Aortic Stenosis主动脉狭窄

What is aortic stenosis?什么是主动脉狭窄？

Aortic stenosis is a heart defect that may be congenital (present at birth) or acquired (develop later in life). If the problem is congenital, then something occurred during the first 8 weeks of pregnancy to affect the development of the aortic valve. 主动脉狭窄是一种心脏病，可能是先天性的（出生时就有的）或者获得性的（在以后的生活中产生的）。如果是先天性的，那么在妊娠最初的8周里发生了什么事影响到主动脉瓣的发育。

The aortic valve is found between the left ventricle and the aorta. It has three leaflets that function like a one-way door, allowing blood to flow forward into the aorta, but not backward into the left ventricle. Aortic stenosis is the inability of the aortic valve to open completely.主动脉瓣位于左心室和主动脉之间。它有三个瓣叶，功能象一个单向们，允许前向血流进入主动脉，但不能返流回左心室。主动脉狭窄使得主动脉瓣不能够完全的开放。

With aortic stenosis, problems with the aortic valve make it harder for the leaflets to open and permit blood to flow forward from the left ventricle to the aorta. In children, these problems can include a valve that:主动脉狭窄的问题在于主动脉瓣狭窄使得瓣膜开放和血流从左心室到主动脉遇到困难。在儿童，可能有以下的情况：

• only has one or two leaflets instead of three.一瓣或两瓣化代替三个瓣叶。
• has leaflets that are partially fused together.瓣叶部分的融合在一起。
• has thick leaflets that do not open all the way.瓣叶增厚不能充分开放。
• becomes damaged by rheumatic fever or bacterial endocarditis.由于风湿热或细菌性心内膜炎造成损害。

Aortic stenosis may be present in varying degrees, classified according to how much obstruction to blood flow is present. A child with severe aortic stenosis will be quite ill, with major symptoms noted early in life. A child with mild aortic stenosis may have few symptoms, or perhaps none until later in adulthood. The degree of obstruction can become worse with time.主动脉狭窄可以有不同的严重程度，分级依据血流受到阻碍的严重程度。一位严重的主动脉狭窄的患儿在生命的早期严重的症状就已经显著，将会是严重的病态，一位较轻的主动脉狭窄的患儿可能有很少的症状或者可能没有症状，直到后来到了成年期才有症状。阻碍的程度随着时间的推移可能变得更严重。

Congenital aortic stenosis occurs in 3 to 6 percent of all children with congenital heart disease. Relatively few children are symptomatic in infancy, but the incidence of problems increases sharply in adulthood.先天性主动脉狭窄的发病率占所有先天性心脏病患儿的3－6％。相当少数的患儿在婴儿期出现症状，但是在成年期问题的发生氯急剧增加。

Congenital aortic stenosis occurs four times more often in boys than in girls.主动脉狭窄发生在男性较女性多4倍。

What causes aortic stenosis?什么原因引起主动脉狭窄？

Congenital aortic stenosis occurs due to improper development of the aortic valve in the first 8 weeks of fetal growth. It can be caused by a number of factors, though, most of the time, this heart defect occurs sporadically (by chance), with no apparent reason for its development.主动脉狭窄的发生是由于在胎儿生长发育的前8周里主动脉瓣的不正常的发育。虽说多个因素可以引起，但多数还是偶发的（偶然的），没有明显的原因导致它。

Some congenital heart defects may have a genetic link, either occurring due to a defect in a gene, a chromosome abnormality, or environmental exposure, causing heart problems to occur more often in certain families.有些先天性的心脏缺陷可能有遗传链，由于基因缺陷，抑或染色体异常，或环境暴露，引起心脏问题在某些家庭多发。

Acquired aortic stenosis may occur after a strep infection that progresses to rheumatic fever.发展成风湿热的链球菌感染之后获得性主动脉狭窄可能发生。

Why is aortic stenosis a concern?为什么主动脉狭窄受到关注？

Mild aortic stenosis may not cause any symptoms. Several problems may occur, however, when aortic stenosis is moderate to severe, including the following:轻度的主动脉狭窄可能不引起任何症状。然而主动脉狭窄是中度至重度时，包括以下的多个问题就来了：

• The left ventricle has to work harder to try to move blood through the tight aortic valve. Eventually, the left ventricle is no longer able to handle the extra workload, and it fails to pump blood to the body efficiently.左心室不得不努力工作推动血液通过狭窄的主动脉瓣口，最终，左心室不堪重负，不能有效地向全身供应血液了。
• There is a higher than average chance of developing an infection in the lining of the heart or aorta known as bacterial endocarditis.在心脏和主动脉的内层发生感染（细菌性心内膜炎）的机会高于一般人。
• The coronary arteries, which supply oxygen-rich (red) blood to the heart muscle, may not receive enough blood to meet the demands of the heart.向心肌供应氧合血（红色）的冠状动脉可能得不到足够的血液去满足心脏的需要。

