醫學四：80題 ( 包括小兒科,皮膚科,神經科,精神科等科目及其相關臨床實例與醫學倫理 )題庫下載題庫

Wide splitting of S1 is a feature of Ebstein anomaly which is associated with right bundle branch block. The extra early systolic sound around S1 is also referred to as the "sail sound." This auscultatory finding in patients with Ebstein anomaly appears not simply as a closing sound of the tricuspid valve, but as a complex closing sound that includes a sudden stopping sound after the anterior and/or other tricuspid leaflets balloon out in systole.

A. 【發紺型先天心臟病】

法洛氏四重症，TOF：VSD、主動脈跨位VSD、肺動脈狹窄、右心室肥大。右到左的分流。

Ebstein 異常：三尖瓣過低，右心室變小，右心房擴大。房室逆流與右心輸出下降，常有ASD右到左，發紺原因除了右到左還有肺血流不足。

左心發育不全症，HLHS：左心房、心室、主動脈、瓣膜變小。依賴PDA右到左，常有ASD左到右。

B. 【非發紺性先天心臟病】

主動脈窄縮，COA：導管前/嬰兒型會PDA右到左下肢發紺；導管後/大人型下肢血壓低。阻塞型。
心音聽不懂的話Ebstein最常右心房擴大QQ
寬且固定的S2分裂音和左上胸骨緣有收縮期噴射性雜音是ASD的聽診特色。