, achite palliative opaleshoni (chatsekedwa atrioseptotomiyu), zomwe cholinga chake ndicho kuwonjezera kulankhulana interatrial.

Total kwakukulu chilema kukonzedwa (okwana mitundu) zikuphatikizapo mwai angapo.

• Ligation posts pathological mtima mitsempha.
• Kutalikirana kwa mitsempha m'mapapo mwanga.
• Kutsekedwa kwa ASD.
• Anastomosis pakati pa atrium anachoka ndi mitsempha m'mapapo mwanga.

Zotsatira za ntchito wotero: kuenjezera m'mapapo mwanga matenda oopsa ndi kulephera nkusani mfundo.

Zoneneratu

Kuti madokotala ananena zawo za njira zachilengedwe vuto ili akumane, popeza 80% odwala kufa chaka choyamba cha moyo.

Odwala pamaso pa ngalande tsankho zimatha kukhala kwa zaka makumi atatu. Kufa kwa wodwala amenewa nthawi zambiri amagwirizana ndi matenda m'mapapo mwanga, kapena kulephera aakulu mtima.

Zotsatira chilango opaleshoni ya chilema zambiri zogwira mtima, koma lethality neonatal pa kapena pambuyo opaleshoni yapamwamba.