Mellies U, Hentrich F, Hofelich B, Neudorf U, Schmaltz A A
Abteilung für pädiatrische Kardiologie, Zentrum für Kinder- u. Jugendmedizin, Universitäts-GHS-Essen.
Klin Padiatr. 1992 Sep-Oct;204(5):323-7. doi: 10.1055/s-2007-1025366.
The diagnosis "innocent murmur" is made when there is no evidence for a heart disease either by history nor by examination, auscultation, electrocardiogram or echocardiography. The purpose of the present study was to determine the usefulness of echocardiography for diagnosing of an innocent heart murmur and further to compare the findings of ultrasound with those of the clinical examination. Children were accepted for the study after clinical examination and evaluation of the electrocardiogram (but before echocardiography) only when two independent pediatricians did not realize any symptoms of a heart disease. A total number of 200 children were examined; 121 were male and 79 female. 194 children (97%) had an innocent murmur, six children (3%) a heart disease [atrial septum defect (3), bicuspid aortic valve (1), aortic stenosis (1) or pulmonary stenosis]. The sensitivity and positive predictive value of clinical examination and auscultation ranged from 92% to 99%, the specificity from 50% to 60%. In six cases the initial diagnosis had to be changed after echocardiography. Three times an innocent murmur was diagnosed as a heart disease and another three times a pathological murmur was regarded as innocent. Left ventricular bands were seen in 53 (26,5%) children and they significantly correlated with the musical heart murmur (77%). If there was no false tendon, the murmur was mostly an uncharacteristic one (74% (less than 0,001). The echocardiographic findings were not different of those children without a murmur or heart disease. The average peak velocity in the ascending aorta was 143,1 +/- 23,6 cm/s (87-215 cm/s), the shortening fraction 36,2 +/- 6,3%. We could not find a correlation between velocity, shortening fraction and aortic diameter.
当通过病史、体格检查、听诊、心电图或超声心动图均未发现心脏病证据时，可诊断为“无害性杂音”。本研究的目的是确定超声心动图在诊断无害性心脏杂音方面的实用性，并进一步将超声检查结果与临床检查结果进行比较。仅当两名独立的儿科医生均未发现任何心脏病症状时，儿童在经过临床检查和心电图评估（但在超声心动图检查之前）后才被纳入研究。总共检查了200名儿童；其中121名男性，79名女性。194名儿童（97%）有无害性杂音，6名儿童（3%）患有心脏病[房间隔缺损（3例）、二叶式主动脉瓣（1例）、主动脉狭窄（1例）或肺动脉狭窄]。临床检查和听诊的敏感性和阳性预测值在92%至99%之间，特异性在50%至60%之间。在6例病例中，超声心动图检查后不得不更改初始诊断。有3次将无害性杂音误诊为心脏病，另外3次将病理性杂音视为无害性杂音。53名（26.5%）儿童可见左心室条带，它们与音乐样心脏杂音显著相关（77%）。如果没有假腱索，杂音大多不典型（74%，P<0.001）。超声心动图检查结果与无杂音或无心脏病的儿童无异。升主动脉平均峰值速度为143.1±23.6cm/s（87 - 215cm/s），缩短分数为36.2±6.3%。我们未发现速度、缩短分数与主动脉直径之间存在相关性。
