主动脉瓣狭窄

无助的妈妈

<p><font color="#0000ff">宝宝快三周岁了，主动脉瓣狭窄，跨瓣压差64mmHg，去儿中心查过两次，徐志伟主任说进行瓣膜成形术，但风险较大，可能引起严重返流，我们很犹豫，想再等等，又怕错过最佳手术期，请ADMIN帮忙分析一下，为我们指点迷津。</font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">仪器型号：</span><span lang="EN-US"><font face="Times New Roman">Philips Sonos 5500<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span></font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">探头频率：</span><span lang="EN-US"><font face="Times New Roman">2-4MHz</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">，</span><span lang="EN-US"><font face="Times New Roman">3-8Hz<span style="mso-spacerun: yes;">&nbsp; </span></font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">检查途径：经胸</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">检查项目：二维、</span><span lang="EN-US"><font face="Times New Roman">M</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">型、彩色、多普勒</span><span lang="EN-US"><span style="mso-spacerun: yes;"><font face="Times New Roman">&nbsp;&nbsp; </font></span></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">图像质量：</span><span lang="EN-US"><font face="Times New Roman">B</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">M</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">型超声心动图（厘米）</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">LVDd<span style="mso-spacerun: yes;">&nbsp; </span>3.0<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>RVDd<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>LVIVSd<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>LVPWd<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>0.4<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>Ao<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>1.36</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">LVDs<span style="mso-spacerun: yes;">&nbsp; </span>1.7<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>RVDs<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>LVIVSs<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span>LVPWs<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>0.9<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>LA<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>1.81</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">心功能</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">LVEF<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>82%<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>LVFS<span style="mso-spacerun: yes;">&nbsp; </span>43%</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">二维超声（平方厘米）</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">LA<span style="mso-spacerun: yes;">&nbsp; </span><place wst="on"></place><city wst="on"></city>LV<city></city><place></place><span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>RA<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>RV<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>MRA<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>TRA</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">频谱多普勒超声（米</span><span lang="EN-US"><font face="Times New Roman">/</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">秒）</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">AAo<span style="mso-spacerun: yes;">&nbsp; </span>3.99<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>Dao<span style="mso-spacerun: yes;">&nbsp; </span>1.2<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>LVOT<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>RVOT<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>MPA<span style="mso-spacerun: yes;">&nbsp; </span>1.0</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">MV<span style="mso-spacerun: yes;">&nbsp; </span>1.2<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp;&nbsp; </span>TV<span style="mso-spacerun: yes;">&nbsp; </span>0.8<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span></font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">跨主动脉瓣跨瓣压差</span><span lang="EN-US"><font face="Times New Roman"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>64mmHg</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">彩色多普勒超声</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman">MR </font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">轻微</span><span lang="EN-US"><font face="Times New Roman"><span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>AI<span style="mso-spacerun: yes;">&nbsp; </span></font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">阴性</span><span lang="EN-US"><font face="Times New Roman"><span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>TR</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">轻度</span><span lang="EN-US"><font face="Times New Roman"><span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>PI<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span></font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">轻微</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">心房水平</span><span lang="EN-US"><span style="mso-spacerun: yes;"><font face="Times New Roman">&nbsp;&nbsp; </font></span></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">无分流</span><span lang="EN-US"><span style="mso-spacerun: yes;"><font face="Times New Roman">&nbsp;&nbsp;&nbsp; </font></span></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">心室水平</span><span lang="EN-US"><span style="mso-spacerun: yes;"><font face="Times New Roman">&nbsp;&nbsp; </font></span></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">无分流；</span><span lang="EN-US"><span style="mso-spacerun: yes;"><font face="Times New Roman">&nbsp;&nbsp; </font></span></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">大动脉水平</span><span lang="EN-US"><span style="mso-spacerun: yes;"><font face="Times New Roman">&nbsp;&nbsp; </font></span></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">无分流</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">超声所见</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">心脏位置及连接正常，房室腔无明显扩大，左室稍肥厚。主动脉、肺动及无增宽。主动脉瓣呈三叶，瓣膜增厚，回声增强，开放活动受限，主动脉瓣环</span><span lang="EN-US"><font face="Times New Roman">1.22cm</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">，主动脉流速</span><span lang="EN-US"><font face="Times New Roman">3.99m/s</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">，压差</span><span lang="EN-US"><font face="Times New Roman">64mmHg</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">，余瓣膜开放活动正常。房隔完整，室隔完整。左位主动脉弓。</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">提示</span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">主动脉瓣狭窄（压差</span><span lang="EN-US"><font face="Times New Roman">64mmHg</font></span><span style="FONT-FAMILY: 宋体; mso-ascii-font-family: 'times new roman'; mso-hansi-font-family: 'times new roman';">）</span></p>

