请教:关于主动脉狭窄

毛毛妈

<p>admin:您好!儿中心的论坛办得真好！对您及您的同事的辛勤劳动深表敬意！我几乎每天都上儿中心的论坛，看得出每天admin都对大家的提问及时回复，感谢你们对广大患儿家属心情的理解。（对比：<u>阜外</u>的在线问答已经在06年7月以后就不能用了，<u>安贞</u>每天问帖不少但没有人回答）</p><p>[简单描述]：7岁，男孩，25kg，身高123cm，刚上小学。目前身体无任何不适。一个多月前做心超提示：主动脉狭窄（轻度）并返流（轻度）。[之前已发详细超声报告见2月25日帖]</p><p>遵嘱，我们严格限制运动量，定期复查。但每天还是焦虑不安，请问：1、这是否属于复杂先天病？我查到大部分问帖是室缺，法四，肺动脉闭锁等，几乎找不到同样病状的可以交流，好着急啊。</p><p>2、依照临床经验，狭窄程度随着年龄增长会不断加重吗？有没有一个参考的时间（或时间跨度）？有没有几十年不加重的病例？（根据您所了解的）</p><p>3、一旦严重狭窄，必须开胸手术处理吗？能否介入治疗？</p><p>殷切等待您的回复！万分感谢！</p>

陆医生

<p>谢谢你的鼓励，建议您不要注册新用户发新帖，否则我无法看到小孩以前的资料，建议把原有资料粘贴过来，以便我回顾分析；</p><p>此类疾病只能定期随访，如果压差超过50mmHg，那么就有手术指证。</p>

毛毛妈

<p>给您带来不便，深表歉意。我不知道在原来的贴子后怎么跟贴，尝试几次都不成功。</p><p>2月份检查报告：（男，7岁，25kg，123cm）</p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><b><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">心腔及大血管内径（单位：</span><span lang="EN-US"><font face="Times New Roman">mm</font></span></b><b><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"><p></p></span></b></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;;">右房：</span><span lang="EN-US"><font face="Times New Roman">22.9<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;;">右室：</span><span lang="EN-US"><font face="Times New Roman">29.1<span style="mso-spacerun: yes;">&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;;">右室流出道：</span><span lang="EN-US"><font face="Times New Roman">18.7<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;;">主肺动脉：</span><span lang="EN-US"><font face="Times New Roman">18.4</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;;">左房：</span><span lang="EN-US"><font face="Times New Roman">24.5<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;;">左室舒张末：</span><span lang="EN-US"><font face="Times New Roman">39<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;;">左室收缩末：</span><span lang="EN-US"><font face="Times New Roman">25<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;;">主动脉：</span><span lang="EN-US"><font face="Times New Roman">19</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><b><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">瓣口血流速度（单位：</span><span lang="EN-US"><font face="Times New Roman">m/s</font></span></b><b><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"><p></p></span></b></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;;">肺动脉瓣：</span><span lang="EN-US"><font face="Times New Roman">0.8<span style="mso-spacerun: yes;">&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;;">主动脉瓣：</span><span lang="EN-US"><font face="Times New Roman">1.95<span style="mso-spacerun: yes;">&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;;">三尖瓣：</span><span lang="EN-US"><font face="Times New Roman">0.73<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;;">二尖瓣：</span><span lang="EN-US"><font face="Times New Roman">1.34</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;;">降主动脉：</span><span lang="EN-US"><font face="Times New Roman">1.13</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><b><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">心功能测定</span><span lang="EN-US"><p></p></span></b></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">73%<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>FS</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">36%</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">&nbsp;<p></p></font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><b><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">超声描述</span><span lang="EN-US"><font face="Times New Roman"><span style="mso-spacerun: yes;">&nbsp; </span><p></p></font></span></b></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;;">心脏节段：心脏左位，心房正位，心室右袢，主动脉正位。</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;;">心房与静脉回流：体静脉回流入右房，肺静脉回流入左房。左、右房大小正常，房间隔完整。</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;;">房室连接：三尖瓣探及返流，面积</span><span lang="EN-US"><font face="Times New Roman">1.6cm2</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;;">，估测右室收缩压</span><span lang="EN-US"><font face="Times New Roman">25mmHg</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;;">；二尖瓣探及返流，面积</span><span lang="EN-US"><font face="Times New Roman">0.73cm2</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 style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">心室：右心室结构及功能正常，左心室增大，室间隔完整，室间隔与左室后壁呈逆向运动，运动幅度正常。</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;;">心室与大动脉连接：肺动脉瓣形态及功能正常，主动脉瓣为三叶瓣，右冠瓣反射增强，与无冠瓣粘连，开放稍受限，血流速度增快，</span><span lang="EN-US"><font face="Times New Roman">Vmax1.95m/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;;">，压差</span><span lang="EN-US"><font face="Times New Roman">15mmHg</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;;">；主动脉瓣探及返流，面积</span><span lang="EN-US"><font face="Times New Roman">1.8cm2</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 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：主肺动脉正常，主动脉窄后扩张，主动脉弓及降主动脉完整。</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;;">冠状动脉：左、右冠状动脉起源、走向正常。</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;;">心包：未见积液。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">&nbsp;<p></p></font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><b><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;;">超声提示</span><span lang="EN-US"><p></p></span></b></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;;">主动脉瓣病变，主动脉瓣狭窄（轻度）并返流（轻</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;;">中度）</span><span lang="EN-US"><span style="mso-spacerun: yes;"><font face="Times New Roman">&nbsp; </font></span></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;;">心脏功能正常</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">&nbsp;</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">admin：我上述的问题是否没表达清楚？还是太幼稚？可我实在是想知道，否则寝食难安。</font></span><span lang="EN-US"><font face="Times New Roman">谢谢理解。</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">&nbsp;<p></p></font></span></p><p></p>

毛毛妈

<p>admin:为什么不回答啊???我每天在等待.....</p><p>根据上面的心超报告,还要请教:</p><p>1、此病有没有自愈的可能?依照临床经验，狭窄程度随着年龄增长会不断加重吗？从轻度到重度有没有一个大致参考的时间（或时间跨度)？（根据您所了解的）</p><p>2、一旦严重狭窄(压差50)，必须开胸手术处理吗？能否介入治疗？</p><p>不胜感激!</p>

陆医生

<p>前几天我出差去了，可能你没有看到论坛公告；</p><p>我想目前而言只能看定期随访的结果了，15mmHg的压差个人认为只能是轻度的狭窄，介入治疗是不行的。</p>

毛毛妈

<p>admin:您好！</p><p>&nbsp;请教：国际上做Ross手术最权威的医院、专家？通过什么途径可以了解相关信息？能提供一些网页么？</p><p>&nbsp;盼回复，非常感谢</p>

陆医生

美国华盛顿儿童医院 Richard Jonas教授，也不是说他是ROSS方面的专家，他是国际知名的小儿先心病外科专家。

毛毛妈

<p>谢谢<span lang="EN-US">admin。</span></p><p>我浏览了论坛以前的问帖好几百条，主动脉狭窄是个棘手问题。感染性心内膜炎可能引起狭窄吗？什么都不做（甚至休学）能否控制病情发展？我实在不甘心，好端端的孩子就坐等那一天的到来。悲哀啊。</p><p>有没有药可以控制左心室增大？</p><p>我想知道国际上<span lang="EN-US">Ross方面的权威机构和专家。请推荐一、二。</span></p><p>期待着<span lang="EN-US">…</span></p>