[求助]先天性主动脉缩窄

canlab

<P  align=center><B ><FONT size=3>患儿今年四岁，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。<p></p></FONT></B></P>
1 j3 p! ?  F: q3 S" R<P  align=center><B ><FONT size=3>中国医学科学院阜外心血管病医院<p></p></FONT></B></P>
9 y/ y- g/ _$ w% U  ?<P  align=center><FONT size=3><B ><FONT face="Times New Roman">EBCT</FONT></B><B >诊断报告<p></p></B></FONT></P>
<P ><FONT size=3>检查日期：<st1:chsdate w:st="on" IsROCDate="False" IsLunarDate="False" Day="15" Month="8" Year="2002"><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>
<P ><FONT size=3>扫描所见：</FONT></P>
<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>
<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" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="8.4" UnitName="mm"><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" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="9" UnitName="mm"><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" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="12" UnitName="mm"><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" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="20" UnitName="mm"><FONT face="Times New Roman">20mm</FONT></st1:chmetcnv>，左肺动脉径约<st1:chmetcnv w:st="on" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="8" UnitName="mm"><FONT face="Times New Roman">8mm</FONT></st1:chmetcnv>，右肺动脉径约<st1:chmetcnv w:st="on" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="9" UnitName="mm"><FONT face="Times New Roman">9mm</FONT></st1:chmetcnv>。</FONT></P>
<P ><FONT size=3>诊断：</FONT></P>
& |. s* A8 Z7 l, m<P ><FONT size=3>先天性心脏病：</FONT></P>
: B4 u+ Q- c, ]* x- e; M/ i" w<P ><FONT face="Times New Roman"><FONT size=3>1.</FONT>       </FONT><FONT size=3>主动脉缩窄；</FONT></P>
6 C2 @' W- s) c! D- A4 b<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>
<P  align=center><B ><FONT size=3>北京市心肺血管医疗研究中心<p></p></FONT></B></P>
<P  align=center><B ><FONT size=3>超声心动图示波报告<p></p></FONT></B></P>
0 x' i: A2 k" B9 q% B* y<P ><FONT size=3>检查日期：<st1:chsdate w:st="on" IsROCDate="False" IsLunarDate="False" Day="12" Month="8" Year="2002"><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>
<P ><FONT size=3>阳性所见：</FONT></P>
/ X. {/ Y: A. R& ?<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>
, d8 q' I: G1 V- q9 h<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>
<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" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="282" UnitName="cm">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 y( H7 R; O9 y<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" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="6" UnitName="mm"><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" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="346" UnitName="cm">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" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="19" UnitName="mm"><FONT face="Times New Roman">19mm</FONT></st1:chmetcnv>。</FONT></P>
, F; h9 `; M( {  b<P ><FONT size=3>诊断：</FONT></P>
<P ><FONT size=3>先天性心脏病</FONT></P>
<P ><FONT size=3>主动脉缩窄</FONT></P>
2 d" q2 Z6 T: o6 p; `% M& M& _<P ><FONT size=3>二尖瓣返流（重度）</FONT></P>
<P ><FONT size=3>三尖瓣返流（轻度）</FONT></P>
<P ><FONT size=3>左室大</FONT></P>
' o" ~% T4 L3 c9 l/ U; \9 L<P ><FONT size=3>左室收缩功能减低</FONT></P>
<P  align=center><B ><FONT size=3>北京市心肺血管医疗研究中心<p></p></FONT></B></P>
<P  align=center><B ><FONT size=3>超声心动图示波报告<p></p></FONT></B></P>
