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病例摘要男、16岁。患者自幼体质差易疲劳,近两年劳累后心悸气促,曾晕厥一次。平素无慢性咳嗽,气喘、胸疼、咯血紫绀、关节痛,浮肿等。家族中否认心脏病史。体查 BP90/60mmHg,一般体征正常,胸骨左缘2～3肋间可闻Ⅲ级吹风样收缩期杂音,P_2亢进。血尿便、肝功、尿素氮,血电介质、血沉、血气分析均在正常范围。ECG示窦性心律,电轴右偏,右室肥厚、超声心动图:二尖瓣E峰高尖,振幅增强,右心房右心室增大,肺动脉瓣a波消失,振幅增高,左房前后径23mm,提示房间隔缺损,肺动脉高压。右心导管检查,右心各部位血氧含量未见明显差异,肺小动脉嵌顿在10mmHg,主肺动脉压60/30(40)右室压64/4mmHg。入院后诊断为先心病,房间隔缺损,肺动脉高压。经开胸拟房间隔修补,术中
Case Summary Male, 16 years old. Poor physical health of patients prone to fatigue, fatigue in the past two years after heart palpitations, had a syncope. Usually no chronic cough, asthma, chest pain, hemoptysis cyanosis, joint pain, edema and so on. Family history of denial of heart disease. Physical examination BP90 / 60mmHg, the general signs of normal, sternal left margin of 2 to 3 intercostal can smell grade Ⅲ systolic murmur, P_2 hyperthyroidism. Hematuria, liver function, blood urea nitrogen, blood dielectric, erythrocyte sedimentation rate, blood gas analysis were in the normal range. ECG showed sinus rhythm, right axis deviation, right ventricular hypertrophy, echocardiography: mitral E peak tip, amplitude increased, right atrium right ventricle increased, pulmonary a wave disappeared, amplitude increased, left atrium before and after the diameter 23mm, suggesting atrial septal defect, pulmonary hypertension. Right heart catheterization, no significant differences in blood oxygen content of various parts of the right heart, pulmonary arterial incarceration at 10mmHg, the main pulmonary artery pressure 60/30 (40) right ventricular pressure 64 / 4mmHg. After admission diagnosed as congenital heart disease, atrial septal defect, pulmonary hypertension. After thoracotomy room interval repair, intraoperative