社区儿童保健体检272例心脏杂音结果分析

目的初步探讨社区卫生中心针对0～6岁散居婴幼儿及儿童保健体检对疾病尤其心脏疾病筛查的重要性,以及心脏杂音体征在0～6岁散居婴幼儿和儿童心脏疾病诊断中的重要性。方法：对2009年7月-2013年6月本社区卫生服务中心所属辖区进行0-6岁散居儿童保健大体检中听诊到心脏杂音的272名婴幼儿及儿童进行专案管理登记并尽快转至上级专科医院进行心脏彩超、心肌酶等检查以明确产生心脏杂音的原因及疾病。结果：转诊的272名查体有心脏杂音的0-6岁儿童上级心血管专科医院的诊断结果为病理性杂音124例,占45．6％,生理性杂音148例,占54．4％,其中病理性杂音包括先天性心脏病85例（占31．3％）,即室间隔缺损（VSD）62例（占22．8％）、房间隔缺损（ASD）13例（占4．8％）、房室间隔缺损（AVSD）2例（0．7％）,动脉导管未闭（PDA）10例（3．7％）;继发性心脏病37例（占13．6％）,包括感染性心肌损害27例（9．9％）、心肌炎2例（0．7％）、感染性心内膜炎I例（0．4％）,贫血性心脏病7例（25．7％）;生理眭杂音148例,包括左室假腱索42例（15．4％）、瓣膜反流及瓣膜脱垂42例（15．4％）,心脏无异常64例（23．5％）。先天性心脏血管病〈1岁年龄组所占比例显著高于1-岁组,更高于2-岁以上组（均P〈0-01）。而继发性心脏病和生理性杂音〈1岁组所占比例显著低于1．岁组和2．岁组（均P〈0-01）。在〈1岁组中先天性心脏血管病所占比例显著高于继发性心脏病和生理性杂音。结论：本社区儿童保健体检查体中对发现的异常体征如心脏杂音的婴幼儿及儿童进行及时专科转诊后发现先天性心脏病和继发性心脏病的比例较高,是引起心脏杂音的主要原因。社区卫生中心针对散居婴幼儿及儿童每年定期免费保健大体检可对散居儿童的生长发育和疾病筛查有重要意义和积极作用,认真做好基层医疗儿童保健工作可使散居儿童得到疾病的早发现、早治疗。     

右心室发育不良综合征误诊误治导致死亡一例

患者女性,2岁.因发现心脏杂音2年入院.体检心尖部可闻及3/6级收缩期杂音.心脏彩色超声心动图示:膜部室间隔缺损约4 mm;左心房内径20 mm,左心室舒张末期内径41 mm,右心室内径10.3 mm.诊断先天性心脏病室间隔缺损,接受介入封堵治疗.     

右室粘液瘤一例

患者,女,27岁。因发现心脏杂音10年余入院。平时体健。曾在外院诊断为“先天性心脏病”、“风湿性心脏瘸”、“心脏生理性杂音”。体检:血压:16.0/10.6kPa,胸廓无畸形。双肺正常。心前区未触及震颤。心率82次/分,律齐。胸骨左缘第三、四肋间闻及Ⅲ级收缩期滚动样杂音及舒张早期杂     

听到心脏杂音就是有心脏病吗？

问:编辑你好,我的儿子今年19岁,体检时医生听到了心前区杂音。他是不是有心脏病了?读者张女士答:张女士你好。心脏杂音可分为生理性杂音和病理性杂音。生理性杂音可见于青春期或者青年     

儿童先天性心脏病介入治疗436例临床分析

目的总结儿童先天性心脏病介入治疗的临床经验,分析其疗效。方法2007年1月至2013年6月新疆维吾尔自治区人民医院北院共施行0～14岁儿童先天性心脏病介入封堵治疗436例,其中继发孔型房间隔缺损213例,室间隔缺损83例,动脉导管未闭139例,房间隔缺损合并动脉导管1例。房间隔缺损、室间隔缺损及动脉导管未闭封堵术均采用Amplatzer法。结果全组患儿无手术死亡病例,封堵成功423例（97．4％）,房间隔缺损组、室间隔缺损组和动脉导管未闭组的成功封堵率分别为97．7％（208／213）,94．0％（79／83）,98．6％（137／139）。室间隔缺损封堵术后早期心律失常发生率较高（15．2％）。全组门诊心脏超声心动图、心电图、胸部X线片随访3-36个月,无残余分流、死亡及严重心脏事件。结论经导管介入治疗先天性心脏病创伤小、安全、可靠、成功率高,部分患者可替代外科手术。     

