[肺动脉闭锁,左肺动脉缺如]

cyhbaby

<p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 45pt; mso-char-indent-count: 3.0; mso-char-indent-size: 15.0pt;"><font size="2"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">男宝宝，</span><span lang="EN-US"><font face="Times New Roman">18</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">个月大，体重</span><span lang="EN-US"><font face="Times New Roman">19</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">斤，身高</span><span lang="EN-US"><font face="Times New Roman">78cm.</font></span></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><font size="2"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">孩子出生后，被诊断为先心病，</span><span lang="EN-US"><font face="Times New Roman">17</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">天时在北京阜外做了一超声心动图，报告单如下：</span></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';"><font size="2">临床诊断：先天性心脏病</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt 36pt; TEXT-INDENT: -36pt; mso-char-indent-count: -2.4; mso-char-indent-size: 15.0pt;"><font size="2"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">阳性所见：心脏位置正常，心房正位，心室右袢。右心房室内径增大，右室壁增厚，左心内径尚可，室间隔及左室壁厚度正常，运动幅度尚可。室间隔干下部回声脱失约</span><span lang="EN-US"><font face="Times New Roman">11mm</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">。房间隔中部回声脱失约</span><span lang="EN-US"><font face="Times New Roman">5mm.</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">主动脉内径增宽，骑跨于室间隔之上，骑跨率约</span><span lang="EN-US"><font face="Times New Roman">40%</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">。未能控及明确的肺动脉瓣启闭现象，主肺动脉及右肺动脉发育不良，未能探及到明确的左肺动脉。余各瓣膜形态、启闭未见明显异常。于降主动脉与主肺动脉之间探及直径约</span><span lang="EN-US"><font face="Times New Roman">3mm</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">的动脉导管，呈迂曲状。主动脉弓降部的起始部内径较窄，内径约</span><span lang="EN-US"><font face="Times New Roman">6mm</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">左右。</span></font></p><p class="MsoBodyTextIndent" style="MARGIN: 0cm 0cm 0pt 36pt;"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';"><font size="2">多普勒检查：收缩期未能探及明确的过肺动脉瓣口血流信号。室水平双向分流。房水左向右分流。动脉水平左向右分流。三尖瓣少量返流。</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';"><font size="2">诊断：</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30pt; mso-char-indent-count: 2.0; mso-char-indent-size: 15.0pt;"><font size="2"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">先天性心脏病</span><span lang="EN-US"><span style="mso-spacerun: yes;"><font face="Times New Roman">&nbsp;&nbsp;&nbsp;&nbsp; </font></span></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">肺动脉闭锁</span><span lang="EN-US"><span style="mso-spacerun: yes;"><font face="Times New Roman">&nbsp;&nbsp; </font></span></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">干下型室间隔缺损</span><span lang="EN-US"><span style="mso-spacerun: yes;"><font face="Times New Roman">&nbsp;&nbsp; </font></span></span></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30pt; mso-char-indent-count: 2.0; mso-char-indent-size: 15.0pt;"><font size="2"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">室水平双向分流</span><span lang="EN-US"><span style="mso-spacerun: yes;"><font face="Times New Roman">&nbsp;&nbsp; </font></span></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">Ⅱ孔型房间隔缺损</span><span lang="EN-US"><font face="Times New Roman">(</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">中央型</span><span lang="EN-US"><font face="Times New Roman">)</font></span></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30pt; mso-char-indent-count: 2.0; mso-char-indent-size: 15.0pt;"><font size="2"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">房水平左向右分流</span><span lang="EN-US"><span style="mso-spacerun: yes;"><font face="Times New Roman">&nbsp; </font></span></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">动脉导管未闭或体肺侧支形成</span></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30pt; mso-char-indent-count: 2.0; mso-char-indent-size: 15.0pt;"><font size="2"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">动脉水平左向右分流</span><font face="Times New Roman">
                        </font><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">左肺动脉缺如？建议心血管造影确诊</span></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';"><font size="2">当时主治大夫是建议不做手术，原因：成功率不是很高；如果成功，随着孩子长大，需要每隔几年做一次手术，手术费用会很高。</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';"><font size="2">所以没再做‘心血管造影’进行确诊。</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span lang="EN-US"><font face="Times New Roman"><font size="2">&nbsp;<p></p></font></font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30pt; mso-char-indent-count: 2.0; mso-char-indent-size: 15.0pt;"><font size="2"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">从孩子出生到现在，发育比同龄孩子缓慢些，现在还不会说话，但能听懂大人的话语，智力尚可。最近一个月，不爱吃饭，体重减少了</span><span lang="EN-US"><font face="Times New Roman">2</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">斤多</span><span lang="EN-US"><font face="Times New Roman">,</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">无精神，每天只让大人抱着。前天到市医院做了一彩超，报告结果如下：</span></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><font size="2"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">心房正位，心室右袢，右心大，左心内径正常，升主动脉增宽，骑跨于室间隔上约</span><span lang="EN-US"><font face="Times New Roman">40%</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">，降主动脉起始部相对较窄，前向血流</span><span lang="EN-US"><font face="Times New Roman">Vmax=197cm/s,</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">室间隔干下部回声中断约</span><span lang="EN-US"><font face="Times New Roman">13mm,</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">并见双向穿隔血流信号，左</span><span lang="EN-US"><font face="Times New Roman">-&gt;</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">右</span><span lang="EN-US"><font face="Times New Roman">Vmax=130cm/s,</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">右</span><span lang="EN-US"><font face="Times New Roman">-&gt;</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">左</span><span lang="EN-US"><font face="Times New Roman">134cm/s.</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">房间隔中部及中上部分见约</span><span lang="EN-US"><font face="Times New Roman">1.5mm</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">及</span><span lang="EN-US"><font face="Times New Roman">6mm</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">回声中断，并见左向右穿隔血流信号，右室壁增厚，室间隔与左室后壁略呈同向流动。肺动脉瓣未显示，也未见血流信号。肺动脉狭窄，左肺动脉显示不清，肺动脉内显示模糊，其内血流量呈点线不规则状。降主动脉与肺动脉间见连续左向右分流信号，</span><span lang="EN-US"><font face="Times New Roman">Vmax=136cm/s,</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">其下附近见不规则血流信号，左冠状动脉及左四族支内径正常</span><span lang="EN-US"><font face="Times New Roman">(</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">约</span><span lang="EN-US"><font face="Times New Roman">2~3mm)</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">，其内可见较明显前向血流信号，</span><span lang="EN-US"><font face="Times New Roman">Vmax=94cm/s</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">，右冠状动脉内无明显血流信号。余瓣膜结构、形态尚好。右上肺静脉前向血流</span><span lang="EN-US"><font face="Times New Roman">Vmax=136cm/s.</font></span></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt;"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';"><font size="2">超声印像诊断：</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 37.5pt;"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';"><font size="2">先心病</font></span></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 37.5pt;"><font size="2"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">肺动脉瓣闭锁，并肺动脉狭窄</span><span lang="EN-US"><font face="Times New Roman">(</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">左肺动脉缺如？</span><span lang="EN-US"><font face="Times New Roman">)</font></span></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 37.5pt;"><font size="2"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">室间隔干下开型缺损</span><span lang="EN-US"><font face="Times New Roman">(</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">双向</span><span lang="EN-US"><font face="Times New Roman">)</font></span></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 37.5pt;"><font size="2"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">房间隔缺损</span><span lang="EN-US"><font face="Times New Roman">(</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">Ⅱ孔型</span><span lang="EN-US"><font face="Times New Roman">)</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">并卵圆孔未闭。</span></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 37.5pt;"><font size="2"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">动脉导管未闭</span><span lang="EN-US"><font face="Times New Roman">(</font></span><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';">左向右</span><span lang="EN-US"><font face="Times New Roman">)</font></span></font></p><p class="MsoNormal" style="MARGIN: 0cm 0cm 0pt; TEXT-INDENT: 30pt; mso-char-indent-count: 2.0; mso-char-indent-size: 15.0pt;"><span style="FONT-FAMILY: 楷体_GB2312; mso-ascii-font-family: 'Times New Roman';"><font size="2">市医院的结论与阜外的有些不同，根据孩子现在情况存在只做一次手术即可的可能，主治医生的建议我们到贵院去看看，所以先咨询一下陆大夫，看看孩子的病情怎么样，是否需要去贵院进一步确诊。</font></span></p>

