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<b>[求助]先天性主动脉缩窄9 a4 z# C5 A9 c( [ ]5 a
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( n8 i! Q+ M& r6 _% P<P align=center><FONT size=3><b>患儿今年四岁，男孩，两年前查出患有先天性主动脉狭窄，现在服用地高辛和利尿剂治疗。 </b>, x2 o- Q- n5 h5 n
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% P' e& B& C" t' x6 a<P align=center><B><FONT size=3>中国医学科学院阜外心血管病医院
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<P align=center><FONT size=3><B><FONT face="Times New Roman">EBCT</FONT></B><B>诊断报告 1 {9 H( N3 a& i2 S1 g" |& d, Z
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/ {& m- n$ E7 D- S7 B<P><FONT size=3>检查日期：<st1:chsdate Year="2002" Month="8" Day="15" IsLunarDate="False" IsROCDate="False" w:st="on"><FONT face="Times New Roman">2002</FONT>年<FONT face="Times New Roman">8</FONT>月<FONT face="Times New Roman">15</FONT>日</st1:chsdate><FONT face="Times New Roman"> </FONT></FONT></P>
- s; Y( K& A1 y4 N6 D- I) g+ K<P><FONT size=3>扫描所见：</FONT></P>
$ m9 b1 L, J$ H2 m/ i<P><FONT size=3>心房正位，心室右袢，房室连接关系正常。左心房室明显增大，以左室为著。</FONT></P>. i3 D; o* B5 H V0 R4 ^
<P><FONT size=3>大动脉起源及位置关系正常。主动脉弓横部较细小（径约<st1:chmetcnv w:st="on" UnitName="mm" SourceValue="8.4" HasSpace="False" Negative="False" NumberType="1" TCSC="0"><FONT face="Times New Roman">8.4mm</FONT></st1:chmetcnv>），降主动脉起始部可见一局限性的狭窄，最窄处径约<FONT face="Times New Roman">5</FONT>×<st1:chmetcnv w:st="on" UnitName="mm" SourceValue="9" HasSpace="False" Negative="False" NumberType="1" TCSC="0"><FONT face="Times New Roman">9mm</FONT></st1:chmetcnv>，且腔内密度明显不均。可见明显的狭窄后扩张。升主动脉径约<st1:chmetcnv w:st="on" UnitName="mm" SourceValue="12" HasSpace="False" Negative="False" NumberType="1" TCSC="0"><FONT face="Times New Roman">12mm</FONT></st1:chmetcnv>。肺动脉显影良好，测主肺动脉径约<st1:chmetcnv w:st="on" UnitName="mm" SourceValue="20" HasSpace="False" Negative="False" NumberType="1" TCSC="0"><FONT face="Times New Roman">20mm</FONT></st1:chmetcnv>，左肺动脉径约<st1:chmetcnv w:st="on" UnitName="mm" SourceValue="8" HasSpace="False" Negative="False" NumberType="1" TCSC="0"><FONT face="Times New Roman">8mm</FONT></st1:chmetcnv>，右肺动脉径约<st1:chmetcnv w:st="on" UnitName="mm" SourceValue="9" HasSpace="False" Negative="False" NumberType="1" TCSC="0"><FONT face="Times New Roman">9mm</FONT></st1:chmetcnv>。</FONT></P>/ q: }" Q, u! A$ R
<P><FONT size=3>诊断：</FONT></P>
: s( F" H, r/ d4 V8 c* }- M! [<P><FONT size=3>先天性心脏病：</FONT></P>% N/ [. E) o% [% F% g9 Z
<P><FONT face="Times New Roman"><FONT size=3>1.</FONT> </FONT><FONT size=3>主动脉缩窄；</FONT></P>
