求助：房间隔缺损＋动脉导管未闭

danzheng

<p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">医生你好：我家宝宝二个多月，是女孩，目前体重１１斤，出生４天检查出是心先病（室间隔缺损４<span lang="EN-US" style="FONT-SIZE: 12pt;"><font face="Times New Roman">mm，</font><font face="宋体">卵圆孔未闭，动脉导管未闭５<span lang="EN-US" style="FONT-SIZE: 12pt;"><font face="Times New Roman">mm，二尖瓣三尖瓣中度返流</font></span></font></span>），近期有感冒和咳嗽现象出现，于８０天再次做</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;;">超声心动图诊断报告如下</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><font face="宋体"></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">一、主要测值：</span><span lang="EN-US" style="FONT-SIZE: 12pt;"><span style="mso-spacerun: yes;"><font face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </font></span></span><span style="FONT-SIZE: 12pt; 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" style="FONT-SIZE: 12pt;"><font face="Times New Roman">mm</font></span><span style="FONT-SIZE: 12pt; 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" style="FONT-SIZE: 12pt;"><p></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;;">主动脉根部内径：</span><span lang="EN-US"><font face="Times New Roman"><span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>11</font></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;;">左室舒张未期内径：</span><font face="Times New Roman">
7 W4 C  v' k' \                        <span lang="EN-US">22</span></font></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;;">左房内径：</span><span lang="EN-US"><font face="Times New Roman"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>16</font></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;;">室间隔厚度：</span><span lang="EN-US"><font face="Times New Roman"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>4</font></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;;">左室后壁厚度：</span><span lang="EN-US"><font face="Times New Roman"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>4</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">二、超声描述：</span><span lang="EN-US" style="FONT-SIZE: 12pt;"><p></p></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; mso-list: l0 level1 lfo1; tab-stops: list 18.0pt;"><span lang="EN-US" style="mso-fareast-font-family: &quot;Times New Roman&quot;;"><span style="mso-list: Ignore;"><font face="Times New Roman">1、<span style="FONT: 7pt &quot;Times New Roman&quot;;">&nbsp; </span></font></span></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;;">右房、右室不增大，房间隔中段见约</span><span lang="EN-US"><font face="Times New Roman">4.0 mm</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;;">的回声缺失，血流图及多普勒检查在此测及少量左向右分流。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; mso-list: l0 level1 lfo1; tab-stops: list 18.0pt;"><span lang="EN-US" style="mso-fareast-font-family: &quot;Times New Roman&quot;;"><span style="mso-list: Ignore;"><font face="Times New Roman">2、<span style="FONT: 7pt &quot;Times New Roman&quot;;">&nbsp; </span></font></span></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;;">左肺动脉与降主动脉有导管相连（</span><span lang="EN-US"><font face="Times New Roman">3.0mm</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">,</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;;">彩色多普勒在此测及连续性分流。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; mso-list: l0 level1 lfo1; tab-stops: list 18.0pt;"><span lang="EN-US" style="mso-fareast-font-family: &quot;Times New Roman&quot;;"><span style="mso-list: Ignore;"><font face="Times New Roman">3、<span style="FONT: 7pt &quot;Times New Roman&quot;;">&nbsp; </span></font></span></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;;">其余无特殊。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; mso-list: l0 level1 lfo1; tab-stops: list 18.0pt;"><span lang="EN-US" style="mso-fareast-font-family: &quot;Times New Roman&quot;;"><span style="mso-list: Ignore;"><font face="Times New Roman">4、<span style="FONT: 7pt &quot;Times New Roman&quot;;">&nbsp; </span></font></span></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;;">静息状态下彩色室壁动力检查：收缩活动未见异常。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt 18pt; TEXT-INDENT: -18pt; mso-list: l0 level1 lfo1; tab-stops: list 18.0pt;"><span lang="EN-US" style="mso-fareast-font-family: &quot;Times New Roman&quot;;"><span style="mso-list: Ignore;"><font face="Times New Roman">5、<span style="FONT: 7pt &quot;Times New Roman&quot;;">&nbsp; </span></font></span></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;;">声学定量检测射血分数</span><span lang="EN-US"><font face="Times New Roman">65%</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-SIZE: 12pt; FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">三、超声提示：</span><span lang="EN-US" style="FONT-SIZE: 12pt;"><p></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;;">先天性心脏病：动脉导管未闭</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">继发孔型房间隔缺损？（不能排除是卵圆孔未闭的可能）</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';"></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';">请问：按目前情况发展能自愈吗．如不能自愈要是做手术还是能用介入疗法吗，几岁做最适宜，费用多少？</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman';"></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>

陆医生

为什么说二尖瓣和三尖瓣中度返流？超声资料为什么没有体现出来？

danzheng

<p>医生您好：您所提到二尖瓣、三尖瓣中度返流是在出生４天时心超报告中有所体现，但８０天心超报告未见体现。以下补上出生４天的心超报告：</p><p>一：测值：左房：17&nbsp; 　左室：23&nbsp; 　 室间隔：３&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 左室后壁：２&nbsp; 　 主动脉根部：10&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp;升主动脉：11&nbsp;&nbsp;；&nbsp;&nbsp;&nbsp;&nbsp; 　右室：10　&nbsp; 主肺动脉：13 　&nbsp; 右室流出道：12　；&nbsp;&nbsp;&nbsp;&nbsp;左心功能测定CO：2.10L／min&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;SＶ:15.00ml/B&nbsp;&nbsp;&nbsp; FS:48.00%&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; &nbsp; 声学定量技术评价左室收缩功能&nbsp;&nbsp; EF:82.00%</p><p>二、超声描述（透声条件：中）：</p><p>1、心脏左位，心轴线指向左下。心房、心室及大血管方位正常，连续关系正常。</p><p>2、左房、左室内径轻度增大。室壁厚度正常，运动未见明显异常。彩色室壁运动分析显示左室壁动度未见明显异常</p><p>3、房间隔连续性未见明显回声失落，但彩色和脉冲多普勒在房间隔中部探及少量左向右穿隔分流信号（考虑卵圆孔未闭）</p><p>4、室间隔肌部回去声失落约4mm，彩色和脉冲多普勒在室缺处探及左向右穿隔分流信号。</p><p>5、主动脉根部内径正常，主动脉瓣形态、结构开启未见明显异常，开启时多普勒探及主动脉瓣中口前向血流最大速度约1.1m/s，关闭时彩色和脉冲多普勒未见明显异常血流信号．</p><p>６、肺动脉内径正常，肺动脉瓣形态、结构未见明显异常，开启时多普勒探及肺动脉瓣口前向血流最大速度约0.88m/s,关闭时彩色和脉冲多普勒未见明显异常血流信号；在左肺动脉与降动脉之间可见一管道相通，宽约５mm，彩色和脉冲多普勒在左肺动脉与降动脉之间探及连续性的左向右的分流．</p><p>７、二尖瓣舒张期血流频谱：Ｖe９０cm/s,&nbsp; Va56cm/s，（HR：136次/分）；二尖瓣形态、结构、开启未见明显异常，关闭时彩色和脉冲多普勒在左房内探及收缩期轻—中度二尖瓣返流信号。</p><p>８、三尖瓣形态、结构、开启未见明显异常，关闭时彩色和脉冲多普勒在右房内探及收缩期轻—中度三尖瓣返流信号，最大返流差约42mmHg。</p><p>请问：80天的心超报告中未提到二、三尖瓣中度返流是否表明这项病情已愈，按目前情况发展动脉导管和房间隔能否自愈吗，<font face="宋体">如不能自愈要是做开胸手术还是能用介入疗法治疗？几岁做最适宜，费用多少？</font></p><p><font face="宋体">期待您的答复，非常感谢！</font></p><p></p><p></p><p></p>

陆医生

建议半岁复查吧，如果没有二尖瓣和三尖瓣的问题，不排除心脏缺损自愈的可能。

danzheng

<p>医生你好：针对我家宝宝这种情况能接种预苗吗，是否<u>所有预苗</u>都适合接种！谢谢！</p>

danzheng

<p>&nbsp;&nbsp; 医生您好：</p><p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 现在宝宝5个月了，近来发现她气喘较之重些，是否表示病情严重了吗，近期想带宝宝到贵中心做检查，是挂&nbsp; 心内科吗，能否推荐挂哪位专家？</p>