
ragib syndrome

ragib syndrome anedi arudaina puttukatho vachhe gunde lopam, ikkada edama superior vena cava (lsvc) laena coronary sinus mariyu karnika septal lopamtho paatu edama karnikaloki pravahistundi. idhi pramaadakaramaina gunde jabbugaa pariganinchabadutundi endukante idhi vyaktini stroke vachhe pramaadam ekkuvagaa kaligi untundi. tarachugaa ragib syndromtho sambandham unna itara lopaalalo ventricular septal lopaalu, tricispid annulus yokka vistarana mariyu pulmonary stenosis undavacchu. idhi chaalaa arudaina abhivruddhi sanklishtamgaa pariganinchabadutunnappatiki, puttukatho vachhe gunde lopaalalo nirantara edama superior vena cava (plsvc) kii sambandhinchina kesulu saapekshamgaa saadhaaranam. plsvc tarachugaa kudi karnikaloki pravahistundani, lopamtho badhapaduthunna sumaru 10 nundi 20 saatam mandhi vyaktulalo edama karnikaloki matrame pravahistundani gamaninchadam kooda mukhyam.
antarleena hridaya paristhiti laeni vyaktilo, unnata vena cava sareeram nundi kudi karnikaku tirigi vachhe raktaanni andistundi. sareeram antataa vividha jeeva prakriyala dwara praanavaayuvu upayoginchabadatam valla, eee raktamlo praanavaayuvu sthaayilu chaalaa takkuvagaa untaayi. anduvalla, gunde yokka kudi vaipu eee raktaanni oopiritittulaku pamputundi, ikkada kesanaalikalaloo gyaas marpidi jarugutundi. aaa taruvaata praanavaayuvu kaligina raktam pulmonary sirala dwara gundeku edama vaipuku tirigi ravana cheyabadutundi. edama karnika mariyu edama jatarika ippudu aamlajanaka santrupta raktaanni mahadhamani dwara paiki mariyu sariiraaniki bayataku nettadaaniki panicheestaayi. mundu cheppinatlugaa, ragib syndrome unna vyaktulu edama unnatamaina vena cava nundi edama karnikaloki paarudalanu anubhavistaaru. dheeni ardham sareeram nundi tirigi vachhe deoxygenated raktam neerugaa oopiritittulanu daatavesi edama karnikaloki pravesistundi, akkada adhi tirigi sareeramloki pump cheyabadutundi, idhi sinosisku kaaranamavutundi. dheeni phalitamgaa aneka jeeva prakriyalapai pedda prabhavalu padavacchu, tarachugaa shastrachikitsa jokyam avasaram.
coronary sinus anedi goppa hridaya sira nundi konasage sira. idhi jatarika sankocham samayamlo gunde kandaraala jatarika sirala nundi raktaanni sekarinchi, eee raktaanni kudi karnikaloki kadilistundi. mukhyamgaa, eee coronary sinus gunde kandaraalaloni sirala nundi (epicardial ventricular siralu) dii-oxygenated raktaanni teesukoni gundeku kudi vaipuku pampinhee chestundi, tadwara daanini oopiritittulaku ravana chesi mallee oxygenate cheyavachu. oka vyaktiki gundelo eee bhaagam lekapovadam chaalaa arudu.
chivaraga, ragib syndrome yokka oka saadhaarana amsam karnika septal lopam. gunde yokka kudi mariyu edama karnikalanu vibhajinche septamlo randhram unnappudu idhi jarugutundi. eee randhram yokka parimaanam vyaktiki vyaktiki gananeeyamgaa maaravacchu, kondaru eee lopam yokka lakshanaalanu yuktavayassulo vachhe varaku gamaninchakapovacchu. karnika septal lopamtho pradhana aandolana emitante, idhi gunde yokka kudi vaipu adhika pani cheyadaaniki kaaranamavutundi. endukante edama karnika nundi raktam tirigi kudi karnikaloki sravistunnanduna oopiritittulaku pampe raktam parimaanam gananeeyamgaa perugutundi. tadwara debbatinna rakta naalaalaku daariteestundi, raktapotu perugutundi mariyu gunde yokka kudi vaipunu kooda penchutundi.
kaaranaalu.
