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<b>[求助]先天性主动脉缩窄
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<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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* e5 E* q; F% @: ~0 A7 x, {<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
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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>; G% a3 ~+ E$ z$ m ?( D0 g
<P><FONT size=3>扫描所见：</FONT></P>: D; Z6 L, _" o5 H1 v3 X
<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>
7 o8 _& u) u5 R) D2 W2 P<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>. y. X4 P, U* g! \' c
<P><FONT size=3>诊断：</FONT></P>
$ g9 ]% U: y! {5 V8 _% n<P><FONT size=3>先天性心脏病：</FONT></P>- m. v3 w% X: f/ M
<P><FONT face="Times New Roman"><FONT size=3>1.</FONT> </FONT><FONT size=3>主动脉缩窄；</FONT></P>! m" y' \$ }0 d6 V% M
<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>
1 V. A( b- v9 c: g<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心
2 ~8 Q1 _# _4 X<p></FONT></B>
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<P align=center><B><FONT size=3>超声心动图示波报告
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, @( g& L) g. J* |( [' o. U<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>
/ k" h8 V$ Y _; L<P><FONT size=3>阳性所见：</FONT></P>! X. F+ Q+ Y! 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>
$ C, |/ {, n, \ }- 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>
9 F% u4 M- D' N, S<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>2 J; l1 b5 ?) h' e
<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>8 W3 m( N" B! ~& N4 W- Q
<P><FONT size=3>诊断：</FONT></P>
4 q3 H: R& F) W5 h& a' [4 U<P><FONT size=3>先天性心脏病</FONT></P>
- d h8 Y7 r& Q. P<P><FONT size=3>主动脉缩窄</FONT></P>4 o) r3 @% R% c
<P><FONT size=3>二尖瓣返流（重度）</FONT></P>
* S4 }8 Z- @: l7 G2 K5 d. f<P><FONT size=3>三尖瓣返流（轻度）</FONT></P>$ T% k7 t' B) b8 y) ?/ l6 J
<P><FONT size=3>左室大</FONT></P>
# u7 T0 O- E* [0 y* x/ ]# H<P><FONT size=3>左室收缩功能减低</FONT></P>
# I ?5 ?8 f- e, w<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心 8 Q' B- X/ R: K3 u+ J& s0 u
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6 c3 k1 A) ?2 E* k# ?<P align=center><B><FONT size=3>超声心动图示波报告 8 V- U2 E" A+ h+ q, F
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<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>3 ~, D) s |7 e& O
<P><FONT size=3>阳性所见：</FONT></P>
1 b' U& T: r% q0 T' q5 ^3 w% q<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左室呈球形扩张</FONT></P>4 \0 U' ^6 i: `, {: T3 T
<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>2 _( r1 W+ m5 ^# l, b/ O
<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>
6 }" ]1 H/ G! A' R8 e3 s& _3 ^<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>9 Y4 T5 V0 B% ]
<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>
- p: j7 | ]( o$ w% D<P><FONT size=3><FONT face="Times New Roman">6 </FONT>大动脉水平未见异常通道</FONT></P>
" v' Z8 T+ x; d1 F<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>& V$ w6 `7 X- [, ^2 L# O9 S* A7 b
<P><FONT size=3>诊断：</FONT></P>; z) }! p- T. K
<P><FONT size=3>先天性心脏病</FONT></P>& H P# T) @2 a& o y
<P><FONT size=3>主动脉缩窄</FONT></P>
, Q* K6 n& u. C+ {4 y<P><FONT size=3>左室增大，左室壁肥厚</FONT></P>) r7 t0 H: \: U: |3 _
<P><FONT size=3>左室假腱索</FONT></P>2 Y. h4 v. I$ C4 m7 U0 ]6 t
<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心 1 P9 [4 j& ]/ M5 ]
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: S! q( }7 T! [0 A# J<P align=center><B><FONT size=3>超声心动图示波报告 $ B5 ^- R- e- i* c
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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>
$ O5 N3 c* | m* q; O<P><FONT size=3>阳性所见：</FONT></P>' Z: `# r% M& Z, i/ C9 n
<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左心扩大，左室壁稍厚</FONT></P>
4 b* {) ^6 o' i" ]7 o( S1 p$ O<P><FONT size=3><FONT face="Times New Roman">2 </FONT>室壁运动幅度未见异常</FONT></P>
, ?* ?9 C; a! u9 d8 h<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>
# { Z) X' x2 J<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>
0 D4 p, W N2 b<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>$ Q% M' r4 h0 c* x: w
<P><FONT size=3>诊断：</FONT></P>
: l, d" \; Q3 F; P<P><FONT size=3>先天性心脏病</FONT></P>
3 R: z+ m$ i- }<P><FONT size=3>主动脉缩窄</FONT></P>
4 p8 t: u$ t% u/ |2 S7 R<P><FONT size=3>从目前的情况来看，病情的会不会继续发展？</FONT></P>2 u% f) e; }% z# e/ i: ?0 C* h" m
<P><FONT size=3>是否必须手术？</FONT></P>
5 W1 W; Z$ ]) O$ U& 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>5 Z, n; r3 U4 `* w- B
<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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