婴幼儿主动脉缩窄外科治疗进展

主动脉缩窄是一种较为常见先天性心脏病,婴幼儿期的主动脉缩窄常伴有复杂畸形,未经治疗死亡率较高.本文主要介绍主动脉缩窄外科手术的选择;伴主动脉弓发育不良的处理方法和时机选择;合并室间隔缺损的主动脉缩窄的外科处理;再缩窄的处理.     

婴幼儿主动脉缩窄外科治疗进展

主动脉缩窄是一种较为常见先天性心脏病,婴幼儿期的主动脉缩窄常伴有复杂畸形,未经治疗死亡率较高。本文主要介绍主动脉缩窄外科手术的选择;伴主动脉弓发育不良的处理方法和时机选择;合并室间隔缺损的主动脉缩窄的外科处理;再缩窄的处理。     

先天性主动脉缩窄致高血压1例

继发性高血压占高血压总数的5%左右,其中又以肾实质性高血压、肾血管性高血压、原发性醛固酮增多症和嗜铬细胞瘤为多见,因各自有其特征性的临床表现和实验室检查方法,临床医生对此不陌生。而先天性主动脉缩窄因临床较少见,故易被忽视[1]。1临床资料患者,女性,19岁,因发现血压升高12年就诊。患者7岁时首次发现血压升高,当时血压为160/90mmHg(1mmHg=0.133kPa),曾到多家医院就诊,诊断为     

成人先天性主动脉缩窄临床特征分析

目的总结成人先天性主动脉缩窄患者的临床特征。资料与方法回顾分析2009年1月至2012年11月在阜外心血管病医院住院治疗的85例年龄大于14岁的先天性主动脉缩窄患者的临床特征。结果平均年龄(25.9±9.9)岁,其中74.1%患者既往有高血压病史,最高血压达到(191.0±26.8/101.7±22.4)mmHg(1mmHg=0.133kPa),合并其他先天性心血管疾病的占69.4%,39.5%的患者接受了外科手术治疗。37.2%的患者接受了介入治疗。结论成人主动脉缩窄患者多因不明原因的高血压而发现,易造成多种高血压并发症,且多合并其他先天性心血管异常,详细的体格检查,测量四肢血压有助于尽早诊断,自然预后差,一旦发现,应尽早进行介入或外科治疗。     

先天性主动脉缩窄介入治疗1例

患者 ,男 ,2 5岁。 6年来常出现不明原因头胀、心慌、气短、四肢乏力、活动后加重。无恶心、呕吐及腹泻 ,不发热 ,无咳嗽及气喘。曾在当地测双上肢血压 2 0 0 /1 1 0mmHg( 1mmHg =0 .1 33kPa) ,未行任何治疗入我院。否认肾炎及风湿热病史。体检 :T 36.0℃ ,P 80次 /min ,R 2 0次 /min分 ;BP左上肢 :2 0 0 /1 1 0mmHg ,右上肢 :2 0 0 /1 1 0mmHg,左下肢 :1 2 0 /80mmHg ,右下肢 :1 2 0 /80mmHg。头颅五官无畸形 ,颈软 ,颈动脉区触及血管搏动增强 ,且闻及收缩期杂音 ,双肺无异常。心音有力 ,律齐 ,心尖区及主动脉瓣区均可闻及 2～ 3级收…     

先天性主动脉缩窄致高血压性心脏病误诊1例

患者,男性,50岁.于18岁人伍体检时发现有高血压,当时测血压180/110 mm Hg,因无自觉症状未诊治.近4年来,患者逐渐出现胸闷、憋喘,活动后加重.曾在本院及外院三级医院多次就诊,诊断为原发性扩张型心肌病,心功能不全,症状好转后仍反复发作,且逐渐加重.于2010-11-20入本院时,已不能从事任何日常活动.入院...     

先天性主动脉缩窄和大动脉炎致主动脉狭窄的临床特点

目的 分析比较先天性主动脉缩窄和大动脉炎致主动脉狭窄的临床特点中的共性和特性.方法 入选2016年11月至2018月2月入住阜外医院高血压中心的先天性主动脉缩窄和大动脉炎致主动脉狭窄的患者,收集所有患者的一般临床资料,血浆肾素、醛固酮水平,血沉,高敏C反应蛋白(hsCRP),以及超声心动图,四肢血压,主动脉增强CT,血...     

先天性主动脉缩窄的超声诊断研究

本文评价超声心动图(UCG)对主动脉缩窄(AOC)的诊断。UCG诊断27例AOC,手术证实25例为AOC,2例为假阳性。25例AOC经胸骨上窝主动脉弓长轴切面均显示主动脉缩窄的直接征象,22例为局限性缩窄,3例为管状缩窄。缩窄部位13例为峡部,10例为左锁骨下动脉降主动脉远端,2例为弓部。23例AOC的缩窄处最大血流速度大于200cm/s。以上结果说明,UCG可以确定AOC的部位和性质,为手术治疗提供可靠的依据。     

142例先天性胸主动脉缩窄的外科治疗

本文报道142例先天性胸主动脉缩窄外科治疗的经验。本组手术死亡串1.41%,远期疗效优良率95.2%,晚期死亡率1.2%。重点讨论近年来在治疗本病的基本方法、手术方法及移植材料方面的新进展。     

先天性主动脉缩窄一例

患男性，22岁。因间断性头昏2年，血压升高1年，于2005年2月24日入院。患3个月前因头昏，去医院测血压高达170/100mm Hg（1mm Hg=0.133kPa），拟高血压住院治疗。入院查体：血压170/110 mm Hg（上肢） 。心率78次/min，律齐，各瓣膜听诊区未闻及病理性杂音，     