三房心的诊断与治疗六例报告

三房心是一种罕见的先天性心脏病,发病率约占先天性心脏病的0.1%。我科自1989年4月～1992年2月共收治6铡,经手术治疗痊愈,现报告如下: 1 临床资料本组6例(男2例,女4例)。体重15～47kg。6例均自幼发现心脏有杂音,1例有紫绀。体检时胸骨左     

室间隔缺损的介入治疗

室间隔缺损（VSD）绝大多数为先天性。先天性VSD是最常见的先天性心内畸形之一,约占先天性心脏病的25％。先天性VSD的危害主要表现在以下几方面：长期的左向右分流导致肺动脉高压、心力衰竭,甚至死亡;发生感染性心内膜炎的几率较正常心脏明显升高;心脏杂音对升学、     

先天性心脏病房间隔缺损合并右房异常索条一例

先天性心脏病房间隔缺损合并右房异常索条一例河南省郑州市第七人民医院，郑州市心血管病研究所杨兴明，李新荣，朱汝军，胡峤１临床资料患者，女性，８岁。自幼发现＂心脏杂音＂。１９９１年１１月１１日，来我院就医。体检：胸骨左缘第３肋间闻及ＩＩＩ级收缩期杂音。彩...     

室间隔缺损封堵后并发频发室早1例

患者,女,36岁,因体检发现心脏杂音15年,于2012年7月30日入院。超声心动图示：先天性心脏病,室间隔膜周部缺损（3mm）。体检：心前区饱满．心尖搏动位于胸骨左缘第5肋间,左锁骨中线内侧1．0cm。未触及收缩期、舒张期震颤,末触及心包摩擦感。心界不大,心率80次／分,律齐,未闻及早搏,心音可,胸骨左缘3～4肋间可闻及3／6级收缩期吹风样杂音。     

先天性心脏病的诊断与治疗(三)

几种常见先天性心脏病的诊治简介本文主要介绍几种常见的且治疗结果好的先天性心脏病 ,如室间隔缺损 ,房间隔缺损 ,动脉导管未闭 ,肺动脉瓣狭窄及法洛四联症。前四种疾病如果手术时机选择好 ,手术不出现并发症远期结果是很好的 ,原则上讲属于终生治愈。1 室间隔缺损 (室缺 )心脏有四个心腔 ,右心房、右心室之间通道有三尖瓣 ;左心房 ,左心室之间有二尖瓣 ;左右心室之间有一厚的间隔称室间隔 ,这个隔有先天缺损即称为室间隔缺损。此病占先天性心脏病的 2 0 %～ 2 5 %。心脏杂音是主要体征 ,心电图表现为左室肥厚 ,心脏X线片示心影扩大 ,左心…     

Spread of heart diseases seen in an open-access paediatric echocardiography clinic

All patients <13 years of age referred to the open-access paediatric echocardiography clinic at the Sultan Qaboos University Hospital, Muscat, Oman, during the five years from 1994 to 1998 were analysed. Among the 2633 patients studied, 1543 (58.6%) were normal, 845 (32.1%) had congenital heart disease, and 245 (9.3%) had acquired heart disease. The major congenital heart diseases identified were secundum atrial septal defect (22.5%), ventricular septal defect (22.5%), patent ductus arteriosus (15.7%), mitral valve prolapse (10.7%), pulmonary stenosis (9.7%) and atrioventricular septal defect (4.5%). Fifty-eight percent of the congenital heart diseases were identified in the first year of life. Among the acquired heart diseases, rheumatic heart disease (30.2%) and cardiac involvement secondary to haemoglobinopathies (16.7%), dilated cardiomyopathy (16.3%) and hypertrophic cardiomyopathy (12.7%) were significant. Although the presence of specific cardiac symptoms was associated with a high yield of abnormalities, such disorders were also discovered in a significant number of children with isolated cardiac murmur. The referral source did not influence significantly the frequency of heart diseases diagnosed in this study. Open-access echocardiography is important in early detection of heart disease in the paediatric population.     