ragib syndrome puttukatho vachhe gunde lopam gaa vargeekarinchabadatam antey eee lopam puttukathone undani ardham. puurva mariyu prushtha cardinal siralu pinda sirala vyavasthalo oka bhaagam. pindam abhivruddhi chendina enimidava vaaramlo eee cardinal siralu nemmadigaa kunchinchukupotayi mariyu itara nirmaanaalloki adrusyamavutaayi. edama puurva cardinal sira chivariki marshal yokka snayuvugaa maarutundi. eee sira adrushyam kakapothe, nirantara edamavaipu unnatamaina vena cava erpadutundi. eee kramaraahityam janabhalo 0.3% nundi 0.5% madhya mariyu puttukatho vachhe gunde jabbulu unnavaarilo sumaru 2.1% nundi 4.3% madhya untundi. saadhaaranamgaa edamavaipu unnatamaina vaenaa cava yokka pattudalanu anubhavinche pillalu itara hridaya kramaraahityaalanu kooda pradarsistaaru. ragib syndromelo eee adanapu lopaalalo karnika septal lopamtho paatu laeni coronary sinus untundi. nirantara edama suupar vena cava sinoatrial praantam yokka bhramanaaniki antaraayam kaligistundi, tadwara gunde yokka kudi mariyu edama cardinal siralu oke sthaayilo padipovadaaniki kaaranamavutundi, idhi coronary sinus erpadataanni nirodhistundi.
sankethaalu mariyu lakshanaalu.
ragib syndrome yokka lakshanaalu
charmam neelam rangu maaradam, lekapothe sinosis gaa vargeekarinchabadutundi, idhi erra rakta kanaala taginanta oxygenation lekapovadam phalitamgaa untundi. idhi pradhanamgaa charmam, gorlu, pedavulu ledhaa vyaktula kalla chuttoo kanipistundi. raktapravaahamlo praanavaayuvu lekapovadam kooda chakkati motaru panulu ledhaa abhignaa samasyalatho samasyalaku sambandhinchina lakshanaalaku kaaranam kaavacchu.
ragib syndrome yokka itara lakshanaalu saadhaaranamgaa cryptogenic stroke gaa vargeekarinchabadataayi, lekapothe teliyani muulam nundi vachhe stroke anie pilustaaru. eee lakshanaalalo aspashtamaina prasangam, edama vaipu mukha timmiri mariyu edama chethi vikrutatvam undavacchu.
ragib syndrome yokka konni lakshanaalu teevramgaa undavacchu, itara vyaktulu lakshanarahitamgaa undavacchu mariyu vaariki eee puttukatho vachhe gunde lopam undani teliyakapovacchu. postmortem moolyaankanam jarige varaku kramaraahityaalu gurtinchabadakapovachhu kabatti roganirdhaarana tarachugaa kashtamgaa untundi. anduvalla, konni sandarbhaallo idhi nirapaayamaina kramaraahityamgaa pariganhinchabadavacchu.
cellular sthaayilo sinosis yokka prabhavam.
mukhyamgaa, eee vyaadhini pramaadakaramgaa chese pradhana lakshanaalu mukhyamaina kanajaalaalu, kandaraalu mariyu avayavalaku cherukune oxygen lekapovadam. sinosis saadhaaranamgaa mea raktapravaahamlo 85 saatam ledhaa anthakante takkuva oxygen santruptata kaligi unnatlu vargeekarinchabadindi. saadhaaranamgaa mea raktamlo oxygen santruptata sthaayilu 95 saatam ledhaa anthakante ekkuva padipovali. mea sareeram antataa aneka jeeva prakriyalalo praanavaayuvu upayoginchabadutundi. bahusha eee prakriyalalo atyanta mukhyamainadi cellular respiration. kanaalu glucose anuvulanu teesukoni vaatini adenosine trifasphate (etipi) roopamlo rasayana saktigaa maarustaayi. glycolysis samayamlo, glucose yokka oke anuvu pairuvet yokka rendu anuvulugaa vibhajinchabadutundi. pairuvet taruvaata acetyl-kmjime eah (acetyl-koo) gaa maarchabadutundi. citric assid saikil appudu acetyl-kooni teesukuntundi mariyu praticharyala shreni dwara electron ravana golusulo upayoginche naad mariyu phaad2 anuvulanu utpatti chestundi.
electron ravana golusu naad mariyu phaad2 nuu upayoginchi mitochondrialo protan pravanatanu yerparustundi, idhi eah. tii. pii. nii utpatti chestundi. electron ravana golusu yokka sanklishta IV loe oxygen amaluloki vastundi. eee prakriyaloo praanavaayuvu tudi electron sweekartagaa pariganinchabadutundi. mukhyamgaa, sanklishta IV cytochrome sii nundi electronlanu oka samayamlo okatigaa sweekarinchi, aapai neetini roopondinchadaaniki vaatini praanavaayuvuku daanam chestundi. eee prakriyaloo, rendu hydrogen protaanlu mitochondria yokka antar-pora pradaesamlooki ravana cheyabadataayi. anduvalla, kanaalaku saktini utpatti cheyadamlo oxygen oka mukhyamaina bhaagam.
