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| 題 名 | Aortic Stenosis in Children: 19-Year Experience=兒童主動脈狹窄:十九年之經驗 |
|---|---|
| 作 者 | 劉靜雯; 黃碧桃; 李必昌; 陸振翮; 孟春昌; | 書刊名 | 中華醫學雜誌 |
| 卷 期 | 59:2 1997.02[民86.02] |
| 頁 次 | 頁107-113 |
| 分類號 | 417.6231 |
| 關鍵詞 | 主動脈瓣閉鎖不全; 主動脈狹窄; 先天性心臟病; 壓力差; Aortic regurgitation; Aortic stenosis; Congenital heart disease; Pressure gradient; |
| 語 文 | 英文(English) |
| 中文摘要 | 背景:我國兒童主動脈狹窄的報告不多。本研究探討這類病童的臨床表徵、治療方法及結果。 方法:過去19年共有3808例先天性心臟病病童接受心導管檢查,其中51例(3.1%)證實為主動脈狹窄。我們以回溯病歷方式,分析其臨床表現、心電圖、心臟超音波、心導管檢查、內科追蹤、開心手術及氣球擴張術的結果。 結果:主動脈狹窄病童中,瓣膜性、瓣膜下及瓣膜上主動脈狹窄分別佔 76.5%、9.8% 和 13.7%。 除瓣膜上主動脈狹窄,其餘兩種以男性佔多數(男女之比為 2.6)。 病童中 84.3 % 合併心臟血管畸形,以主動脈瓣閉鎖不全最常見。 臨床表現以無症狀者居多,佔 56.9%。典型症狀包括運動時呼吸困難(17.6%),昏厥(9.8%)及胸痛(7.8%)。平均追蹤時間為3.9 ± 3.4年。 10位病童接受開心手術,2位接受氣球擴張術。狹窄兩端壓力差最初為 95.3 ± 29.3 mmHg,在早期及晚期術 後追蹤各降為51.4 ± 35.8 mmHg,53.1 ± 12.3 mmHg(p < 0.05)。 未經手術者,其壓力差自 36.9 ± 25.3 mmHg 增加為 40.8 ± 32.6 mmHg,但無統計意義。 經開心手術者無病例死亡。一位瓣膜性主動脈狹窄病童在手術臺上接受開放性動脈導管結紮及氣球擴張術後因心臟衰竭致死,解剖發現主動脈瓣膜破裂。未經手術者有一例因家長拒絕治療於出院後死亡。 結論:本研究發現我國兒童患主動脈狹窄的臨床特徵與西方報告不同之處如下:1. 國人發生率較低。2. 瓣膜下主動脈狹窄最罕見。3. 瓣膜上主動脈狹窄病童中,男女比例相當。4. 威廉氏症侯群較常見,而無一例為透納氏症侯群。5. 單純性主動脈狹窄較不常見。6.異於西方的心電圖發現如右心室肥大,其原因在有合併其它心臟畸形。開心手術安全而有效,但氣球擴張術仍需進一步探討。 |
| 英文摘要 | Background: In the Taiwanese literature, few articles describe the pertinent features of aortic stenosis (AS). This study explores the features of AS in Chinese children. Methods: 3808 children with congenital heart diseases have undergone cardiac catheterization at our institution over the past 19 years. Among them, 51 (1.3%) cases were AS. The clinical, electrocardiographic, echocardiographic and catheterization findings, the methods of treatment and outcomes were reviewed. Results: Valvular AS occurred in 39 children (76.5%), subvalvular AS in 5 (9.8%), and supravalvular AS in 7(13.7%). Male was predominant (M/F ratio, 2.6) except in supravalvular type. Forty-three patients had associated cardiovascular defects. Aortic regurgitation (AR) was the most common one. Most patients (56.9%) were asymptomatic. Classic symptoms included exertional dyspnea (17.6%), syncope (9.8%), and chest pain (7.8%), etc. Left ventricular hypertrophy was noted in 31.2% of cases. The mean duration of follow-up was 3.9 +/- 3.4 years. Ten patients received open-heart surgery and 2 received balloon dilation. The pressure gradients across the stenotic area dropped from 95.3 +/- 29.3 to 51.4 +/- 35.8 and 53.1 +/- 12.3 mm Hg in early and late Doppler follow-up studies, respectively (p < 0.05). The average gradient increased from 36.9 +/- 25.3 to 40.8 +/- 32.6 mm Hg in nonsurgical patients. The result was insignificant. No mortality occurred following open-heart surgery. One child expired due to heart failure after the ligation of the patent ductus arteriosus and dilation of the stenotic aortic valve on the surgical table under general anesthesia. Autopsy revealed valvular rupture. In the nonsurgical group, no mortality occurred, but one patient was brought home by parents in critical condition and later died. Conclusions: We found that some clinical features of AS in Chinese children were different from those in occidental populations. (1) The incidence of AS was relatively low. (2) Subvalvular AS was the least common type in contrast to supravalvular AS in western studies. (3) Male predominance was not present in the supravalvular type, which lacked sexual proclivity. (4) Williams syndrome was a more frequently associated anomaly. Turner syndrome was not present in our study. (5) Isolated AS was less frequent. (6) The unusual finding such as right ventricular hypertrophy on EKG was present due to associated cardiac anomalies. Open-heart surgery is effective and safe, but the efficacy of balloon dilation requires further investigation. |
本系統中英文摘要資訊取自各篇刊載內容。