清医生帮我看看我小孩的先心问题

zouhr

<p>首先感谢医生百忙中抽空回答我的问题！</p><p>我老婆去年7月底怀孕，今年3月初（孕31周时）查出胎心心率不齐，去国际和平妇幼保健院围产中心做排畸和心脏彩超，显示小孩心脏结构正常，怀疑是室性早搏，每分钟15～25次。孕后期（37～39周）做胎心监护，心律不齐已基本消失。产前（40周）胎心监护又有心率不齐，因羊水少剖腹产（07年5月5日），女孩，出生时3370克，有早搏，每分钟3～4次。做24小时心电图提示为房性早搏，每分钟3～4次。后又做24小时心动图，医生说结果是房间隔缺损由左向右0.45×0.5cm，动脉导管未闭从左向右0.2cm，肺动脉高压，但报告以医院留档为由未给我们，尚未从病史室取得复印件。由于心里着急，麻烦医生是否可先帮忙回答以下几个问题：</p><p>1）小孩在胎儿期做心超显示心脏结构正常，且早搏有减少的迹象，房性早搏3～4次/分并不严重，但房间隔缺损＋动脉导管未闭＋肺动脉高压是挺严重的，24小时心动图会否有误诊的可能？</p><p>2）如果心动图结果准确，从这个结果来看，是否需要手术，何时手术好（小孩目前刚满1周），术后效果如何，可以和正常人完全一样吗？</p><p>不好意思现在详细的资料还没拿到，麻烦医生帮忙解答一下，非常感谢！</p><p></p>

陆医生

<p>房间隔缺损和动脉导管未闭都有可能自愈的，建议半岁复查心脏超声；</p><p>心律失常问题建议到我中心看心脏内科李奋主任门诊。</p>

zouhr

好的，非常感谢陆医生的回答。那她现在应该可以和正常小孩一样接种疫苗之类的了？

zouhr

<table class="tableborder1" cellspacing="1" cellpadding="3" align="center" style="WIDTH: 75%;"><tbody><tr align="center"><th width="100%" colspan="2" height="25">上海儿童医学中心-小儿先天性心脏病论坛-zouhr用户短信服务<td></td>
                                        <tr></tr></th></tr><tr align="left"><td class="tablebody1" width="100%" colspan="2">&nbsp;&nbsp;&nbsp;<b>您在"<font color="#ff0000">zouhr用户短信服务</font>"的时候发生错误,下面是错误的详细信息</b></td></tr><tr><td class="tablebody1" width="100%" colspan="2"><li>您没有浏览发送短信的权限，请<a href="http://www.ibabyheart.com/login.asp"><font color="#000000">登录</font></a>或者同管理员联系。 </li></td></tr><tr><td class="tablebody1" width="100%" colspan="2"><ul style="MARGIN-TOP: 0px; MARGIN-BOTTOM: 0px;"><li>请仔细阅读论坛帮助文件，确保您有相应的操作权限。 </li></ul></td></tr></tbody></table><p></p><p>不好意思看不到短信，如果方便是否可以邮件给我？<a href="mailto:whyangfan@126.com">whyangfan@126.com</a>，非常感谢！</p>

