每日一题_2023.08.01

A 12-year-old boy is brought to the doctor for progressive fatigue and shortness of breath on exertion. He was born full term and has been generally healthy until a few months ago, when his parents noticed that he became tired after only five minutes of playing with his siblings. Physical examination reveals a loud, holosystolic murmur and mild cyanosis of his lips. Examination of his hands reveals club- bing of the fingers. Which of the following cardiac defects is most likely to be found on echo- cardiogram?

一名12岁的男孩因进行性疲劳和用力时呼吸急促被带到医生那里。他是足月出生的，一直很健康，直到几个月前，他的父母发现他只和兄弟姐妹玩了五分钟就累了。体格检查示收缩期杂音，口唇轻度发绀。检查他的手，发现他的手指呈棒状。下列哪一种心脏缺陷最容易在超声心动图上发现?

(A) Bicuspid aortic valve 二叶式主动脉瓣

(B) Left-to-right shunt 左向右分流

(C) Mitral regurgitation 二尖瓣反流

(D) Right-to-left shunt 右向左分流

(E) Valvular vegetations 瓣膜赘生物

答案解析：

这个男孩很可能患有艾森曼格综合征，表现为发绀和杵状指。在艾森曼格综合征中，室间隔缺损(VSD)、房间隔缺损(ASD)或动脉导管未闭会导致左向右分流，从而形成非紫绀型病变，这就是他一生中大部分时间无症状的原因。随着时间的推移，由于肺血管阻力增加而引起的右心室肥厚，未纠正的分流发生逆转，并形成右向左分流，从而形成无症状性心脏病。由此产生的低血氧水平可导致运动不耐受、发绀和如该患者所见的杵状指。

正确答案：D