leonidas

需要两次手术，建议行心导管检查以明确诊断和肺动脉发育情况。

cyhbaby

<p>今天咨询了一下，现在排号的话，得到9月底才能排上，孩子的病情会不会越来越严重,很担心...</p><p>麻烦再问一下大夫</p><p>1.上面说的两次手术包括心导管检查吗？</p><p>2.心导管检查对孩子心脏的副作用大不大？</p><p>3.根据上面的彩超结果，有左肺动脉的可能性有多少？</p><p>4.如果动手术后，孩子能同其它孩子一样生活吗？现在很犹豫，希望能给个建议。</p><p>&nbsp; 盼回复，谢谢!</p>

leonidas

<p>1、不包括心导管检查。</p><p>2、一般没什么影响</p><p>3、可能性不大</p><p>4、可以正常生活，但活动量不一定能达到剧烈运动</p>

wincatcher

短期内病情不会有大的变化。两次手术不包括导管检查。导管检查一般是比较安全的，何况是必须进行的检查，您也没有选择的余地。彩超没有看到左肺动脉，这不是个好现象。还是等心导管的结果再看吧。如果确实左肺动脉缺如的话，手术治疗的可能性就不大了。

cyhbaby

<p>谢谢大夫详细、耐心的解答。</p>

leonidas

<p>不用客气</p>