|
|
<b>[求助]先天性主动脉缩窄2 G1 k |5 T$ A9 C( S/ k
</b>
* c4 {. B* t( m<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>
& x" Q+ h7 u/ `) K! z<P><b></b></P></FONT>
9 J8 ^( X# W0 z
8 |) h( D: h! j N) S
- Y5 L2 V+ x; ~, q4 Z) c<P align=center><B><FONT size=3>中国医学科学院阜外心血管病医院 Y; q# D, }5 i7 d( s9 ^/ l* p V* u
<p></FONT></B>1 C# f. ~: e6 t% i$ N- l. }
<p>
" A- U5 o# e y<P align=center><FONT size=3><B><FONT face="Times New Roman">EBCT</FONT></B><B>诊断报告
7 K+ v6 ` L9 O6 s1 b1 ^<p></B></FONT>
) E; Y; v" ~8 i. O" t% O# ]<p>/ h2 t& A5 G- q6 N; |! F, h0 J
<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>
% g. A# ~+ _4 m+ J6 n<P><FONT size=3>扫描所见：</FONT></P>
4 K$ j/ D% s6 R6 H5 V# f8 P5 s<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>. z1 p' @/ D3 O) p, |: D' L
<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>2 p j6 ^8 O5 S" |) U
<P><FONT size=3>诊断：</FONT></P>
) q/ K3 D) n0 C+ o7 J4 [% H<P><FONT size=3>先天性心脏病：</FONT></P>. a* h- z$ D& H/ m4 {
<P><FONT face="Times New Roman"><FONT size=3>1.</FONT> </FONT><FONT size=3>主动脉缩窄；</FONT></P>
5 i# [8 ^' X8 |1 m% e* |7 p<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>
3 |- [* s* g3 O) l) ~# u) w/ S& @/ w<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心 8 x4 f+ E' Y# P3 u' B7 }
<p></FONT></B>
' }2 f0 @( _1 @. C! L x; F<p>; i$ U0 @) m# E1 D7 a
<P align=center><B><FONT size=3>超声心动图示波报告
6 t" O3 ]. V) H" J<p></FONT></B>2 _" D8 U: @/ V- g; s; ?
<p>
. e ^/ P9 x i( l! |9 N) J1 `4 ?7 ~<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>! v5 |. b/ B6 b* K; y+ j
<P><FONT size=3>阳性所见：</FONT></P>: @# O3 I7 P T7 F
<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>
& D6 F; a& S7 V* n/ L<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>4 m: _8 A( e! ?/ Q+ Z2 U9 A* F
<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> c& |% p/ ?) l2 r" H$ f; F7 u
<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>
1 x& S& G6 L8 v2 ~<P><FONT size=3>诊断：</FONT></P> {7 c2 z! K. i- p _
<P><FONT size=3>先天性心脏病</FONT></P>+ ]' V- k! Z4 Y3 {* t, G
<P><FONT size=3>主动脉缩窄</FONT></P>
! ]' o9 C; u3 v+ a$ m5 E<P><FONT size=3>二尖瓣返流（重度）</FONT></P>
$ ^" p( b8 r# M) [1 [ C$ a& J<P><FONT size=3>三尖瓣返流（轻度）</FONT></P>
; g0 Y2 t, l( c/ K<P><FONT size=3>左室大</FONT></P>
5 [' F- r, y4 R<P><FONT size=3>左室收缩功能减低</FONT></P>$ w' J7 R8 \+ H
<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心
4 N9 U6 m6 E0 G2 {: R<p></FONT></B>
- I9 Y2 ^$ \' a' J) c- T# o7 u<p># L3 K6 G' K% n& c1 {- S& f( ~9 S, |
<P align=center><B><FONT size=3>超声心动图示波报告
% H0 c8 _) Z, x- k0 B<p></FONT></B>
+ o7 m' ^2 L( F: G l5 t& z<p>
% o6 d) D0 T0 R<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>
, c! }" [* M- {. x<P><FONT size=3>阳性所见：</FONT></P>+ w5 E% H z0 p* K, h6 N
<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左室呈球形扩张</FONT></P>
) s( |3 u" F# g! ]( Y; i<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>
1 i; W6 S, ]9 L2 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>. f1 i1 y* n, i( P1 n3 @3 ], g
<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>
0 j( I& }( P4 i9 @5 |* x<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>
" I( N, l7 N% \. h<P><FONT size=3><FONT face="Times New Roman">6 </FONT>大动脉水平未见异常通道</FONT></P>
7 ?6 @% l1 ~( p3 _/ L<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>
' f& F; W& a! ^: ^<P><FONT size=3>诊断：</FONT></P>, ? r1 w3 ~* V
<P><FONT size=3>先天性心脏病</FONT></P>! v0 e) ]* R! p% D. A
<P><FONT size=3>主动脉缩窄</FONT></P>
# C9 A8 p8 h( c6 P( b6 f<P><FONT size=3>左室增大，左室壁肥厚</FONT></P>
( j o. C/ Q( I6 _9 N# i3 ?7 I<P><FONT size=3>左室假腱索</FONT></P>
9 a" o( Z8 Y2 _0 X% }" J6 U<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心 - C3 x' i: J/ L2 Q# B' u; t, d
<p></FONT></B>
6 r7 t1 O; [: o. j/ ~5 X0 J, Y+ l<p>
( m" |: s' q5 C2 S7 w$ }5 P1 P% }6 R8 ?<P align=center><B><FONT size=3>超声心动图示波报告
7 V6 l6 m) I8 g4 i' Q8 ?) Q<p></FONT></B>
* v- T" z4 N4 C( b- n<p>
! a+ L7 P0 ~9 _<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>
2 [- ?! S4 p1 l<P><FONT size=3>阳性所见：</FONT></P>& y. W1 g2 W6 E7 o6 s! x
<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左心扩大，左室壁稍厚</FONT></P>: z# v7 W# ^& P9 c/ k- i- E& i
<P><FONT size=3><FONT face="Times New Roman">2 </FONT>室壁运动幅度未见异常</FONT></P>
$ s" s, u3 ~( s; @) J! a<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>! Q, s; r) l( y4 \) b
<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>
. l, C/ e/ H8 Q" Z+ A<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>! e. Y; B; ?: h+ I4 p, N. C
<P><FONT size=3>诊断：</FONT></P>
: `8 ]# t: \1 Q) _" k5 O; f, l<P><FONT size=3>先天性心脏病</FONT></P>7 k" u$ W3 X; R2 L. ^9 P, J
<P><FONT size=3>主动脉缩窄</FONT></P>
# [: k1 }1 L* `<P><FONT size=3>从目前的情况来看，病情的会不会继续发展？</FONT></P>
7 D, H6 {. S# z, M0 A9 M8 h# b: H<P><FONT size=3>是否必须手术？</FONT></P>" L8 R9 v* M; |6 ]& v- O s
<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>
3 j/ }( v8 c4 B1 ?4 K<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> |
|
IP卡
发表于 2005-1-5 03:34:32
提升卡
置顶卡
锁帖卡
变色卡
千斤顶
发表于 2005-1-5 03:56:11
发表于 2005-1-10 20:40:44
发表于 2005-1-10 22:39:16
