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<b>[求助]先天性主动脉缩窄
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<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>
1 R5 i n" W5 s6 O! `5 g4 A<P><b></b></P></FONT>; K7 H4 z3 D+ Z: b( s- Q U
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5 W6 x+ r6 G( V, O3 `, ~: M<P align=center><B><FONT size=3>中国医学科学院阜外心血管病医院 1 T8 l( a* Z! b8 J4 Z
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<P align=center><FONT size=3><B><FONT face="Times New Roman">EBCT</FONT></B><B>诊断报告
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0 x$ N4 i# B- H1 x; K+ G# A; K+ {<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>
! q9 L9 N& ` h! @<P><FONT size=3>扫描所见：</FONT></P>
. a9 z) {" |* \ n! o2 U" A<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>) @3 b6 L5 q" M2 ]+ A$ T
<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>
# @, q9 U- \2 p W7 `) P<P><FONT size=3>诊断：</FONT></P>
! B3 c. L! N& V U* x/ Z- x" g<P><FONT size=3>先天性心脏病：</FONT></P>
9 F( m! Q# h g6 I9 f$ D<P><FONT face="Times New Roman"><FONT size=3>1.</FONT> </FONT><FONT size=3>主动脉缩窄；</FONT></P>/ R* [( m8 }/ K1 ^: C
<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>9 _+ @+ q8 Q6 ~
<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心
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<P align=center><B><FONT size=3>超声心动图示波报告
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2 s, o$ [0 T+ f" C0 c! m$ W<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>7 W# d" [5 J0 d/ V( S9 S6 y. P2 ]+ e! w
<P><FONT size=3>阳性所见：</FONT></P>
6 z6 O/ p, H& c ^<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>8 [) i: I8 S) P8 R7 O
<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>$ U8 S3 u5 f: m) U- I) A! p. D7 o! Y
<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>. y: F0 O$ {! j w, m8 l: G7 J
<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>
: R( }( U" `/ V" Q1 c: @<P><FONT size=3>诊断：</FONT></P>
, s) U8 D" a- F2 h) E! N<P><FONT size=3>先天性心脏病</FONT></P>9 r/ m/ p/ f `: w: i/ `/ V/ M
<P><FONT size=3>主动脉缩窄</FONT></P>
* s& a6 c; |# x& N9 I<P><FONT size=3>二尖瓣返流（重度）</FONT></P>' J/ V1 a6 m1 Q M6 K/ C' G" b
<P><FONT size=3>三尖瓣返流（轻度）</FONT></P>
: E* W( k9 e( W) K! Q. E<P><FONT size=3>左室大</FONT></P>" ~4 g s, P* `) h8 j9 u* g
<P><FONT size=3>左室收缩功能减低</FONT></P>+ x; \8 P& `3 G5 g8 E6 F# t
<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心
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<P align=center><B><FONT size=3>超声心动图示波报告 ; R6 ~5 u# {) ^$ u
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<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>
/ ? T1 K4 Y5 R2 z( A2 G' }' i- v<P><FONT size=3>阳性所见：</FONT></P>& T4 R0 p; ^8 o8 I/ N5 }
<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左室呈球形扩张</FONT></P>( D$ S0 d3 q' n0 P. 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>
( ]: ]" 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>/ B1 c' k6 g- s2 q4 d
<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>
( a# C/ g i- ^: v, j4 S7 g5 p7 @<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>3 U7 S A# x \
<P><FONT size=3><FONT face="Times New Roman">6 </FONT>大动脉水平未见异常通道</FONT></P>5 G+ F8 U' N4 y9 C# f* 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>( t9 i' h" t& S: ]9 B
<P><FONT size=3>诊断：</FONT></P>
2 I4 z" U4 i" o: `7 v<P><FONT size=3>先天性心脏病</FONT></P>' ?$ ?; S) [3 H k6 b. e# u
<P><FONT size=3>主动脉缩窄</FONT></P>
% Q5 C' u$ X5 f9 R<P><FONT size=3>左室增大，左室壁肥厚</FONT></P>
& j! ?2 m; U- z3 z$ p<P><FONT size=3>左室假腱索</FONT></P>
5 B/ A1 t6 g, |# b! I) ]) r<P align=center><B><FONT size=3>北京市心肺血管医疗研究中心
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<P align=center><B><FONT size=3>超声心动图示波报告 9 P0 R) Y6 I2 W/ V$ e* @4 M
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<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>
3 e/ N9 y1 p/ P7 k1 k<P><FONT size=3>阳性所见：</FONT></P>
3 m1 w& k+ c6 G. F& w<P><FONT size=3><FONT face="Times New Roman">1 </FONT>左心扩大，左室壁稍厚</FONT></P>
$ @1 B$ G7 {5 \; k2 H<P><FONT size=3><FONT face="Times New Roman">2 </FONT>室壁运动幅度未见异常</FONT></P> q/ I1 [2 r! r; j
<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>9 I+ b0 v1 z5 f( \' F6 H3 g
<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>4 E4 Q: Y Q! b4 `# F0 S7 J0 u
<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>) [7 ?) `& o+ h6 P% e0 |' s$ h
<P><FONT size=3>诊断：</FONT></P>, _* G7 J7 V# `' D5 T3 `" k# N
<P><FONT size=3>先天性心脏病</FONT></P>4 w. @3 L+ Z- F0 P" ?; \; X
<P><FONT size=3>主动脉缩窄</FONT></P>8 I3 N5 D1 m' x
<P><FONT size=3>从目前的情况来看，病情的会不会继续发展？</FONT></P>1 P. o6 B/ u7 o9 M# S( ]
<P><FONT size=3>是否必须手术？</FONT></P>5 {0 ]+ E4 x/ c3 H r% R) 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>6 G; x, S- ]4 s' H: u$ e$ ]1 g" c
<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> |
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