rooga nirdhaarana.
konni sandarbhaallo, oka vyakti yokka postmortem moolyaankanam jarige varaku ragib syndrome nirdhaarana cheyabadadu. ayithe, lakshanaalu unte ledhaa oka vyakti vaari gundenu anchanaa vesthe idhi mundugaane gurtinchadaaniki daariteestundi. roganirdhaaranalo saadhaaranamgaa cardiac magnetic resonance imaging (CMRI) vadakam untundi. ayaskanta pratidhvani ooha anedi oka vaidya ooha saanketikata, ikkada ayaskanta kshetram mariyu computer-generated radeo taramgaala upayogam mea sariiramlooni avayavalu ledhaa kanajaalaala 3dii chitraalanu nirminchagaladu.
tarachugaa dheenitho paatu cardiac computed tomography (sisiti) skaan untundi, idhi gunde mariyu daani rakta naalaala yokka 3dii chitraalanu srushtistundi. CMRI kakunda, gunde yokka vivaranaatmaka mariyu adhika-resolution skaannu roopondinchadaaniki vividha koonaalaloo ex-raelanu nirdesinchadam dwara idhi jarugutundi. anduvalla, gunde, kavaataalu, dhamanulu, mahadhamani, siralu mariyu marinni nirmaanaaniki sambandhinchina samasyala nirdhaaranaku daariteestundi. sii. sii. tii. skaan loe contrast media yokka intravenous injection untundi, idhi kanajalalanu nirvachinchadaaniki matrame kakunda, vaati madhya thedaanu gurtinchadaaniki kooda upayoginchabadutundi. mri mariyu sisiti skaan vadakam kooda shastrachikitsa jokya pranaalikanu nirnayinchadamlo vaidyulaku sahaayapadutundi.
eee gunde paristhitini nirdhaarinchadaaniki maroka saadhyamaina maargam electrocardiogram (eesiji ledhaa eekeji) nuu upayoginchadam. oka vyakti gunde kottukunetappudu gunde nundi vachhe vidyut sanketaanni koliche electrodelanu vaari chaatiipai unchutaaru. oka eKG samayamlo aneka vishayalu track cheyabadataayi. modatidi "p tarangam", idhi vidyut prerana edama mariyu kudi karnikaku prayaanistunnappudu jarugutundi, tadwara avi kudimpuku gurai jatarikalaloki raktaanni pamputaayi. eee jatarikalu gunde kandaraala nundi raktaanni paiki mariyu bayataku nettivestuu, sankuchitam avutuu "qrs" sanklishtatanu yerparustaayi. appudu gunde puurtigaa vishraanti teesukuntundi mariyu "tii wave" anedi jatarikala punah dhruveekarana. ragib syndrome unna vyaktula eKG luu leads v2-v4 mariyu edama ventricular hypertrophy t taranga vilomaalanu chuupavachchu. marovaipu, ekhocardiogram, gunde kadalikalo unnappudu daani 3dii chitraalanu roopondinchadaaniki dhwani taramgaalanu upayogistundi. idhi gunde antataa raktam entha baga pump cheyabadutundo vaidyulu oohinchadaaniki veelu kalpistundi.
gunde dwara rakta pravahanni ardham chesukovadaniki cardiac catheterization maroka maargam. cardiac catheterization samayamlo, catheter anie piluvabade podavaina sannani gottam, gunde kavaataalanu pariseelinchadaaniki, raktam ledhaa gunde namuunaalanu teesukoovadaaniki rakta naalamloki choppinchabadutundi mariyu merugaina visualization kosam raktapravaahamlo rangunu kooda unchavacchu. eee kaathetarnu gajja, eguva toda, cheyi ledhaa medalooni rakta naalamloo unchavacchu.
chivaraga, rogulu dhamanula rakta oxygen santruptilo gananeeyamaina taggudalanu kooda pradarsinchavacchu. conny eee hridaya lopaala parimaanam mariyu prabhavanni batti, ragib syndrome unna kontamandi rogulu 90 saataaniki paiga oxygen santrupta sthaayilanu konasaginchagalaru.
chikitsa.