Cost-effectiveness of echocardiography for evaluation of children with murmurs

Echocardiography is widely accepted as an accurate diagnostic test to evaluate heart murmurs in children, however its costs, and the ubiquity of murmurs in children, discourage its universal application. The purpose of this article is to identify some clinical circumstances in which the cost of echocardiography is justified for the evaluation of heart murmurs in infants and children. Eight common clinical problems were selected in which a heart murmur is present and a diagnosis is called for. Effectiveness of echocardiography and less costly clinical diagnostic methods in these settings were compared. In some circumstances, echocardiography is worth the cost, because clinical evaluation is unacceptably insensitive to important disease (the premature infant with a murmur which might represent a patent ductus arteriosus, the infant with a dysmorphic syndrome and a murmur). In others, the expert clinical examination is highly accurate (the asymptomatic child with a heart murmur) and is preferred over the echocardiogram as the initial diagnostic approach on the grounds of cost. When the expert clinical examination suggests minor structural heart disease, a continuum of echocardiographic cost-effectiveness relative to the expert clinical examination exists between these extremes depending on the working diagnosis. A threshold has not yet been defined at any point on this continuum above which the public will demand the greater diagnostic detail available echocardiographically, and below which the public will refuse to accept its greater cost. Quantitative formal cost-effectiveness analysis of echocardiography for evaluation of heart murmur in infants and children is not yet feasible because the benefits of echocardiography are indirect, dependent upon the as yet unmeasured benefits of correct management of congenital heart defects. To go beyond simple comparison of efficacy of echocardiography with less costly methods, further work is required in outcomes research in congenital heart disease.     

Clinical features of hypertrophic cardiomyopathy in the young

BACKGROUND: We analysed the experience with hypertrophic cardiomyopathy in two paediatric centres to establish the differences from older patients. METHODS: Out of 45 young patients seen from 1974 to 1999, we included 38. Criterions for exclusion were secondary forms, or association with severe congenital cardiac disease which could alter the outcome. RESULTS: The patients presented at the age of 5.7 years, and were followed for 7.0 years. The 34 patients referred because of a murmur or cardiomegaly were older than the four with heart failure, presenting at 6.2 as opposed to 2.1 years of age, p = 0.08. Of the patients, 29 (76%) had primary cardiomyopathy, while 9 (24%) had secondary forms associated with Noonan's and LEOPARD syndromes. Familial tendency was ascertained in 7 patients (18%). The septal thickness in mm/m2 at presentation was greater in patients under 2 years than in older children (29 vs 18, p = 0.02). Obstructive hypertrophic cardiomyopathy was found in 17 patients (45%), with six of these having mild associated congenital cardiac defects. Nine had symptomatic arrhythmias. Overall, treatment was medical in 31, with DDD pacing used in 5, and surgery, radiofrequency ablation, and transplantation in one patient each. Total mortality was 24%, at a rate of 4.3% per year. Four patients died in heart failure and 5 had sudden death. Those in failure were significantly younger (p = 0.01). CONCLUSIONS: Hypertrophic cardiomyopathy in the young is characterized by referral for murmur or heart failure; frequent secondary forms; the obstructive variant being as common as the non-obstructive form; a mortality rate similar to that for adults attending tertiary centres; and less frequent familial forms than in older populations.     