单纯主动脉缩窄的外科治疗

目的总结单纯主动脉缩窄外科治疗的经验,评价手术时机和方法。方法1990年6月至2005年8月,手术治疗单纯主动脉缩窄17例,其中行主动脉缩窄切除对端吻合术5例,人工血管移植术3例,补片成形术7例,Vosschulte成形术1例,左锁骨下动脉-降主动脉人工血管转流术1例。结果术毕上下肢平均动脉压的压差<10mmHg者13例,上肢平均动脉压仍高于下肢10～30mmHg者4例。术后早期高血压者14例。随访5个月至10年,下肢血压高于上肢者13例,无明显差异者3例,下肢血压仍明显低于上肢者1例,仍有高血压者5例;成形部位动脉瘤样扩张1例,再缩窄1例。结论早期诊断、早期治疗是提高生存率和减少术后高血压的关键。手术方法应根据患者年龄、病理特征和术者经验选择。     

Surgical experience of coarctation of the aorta in infants and young children

We evaluated the effectiveness of surgical treatment for coarctation of the aorta in infants and young children, based on our experience over 7 years. From March 1999 to December 2005, 168 cases of coarctation of the aorta in patients aged 21 days to 3 years were treated by end-to-end, extended end-to-end, or extended end-to-side ascending aorta and aortic arch anastomosis. The mortality rate was 0.6%. In 138 (82%) patients, the pressure in the lower extremity was higher than in the upper extremity. During 6-24 months of follow-up, hoarseness appeared in 6 patients. Echocardiography revealed stenosis of the end-to-end anastomosis in only 2 patients. We suggest that the best option for surgical treatment of coarctation of the aorta with associated cardiac malformations is a one-stage procedure using a median sternotomy approach. It is better to perform extended end-to-end anastomosis or anastomosis between the distal descending aorta and the left wall of the ascending aorta, or to extend this anastomosis to the transverse arch.     

婴幼儿单纯乳房早发育的病因研究进展

据相关流行病学资料,单纯乳房早发育在婴幼儿并不少见;部分患儿的单纯乳房早发育会发展为中枢性性早熟,导致其成年终身高受损,并给其心理健康留下隐患.因此明确婴幼儿单纯乳房早发育的病因对其治疗非常重要.除了生理性小青春期、疾病(卵巢囊肿)及遗传因素外,它的病因还包括误服某些药物、生活坏境和营养因素.其中前者是内因,或机体自身分泌雌激素增多,或乳房的雌激素受体对雌激素敏感性增加;后者为外因,或食道摄入雌激素或类雌激素增多,或环境影响(光照、迁徙、环境内分泌干扰物).     

Balloon catheter dilatation of coarctation of the aorta in young infants.

In four young infants with symptomatic coarctation of the aorta the narrow aortic segment was dilated with a balloon angioplasty catheter. Three of the infants also had appreciable heart defects and one infant had undergone surgery before and had had one previous dilatation. Dilatation was well tolerated and good femoral pulses appeared in all cases, but these disappeared over one to seven days. Despite this, two patients showed some symptomatic improvement over four months. One patient died after perforation of the aorta by an angiographic catheter after dilatation. Relieving coarctation in young infants by catheter dilatation appears incomplete, but it may give symptomatic improvement. Further trial of the procedure will determine whether patients who have undergone surgery and those who have not may benefit. Careful attention to technique and avoidance of manipulations after dilatation are essential if complications are to be avoided.     

Echocardiographic and hemodynamic findings in isolated symptomatic coarctation of the aorta in infancy

Echocardiographic findings and cardiac catheterization data were evaluated in 18 infants less than 1 year old in order to define anatomical or pathophysiological features that were associated with early cardiac decompensation. The infants could be divided into three groups: Group I (10 patients) had left ventricular dilatation and depressed contractility in response to the severe systemic hypertension. Group II (3 patients) had marked myocardial hypertrophy In response to the systemic hypertension. Group III (5 patients) were the youngest patients and had findings of right ventricular volume overload and pulmonary hypertension. This study demonstrates that, in early infancy, the ventricular response to simple coarctation of the aorta is variable in infants in a state of cardiac decompensation. The different echocardiographic and hemodynamic findings may be a consequence of the lesion exerting its influence at various stages of the patients' intrauterine or postnatal life. In most patients, resection of the coarctation results in rapid normalization of the echocardiographic findings.     

婴幼儿主动脉缩窄合并心内畸形的Ⅰ期手术纠治

目的:总结主动脉缩窄合并心内畸形的外科治疗经验。方法:回顾分析2007年1月至2011年6月我院收治的婴幼儿主动脉缩窄合并心内畸形Ⅰ期手术治疗的临床病例。共计42例,其中男性26例,女性16例。平均年龄(1.6±0.9)岁(6 d～3岁),平均体质量(7.2±2.5)kg(2.8～12kg)。主动脉缩窄合并心内畸形:37例合并室间隔缺损,5例合并房间隔缺损,7例同时合并主动脉瓣二瓣畸形,手术方法采用双切口I期纠治5例,正中切口I期纠治37例,其中锁骨下动脉翻转法(8例)、人工补片法(6例)、端端吻合法(15例)、端端吻合+补片法(13例)。结果:本组42例中,死亡1例,术后9 d死于肺部感染,病死率2.4%。术后均复查心脏彩超显示降主动脉血流通畅,无明显狭窄,3例提示降主动脉内仍存在20～40 mmHg(1 mmHg=0.133 kPa)压差,心脏彩超示吻合口处狭窄,血流速度增快。结论:婴幼儿主动脉缩窄合并心内畸形采用深低温选择性脑灌注方法经胸骨正中切口I期手术治疗可以达到满意疗效。彻底切除缩窄段及导管组织是手术成功的关键。