What are the symptoms of aortic stenosis?主动脉狭窄有些什么症状？

The following are the most common symptoms of aortic stenosis. However, each child may experience symptoms differently. Symptoms may include:以下是主动脉狭窄的最常见的症状。然而每个孩子的症状有所不同。症状可能包括：

• fatigue疲劳
• dizziness with exertion劳力时头晕眼花
• shortness of breath呼吸短促
• irregular heartbeats or palpitations心跳不规则或心悸
• chest pain胸痛

The symptoms of aortic stenosis may resemble other medical conditions or heart problems. Always consult your child's physician for a diagnosis.主动脉狭窄的症状可能类似于其他的疾病或心脏问题。对于诊断，总要请教你孩子的医生。

How is aortic stenosis diagnosed?怎样作出主动脉狭窄的诊断？

Your child's physician may have heard a heart murmur during a physical examination, and referred your child to a pediatric cardiologist for a diagnosis. A heart murmur is simply a noise caused by the turbulence of blood flowing through the obstruction from the right ventricle to the pulmonary artery. Symptoms your child exhibits will also help with the diagnosis.在查体时你孩子的医生可能听到心脏杂音，并把你孩子交付给一位小儿心脏病专家以明确诊断。心脏杂音是血流从左心室到升主动脉通过狭窄的主动脉瓣口时产生的湍流引起的噪音。你孩子表现出来的症状对于诊断也有帮助。

A pediatric cardiologist specializes in the diagnosis and medical management of congenital heart defects, as well as heart problems that may develop later in childhood. The cardiologist will perform a physical examination, listening to your child's heart and lungs, and make other observations that help in the diagnosis. The location within the chest that the murmur is heard best, as well as the loudness and quality of the murmur (harsh, blowing, etc.) will give the cardiologist an initial idea of which heart problem your child may have. However, other tests are needed to help with the diagnosis, and may include the following:一位儿童心脏病专家专门研究先天性心脏病的诊断和医疗方法，和随后心脏问题在儿童期可能的发展。心脏专家将进行体检，听诊你的孩子的心和肺，作一些有助于诊断的观测。在胸部杂音听得最清楚的位置，以及杂音的响度和性质（粗糙的，吹风样的，等等）对于你的孩子可能患有什么样的心脏问题，将给心脏专家一个初步的意向。然而，有助于诊断的其他的一些检查也是需要的，可能包括以下的检查：

• chest x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.胸部X线检查：用一种看不见的电磁波投射在胶片上产生内部组织，骨骼，和脏器的影像的诊断性的检查。
• electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle stress.心电图（ECG或EKG）：一种记录心脏电活动的测试，可以显示不正常的心律（arrhythmias或dysrhythmias),还可以发现心肌损害。
• echocardiogram (echo) - a procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor that produce a moving picture of the heart and heart valves.超声心动图（echo)：一种通过把超声波记录在电子传感器上再转换成心脏和心脏瓣膜的活动影像来评价心脏的结构和功能的方法。
• exercise electrocardiogram (ECG or EKG) - an exercise EKG is done to assess the heart's response to stress or exercise. The EKG is monitored while your child is exercising on a treadmill or stationary bike. An EKG measures the electrical activity of your child's heart.运动心电图（ECG或EKG)：运动EKG使用来评价心脏对于紧张和运动的反应。当你孩子在踏车或固定的脚踏车上运动时监测EKG。EKG测量你孩子的心脏的电活动。
• cardiac catheterization - a cardiac catheterization is an invasive procedure that gives very detailed information about the structures inside the heart. Under sedation, a small, thin, flexible tube (catheter) is inserted into a blood vessel in the groin, and guided to the inside of the heart. Blood pressure and oxygen measurements are taken in the four chambers of the heart, as well as the pulmonary artery and aorta. Contrast dye is also injected to more clearly visualize the structures inside the heart.心导管检查：心导管检查是一种侵入性的检查，它能够提供关于心内结构的很详细的信息。在镇静状态下，一条细小，壁薄，柔软的管子（心导管）在腹股沟部位插入血管，并且引导进入心内。在心脏的四个腔里以及肺动脉和主动脉里分别测量血压和血氧。也可以注入造影剂以便于更清楚的观察心内的结构。

Treatment for aortic stenosis:主动脉狭窄的治疗：

Specific treatment for aortic stenosis will be determined by your child's physician based on:主动脉狭窄的特殊治疗将由你孩子的医生根据以下几点作出决定：

• your child's age, overall health, and medical history
• extent of the disease
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

