Hemodynamics in Children with Patent Ductus Arteriosus and Its Clinical Correlation

開放性動脈管病兒的血行力學與臨床症狀的相互關係

呂鴻基(Hung-Chi Lue) ； 陳烱霖(Chiung-Lin Chen) ； 陳烱明(Chiung-Ming Chen)

《Acta Paediatrica Sinica》 3卷4期 (1962/12) Pp. 143-153

摘要

凡有連續性心臟雜音，似隧道中火車輾轉聲音者輕而易舉地可診斷有開放性動脈管。由開刀告痊癒者旣不鮮，然而未被診斷或被誤診而失去開刀治癒機會者亦不少。這些所謂非典型則併有肺高血壓的開放性動脈管者，約佔全部開放性動脈管的11%。所聽到的旣不是典型的連續性機械性心臟雜音，其臨床症狀也不一，惟其如此，診斷卽不容易。心臟導管術乃是最有用的檢查，有助於診斷及血行力學上的評價。
過去兩年間，經著者確定有開放性動脈管而開刀者共有8例，五女三男，年齡為六至十歲，其中6例為典型，另兩例為非典型者。隨著血行力學上的變化，臨床症狀，心電圖，心音圖及X光檢查所見也不同。
著者特報告非典型者之一，有非典型連續性心臟雜音的突然消失而數分鐘後再出現的有趣症狀。
另一非典型病例，具有動脈管双方向性分流者在手術臺上當試暫時的動脉管閉塞時突告死亡。其他7例的開刀結果良好。
關於非典型關放性動脈管症的開刀適應標準及應該注意事項也有論及。

並列摘要

Being characterized by a continuous machinery murmur like ”a train in a tunnel”, patent ductus arteriosus is quite familiar to every physician and can be easily diagnosed. It has been resorted to surgical correction with good results for many years since the first case of surgical intervention by Gross in 1939. However, it was estimated by Keith, that about 11% of patients with patent ductus arteriosus (PDA) have so-called atypical PDA or PDA with pulmonary hypertension which can hardly be diagnosed clinically because of the complexity of its symptoms and signs. Atypical PDA is an important disease in need of surgery as soon as the diagnosis is made, otherwise the patient is destined to run a poor course. Detection and exact hemodynamic evaluation of this kind of congenital heart disease are important and necessary before operation.
The purpose of this paper is to discuss the salient picture of the hemodynamics of eight patients with PDA and to find out its correlation with clinical findings basing on the critical analysis of the clinical data and the data obtained by the cardiac catherization.