; D: ?. s# v) l% |. s5 g<P ><FONT size=3>检查日期：<st1:chsdate w:st="on" IsROCDate="False" IsLunarDate="False" Day="30" Month="5" Year="2004"><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 O. N6 e! W4 ?. [6 J+ L6 J* n: n<P ><FONT size=3>阳性所见：</FONT></P>
' ^2 E/ g9 Q6 C; g0 o# O  T<P ><FONT size=3><FONT face="Times New Roman">1 </FONT>左室呈球形扩张</FONT></P>
" U& {+ X& G( a4 Q2 [<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>
. L3 [  Z% 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>
9 L5 _) L# g  W+ h5 S<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>
3 U% p6 ?" ?- `<P ><FONT size=3><st1:chmetcnv w:st="on" TCSC="0" NumberType="1" Negative="False" HasSpace="True" SourceValue="5" UnitName="升"><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" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="8" UnitName="mm"><FONT face="Times New Roman">8mm</FONT></st1:chmetcnv>，左锁骨下动脉以远<st1:chmetcnv w:st="on" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="4.4" UnitName="mm"><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" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="5" UnitName="mm"><FONT face="Times New Roman">5mm</FONT></st1:chmetcnv>，远端狭窄后扩张内径<st1:chmetcnv w:st="on" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="12" UnitName="mm"><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" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="395" UnitName="cm">395cm</st1:chmetcnv>/s</FONT>，<FONT face="Times New Roman"> PG62mmHg.</FONT></FONT></P>
& P' d6 l0 A$ A, q<P ><FONT size=3><FONT face="Times New Roman">6 </FONT>大动脉水平未见异常通道</FONT></P>
( b! E2 H. Q. Z<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>
<P ><FONT size=3>诊断：</FONT></P>
  ^' X6 h& k" c: ~8 R' O<P ><FONT size=3>先天性心脏病</FONT></P>
, Q  G+ q' c5 A9 c) W; }<P ><FONT size=3>主动脉缩窄</FONT></P>
<P ><FONT size=3>左室增大，左室壁肥厚</FONT></P>
! R& l+ w1 W$ s( O<P ><FONT size=3>左室假腱索</FONT></P>
<P  align=center><B ><FONT size=3>北京市心肺血管医疗研究中心<p></p></FONT></B></P>
; Q* U( }  V2 s, t6 v9 d$ o<P  align=center><B ><FONT size=3>超声心动图示波报告<p></p></FONT></B></P>
<P ><FONT size=3>检查日期：<st1:chsdate w:st="on" IsROCDate="False" IsLunarDate="False" Day="18" Month="10" Year="2004"><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>
( x. t9 g, p8 r1 ^6 C4 a<P ><FONT size=3>阳性所见：</FONT></P>
6 k; t# ?) x3 @9 b4 o<P ><FONT size=3><FONT face="Times New Roman">1 </FONT>左心扩大，左室壁稍厚</FONT></P>
<P ><FONT size=3><FONT face="Times New Roman">2 </FONT>室壁运动幅度未见异常</FONT></P>
<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 ><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>
& ?' q7 j" ]: P& x4 F! K% d3 l) Q<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" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="7" UnitName="mm"><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" TCSC="0" NumberType="1" Negative="False" HasSpace="False" SourceValue="335" UnitName="cm">335cm</st1:chmetcnv>/s</FONT>，<FONT face="Times New Roman"> PG 45mmHg</FONT></FONT></P>
<P ><FONT size=3>诊断：</FONT></P>
<P ><FONT size=3>先天性心脏病</FONT></P>
<P ><FONT size=3>主动脉缩窄</FONT></P>
<P ><FONT size=3>从目前的情况来看，病情的会不会继续发展？</FONT></P>
* z& N( n: s2 G, [<P ><FONT size=3>是否必须手术？</FONT></P>
) }: w; {4 `. P<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>
<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>
4 T/ [3 T9 ^( r# _) p) D4 g2 A<P ><p><FONT face="Times New Roman" size=3> </FONT></p></P>

陆医生

您好：
3 n# ?$ U7 p2 B! {. K* ?    1，个人认为您不应该拖延这么长时间；
    2，目前已经出现左室肥厚增大等并发症，此外缩窄段也没有转好的趋势；
    3，这样长期下去小孩的心脏负担会越来越重，甚至最后可出现心衰；
8 x' q2 {% R" y( \    4，建议您抓紧治疗，不要再拖延；
# Y& B; F% v: M3 v$ Y9 X) j    5，费用4万元左右。