saadhaaranamgaa, chikitsalo edama karnikaloki nirantara edama superior vena cava (plsvc) parakunda saricheyadaaniki shastrachikitsa jokyam untundi. vyakti aadhaaramgaa aneka shastrachikitsa empikalanu upayoginchavacchu. eee shastrachikitsa jokyala pradhana lakshyam gunde dwara gunde lopala raktam pravahanni tirigi sthaapinchadam. edama karnika paikappu ledhaa coronary sinus ekkada undaali vanti aandolana kaliginche praantaalaku karnika paachesnu vartimpajeyavachu. idhi rakta pravaahaaniki sahayapade soramgaanni roopondinchadaaniki sahaayapadutundi. tarachugaa plsvc nundi rakta pravahanni edama karnikaku badulugaa kudi karnikaloki mallinchadaaniki shastrachikitsa diddubaatu cheyavachu. konni muulaalu idhi pradhana shastrachikitsa parishkaram anie suuchistunnaayi. graft upayoginchi neerugaa kudi karnikaku pslvcni jodinchadam dwara, pslvcni edama pulmonary artariiki intra-atrial baffle thoo jodinchadam dwara ledhaa saadhaaranamgaa pslvc yokka vyajyaanni nirvahinchadam dwara idhi cheyavachu. ayithe, shastrachikitsa dwara plsvcni edama pulmonary artariiki jodinchadam valla thrombosis pramaadaanni penchutundi. eee prakriyaloo coronary sainasnu tirigi paikappu veyadam anedi vaanchaneeya phalitaalanu ivvadaaniki mukhyamani konni muulaalu suuchimchaayi. maroka muulam oka vyakti yokka saadhaarana paryaveekshanhanu suuchistumdi mariyu vaatini mandulapai unchadam takkuva teevramaina sandarbhaallo upayoginchavacchu. eee lopam yokka lakshanaalu mariyu sthaayilu chaalaa vyaktigatamgaa chaalaa ekkuvagaa untaayi kabatti, nipunula nundi vaidya salahanu pondadam chaalaa mukhyam.
cases studies.
oka cases studylo 40 yella mahilaku karnika septal lopaanni muusivaeyadaaniki pericardial pyaach ivvabadindi, aapai pslvcni neerugaa edama pulmonary artariiki anastomose chesaaru. anduvalla, edama karnikaku raktam leak avadanni vadilinchukovatam mariyu pslvc nundi raktam gundeku kudi vaipuku velli oopiritittulaku pump cheyabadutundani nirdhaarinchukovadam. aneka samvatsaraala taruvaata tadupari pariseelana shastrachikitsa vijayavantamaindani mariyu aameku cryptogenic stroke lakshanaalu levani suuchimchimdi.
maroe cases studdy 18 nelala sisuvu gundepai mri chesina tarvaata ragib syndrome unnatlu nirdhaarana cheyabadindi. plsvc neerugaa kudi karnika anubandhaaniki anusandhaaninchabadina chota extra cardiac jokyam paddhatini vartimpajesaaru. idhi pulmonary sira rakta pravaahaaniki aatamkam kaliginche pramaadaanni taggistundi, edama karnikapai udriktatanu taggistundi mariyu bhavishyattulo arithmiyaasnu nivaaristundani aasistunnanduna idhi uttama jokya paddhatigaa pariganinchabadindi.
edama chethi vikaaratvam, adhika raktapotu mariyu mukha timmiri mariyu aspashtamaina prasangam vanti stroke vanti lakshanaalanu chuupistunna 31 yella mahilanu rooga nirdhaarana kosam teesukuvacchaaru. aame medadu mariyu gundepai lothaina vislaeshanha ragib syndrome sankethaalanu choopinchindi. ikkadi itara vyaktula maadirigaa kakunda, aame aneka mandulu (aspirin mariyu metoprolol), alaage aame lakshanaalanu track cheyadaaniki holter monetor thoo discharge cheyabadindi.
chivaraga, oka 25 yella mahila aneka samvatsaraala paatu sinosis mariyu gunde dadanu anubhavinchindi. chaatii ex-rae mariyu eesiji upayoginchi ragib syndrome unnatlu nirdhaarana ayina tarvaata vyakti shastrachikitsa cheyinchukunnadu. shastrachikitsa samayamlo vaidyulu aame coronary sinus puurtigaa paikappu laenidigaa mariyu plsvc neerugaa edama karnikaloki pravahistunnatlu kanugonnaru. shastrachikitsakulu coronary sainasnu tirigi tolaginchaaru, paarudalanu nivaarinchadaaniki karnika septamnu punarnirminchaaru mariyu plsvcni kudi karnikaku mallinchaaru.
rooga niruupana.
shastrachikitsa jokyamtho, eee lopamtho badhapaduthunna chaalaa mandhi vyaktulu konasaaginchagalugutaaru mariyu puurtigaa kriyaatmaka jeevitaalanu gadapagalugutaru. gunde paristhiti nirdhaarana kakapothe samasyalu talettavachhu, tadwara oka vyakti stroke vachhe pramaadam perugutundi. ayithe, idhi itara vyaktulalo nirapaayamaina kramaraahityamgaa undochu mariyu eppuduu lakshanaalu ledhaa rooga nirdhaaranaku daariteeyadu.