! S9 ^) \+ v' w<P><FONT face="Times New Roman"><FONT size=3>2.</FONT> </FONT><FONT size=3>左心房、室明显增大，结合临床提示有二尖瓣病变并存（关闭不全）。</FONT></P>
! a$ g8 b' s) X! @8 s2 m- g$ Z2 X<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心 + ~1 M: P) T2 H' b) A, }# C) r
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<P align=center><B><FONT size=3>超声心动图示波报告
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0 b/ s' e* B. Y7 x `& i<P><FONT size=3>检查日期：<st1:chsdate Year="2002" Month="8" Day="12" IsLunarDate="False" IsROCDate="False" w:st="on"><FONT face="Times New Roman">2002</FONT>年<FONT face="Times New Roman">8</FONT>月<FONT face="Times New Roman">12</FONT>日</st1:chsdate></FONT></P>/ }0 c' N' s. O% I
<P><FONT size=3>阳性所见：</FONT></P>
, c( X2 w, E& m* q+ I3 g<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左心增大，以右室为重，室壁厚度正常，运动减低；</FONT></P>
& c7 I8 R ? I" a$ e5 |8 q<P><FONT size=3><FONT face="Times New Roman">2 </FONT>房室间隔连续性完整，<FONT face="Times New Roman">CDFI</FONT>未见过隔血流；</FONT></P>
; ?' c' d Q8 V4 E) k" A0 X<P><FONT size=3><FONT face="Times New Roman">3 </FONT>二尖瓣前叶瓣尖略厚，回声略强，<FONT face="Times New Roman">CDFI</FONT>可见二尖瓣重度返流信号，二尖瓣形态结构未见明显异常，<FONT face="Times New Roman">CDFI</FONT>可见三尖瓣轻度返流信号，<FONT face="Times New Roman">CW</FONT>：<FONT face="Times New Roman">Vmax<st1:chmetcnv w:st="on" UnitName="cm" SourceValue="282" HasSpace="False" Negative="False" NumberType="1" TCSC="0">282cm</st1:chmetcnv>/s</FONT>，<FONT face="Times New Roman">PG31mmHg</FONT>，主动脉瓣冠瓣叶回声略强，启闭未见明显异常，左右冠状动脉起源正常，内径正常。</FONT></P>0 s X3 ?# d, O4 ?% k9 n8 m- f
<P><FONT size=3><FONT face="Times New Roman">4 </FONT>降主动脉左锁骨下动脉发出后向动脉方向走行扭曲，最窄处为<st1:chmetcnv w:st="on" UnitName="mm" SourceValue="6" HasSpace="False" Negative="False" NumberType="1" TCSC="0"><FONT face="Times New Roman">6mm</FONT></st1:chmetcnv>，<FONT face="Times New Roman">CDFI</FONT>：前向血流加快，<FONT face="Times New Roman">CW: Vmax<st1:chmetcnv w:st="on" UnitName="cm" SourceValue="346" HasSpace="False" Negative="False" NumberType="1" TCSC="0">346cm</st1:chmetcnv>/s</FONT>，<FONT face="Times New Roman">PG47.9mmHg</FONT>，降主动脉狭窄后扩张为<st1:chmetcnv w:st="on" UnitName="mm" SourceValue="19" HasSpace="False" Negative="False" NumberType="1" TCSC="0"><FONT face="Times New Roman">19mm</FONT></st1:chmetcnv>。</FONT></P>
* v1 c4 v4 Y6 W/ ^& R2 d. Q<P><FONT size=3>诊断：</FONT></P>" ~5 J5 P" d9 T% u- L9 l8 L; j8 a* X4 U
<P><FONT size=3>先天性心脏病</FONT></P>/ ]) l/ f7 L- g3 c* O! ?