陆医生

您好：<br/>&nbsp;&nbsp;&nbsp; 首先，徐志伟教授是我的导师，我想他的意见应该是很权威的了；<br/>&nbsp;&nbsp;&nbsp; 压差大于50mmHg，已经有手术指征了，如果这样拖下去，对小孩也未必好。<br/>&nbsp;&nbsp;&nbsp; 抉择总是比较难的，但是你必须面对这个问题。

无助的妈妈

您好：<br/>&nbsp;&nbsp;&nbsp; 徐教授没有明确建议我们现在手术，因为两次检查结果基本相同，听他意思好象是再等等。他的话理解的不透，我们很迷茫。能不能麻烦admin去咨询一下您的导师，到底是现在手术好，还是再等等！先谢谢您啦！！

陆医生

<p>关键是你们要下决心啊，因为毕竟主动脉瓣的手术风险很高，弄不好术后又出现主动脉返流，你们如果决心已下，那么就应该及早手术。</p>

无助的妈妈

<p>admin您好!</p><p>&nbsp;&nbsp;&nbsp; &nbsp;如果再等下去会有什么后果?手术后主动脉返流的几率有多大?手术后主动脉返流后再怎么办?对不起,问题较多,麻烦您了!还想请教个问题,现在麻疹防疫针能不能打?麻烦您一并回答,谢谢!!!</p>

陆医生

您好：<br/>&nbsp;&nbsp;&nbsp; 如果不手术，主要是狭窄的问题，如果狭窄程度加重，小孩活动肯定受影响，也不排除猝死的可能性；<br/>&nbsp;&nbsp;&nbsp; 手术的话返流发生的机率比较高，如果返流严重，还要考虑换瓣；<br/>&nbsp;&nbsp;&nbsp; 预防针可以打。

无助的妈妈

<p>admin您好!</p><p>&nbsp;&nbsp;&nbsp; 我儿子这种情况适不适合ROSS手术?与瓣膜成形相比,有什么优缺点?谢谢!!</p>

陆医生

看来你是了解了一定的知识的，ROSS手术用自体肺动脉瓣来作为主动脉瓣，效果虽然可能好些，但手术风险很大。远期效果目前还没有明确的支持数据。

无助的妈妈

<p>admin您好!</p><p>&nbsp;&nbsp;&nbsp; 如果是您的孩子,您会选择现在手术还是再等等?会不会冒险选择ROSS手术?谢谢您!!</p>

陆医生

呵呵，这个责任大了，我觉得我会积极考虑手术吧。

无助的妈妈

<p>谢谢admin!!&nbsp; 现在开始攒钱，估计十月份能去上海，应该还来得及吧？！</p>

无助的妈妈

<p>admin您好!</p><p>&nbsp;&nbsp;&nbsp; 想请教您几个医学术语:<span lang="EN-US" style="FONT-SIZE: 10.5pt; FONT-FAMILY: &quot;Times New Roman&quot;; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 宋体; mso-font-kerning: 1.0pt; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;">LVEF<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span>82%<span style="mso-spacerun: yes;">&nbsp;&nbsp;&nbsp; </span>LVFS<span style="mso-spacerun: yes;">&nbsp; </span>43%&nbsp;&nbsp; 什么意思?</span></p><p><span lang="EN-US" style="FONT-SIZE: 10.5pt; FONT-FAMILY: &quot;Times New Roman&quot;; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 宋体; mso-font-kerning: 1.0pt; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;MR 轻微&nbsp;&nbsp;&nbsp; <span lang="EN-US" style="FONT-SIZE: 10.5pt; FONT-FAMILY: &quot;Times New Roman&quot;; mso-bidi-font-size: 12.0pt; mso-fareast-font-family: 宋体; mso-font-kerning: 1.0pt; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA;">PI<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span></span><span style="FONT-SIZE: 10.5pt; FONT-FAMILY: 宋体; mso-ascii-font-family: &quot;Times New Roman&quot;; mso-hansi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 12.0pt; mso-font-kerning: 1.0pt; mso-ansi-language: EN-US; mso-fareast-language: ZH-CN; mso-bidi-language: AR-SA; mso-bidi-font-family: &quot;Times New Roman&quot;;">轻微&nbsp;&nbsp;&nbsp; 什么意思?</span></span></p>

陆医生

参考这里：<a href="http://www.babyheart.com.cn/know_article.asp?id=131">http://www.babyheart.com.cn/know_article.asp?id=131</a>

liang99

<p>我知道你的心情，我儿子也是主动脉的问题，他是主动脉峡部局限性狭窄，跨狭窄处压力梯度PPG60mmHg,MPG16mmHg。7岁了，正在寻医，他现在生长发育正常，甚至好于一般儿童，对他的手术及术后前景我们很没底。</p><p>事情已经来了，顶住吧。</p>

无助的妈妈

<p>admin:</p><p>&nbsp;&nbsp;&nbsp; 您好！</p><p>&nbsp;&nbsp;&nbsp; 小儿这种情况手术前需要做导管检查吗？</p>