• 你孩子的年龄，全面的健康情况，和病史。
• 病的程度。
• 你的孩子对于特殊的药物，手术，或其他治疗的耐受性。
• 疾病过程的预后。
• 你的意见或选择。

Aortic stenosis is treated with repair of the obstructed valve. Several options are currently available.主动脉狭窄是用修复梗阻的瓣膜来治疗的。目前可以有几种选择。

Some infants will be very sick, require care in the intensive care unit (ICU) prior to the procedure, and could possibly even need emergency repair of the aortic stenosis. Others, who are exhibiting few symptoms, will have the repair scheduled on a less urgent basis.有的婴儿可能非常虚弱，治疗前需要在监护室（ICU）护理，而且甚至可能需要缩窄的紧急治疗，其他表现出少数症状的患儿，在不那么紧急的情况下，将会预先安排修复的日程。

Children who do not require immediate repair in infancy may need to receive antibiotics to prevent an infection of the inner surfaces of the heart known as bacterial endocarditis prior to procedures such as a routine dental check-up and teeth cleaning. Other procedures may also increase the risk of the heart infection occurring. It is important that you inform all medical personnel that your child has aortic stenosis so they may determine if antibiotics are necessary prior to the procedure.患儿并不需要在婴儿期立即手术，然而在接受某些可能受到感染的治疗前比如常规的牙医检查和牙齿清洁等需要给与抗生素以预防称之为细菌性心内膜炎的心脏内表面的感染。另外一些治疗也有增加心脏感染的危险。重要的是你要告诉医务人员你的孩子患有主动脉狭窄，如此他们就能够决定在做这些治疗前是否有必要给与抗生素。

Activity may be limited in children who have moderate aortic stenosis prior to repair. For instance, competitive sports that require endurance may be restricted.中等程度的主动脉狭窄的患儿在手术前可能要限制活动。例如，需要耐力的竞争性运动可能要限制。

Repair options include the following:修复的方法包括以下：

• balloon dilation - a cardiac catheterization procedure, a small, flexible tube (catheter) is inserted into a blood vessel in the groin, and guided to the inside of the heart. The tube has a deflated balloon in the tip. When the tube is placed in the narrowed valve, the balloon is inflated to stretch the area open.球囊扩张术：心导管治疗，一条柔软的小管（心导管）在腹股沟部插入血管，并且引导进入心脏里。在导管的前端有一个球囊，当它位于狭窄的瓣膜时，使其膨胀扩张开狭窄部位。
• valvotomy - surgical release of adhesions that are preventing the valve leaflets from opening properly.瓣膜切开术：手术解除限制瓣叶充分开放的粘连。
• aortic valve replacement - the aortic valve is replaced with a new mechanism. Replacement valve mechanisms fall into two categories: tissue (biological) valves, which include animal valves, and mechanical valves, which can be metal, plastic, or another artificial mechanism.主动脉瓣置换：用一个新的装置置换病变的主动脉瓣。置换的瓣膜装置分成两个类别：组织（生物的）瓣，包括动物的瓣膜；机械搬，可以是金属的，塑料的，或其他的人造装置。
• aortic homograft - a section of aorta from a tissue donor with its valve intact is used to replace the aortic valve and a section of the ascending aorta.主动脉同种移植物：来自于组织供体的带有完整瓣膜的一段主动脉用来置换主动脉瓣和这一段升主动脉。
• pulmonary homograft (Ross procedure) - a section of the child's own pulmonary artery with the valve intact is used to replace the aortic valve and a section of the aorta. A section of pulmonary artery from a tissue donor with its valve intact is used to replace the transplaced pulmonary artery.肺动脉自体移植物（Ross手术）：用一段孩子自己的带有完整瓣膜的肺动脉来替换主动脉瓣和这段主动脉。再用一段取自组织供体的带有完整瓣膜的肺动脉代替已经换位的肺动脉。

Postoperative care for your child:你孩子的术后护理：

After surgery, your child will go to the intensive care unit (ICU). While your child is in the ICU, special equipment will be used to help him/her recover from surgery, and may include the following:手术后你的孩子将去监护室（ICU)。当你的小孩在监护室时，以下的特殊的设备将可能用来帮助他／她康复。

