[求助]小儿主动脉缩窄、二尖瓣狭窄

智英杰妈妈 · 发表于 2006-8-30 20:25:39

<div style="BORDER-RIGHT: black 0.75pt solid; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: black 0.75pt solid; PADDING-TOP: 0cm; BORDER-BOTTOM: black 0.75pt solid;"><h4 style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; MARGIN: auto 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 14pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">各位专家：您们好！</h4><h4 style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; MARGIN: auto 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">   非常冒昧地打扰，实因心急小儿病情，心急如焚。故请您们在百忙之中看看小儿的检查结果，并给予指点，我将不盛感激。</h4><p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">    小儿，男性，于2002年2月13日出生，早产一月，出生时评分满分，现年2岁半，身高97CM，体重18.3KG。于今年8月11日儿保体检时发现心脏有杂间，2006年8月24日至复旦大学附属儿科医院检验，心脏超声检查如下：<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">一、普通心脏M型超声检查：<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">1、主动脉根部内径14(mm)   2、左房内径26(mm)    3、室间隔7(mm)  4、左室舒张末期内径27(mm)  5、左室收缩末期内径17(mm)  6、舒张末期左室后壁7(mm)   7、收缩末期左室后壁9(mm)  8、R-R间期0.66(秒)<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">二、普通二维超声心动图和彩色多普勒超声检查：<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">1、主肺动脉内径15(mm)<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">三、左心功能及血液动力学测定：<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">1、左室舒张末期容量27.1(ml)  2、左室短轴缩短率37.6(%)   3、二尖瓣E峰1.33   4、左室收缩末期容量8.2(ml)   5、左室射血分数69.7(%)   6、二尖瓣A峰1.92   7、每博量18.9(ml)   8、心输出量1.72(L/分)  9、肺动脉流速 0.95<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">描述：1、心脏为左位心，A-V与V-A连接一致，左位主动脉弓。<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">      2、左室壁肥厚，左房内径明显增大。<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">      3、主动脉根部内径可，主动脉弓内径6mm，主动脉弓降部左锁骨下动脉远侧见狭窄段，最狭处内径约为4mm，CW测此处压差为49mmHg。<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">      4、房、室间隔无明显回声失落，CFM未探及心内分流。<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">      5、肺动脉内径可，多普勒于肺动脉内探及层流频谱。<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">      6、二尖瓣瓣膜反光增强，瓣环直径2.4cm，开放受限，以后叶活动受限为主，瓣膜开放面积仅1.46平方厘米。三尖瓣形态活动尚可，多普勒示三尖瓣轻度反流。<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">结论：1、主动脉缩窄   2、二尖瓣狭窄   3、左心松弛功能不全。<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">四、X线摄片报告（2006年8月24日）<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">影像学表现：两肺纹理多，未见明显渗出影；肺门影略浓。两肺血偏多，心影轻中度增大，左位主动脉弓，肺动脉段平；两膈面光整，肋膈角锐利。<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">影像学诊断：两肺血偏多，心影增大，请结合心超检查。<p style="BORDER-RIGHT: medium none; PADDING-RIGHT: 0cm; BORDER-TOP: medium none; PADDING-LEFT: 0cm; PADDING-BOTTOM: 0cm; BORDER-LEFT: medium none; LINE-HEIGHT: 13.5pt; PADDING-TOP: 0cm; BORDER-BOTTOM: medium none; mso-line-height-rule: exactly; mso-border-left-alt: solid black .75pt; mso-border-bottom-alt: solid black .75pt; mso-border-right-alt: solid black .75pt; mso-padding-alt: 0cm 0cm 0cm 0cm;">    小儿目前的检查情况就是如此，平时也不见任何先心病的病症，请各位专家务必在百忙之中抽空看看，这种病情是否严重，是否必须要动手术，主动脉缩窄的情况能否用球囊导管扩张术？二尖瓣狭窄的问题又该如何解决？急切地等待您的回复，急急急，盼盼盼......</div>

陆医生 · 发表于 2006-8-31 20:23:43

您好：     此类疾病必须手术治疗，建议到我中心明确诊断及治疗方案。

智英杰妈妈 · 发表于 2006-8-31 21:18:42

陆博士：（没错吧？错了请谅解！）    像小儿这样的病情，在贵中心是否有过相似的病例，这种病情在先心病中算严重吗？术后的恢复情况如何？对小孩将来有没有影响。最近一直在贵中心的网站上看相关资料，关于二尖瓣的问题似乎较为严重，像小儿二尖瓣开放受限的问题要怎么处理呢？急盼陆博士的回复。

陆医生 · 发表于 2006-9-1 03:27:27

您好：     涉及主动脉瓣和二尖瓣的问题确实比较棘手，建议还是先到我们这里明确诊断吧。

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