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<b>[求助]先天性主动脉缩窄
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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>3 {3 B$ x5 m1 Z
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<P align=center><B><FONT size=3>中国医学科学院阜外心血管病医院 1 g) w# H4 R# ]: r& _# c8 v
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<P align=center><FONT size=3><B><FONT face="Times New Roman">EBCT</FONT></B><B>诊断报告 , Y& B2 {8 K! T
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<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>! a; i1 i* ^; Y+ p
<P><FONT size=3>扫描所见：</FONT></P>3 g3 E+ N- Y& I3 @4 s' T1 e
<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>& U5 ?, I$ n- h* k2 n6 J9 W
<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>
) x' C8 t! N$ A/ o# f7 s<P><FONT size=3>诊断：</FONT></P>
8 H1 C9 L5 W9 t4 K<P><FONT size=3>先天性心脏病：</FONT></P>
7 {; c7 N4 {7 R- I& e<P><FONT face="Times New Roman"><FONT size=3>1.</FONT> </FONT><FONT size=3>主动脉缩窄；</FONT></P>9 P# C9 y; ~# r, H; G
<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>
/ _8 ?6 n! [. l) p( ^6 b5 T6 h<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心
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$ y |1 x- n5 J5 c: D<P align=center><B><FONT size=3>超声心动图示波报告 * [# v$ m- f: [6 s5 [0 z( z- U
<p></FONT></B>
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8 t; T$ q) B, X$ [<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>/ g- z4 f8 O9 v; `, i' Z5 s2 c
<P><FONT size=3>阳性所见：</FONT></P>
$ U$ m; w: Z8 T<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>; ~$ Z0 w1 L1 `) J
<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>
3 M) `8 a9 L: g<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>
! i) f- U; t5 ?& g" n9 `3 O<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>
. U1 o9 r( h3 I' q7 h/ e! Z* b<P><FONT size=3>诊断：</FONT></P>
0 Q) J% N' t' @$ {) b<P><FONT size=3>先天性心脏病</FONT></P>9 E+ v0 r; B5 L% q6 Z( |, r
<P><FONT size=3>主动脉缩窄</FONT></P>
0 g8 \1 G4 m0 Z<P><FONT size=3>二尖瓣返流（重度）</FONT></P>7 C% b* q0 \8 M. Y" I, {4 ]# A9 A6 U
<P><FONT size=3>三尖瓣返流（轻度）</FONT></P>
o, L6 t. o; `. w<P><FONT size=3>左室大</FONT></P>
5 i) ?/ |; @5 {# [5 X<P><FONT size=3>左室收缩功能减低</FONT></P>1 R% U! r% [1 i! T
<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心 ( J4 s, F' Y4 q
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8 [; \7 U" w1 K, e, F' [6 ], y i<P align=center><B><FONT size=3>超声心动图示波报告 0 G v" a e B0 S& i
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4 r, G& u) v, G<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>8 I/ {; `# Y9 u! f5 z6 N
<P><FONT size=3>阳性所见：</FONT></P>* t. L- m# v2 Z' S
<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左室呈球形扩张</FONT></P>7 l, e9 L3 |2 `
<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>
( n4 y, r8 H' G1 [+ q<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>
/ r2 {* {6 N0 v3 T<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>! x6 f3 I/ F1 R
<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>: M4 ^ I& [& z1 i
<P><FONT size=3><FONT face="Times New Roman">6 </FONT>大动脉水平未见异常通道</FONT></P>9 L; P- ~, V. ^0 G3 E$ Z' r! O( U
<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>
: T$ `2 _5 G- F1 S" V5 [<P><FONT size=3>诊断：</FONT></P>4 d( }0 c/ X, v
<P><FONT size=3>先天性心脏病</FONT></P>
3 h% r# q$ P [<P><FONT size=3>主动脉缩窄</FONT></P>! X3 n4 W3 M) t" Q
<P><FONT size=3>左室增大，左室壁肥厚</FONT></P>
% z0 J5 W& T G# \<P><FONT size=3>左室假腱索</FONT></P>, X2 Y; Y' u5 l! v6 X+ Z: ~
<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心 ' V# w/ [0 \7 J/ A7 [% p( W
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& B# R |1 _. V$ Z3 ]) v; u+ O<P align=center><B><FONT size=3>超声心动图示波报告 % V* T$ K+ l( T+ R
<p></FONT></B>
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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>
G3 y* Y4 O7 a" J! y$ o% a0 L<P><FONT size=3>阳性所见：</FONT></P>1 Q0 o4 {4 V$ i; @" h. ^% d+ m
<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左心扩大，左室壁稍厚</FONT></P>
- W2 a% v$ b' y4 t: y- L! P% G6 C$ d<P><FONT size=3><FONT face="Times New Roman">2 </FONT>室壁运动幅度未见异常</FONT></P>
B$ Q: j {. W3 d' O' F<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>
. Z$ w4 u$ u' ]8 D3 }8 c<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>( F; `. p: S! m4 C9 \3 r8 G" 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" 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>
; O! H3 o' y# e<P><FONT size=3>诊断：</FONT></P>
; L1 y" v7 j8 P: M+ v$ ]+ Y<P><FONT size=3>先天性心脏病</FONT></P>8 o2 Z+ n1 b$ |) V/ ~
<P><FONT size=3>主动脉缩窄</FONT></P>
& s+ M. f- \* ^" T0 a<P><FONT size=3>从目前的情况来看，病情的会不会继续发展？</FONT></P>& t' @' k% B3 e4 P+ U0 E
<P><FONT size=3>是否必须手术？</FONT></P>8 ~+ S" {6 z& E' @* u4 h
<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>
8 Z# V6 `1 F5 c$ R<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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