[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>
- l9 p! l8 x' i. N8 V* p( V# f<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>
( K# ]3 d- w6 Y( n, Z<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>
) k# h# A/ I: E<P ><FONT size=3>扫描所见：</FONT></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>
/ X' a$ j; E/ Y! ^, l( 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" 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>
<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>
<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>
$ U% |& q) M! w- C) D7 v<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>
6 F7 u9 ?, K- Y" 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>
<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>
<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>
. w  u% F4 O/ n8 ]<P ><FONT size=3>诊断：</FONT></P>
9 L7 @( p/ a( Z2 e5 K<P ><FONT size=3>先天性心脏病</FONT></P>
<P ><FONT size=3>主动脉缩窄</FONT></P>
) X0 Q( [# M1 H! L5 \4 C<P ><FONT size=3>二尖瓣返流（重度）</FONT></P>
<P ><FONT size=3>三尖瓣返流（轻度）</FONT></P>
<P ><FONT size=3>左室大</FONT></P>
5 n2 s* d' {: X( e! P+ S6 m+ M! ]<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>
" `6 ^) X6 v. [: Q5 h: n<P  align=center><B ><FONT size=3>超声心动图示波报告<p></p></FONT></B></P>
$ Z) Q- f( Z7 j, Z- \! 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>
<P ><FONT size=3>阳性所见：</FONT></P>
2 l8 k- j" a3 Y- c3 ?<P ><FONT size=3><FONT face="Times New Roman">1 </FONT>左室呈球形扩张</FONT></P>
/ P7 R" M$ h9 [" g5 A<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>
$ R! O. e: A2 f! b9 ~% h<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>
<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>
- ^4 O# u- p5 X& m<P ><FONT size=3><FONT face="Times New Roman">6 </FONT>大动脉水平未见异常通道</FONT></P>
' j6 g. U  ?, s5 y. V* T. T<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 ><FONT size=3>诊断：</FONT></P>
<P ><FONT size=3>先天性心脏病</FONT></P>
) p8 Y( F. q  x4 t* \3 h" H; o<P ><FONT size=3>主动脉缩窄</FONT></P>
! B: v' r6 h8 q/ o3 @6 |% O3 t<P ><FONT size=3>左室增大，左室壁肥厚</FONT></P>
<P ><FONT size=3>左室假腱索</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>
" F6 J+ z3 d/ C7 ^<P  align=center><B ><FONT size=3>超声心动图示波报告<p></p></FONT></B></P>
<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>
. o# s7 d3 a+ v& f7 G/ c<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>
. W. x3 Z% |, T, S8 U<P ><FONT size=3><FONT face="Times New Roman">2 </FONT>室壁运动幅度未见异常</FONT></P>
3 z0 @) h) N8 v5 r7 V8 c& r$ \<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>各瓣膜形态结构正常<FONT face="Times New Roman"> CDFI</FONT>：二尖瓣少量返流</FONT></P>
/ o9 m$ s: y7 n2 d& T% j( m+ b7 ^<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>
) o- W1 J3 }7 [0 w<P ><FONT size=3>诊断：</FONT></P>
# R' P7 W" s$ G/ ?& Y* G/ i3 ~3 u<P ><FONT size=3>先天性心脏病</FONT></P>
: L& t3 K, {' P& R- y; @<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>
5 M$ ], p6 W7 e5 w0 s<P ><FONT size=3>是否必须手术？</FONT></P>
* V' i7 V' t/ F$ n<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>
! u1 i& f- t! N5 X<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>
<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；
5 ]" x. k4 ]* B: W& u4 @& 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 G! @, Q6 q9 z$ o" Z    5，费用4万元左右。