法四术前
请问陆医生，我家孩子下个星期准备手术，见主刀医生前心脏科医生说要做心导管，可是见了主刀医生他却没说，请问，我们有必要向主刀医生提出吗？这个心导管是做还是不做好？谢谢！ 根据我们的常规，法四术前绝大多数已经不需要进行导管检查。 临床适应症： 五个月大的法洛氏四联症和肺小动脉分支。 步骤： 二维，M型，彩色流多普勒研究完成了，而她举行mother.This研究表明，正常心脏segments.The全身和肺静脉连接出现normal.The房间隔完整的出现与按颜色注意到没有分流流映射。三尖瓣和二尖瓣显示正常。有一个大的排列不齐心室室间隔缺损与色流映射双向分流。测量主动脉阀10-11毫米之间的环主动脉略有放大。肺动脉瓣环措施与Z评分小于3稍5mm以上。肺动脉分支都比较小，与一览表3.4毫米和RPA3.6mm。有轻度漏斗部狭窄。梯度，然而，似乎是在肺动脉瓣水平最大。由连续波多普勒横跨右心室流出道的峰值速度是之间4.6-5.5m/sec的。左心室大小和功能都正常，预计缩短分数由左，右冠状动脉近端过程中出现是正常的，没有冠状动脉指出过路的右心室流出道。主动脉弓似乎是左侧是在降主动脉的1.2m/sec流的通畅。 印象： 轻度漏斗部狭窄和相对较小的主肺动脉及肺动脉分支的法洛氏四联症。陆医生能看懂吗？我孩子是不是比较严重？ 不如直接把英文原文发给我看。 陆医生：我手上只有这个报告，请帮忙看看孩子是不是很严重的法四？谢谢！
Clinical Indication:
Five-month-old with tetralogy of Fallot and small pulmonary artery branches.
Procedure:
Two-dimensional,M-mode,color-flow and Doppler studies were accomplished while she was held by mather.This study demonstrates normal cardiac segments.The systemic and pulmonary venous connections appear normal.The atrial septum appears intact with no shunting noted by color-flow mapping. The tricuspid and mitral valves appear normal. There is a large malalignment ventricular septal defect with bidirectional shunting by color-flow mapping . The aorta is slightly enlarged with the aortic valve annulus measuring between 10-11mm. The pulmonary valve annulus measures slightly above 5mm with a Z score of less than-3. The pulmonary artery branches are rather small, with LPA 3.4mm and RPA3.6mm. There is mild infundibular stenosis. The gradient ,however,appears to be maximal at the pulmonary valve level. By continuous wave Doppler the peak velocity across the right ventricular outflow tract is between 4.6-5.5m/sec. The left ventricular size and function are normal with estimated shortening fraction by proximal course of right and left coronary arteries appear to be normal with no coronary artery noted crossing the right ventricular outflow tract. The aortic arch appears to be left-sided and is unobstructed with the flow in the descending aorta of 1.2m/sec.
Impression:
Tetralogy of Fallot with mild infundibular stenosis and relatively small main pulmonary artery and pulmonary artery branches. 好的，看到这个超声报告我列出以下看法：
1，肺动脉瓣Z值小于-3，说明肺动脉瓣口狭窄明显；
2，左右肺动脉发育都比较小，对于7.2Kg的宝宝来说，但我们通常会测定降主动脉横膈水平的直径，籍以测算McGoon指数，你可以咨询当地医师是否考虑测得此值；
3，其他测定肺动脉瓣口流速之类我想有参考意义，但不大，毕竟这就是法四的典型特征；
4，心导管在我们这里不作为常规，除非临床医师怀疑侧枝循环的存在及其他超声尚未确认的问题。 那严重吗？陆医生，能一次根治吗？ 这边主刀医生给的方案是：修补室缺和肺动脉瓣口，可没确定说要弄左右肺动脉，是否弄了肺动脉瓣口后，左右肺动脉就会好转？ 如果准备修补室缺，那就意味着可以根治，但跨瓣扩大流出道的话肯定要一并扩大肺动脉的。 谢谢陆医生的耐心回答。
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