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<b>[求助]先天性主动脉缩窄6 ~( \+ G; l; |6 Q
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6 l# e0 J! {( p+ n9 B<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>
8 a4 h6 ^0 y3 x: s- v<P><b></b></P></FONT>$ p3 s; C# G; @" O7 u8 N
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. S/ g, n ^, w# J: @" F/ {& h9 d<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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5 r: k5 r7 t( D( K7 T/ R( G<P align=center><FONT size=3><B><FONT face="Times New Roman">EBCT</FONT></B><B>诊断报告
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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>. l* [8 N+ `7 y" r+ d
<P><FONT size=3>扫描所见：</FONT></P>
3 P) g$ s" c6 A<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>) ~$ }( a# Q- n: ]9 B/ C6 x1 d; \
<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* U6 H. m3 N# s
<P><FONT size=3>诊断：</FONT></P>
, G' U% i' j p- {1 s<P><FONT size=3>先天性心脏病：</FONT></P>
# u/ V* _* i2 y7 _<P><FONT face="Times New Roman"><FONT size=3>1.</FONT> </FONT><FONT size=3>主动脉缩窄；</FONT></P>" z5 o$ Z% G9 A! 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>0 W4 X# ?7 ?$ }4 ~ c" g0 o; {
<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 - r5 D4 e8 C5 J" L/ U* V
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; q( i( A0 Q6 m7 Y h% `3 I& c<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 U N O+ p, y0 U$ F4 `4 j<P><FONT size=3>阳性所见：</FONT></P>- v j! c) F! J' J$ i6 K% |: l
<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>
" J1 h* B/ l' z" X( ]$ S<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>: s6 G: c9 O* _: G6 c( P5 j% V
<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>+ X! z+ |% H. P8 h" Q
<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>
9 R% w& Z. F" |& m: J/ X; W<P><FONT size=3>诊断：</FONT></P>
% B* x, ~- V2 @" U<P><FONT size=3>先天性心脏病</FONT></P>
8 Z) ^+ Y4 L9 \! f6 a& |0 b<P><FONT size=3>主动脉缩窄</FONT></P>. Q( m' H8 g6 q3 B9 `& u
<P><FONT size=3>二尖瓣返流（重度）</FONT></P>
5 N2 A% I, ^4 |$ y5 z3 {' q/ f<P><FONT size=3>三尖瓣返流（轻度）</FONT></P>
1 Y/ L6 R: K, Y/ T5 N- ~<P><FONT size=3>左室大</FONT></P>
( H2 B6 T% F6 p' V<P><FONT size=3>左室收缩功能减低</FONT></P>4 _+ @+ g& N2 J
<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心 : B- Y3 O# `; _( `% ?+ d
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<P align=center><B><FONT size=3>超声心动图示波报告 x# K# t! R. H3 X* Q j8 N
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& z& c% y4 ?: Y4 w6 B1 b t<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>7 A- g0 T3 n- ^# a) ^
<P><FONT size=3>阳性所见：</FONT></P>1 E; D! A8 r# ~8 [7 |4 r! t1 U
<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左室呈球形扩张</FONT></P>2 U% E6 F. J$ ~$ E
<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>
9 Y4 @" i9 q" Z% v( Z- 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>
/ ^$ V$ t) m. ?5 q* w2 `, k8 T<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>- K' R7 L0 t+ a& e+ c
<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>' `6 c; l: U) T) B' j* Q% v7 J
<P><FONT size=3><FONT face="Times New Roman">6 </FONT>大动脉水平未见异常通道</FONT></P>( n. T {7 \1 ^0 Y4 c( l
<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>" c4 l( T- r. l7 r4 K* H
<P><FONT size=3>诊断：</FONT></P>% l/ s, i+ j' X- M( v" @# p
<P><FONT size=3>先天性心脏病</FONT></P>. w4 J' r- F5 y( Y8 W2 N
<P><FONT size=3>主动脉缩窄</FONT></P>3 G1 N. ]& V$ V* h- O9 Z$ e
<P><FONT size=3>左室增大，左室壁肥厚</FONT></P>9 O" j( t( |0 \4 y
<P><FONT size=3>左室假腱索</FONT></P>. V% ^9 {; U' ]" M4 P
<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心 " }1 E0 v3 ]3 E; t+ [ K4 n
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; v/ S0 C! O5 L4 ~! [ p$ k<P align=center><B><FONT size=3>超声心动图示波报告 ! J/ V6 W3 T. x# o0 S( `# Y
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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>' D4 ^. B v: W
<P><FONT size=3>阳性所见：</FONT></P>+ @% i# M% W. p. V
<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左心扩大，左室壁稍厚</FONT></P>
0 Q g8 H* [- p: ]+ Z# [8 h" J) v<P><FONT size=3><FONT face="Times New Roman">2 </FONT>室壁运动幅度未见异常</FONT></P>
) b* e; K9 T. L8 @2 P, R<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>
/ [- A H: [ }- f+ i! i( p<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>' B S! Y. q' J- J
<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>
1 }/ c6 L1 Z$ u<P><FONT size=3>诊断：</FONT></P>. U1 T! B" ~8 p7 X5 U4 V8 q
<P><FONT size=3>先天性心脏病</FONT></P>
" i/ G( x! {/ w c6 f& b<P><FONT size=3>主动脉缩窄</FONT></P>+ {: I% A) O+ f k* ?# t- p9 m
<P><FONT size=3>从目前的情况来看，病情的会不会继续发展？</FONT></P># z. d' ~0 x% x
<P><FONT size=3>是否必须手术？</FONT></P>
5 z% s, P3 e9 R. B; ?& D/ M- t {1 F<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>
+ w8 C& j) j) K) M<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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