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<b>[求助]先天性主动脉缩窄
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5 w$ P2 V' z4 y: B0 A6 [- _; M5 r<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>
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<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: O- J" c* t: S<P align=center><FONT size=3><B><FONT face="Times New Roman">EBCT</FONT></B><B>诊断报告 3 ] k. q0 I2 y0 f
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<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>6 ^$ F7 q( S5 G9 I0 |' C
<P><FONT size=3>扫描所见：</FONT></P>
; d; I& j) L" q) u<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>
. K) x" V* V( h1 A& W* }2 G3 i( Y& B R<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>( K' j; W* V! i3 [8 P; J
<P><FONT size=3>诊断：</FONT></P>
% R- Y) s7 R) u, q8 C5 D<P><FONT size=3>先天性心脏病：</FONT></P>
0 x, B# i. P% i# w' y<P><FONT face="Times New Roman"><FONT size=3>1.</FONT> </FONT><FONT size=3>主动脉缩窄；</FONT></P>
/ ^! `- ~6 Y& c<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>
# C: u" b9 ]$ ~, f; m" k; n<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心 , {. Z1 {+ e# ~1 O
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1 `- [: o9 B) J" l% G3 C<P align=center><B><FONT size=3>超声心动图示波报告 8 Z U+ B. A) h0 c
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<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 _/ r2 V, N- x- C
<P><FONT size=3>阳性所见：</FONT></P>; Y7 c- A/ U: e. q) @
<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>
, ~( `6 k$ {4 i4 y; ?6 O3 P<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>! p1 X/ ~/ |) O; I8 j$ ^
<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>1 \; E* n# l( n# X u
<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>+ f. g: f! P: o# \% s: _
<P><FONT size=3>诊断：</FONT></P>+ L$ ]7 P. G* @3 b4 V/ L7 M. C
<P><FONT size=3>先天性心脏病</FONT></P>7 ^1 j& G) \* P% c# U# i6 j
<P><FONT size=3>主动脉缩窄</FONT></P>. h" T0 }7 v4 ?; J) o( O
<P><FONT size=3>二尖瓣返流（重度）</FONT></P>6 D' ?, h3 e9 Z* n6 k
<P><FONT size=3>三尖瓣返流（轻度）</FONT></P>
& T* e+ C- B. _<P><FONT size=3>左室大</FONT></P>1 U, @$ y% U$ S' w! m8 X& k
<P><FONT size=3>左室收缩功能减低</FONT></P>
9 L! T) p- B1 J+ k3 l* E1 _<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 5 U* P& M9 O; y! t9 r, f8 b6 `( ]
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9 s4 t; a, Y* Y3 N 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>
5 d& S6 a }$ }. @1 c<P><FONT size=3>阳性所见：</FONT></P>
' `$ a$ J4 j2 C8 D& J1 v0 D( p" W<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左室呈球形扩张</FONT></P>
' n7 D% l; M3 W U1 S<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>
1 o0 ]9 L6 J5 ^7 D* g. r7 G( o9 _: g<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>$ c# I% Z2 Y# A" B
<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>; L1 q$ Y6 ]4 ~
<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>
+ J" q5 d, n% B' H& i) z$ s1 H<P><FONT size=3><FONT face="Times New Roman">6 </FONT>大动脉水平未见异常通道</FONT></P>- M9 C3 W7 d' s- h4 O
<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>
& M% J! v4 r% k5 Y+ e<P><FONT size=3>诊断：</FONT></P>
; T5 }$ S9 l6 D$ G Z$ J& n<P><FONT size=3>先天性心脏病</FONT></P>
3 _, i9 Z, d9 r9 U<P><FONT size=3>主动脉缩窄</FONT></P>
3 z9 H" t2 m- b/ u1 P' Y' g; g<P><FONT size=3>左室增大，左室壁肥厚</FONT></P>
% [; X; f7 [" L. q: O! O<P><FONT size=3>左室假腱索</FONT></P>
+ ]3 O" P& p1 q3 F: g. K6 g<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心 7 x4 b7 b8 l& L* b+ V
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0 U7 M. E6 B- b/ O( G" ?<P align=center><B><FONT size=3>超声心动图示波报告
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7 @4 r3 M; b% { l1 X<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># W" x4 v% e2 G$ R! U6 F6 k
<P><FONT size=3>阳性所见：</FONT></P>4 z& W3 ?: x8 |- y8 n8 X5 {) p x
<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左心扩大，左室壁稍厚</FONT></P>0 ]6 j. h+ ]; c3 t3 W2 L
<P><FONT size=3><FONT face="Times New Roman">2 </FONT>室壁运动幅度未见异常</FONT></P>8 d9 F5 o: U) D
<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>7 D: [" W ]1 I$ {
<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>
& Q( p; Z0 m& U }<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>
* W0 }) z$ C3 T) G4 M9 i2 ^<P><FONT size=3>诊断：</FONT></P>
- j4 w8 ^* }$ R3 r) y<P><FONT size=3>先天性心脏病</FONT></P>
$ c# F8 K( [4 Z0 n- t) Y7 V6 E<P><FONT size=3>主动脉缩窄</FONT></P>
' A! s" R5 B' T9 x& y9 Q: O<P><FONT size=3>从目前的情况来看，病情的会不会继续发展？</FONT></P>; C0 h0 C9 ^2 T2 t' x' z
<P><FONT size=3>是否必须手术？</FONT></P>. }! d) D- q8 C7 ^' y; {
<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>* T8 Y- X# `- p: \
<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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