[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>
<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>
<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>
5 l& X0 U" @# e) O" @, ~<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>
8 @5 f" T: {7 C* D. f9 J+ s1 e2 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>
/ U" D8 o6 G0 D7 {0 p& i# S<P ><FONT size=3>先天性心脏病：</FONT></P>
<P ><FONT face="Times New Roman"><FONT size=3>1.</FONT>       </FONT><FONT size=3>主动脉缩窄；</FONT></P>
7 a/ F( \+ q8 Y& a8 Y4 F<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>
$ X" i2 g. S7 \# g# [; |3 [<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>
8 Q5 U7 {3 X: c9 G7 V<P ><FONT size=3>阳性所见：</FONT></P>
<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>
" `) \6 h& x" W9 h& O) D<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>
- I  C( t7 {+ @  `$ A<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>
<P ><FONT size=3>诊断：</FONT></P>
& m! F+ z- l5 s) p( Z, G<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>二尖瓣返流（重度）</FONT></P>
9 L7 R% |! A- a! L8 d<P ><FONT size=3>三尖瓣返流（轻度）</FONT></P>
3 ^& U% J+ _- ]' T<P ><FONT size=3>左室大</FONT></P>
<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>
4 F1 z7 g, H6 @. ?# Y# ~6 c<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>
1 r- U* I) L# y! g" S# Q, E) B<P ><FONT size=3>阳性所见：</FONT></P>
<P ><FONT size=3><FONT face="Times New Roman">1 </FONT>左室呈球形扩张</FONT></P>
! l* ^* s9 R: I% d- @<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>
* C# ?9 Y- c, d% l) ]<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>
" Z2 a# X0 F* l+ r( i& p- {<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>
) S- J" K2 t3 g! D<P ><FONT size=3><FONT face="Times New Roman">6 </FONT>大动脉水平未见异常通道</FONT></P>
<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/ x& p4 V1 }6 i0 L( 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>
8 Z) M8 K0 k" x6 f2 N. x<P ><FONT size=3>左室增大，左室壁肥厚</FONT></P>
1 y; l  b, c6 j; F% R<P ><FONT size=3>左室假腱索</FONT></P>
( B& d/ c& I0 j0 }+ Z2 A<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>
/ V2 j8 p, b# t2 r( B# S& l" O<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>
<P ><FONT size=3>阳性所见：</FONT></P>
<P ><FONT size=3><FONT face="Times New Roman">1 </FONT>左心扩大，左室壁稍厚</FONT></P>
9 s) p. k. B0 U% f$ a<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>
7 D! P) u  O) G% ?% E<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>
3 g1 e+ W9 r" V" W<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>
! I7 p1 s" o3 {; _! T$ j: _1 K<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>
9 v, o% K, |9 e; T9 {" W5 t<P ><FONT size=3>是否必须手术？</FONT></P>
0 B$ i0 Q+ K$ C* I) F<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>
& l- N% `0 R# I& }/ D, {<P ><p><FONT face="Times New Roman" size=3> </FONT></p></P>

陆医生

您好：
    1，个人认为您不应该拖延这么长时间；
+ G9 }8 g9 `- p' F( q    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；
    4，建议您抓紧治疗，不要再拖延；
    5，费用4万元左右。