Hypertrophic cardiomyopathy in infants: clinical features and natural history

The clinical and morphologic features of hypertrophic cardiomyopathy in 20 patients recognized as having cardiac disease in the first year of life are described. Fourteen of these 20 infants were initially suspected of having heart disease solely because a heart murmur was identified. However, the infants showed a variety of clinical findings, including signs of marked congestive heart failure (in the presence of non-dilated ventricular cavities and normal or increased left ventricular contractility) and substantial cardiac enlargement on chest radiograph. Other findings were markedly different from those usually present in older children and adults with hypertrophic cardiomyopathy (e.g., right ventricular hypertrophy on the ECG and cyanosis). Consequently, in 14 infants, the initial clinical diagnosis was congenital cardiac malformation other than hypertrophic cardiomyopathy. Twelve of the 14 infants who underwent left-heart catheterization showed substantial obstruction to left ventricular outflow (peak systolic pressure gradient greater than or equal to 35 mm Hg). However, unlike older patients with hypertrophic cardiomyopathy, infants with this condition commonly had marked obstruction to right ventricular outflow (35-106 mm Hg) (nine patients); in six patients, the magnitude of obstruction to right ventricular outflow was at least as great as that to left ventricular outflow. Asymmetric hypertrophy of the ventricular septum relative to the left ventricular free wall was present in the 16 patients who had echocardiographic or necropsy examination. Ventricular septal thickening was substantial in patients studied both before and after 6 months of age (mean 16 mm), indicating that in patients with hypertrophic cardiomyopathy, marked left ventricular hypertrophy may be present early in life and is probably congenital. The clinical course was variable in these patients, but the onset of marked congestive heart failure in the first year of life appeared to be an unfavorable prognostic sign; nine of the 11 infants with congestive heart failure died within the first year of life. In infants with hypertrophic cardiomyopathy, unlike older children and adults with this condition, sudden death was less common (two patients) than death due to progressive congestive heart failure.     

A study of congenital cardiac disease in a neonatal population--the validity of echocardiography undertaken by a neonatologist

OBJECTIVES: To estimate the incidence of, and profile the spread of, congenital cardiac defects, and to assess the accuracy of the echocardiographic diagnosis as performed by a neonatologist. DESIGN: Hospital-based study. METHODS: All neonates meeting our criterions, specifically those with a persistent murmur 48 hours after birth, underwent an echocardiographic examination to exclude an underlying congenital cardiac defect. All scans performed by the neonatologist were videotaped and reviewed by a paediatric cardiologist. We assessed concordance according to inter-rater agreement. RESULTS: Out of 11,085 live births, there were 83 infants with a congenital cardiac defect, giving an incidence of 7.49 per 1000 live births, with 95% confidence interval from 5.88 to 9.09. Of the infants with a murmur persisting at or greater than 48 hours after birth, who had a median age of 4.5 days, 75% had a congenital heart defect, with ventricular septal defect being the commonest, encountered in 56.7% of cases. Concordance between the neonatologist and the cardiologist was good, with Cohen's Kappa coefficient being calculated at 0.68, and 95% confidence interval from 0.51 to 0.85. CONCLUSION: The incidence of congenital cardiac malformations as determined in our hospital-based study in the United Arab Emirates is similar to that described in the Gulf region and worldwide. A persistent murmur at or greater than 48 hours after birth is strongly suggestive of an underlying congenital cardiac malformation. Our experience shows that a neonatologist appropriately trained in echocardiography can perform as well as a paediatric cardiologist. Where specialist resources are limited, this allows for early diagnosis, earlier referral if necessary, and early institution of appropriate therapy.     

Resources,use, and regionalization of pediatric cardiac services

Care for children with congenital heart disease requires specialized services and various healthcare resources. The purpose of this article is to provide an updated overview of healthcare resources for infants and children with heart disease. In 2001, there were 1609 certified pediatric cardiologists in the United States. The ratio was approximately 45,000 children younger than 18 years per pediatric cardiologist. It is estimated that more than 19,000 cardiac surgeries are performed in children younger than 18 years in the United States each year. This article also reviews the effect of patient characteristics on access to healthcare and use of pediatric cardiac services, and discusses issues related to optimal use of these resources and the development of an organized approach toward service management by regionalization. The authors believe that improved access to high-quality facilities and providers coupled with thoughtful changes in the healthcare delivery system represent an excellent opportunity for optimizing outcomes for children with heart disease.     