<P><FONT size=3>主动脉缩窄</FONT></P>
: G4 p, m7 y2 {; A<P><FONT size=3>二尖瓣返流（重度）</FONT></P>
8 }) p& ~* } z& [- |5 s<P><FONT size=3>三尖瓣返流（轻度）</FONT></P>& a2 F) S3 K( j. h: T
<P><FONT size=3>左室大</FONT></P>+ U2 [$ p5 v' H9 ~! J
<P><FONT size=3>左室收缩功能减低</FONT></P>+ r% |* y4 ?/ F. _0 J5 D
<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心
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4 V- L; ^+ j. b' x0 a# B<P align=center><B><FONT size=3>超声心动图示波报告 - s Q( e! ?" v
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0 U1 v! L t3 H/ X+ J, ?& V<P><FONT size=3>检查日期：<st1:chsdate Year="2004" Month="5" Day="30" IsLunarDate="False" IsROCDate="False" w:st="on"><FONT face="Times New Roman">2004</FONT>年<FONT face="Times New Roman">5</FONT>月<FONT face="Times New Roman">30</FONT>日</st1:chsdate></FONT></P>4 F/ _% e# F0 ]1 w$ D# c8 Q
<P><FONT size=3>阳性所见：</FONT></P>! c6 I) k5 n( E- ?% D( j0 k, ?
<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左室呈球形扩张</FONT></P>4 H4 K5 e6 p: k7 ~+ G C
<P><FONT size=3><FONT face="Times New Roman">2 </FONT>左室壁增厚，室壁厚度及运动幅度正常，左室心内膜增厚，回声增强</FONT></P>( Q2 Z7 N; L A! k
<P><FONT size=3><FONT face="Times New Roman">3 </FONT>房室间隔连续完整<FONT face="Times New Roman">CDFI</FONT>：阴性</FONT></P>. G- `7 |4 y P
<P><FONT size=3><FONT face="Times New Roman">4 </FONT>各瓣膜形态回声及启闭运动正常。<FONT face="Times New Roman">CDFI</FONT>：收缩期二尖瓣少量返流舒张期主动脉瓣微量返流。</FONT></P>
) I' t9 a4 B& N* e `) `<P><FONT size=3><st1:chmetcnv w:st="on" UnitName="升" SourceValue="5" HasSpace="True" Negative="False" NumberType="1" TCSC="0"><FONT face="Times New Roman">5 </FONT>升</st1:chmetcnv>主动脉内径正常，主动脉横内径<st1:chmetcnv w:st="on" UnitName="mm" SourceValue="8" HasSpace="False" Negative="False" NumberType="1" TCSC="0"><FONT face="Times New Roman">8mm</FONT></st1:chmetcnv>，左锁骨下动脉以远<st1:chmetcnv w:st="on" UnitName="mm" SourceValue="4.4" HasSpace="False" Negative="False" NumberType="1" TCSC="0"><FONT face="Times New Roman">4.4mm</FONT></st1:chmetcnv>处可见膜性或薄嵴性狭窄，最窄处内径<st1:chmetcnv w:st="on" UnitName="mm" SourceValue="5" HasSpace="False" Negative="False" NumberType="1" TCSC="0"><FONT face="Times New Roman">5mm</FONT></st1:chmetcnv>，远端狭窄后扩张内径<st1:chmetcnv w:st="on" UnitName="mm" SourceValue="12" HasSpace="False" Negative="False" NumberType="1" TCSC="0"><FONT face="Times New Roman">12mm</FONT></st1:chmetcnv>，<FONT face="Times New Roman">CDFI</FONT>见狭窄处花样血流，<FONT face="Times New Roman">CW</FONT>测得血流速度<FONT face="Times New Roman"><st1:chmetcnv w:st="on" UnitName="cm" SourceValue="395" HasSpace="False" Negative="False" NumberType="1" TCSC="0">395cm</st1:chmetcnv>/s</FONT>，<FONT face="Times New Roman"> PG62mmHg.</FONT></FONT></P>