陆医生

可以预防接种。

zouhr

<p>谢谢陆医生！</p><p>昨天去医院抄了小孩二十四小时心动图的报告，结果如下：</p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">仪器　　</span><span lang="EN-US"><font face="Times New Roman">Philips Sonos 5500<span style="mso-spacerun: yes;">&nbsp; </span></font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　　频率：</span><span lang="EN-US"><font face="Times New Roman">2-4 MHz<span style="mso-spacerun: yes;">&nbsp; </span>3-8MHz<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span></font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">途径：经胸</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">项目：二维　</span><span lang="EN-US"><font face="Times New Roman">M</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">型　彩色　多普勒　&nbsp;&nbsp;&nbsp; 　　图像质量：</span><span lang="EN-US"><font face="Times New Roman">B</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><p><font face="Times New Roman">&nbsp;</font></p></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">M</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">型超声心动图（厘米）</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">LVDd</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　</span><span lang="EN-US"><font face="Times New Roman">1.7</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　　</span><span lang="EN-US"><font face="Times New Roman">RVDd</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　　　</span><span lang="EN-US"><font face="Times New Roman">IVSd<span style="mso-spacerun: yes;">&nbsp; </span></font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　　</span><span lang="EN-US"><font face="Times New Roman"><span style="mso-spacerun: yes;">
0 b% b) ]- u9 o; o; Y5 ^                                </span>LVPWd</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　</span><span lang="EN-US"><font face="Times New Roman">0.23</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　　　</span><span lang="EN-US"><font face="Times New Roman">Ao</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　</span><span lang="EN-US"><font face="Times New Roman">1.02</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">LVDs</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　</span><span lang="EN-US"><font face="Times New Roman">0.97</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　</span><span lang="EN-US"><font face="Times New Roman"> RVDs</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　　　</span><span lang="EN-US"><font face="Times New Roman">IVSs<span style="mso-spacerun: yes;">&nbsp; </span></font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　　</span><span lang="EN-US"><font face="Times New Roman"><span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>LVPWs</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　</span><span lang="EN-US"><font face="Times New Roman">0.4 </font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　　　</span><span lang="EN-US"><font face="Times New Roman">LA</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　</span><span lang="EN-US"><font face="Times New Roman">1.05</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><p><font face="Times New Roman">&nbsp;</font></p></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">心功能</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">LVEF</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　　</span><span lang="EN-US"><font face="Times New Roman">77%</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　　　</span><span lang="EN-US"><font face="Times New Roman">LVFS</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　　</span><span lang="EN-US"><font face="Times New Roman">39%</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><p><font face="Times New Roman">&nbsp;</font></p></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">二维超声（平方厘米）</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><font face="Times New Roman"><span lang="EN-US">LA<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span><city><place><span lang="EN-US">LV</span></place></city><span lang="EN-US">
) e1 r& \. U9 a& R: R                                <span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span>RA<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>RV<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>MRA<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>TRA</span></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><p><font face="Times New Roman">&nbsp;</font></p></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">频谱多普勒超声</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">AAo<span style="mso-spacerun: yes;">&nbsp; </span>0.8<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>DAo<span style="mso-spacerun: yes;">&nbsp; </span>1.6<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>LVOT<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>RVOT<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>MPA<span style="mso-spacerun: yes;">&nbsp; </span>1.0</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">MV<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>0.8<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>TV<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>0.8<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">跨瓣压差　　</span><span lang="EN-US"><font face="Times New Roman">mmHg</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><p><font face="Times New Roman">&nbsp;</font></p></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">彩色多普勒超声</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">MR<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span></font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">轻微　　　　</span><span lang="EN-US"><font face="Times New Roman">AI<span style="mso-spacerun: yes;">&nbsp; </span></font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　阴性　　　　</span><span lang="EN-US"><font face="Times New Roman">TR<span style="mso-spacerun: yes;">&nbsp; </span></font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　轻微　　　　</span><span lang="EN-US"><font face="Times New Roman">PI</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">　　轻微</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">心房水平　　左向右　分流　　　　　心室水平　　无　分流</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">大动脉水平　左向右　分流　　</span><span lang="EN-US"><font face="Times New Roman">2.93m/s</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><p><font face="Times New Roman">&nbsp;</font></p></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">超声所见</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 21pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">心脏位置及连接正常。房室腔无明显增大，左心收缩功能正常。主动脉无增宽，肺动脉稍增宽。各瓣膜开放活动正常。房间隔缺损（</span><span lang="EN-US"><font face="Times New Roman">II</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">）</span><span lang="EN-US"><font face="Times New Roman">0.45cm*0.5cm</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">，左向右分流，可见房间隔摆动。室间隔完整。左位主动脉弓。动脉导管未闭</span><span lang="EN-US"><font face="Times New Roman">0.2cm</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">，左向右分流</span><span lang="EN-US"><font face="Times New Roman">2.93m/s</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><p><font face="Times New Roman">&nbsp;</font></p></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">提示：</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 21pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">房间隔缺损（</span><span lang="EN-US"><font face="Times New Roman">II</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">）</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 21pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">动脉导管未闭</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 21pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">肺动脉高压</span><span lang="EN-US"><p></p></span></p><p>不知道她这种情况严不严重，有没有自愈的可能？提示肺动脉高压，但压力有多少，医生说没有具体数据。。。</p><p></p><p>麻烦陆医生帮忙解答一下，非常感谢！</p><p></p><p>另外，我没开通网上银行，看不到短信，不知道是否可以直接到贵院交费升级为VIP用户，或者有无其它办法？多谢陆医生的回答。（不好意思上面的email地址有误，应为<a href="mailto:whyangfan@163.com">whyangfan@163.com</a>）</p>

陆医生

<p>疾病本身看起来并不严重，肺动脉高压也只是轻度；且不排除自愈可能，建议3个月再复查一次；</p><p>VIP的问题我就赠送你一个短期VIP的身份吧，不必付费了。</p>

zouhr

再次顶起来，麻烦陆医生！
2 Z- d9 G' {. S+ `5 i
! |6 Z9 p- R; [: k' C3 S小孩已经3个月了，现在发育还可以，全母乳喂养，身高63cm，头围40.5cm，但体重偏轻，3个月只长了4斤多。平时活泼好动，醒了就基本上一刻不停的动，一逗就笑，除了吐过几次奶外，没有其它任何问题，也没生过病。专门去检查过（一般的门诊体检），心脏早搏已经听不到了，心脏也没有听到杂音。

后来给她做心动图检查的医生给我打过电话，我问肺动脉高压的问题，她说先心病不严重，肺动脉高压可能是生理性的，刚出生的小孩都有肺动脉高压（检查时小孩刚4天）。我后来在网上查相关资料，按她的先心病情况（房缺II 0.45×0.5cm，动脉导管未闭0.2cm，刚出生4天），应该也不会这么快就引起肺动脉高压。
% S/ z3 \3 a  |' x3 O9 L# f
现在小孩已经3个月了，想带她去贵院复查一下心脏彩超，但觉得她还小，怕太折腾她，不去又怕病情严重会不会拖延治疗。所以想请教陆医生，按她这种情况，是否可以到6个月的时候再去复查？
8 O* x. w! \( p/ F! h6 u
: o9 L% Q5 e& v# E- w  h2 d麻烦陆医生百忙之中抽空解答一下，非常感谢！！

陆医生

我想还是半岁的时候再来复查吧。

zouhr

谢谢陆医生的解答，非常感谢您！

陆医生

不必客气。