懂E文的可否帮忙一阅～

姜睿浠

搜索美国的网站，找到的有关VSD的信息，里面貌似有提到药物治疗，因为有太多专业词汇，看不太懂。。。。
http://www.emedicine.com/PED/topic2402.htm

• Children with small VSDs are asymptomatic and have excellent long-term prognoses. Neither medical therapy nor surgical therapy is indicated. Antibiotic prophylaxis against endocarditis should be provided at the time of dental or surgical procedures likely to produce bacteremia. For more information, see Antibiotic Prophylactic Regimens for Endocarditis.
• In children with moderate or large VSDs, a trial of medical therapy is indicated to manage symptomatic CHF because many VSDs may become smaller with time. Therapies may include the following:
• • Increased caloric density of feedings to ensure adequate weight gain. On occasion, oral feeds must be supplemented with tube feeds because a baby in CHF may be unable to consume adequate calories for appropriate weight gain.
  • Diuretics (eg, furosemide) may be used to relieve pulmonary congestion. Furosemide is usually given in a dosage of 1-3 mg/kg/d in 2 or 3 divided doses. Long-term furosemide treatment results in hypercalcemia and renal damage and electrolyte disturbances
  • Captopril 0.1-0.3 mg/kg given every 8 hours can be useful to reduce systemic afterload. The mechanism of action of angiotensin-converting enzyme (ACE) inhibitors is to reduce both the systemic and pulmonary pressures (more so of the latter), and this results in reducing the left to right shunt.
  • Digoxin 5-10 mcg/kg/d may be indicated if diuresis and afterload reduction do not relieve symptoms adequately.
• Transcatheter closure Muscular VSDs have been closed with transcatheter devices for the past 15 years. Although relatively common, perimembranous VSDs can be difficult to close percutaneously. Previous devices (eg, Rashkind or button devices) have been unsuccessful in attempts to close the VSDs because of the proximity of the defects to the aortic valve and potential aortic valve damage.
  A new device has just undergone phase I trials in the United States. The device is an Amplatzer membranous VSD occluder (AGA Medical Corporation; Golden Valley, Minn), which is an asymmetric, self-expandable, double-disk device, unlike the membranous occluder. Current recommendations are to use this device in older patients who weigh >8 kg and who have a subaortic rim >2 mm.
  Most procedures are performed with the patient under general anesthesia and with echocardiographic guidance. Reported complications have included aortic and tricuspid regurgitation, device embolization, complete heart block, transient left bundle-branch block, hemolysis, small residual shunts, and perforation.
  In their phase I study, Fu et al (2006) reported 3 adverse events of complete heart block, perihepatic bleeding, and rupture of tricuspid valve chordae tendineae. In a previous article, they reported 2 cases of transient heart block that responded to high-dose steroids (Yip, 2005).
  Surgical closure
  The first operation described for the treatment of a VSD was a palliative one and involved placing a restrictive band across the main PA (Muller, 1952). This was proposed since pulmonary vascular disease as a result of unimpeded flow to the lungs was recognized as a dreaded complication of a VSD. This surgery was popular for about 2 decades because it was associated with low mortality and morbidity.
  Lillehei and associates performed the first intracardiac repair was at the University of Minnesota in 1954 using a parent as an oxygenator and a pump in controlled cross-circulation. In the 1970s, the current techniques of hypothermia and cardiopulmonary bypass were first reported (Barratt-Boyes, 1971; Castaneda, 1974). At present, direct surgical repair by using cardiopulmonary bypass is the preferred surgical therapy in most centers. PA banding, part of a 2-stage procedure, is largely reserved for critically ill infants with multiple VSDs or for those with associated anomalies.
  • Indications for surgical repair
    • Uncontrolled CHF, including growth failure and recurrent respiratory infection is an indication for surgical repair. Neither the age nor the size of the patient is prohibitive in considering surgery.
    • Large, asymptomatic defects associated with elevated PA pressure are often repaired when infants are younger than 1 year.
    • Surgical repair is indicated in older asymptomatic children with normal pulmonary pressure if pulmonary to systemic flow is greater than 2:1.
    • Prolapse of an aortic valve cusp. Early repair may prevent progression of the aortic insufficiency.
  • Video-assisted cardioscopy
    • Short-term results of video-assisted cardioscopy for intraventricular repair of VSD have led to its wide adoption as a means to reduce surgical trauma. Short-term results are excellent.
    • Long-term follow-up is necessary.
  • Approach
  • • Most perimembranous and inlet defects are repaired by transatrial surgical approach.
    • Defects in the outlet septum are approached through the pulmonary valve.
    • Multiple muscular defects, especially near the apex, pose a difficult problem. Initial pulmonary banding or LV approach through an apical left ventriculotomy and closing the defect by a single patch are the standard approaches.
    • Transcatheter therapy remains an experimental approach.
    • A hybrid operation is a joint procedure involving the interventional cardiologist and the cardiac surgeon who concomitantly optimize surgical management of complex congenital heart disease. This approach may be used for multiple VSDs where the perimembranous VSD is repaired surgically and the muscular VSDs are closed by using a transcatheter device.
  • Postoperative sequelae
  • • A murmur of a residual VSD is not infrequent. Selective use of intraoperative TEE to assess closure may be useful.
    • Decisions regarding reoperation are based on symptoms, left heart size, pulmonary pressure, and degree of shunting.
    • Right bundle-branch block (RBBB) is common and may be caused by ventriculotomy or direct injury to the right bundle itself.
    • Complete heart block can rarely occur and is associated with late mortality.
    • LV dysfunction may occur after left ventriculotomy to close a muscular VSD.
    • Ventricular arrhythmia can be a late problem.

[ 本帖最后由 姜睿浠 于 2008-8-5 14:30 编辑 ]

姜睿浠

文章提到，随着时间长了，在适当的药物调理下，中或大的VSD会变小的
那么很想知道，这种药物的调理，是否在国内也有～

姜睿浠

2006年10月的文章，这个是学术性文章，不是什么江湖医生了，不知道陆医生怎么看～

EmmaMom

原文是说，有中等或大缺损的患儿可以尝试通过药物控制充血性心衰的症状，因为缺损可能随时间逐渐变小。（我想是指如果能坚持到缺损小到很小以后就不用管它了。）之后列的是高热量饮食和三种防治心衰的药物：速尿，开博通和地高辛。（心脏外科版对这些药物有很多讨论。）
这篇综述全文没有说存在使缺损变小，或者自愈的药物。

姜睿浠

谢谢楼上MM～俺E文超级不过关，这下总算明白了～:11: :11: :11: