Swiderski J, Materska-Radziwoń T, Margiewicz E, Weicher E, Kubicz S, Stodulski J, Roguska H, Tlomińska H, Jagoda B, Zaremba B, Zienkiewicz E, Szewczykowska M, Walecki Z, Empel A
Probl Med Wieku Rozwoj. 1975;5:193-201.
In order to facilitate for the general physicians the making of a suitable selection of babies who are in the most urgent need of specialized treatment at cardiac centres, simple methods for diagnosing and qualifying congenital cardiovascular diseases were elaborated. The following "minor" criteria were taken for suspecting a CHD: 1) cardiorespiratory distress following birth, 2) sequentially repeated Apgar score below normal, 3) "pneumonia" symptoms with respiratory distress, dyspnoea and cyanosis, attacks of unconsciousness, 4) feeding difficulties, failure to thrive, inexplicable irritability, 5) presence of other congenital anomalies. The almost certain presence of serious heart disease should be recognized in children, showing the following "major" symptoms: 1) permanent cyanosis, pallor or greyish colour, 2) cardiorespiratory failure (resembling usually symptoms of pneumonia), 3) ECG patterns indicating ventricular hypertrophy signs, 4) other significantly abnormal ECG patterns (e.g. AV and intraventricular conduction disturbances), 5) cardiac enlargement and lung vascularity abnormalities in chest X-rays, 6) weak, or impalpable arterial, particularly femoral pulses, femoral arterial pressures significantly lower, than at upper extremities, bounding pulses and high-pressure amplitude in arms and legs, 7) abnormal heart sounds and pathologic heart and vascular murmurs. A diagnostic "key", based upon evaluation of the "major criteria" facilitates the diagnosis and differentiation of the most important CHD's at neonatal and infantile age. When using this "key" one should keep in mind the relative frequency of incidence of particular lesions. The initial diagnoses by the above "key" were verified in 354 patients by cardiovascular catherisation, angiocardiography, surgical exploration, and for by autopsy. The diagnoses were perfectly accurate in 83.6% cases, in further 11.3% cases being also accurate but were supplemented by some details, and had to be corrected in only 5.1% cases.
为了便于普通医生挑选出最急需在心脏中心接受专科治疗的婴儿，我们制定了简单的先天性心血管疾病诊断和评估方法。以下“次要”标准可用于怀疑患有先天性心脏病：1）出生后出现心肺窘迫；2）阿氏评分连续反复低于正常；3）出现“肺炎”症状，伴有呼吸窘迫、呼吸困难和发绀、昏迷发作；4）喂养困难、生长发育迟缓、莫名烦躁；5）存在其他先天性异常。对于出现以下“主要”症状的儿童，应认定几乎可以肯定患有严重心脏病：1）持续性发绀、面色苍白或呈灰色；2）心肺衰竭（通常类似肺炎症状）；3）心电图显示心室肥厚迹象；4）其他明显异常的心电图模式（如房室和心室内传导障碍）；5）胸部X线显示心脏扩大和肺血管异常；6）动脉搏动微弱或触不到，尤其是股动脉搏动，股动脉血压明显低于上肢，手臂和腿部脉搏强劲且血压幅度高；7）心音异常以及病理性心脏和血管杂音。基于对“主要标准”的评估而制定的诊断“关键”有助于诊断和区分新生儿及婴儿期最重要的先天性心脏病。使用此“关键”时应牢记特定病变的相对发病率。通过心血管导管检查、心血管造影、手术探查以及尸检，对354例患者采用上述“关键”进行的初步诊断得到了验证。诊断在83.6%的病例中完全准确，在另外11.3%的病例中也准确，但补充了一些细节，仅在5.1%的病例中需要修正。