2 `$ ?0 h; x% b<P><FONT size=3><FONT face="Times New Roman">6 </FONT>大动脉水平未见异常通道</FONT></P>& i' {# a( _. B S; @
<P><FONT size=3><FONT face="Times New Roman">7 </FONT>室间隔高位及中位至左室侧壁可见两条腱索样回声</FONT></P>
$ X7 W _' G9 c2 J* ~1 {<P><FONT size=3>诊断：</FONT></P>
# F* s) R3 G3 K! e' G0 p<P><FONT size=3>先天性心脏病</FONT></P>1 D: l6 \7 I3 p4 J- ^
<P><FONT size=3>主动脉缩窄</FONT></P>
7 B) @" Y* c0 j, s: e9 y<P><FONT size=3>左室增大，左室壁肥厚</FONT></P>
4 p2 S; r( k- \; ]( W<P><FONT size=3>左室假腱索</FONT></P>& W; p% y1 P) p
<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心
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<P align=center><B><FONT size=3>超声心动图示波报告 7 a6 ]; h% @& D" `- U7 r$ e
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<P><FONT size=3>检查日期：<st1:chsdate Year="2004" Month="10" Day="18" IsLunarDate="False" IsROCDate="False" w:st="on"><FONT face="Times New Roman">2004</FONT>年<FONT face="Times New Roman">10</FONT>月<FONT face="Times New Roman">18</FONT>日</st1:chsdate></FONT></P>1 Q+ g* u; }4 ^8 H
<P><FONT size=3>阳性所见：</FONT></P>
1 U' H( x% {2 p$ X# ]7 @<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左心扩大，左室壁稍厚</FONT></P>. a/ Y/ R5 J, z, Y: l+ u
<P><FONT size=3><FONT face="Times New Roman">2 </FONT>室壁运动幅度未见异常</FONT></P>- J! L7 h L5 f* T( e2 Y
<P><FONT size=3><FONT face="Times New Roman">3 </FONT>房室间隔连续完整<FONT face="Times New Roman"> CDFI</FONT>：阴性</FONT></P>
; _3 K; f/ H3 D<P><FONT size=3><FONT face="Times New Roman">4 </FONT>各瓣膜形态结构正常<FONT face="Times New Roman"> CDFI</FONT>：二尖瓣少量返流</FONT></P>. D- F0 O+ C( \8 v0 f
<P><FONT size=3><FONT face="Times New Roman">5 </FONT>降主动脉起始部内径<st1:chmetcnv w:st="on" UnitName="mm" SourceValue="7" HasSpace="False" Negative="False" NumberType="1" TCSC="0"><FONT face="Times New Roman">7mm</FONT></st1:chmetcnv>，远端扩张，<FONT face="Times New Roman">CDFI</FONT>：起始部血流速度增快，<FONT face="Times New Roman">CW</FONT>：<FONT face="Times New Roman">Vmax <st1:chmetcnv w:st="on" UnitName="cm" SourceValue="335" HasSpace="False" Negative="False" NumberType="1" TCSC="0">335cm</st1:chmetcnv>/s</FONT>，<FONT face="Times New Roman"> PG 45mmHg</FONT></FONT></P>
; L t4 \0 s' V) w. _) ?<P><FONT size=3>诊断：</FONT></P>
5 _. H% q& X( `$ I0 G2 @<P><FONT size=3>先天性心脏病</FONT></P>
8 C }; l3 ?9 ^1 a- B4 v0 n<P><FONT size=3>主动脉缩窄</FONT></P>- |) F, z! ?1 _. v( V
<P><FONT size=3>从目前的情况来看，病情的会不会继续发展？</FONT></P>6 v& T, y: h; l& ^6 q
<P><FONT size=3>是否必须手术？</FONT></P>
% {9 F1 ^* e6 }( Z0 }0 c0 h/ Q<P><FONT size=3>不做手术对以后生长发育有什么影响？手术是否复杂？手术费用以多少？</FONT></P>2 M6 m( e2 X: P {( X3 e& q
<P><FONT size=3>现在仍服用地高辛和利尿剂，一般状况还好，可以象其他小孩一样活动，请问还要服用多久？</FONT></P> |
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