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<b>[求助]先天性主动脉缩窄" X v, ?; o1 c% `( M
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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>. T+ d4 \( X* a2 ~; S* e
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6 U: q, u$ l0 d$ C<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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E4 V8 V) z5 _+ y# Z; a) [<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>
: C! m& S9 J1 d {: M! H<P><FONT size=3>扫描所见：</FONT></P>
) m: |8 h- }6 d* K<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>
0 I2 ?* B% H M<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>' Z8 A4 H+ _- j0 |
<P><FONT size=3>诊断：</FONT></P>
L/ E7 I7 ?- T# h<P><FONT size=3>先天性心脏病：</FONT></P>
( s+ E0 i4 q; q+ W% M- N<P><FONT face="Times New Roman"><FONT size=3>1.</FONT> </FONT><FONT size=3>主动脉缩窄；</FONT></P> o: P* ^3 R1 }
<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>
. x3 _, A' d/ p<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心 $ x2 j* o. v# v9 ~8 g6 ~
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7 ^1 h4 L* x% a* \5 ^<P align=center><B><FONT size=3>超声心动图示波报告
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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>! k2 E4 p2 o$ A2 f! v, b; O I
<P><FONT size=3>阳性所见：</FONT></P>
! P! J: Q! W8 R( ~* f<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>
# k9 t I( _- b$ A [- Z<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>
# q& I! _" I2 o+ k+ v- K<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>! D f& D5 R; a6 b: ?
<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>
# D0 `) W. A1 H( J8 t<P><FONT size=3>诊断：</FONT></P>
9 F9 j7 H" T: o: `. S9 E<P><FONT size=3>先天性心脏病</FONT></P>; C+ n) [, Y6 ^; b
<P><FONT size=3>主动脉缩窄</FONT></P>) V5 W) i! i4 W
<P><FONT size=3>二尖瓣返流（重度）</FONT></P>
/ J: w: F7 H3 A1 m8 {8 p$ H# |3 y<P><FONT size=3>三尖瓣返流（轻度）</FONT></P>
3 e0 S8 z- l; Q L- ^<P><FONT size=3>左室大</FONT></P>) R0 E) C+ X8 n$ w" p
<P><FONT size=3>左室收缩功能减低</FONT></P>, o5 Y; [) A, r/ Q6 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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H; E) z) d' }- d<P align=center><B><FONT size=3>超声心动图示波报告
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" E- C H4 `. O<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>9 ?2 O( t7 w0 h, L3 F
<P><FONT size=3>阳性所见：</FONT></P>5 w# i. f& M9 |( u' Y
<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左室呈球形扩张</FONT></P>
5 {! C- S! B8 F% m: D8 i<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>$ B1 Y" X p2 a7 U r1 W! k& i
<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>
# d x7 C8 ~/ A u* X9 x<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>, ?8 T: H8 E4 w2 ]( X! S
<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>0 U. s% }( l/ A( V0 Y. h9 y" R$ V5 e6 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>
+ y; e, d5 e, e, K; d' g0 g<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>7 _$ h8 V% P# u; p. U( Z
<P><FONT size=3>诊断：</FONT></P>
, z# e* \) ]* L( m, E& O5 Z7 L2 D; r<P><FONT size=3>先天性心脏病</FONT></P>: a4 ~" H4 r A! p9 {
<P><FONT size=3>主动脉缩窄</FONT></P>' S4 l' e6 Z7 @/ d' |
<P><FONT size=3>左室增大，左室壁肥厚</FONT></P>9 k2 ?! _% C/ Z
<P><FONT size=3>左室假腱索</FONT></P>
2 n# S, |5 D7 Y* b* V! Z<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心 & r$ N2 o8 _0 |" |- z) Q! y! Z* t4 X
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A% g6 ~ G7 {<P align=center><B><FONT size=3>超声心动图示波报告 / v# @5 X; E0 e* E$ d
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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>
& L. g8 u! U" K; _2 W0 x<P><FONT size=3>阳性所见：</FONT></P>
( i0 K4 E! K9 F<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左心扩大，左室壁稍厚</FONT></P>
$ X& i. R$ e; }8 J, O5 ?<P><FONT size=3><FONT face="Times New Roman">2 </FONT>室壁运动幅度未见异常</FONT></P>* I; \2 I: P! v% Q- 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>
# P' A/ P. E! z<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>3 L: F- \7 y9 B/ u# H: s8 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>3 J& I2 R4 `& l8 A; \
<P><FONT size=3>诊断：</FONT></P>
& [7 ~0 C& j1 J1 W; W* Y<P><FONT size=3>先天性心脏病</FONT></P>4 u: y+ a3 y' t& F2 k, B
<P><FONT size=3>主动脉缩窄</FONT></P>8 p6 c- T" o' l9 m+ G+ Y
<P><FONT size=3>从目前的情况来看，病情的会不会继续发展？</FONT></P>
4 ? c* C; h8 U1 Q<P><FONT size=3>是否必须手术？</FONT></P>
L: n7 g( Q/ f" a<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>
3 j+ P( |! 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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