Heart surgery without previous heart catheterization, in pediatric cardiology]

STUDY OBJECTIVE: To determine the influence of echocardiography in the preoperative diagnosis of heart diseases in children. DESIGN: Retrospective study. SETTING: Hospitalized children admitted in Departments of Pediatric Cardiology and Cardiothoracic Surgery. PATIENTS: Children of both sexes, aged from neonate to 14 years old, with heart disease who underwent cardiac surgery. MATERIAL AND METHODS: From January 1989 to July 1990, 220 consecutive cardiac surgeries were performed in children with heart disease. The initial diagnosis was based on data from clinical examination, electrocardiogram, thorax X-Ray and echocardiogram (M-mode, 2D, conventional and colour Doppler). Patients were separated in three groups according to their ages: newborn infants less than 28 days old; infants less than 12 months old; children more than 1 year old and less than 14 years old. Patients were separated according to the investigations used further for preoperative diagnosis: whether they had or not cardiac catheterization performed prior to surgery. RESULTS: From 220 surgical interventions performed, 124 were "open heart" surgeries (9 neonates, 28 infants and 87 children) and the remaining had "closed heart" operations (14 neonates, 37 infants and 45 children). Preoperative diagnosis was mainly dependent on echocardiography, dispensing catheterization in 90 cardiac interventions. The diagnosis was confirmed at surgery or at autopsy. There were 9 deaths, 3 of which occurred in patients not submitted to cardiac catheterization. CONCLUSIONS: Echocardiography is a reliable method for investigation and establishment of the preoperative diagnosis of heart diseases in children. Its use may further reduce the need for diagnostic catheterization in children, particularly in risk groups.     

Left ventricular false tendon: the most frequent cause of "innocent" murmur in childhood?]

BACKGROUND. The left ventricular false tendon (FT) is an anomalous fibrous or fibromuscular band stretching across the left ventricle. The false tendons extend from the septum to the left ventricular free wall or, more rarely, from the septum to a papillary muscle. The association between FT and innocent cardiac murmur has been pointed out. The aim of the present study was to assess the incidence of FTs in children with a murmur classified as innocent. METHODS. Two groups of subjects were selected. Group A consisted of 253 children with: 1) systolic ejection murmur; 2) normal electrocardiogram and 3) absence of clinical data suggesting cardiac disease. Group B consisted of 240 children clinically free of cardiac disease, and without any cardiac murmur. A FT was diagnosed by means of 2D echocardiogram whenever a linear band stretching across the left ventricular chamber was evident in at least two sections. RESULTS. One hundred and sixty-one children of group A (63.6%) reflected a left ventricular FT; only in 3 patients out of 161 the FT was associated with a small ventricular septal defect, whereas in 158 children the FT was the only abnormal finding. A normal echocardiogram was observed in 71 children (28.1%) of group A; whereas in 21 patients (8.3%) a congenital heart disease was diagnosed. In group B, only 33 subjects (13.8%) had a FT. The different incidence of FT in the two groups (63.6% versus 13.8%) was statistically significant (p less than 0.01). CONCLUSIONS. The study shows that about two thirds of children with innocent heart murmur reflect a left ventricular FT. Furthermore, FT is far more common in subjects with innocent cardiac murmur than in normal subjects. The relationship between FT and murmur thus appears very likely, although not definitely proven.     

Digital subtraction angiography in infants and children with congenital heart disease

Digital subtraction angiography was used as the sole imaging technique in 95 infants and children aged 13 hours to 16 years undergoing cardiac catheterisation for the investigation of congenital heart disease. Injections of diluted contrast medium were made selectively at central sites, and the images were obtained using continuous image intensification fluoroscopy at either 32.25 nC/kg/s (125 microR /s) or 129 nC/kg/s (500 microR /s). In all cases images adequate for diagnosis and management were obtained with appreciably less contrast medium and a lower radiation dose than in a comparable group of patients using conventional biplane cineangiography. Thus digital subtraction angiography is a viable alternative to biplane cineangiography for children with congenital heart disease.