肺动静脉瘘的诊断与治疗:附8例报告

肺动静脉瘘是一种少见的青紫型心血管疾病。1992年 1月至 2 0 0 2年 5月我科共收治肺动静脉瘘8例 ,占同期先心病患儿住院行心导管术总数的2 .5‰ ,现将体会报告如下。1　临床资料1.1　一般资料本组肺动静脉瘘患者 8例 ,男 4例 ,女 4例 ,年龄 3～ 12岁 (平均 7岁 ) ,7例经心导管及心血管造影证实 :1例为右下肺动静脉瘘 ,1例为右侧多发性肺动静脉瘘 ,5例为两肺弥漫性肺动静脉瘘 ;另有 2例经肘静脉注射震荡后含微泡的生理盐水超声检查证实为两肺弥漫性肺动静脉瘘 ,其中 1例心导管检查正常。 2例行经心导管肺动静脉瘘弹簧圈 (Cook公司 )Coil堵…     

遗传性出血性毛细血管扩张症伴肺动静脉瘘 1例

患儿,男,10岁,出生后即发现毛细血管增生,呈弥漫性,以颜面、四肢多见,同时皮肤还有较多血管瘤,阴囊部、腹股沟两侧为多。1～5岁期间有反复发热、鼻出血病史,2岁时左侧腹股沟处血管瘤行冷冻治疗,9岁发现颜面和指趾甲青紫、活动耐力下降来我院明确诊断。     

遗传性出血性毛细血管扩张症并肺动静脉瘘1例

患儿,男,6岁。3年前出现皮肤黏膜青紫,伴活动后心慌气短。2年前出现杵状指(趾),有反复上呼吸道感染史及鼻出血,多次胸片检查示肺纹理改变。查体:血压120/90 mm Hg,体质量17 kg,营养发育差,重度发绀,全身皮肤可见鱼鳞样脱屑;双肺呼吸音粗,无音,肺部无血管杂音;心界不大,心率98次     

Pulmonary arteriovenous fistula

A case of pulmonary arteriovenous fistula in a 6 1/2 year-old girl is reported. The fistula which was first seen on X-ray films resulted in low arterial oxygen saturation, asthenia and dyspnea during exercise. It was confirmed by right catheterism and angiography. The child was cured after left inferior lobectomy. No other vascular malformations could be demonstrated in the child or in her family. Literature data are reviewed.     

Pulmonary arteriovenous fistula: Ultrasonographic approach

Report of a pediatric case with pulmonary arteriovenous fistula (PAVF) in hereditary hemorrhagic teleangiectasia (HHT), primary suspected by ultrasound. There is a characteristic sonographic feature of the complex type of PAVF revealing septations in contrast of the simple type. The diagnosis was established by angiography.     

心肌致密化不全合并弥漫性冠状动脉右室瘘1例

目的：探讨心肌致密化不全合并弥漫性冠状动脉瘘的临床特点及诊断方法。方法：报告1例心肌致密化不全合并弥漫性冠状动脉右室瘘患儿,回顾其临床症状、辅助检查结果和治疗方案。在国外数据库（Pubmed、OVID和Elsevier）和国内数据库（万方和维普）中检索心肌致密化不全合并冠状动脉瘘和心肌病合并冠状动脉瘘病例的文献,检索时间为建库至2017年3月30日。总结此类病例的临床表现、诊断和治疗。结果：本文患儿为6月龄女婴,因“胃纳差伴盗汗2周”于2013年10月12日在上海交通大学医学院附属上海儿童医学中心心内科就诊。二维超声心动图显示,左心室增大伴左室致密化不全、左右冠状动脉扩张、右心室内心肌窦状间隙持续状态、二尖瓣中度返流、心室收缩功能低下等。心导管造影及冠状动脉造影检查显示,右冠状动脉及左前降支弥漫性微小右心室瘘、二尖瓣返流、左心室增大。予地高辛、速尿、安体舒通后患儿症状稍好转。国外数据库中检索到2例心肌致密化不全合并冠状动脉左室瘘的成年病例,以进行性呼吸困难和心前区疼痛为主要临床表现,心肌缺血表现更明显,诊断主要依靠二维超声心动图及心导管造影和冠状动脉造影检查,缺乏有效治疗手段;有部分心肌病合并心肌致密化不全患者接受选择性冠状动脉瘘介入封堵术的尝试。结论：心肌致密化不全合并冠状动脉瘘是一类罕见的先天性心脏发育异常疾病,婴儿临床症状主要为纳差、盗汗等心功能不全的表现,确诊主要依靠二维超声心动图以及心导管造影、冠脉造影检查,目前尚缺乏有效治疗手段,以强心、利尿、扩血管改善心功能治疗为主。     

Iatrogenic arteriovenous fistula in infancy

Iatrogenic arteriovenous fistulas (AVF) in infancy are rare and are usually located at the level of femoral and antecubital vessels. They are generally secondary to multiple diagnostic or therapeutic arterial or venous punctures. The diagnosis is usually easy to make on clinical grounds; however, invasive procedures such as digital subtraction angiography (DSA) can be used to locate the fistula. These iatrogenic AVF may present as direct vascular communications or pseudoaneurysms originating in the venous wall. Surgical treatment is the therapy of choice. The case of an infant with an iatrogenic AVF of the femoral vessels is presented.     

Post-biopsy renal arteriovenous fistula

A 6-yr-old boy developed progressively severe hypertension, which was unresponsive to medications, 1 week after percutaneous biopsy of his renal transplant. Renal angiogram revealed an arteriovenous fistula (AVF) in the lower pole at the site of the biopsy. Case findings and resolution after embolization are described, and the current literature is briefly reviewed.