• ventilator - a machine that helps your child breathe while he/she is under anesthesia during the operation. A small, plastic tube is guided into the windpipe and attached to the ventilator, which breathes for your child while he/she is too sleepy to breathe effectively on his/her own. Many children remain on the ventilator for a while after surgery so they can rest.呼吸机：一个当你孩子在麻醉下手术时帮助他／她呼吸的机器。一个细小的塑料管插入气管并与呼吸机连接，当你的孩子沉睡不能自己有效地呼吸时，它给你的小孩通气。手术后许多患儿继续使用呼吸机一段时间，如此他们可以得到休息。
• intravenous (IV) catheters - small, plastic tubes inserted through the skin into blood vessels to provide IV fluids and important medicines that help your child recover from the operation.静脉内（IV）导管：一条细小的塑料管经过皮肤插入血管，输注你的孩子手术后康复所需要的静脉液体和重要的药物。
• arterial line - a specialized IV placed in the wrist, or other area of the body where a pulse can be felt, that measures blood pressure continuously during surgery and while your child is in the ICU.动脉管：一个专门的动脉内小插管，安置在腕部或身体其他可以触到脉搏的地方，当你的小孩在手术期间或在ICU里时用来连续测量血压的。
• nasogastric (NG) tube - a small, flexible tube that keeps the stomach drained of acid and gas bubbles that may build up during surgery.鼻胃（NG)管：一个细小的，柔软的管子，用来持续排空胃内在手术期间可能聚集的胃酸和胃内气体。
  
• urinary catheter - a small, flexible tube that allows urine to drain out of the bladder and accurately measures how much urine the body makes, which helps determine how well the heart is functioning. After surgery, the heart will be a little weaker than it was before, and, therefore, the body may start to hold onto fluid, causing swelling and puffiness. Diuretics may be given to help the kidneys to remove excess fluid from the body.导尿管：一个细小的，柔软的管子从膀胱引流尿液并且精确的测量机体产生了多少尿液，这对于判断心功能如何有帮助。在手术后，心脏比以前会有一点虚弱，并且，因此，机体可能开始保持液体，引起水肿和虚胖。可能会给与利尿药以帮助肾脏从身体里排出过多的液体。
• chest tube - a drainage tube may be inserted to keep the chest free of blood that would otherwise accumulate after the incision is closed. Bleeding may occur for several hours, or even several days after surgery.胸管：一根胸腔引流管保持切口缝合以后胸腔里没有集血。出血可能发生在术后数小时或甚至几天。
• heart monitor - a machine that constantly displays a picture of your child's heart rhythm, and monitors heart rate, arterial blood pressure, and other values.
• 心脏监视器：一个机器持续的显示你孩子的心律的图形，并且监视心率，动脉血压，和其它的数值。

Your child may need other equipment not mentioned here to provide support while in the ICU, or afterwards. The hospital staff will explain all of the necessary equipment to you.当你的小孩在ICU里时可能需要这里没有提到的设备提供支持。医院的职员将向你说明所有的这些必需的设备。

Your child will be kept as comfortable as possible with several different medications; some which relieve pain and some which relieve anxiety. The staff will also be asking for your input as to how best to soothe and comfort your child.使用几种不同的药物治疗，将使你的孩子尽可能的保持舒适；有的止痛，有的解除焦虑。职员将会告诉你怎样最好的使你的孩子安静和舒适。

After discharged from the ICU, your child will recuperate on another hospital unit for a few days before going home. You will learn how to care for your child at home before your child is discharged. Your child may need to take medications for a while, and these will be explained to you. The staff will give you instructions regarding medications, activity limitations, and follow-up appointments before your child is discharged.

从ICU转出之后，在回家之前你的孩子要在医院的另一个单元里恢复几天。在你的孩子出院之前，你将要学习在家里怎样照顾你的孩子。你的孩子可能需要服药一段时间，并且这些将向你解释。在你的孩子出院之前，职员将给你关于药物治疗，活动限制，和随访约定的指导。

Long-term outlook after aortic stenosis surgical repair:主动脉缩窄外科修复以后的长期前景：

Most children who have had an aortic stenosis surgical repair will live healthy lives. Activity levels, appetite, and growth should eventually return to normal.

绝大多数经过主动脉狭窄的外科修复的儿童将会过上健康的生活。活跃程度，食欲，和生长将会恢复正常。

As the child grows, a valve that was ballooned may once again become narrowed. If this happens, a second balloon procedure or operation may be necessary to repair aortic stenosis.随着孩子的成长，球囊扩张开的瓣膜可能会再次变狭窄。如果发生了，再次球囊导管介入或手术对于修复主动脉狭窄可能是必要的。

Your child's cardiologist may recommend that antibiotics be given to prevent bacterial endocarditis after discharge from the hospital.

你孩子的心脏专家可能会劝告你在出院以后使用抗生素以防治细菌性心内膜炎。

 Children who had an artificial valve replacement may need to take anticoagulants (blood thinners) to prevent blood clots from forming on the artificial valve surfaces.接受人造瓣膜置换的儿童需要服用抗凝药以防止血凝块在人造瓣膜表面上形成。

Consult your child's physician regarding the specific outlook for your child.

教请你孩子的医生关于你孩子的前景。

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