Hagel K J, Rautenburg H W
Klin Padiatr. 1979 May;191(3):293-300.
Diastolic murmurs in childhood are in most cases due to pulmonary insufficiency. They may be functional (Graham-Steel-murmurs, for instance with idiopathic pulmonary ectasis or pulmonary hypertension), but are more and more the symptom of postoperative pulmonary insufficiency. Diastolic murmurs of pulmonary insufficiency were found after operations of valvular and infundibular pulmonary stenosis in 92,5% of the cases (40 children) and after total correction of tetralogy of Fallot in 89% of 27 children. The diastolic murmur of pulmonary insufficiency is very good recorded in phonocardiography; with postoperative heart catheterisations and angiocardiography there is good estimation of the degree of the pulmonary insufficiency. There is no doubt about the curative effort of operations in these congenital heart defects, and postoperative pulmonary insufficiency does not impair the operative improvement in childhood. Till now long term observations of these cases up to late adulthood cannot be possible; regular pediatric cardiologic examinations of these operated children are mandatory.
儿童期舒张期杂音多数情况下是由肺动脉瓣关闭不全所致。它们可能是功能性的（例如格雷厄姆 - 斯蒂尔杂音，见于特发性肺动脉扩张或肺动脉高压时），但越来越多是术后肺动脉瓣关闭不全的症状。在瓣膜性和漏斗部肺动脉狭窄手术后，92.5%的病例（40名儿童）出现肺动脉瓣关闭不全的舒张期杂音；在法洛四联症根治术后，27名儿童中有89%出现这种杂音。肺动脉瓣关闭不全的舒张期杂音在心音图上记录良好；通过术后心导管检查和心血管造影可很好地评估肺动脉瓣关闭不全的程度。对于这些先天性心脏病，手术的治疗效果毋庸置疑，术后肺动脉瓣关闭不全并不影响儿童期手术带来的改善。到目前为止，对这些病例直至成年晚期进行长期观察尚不可能；必须对这些接受手术的儿童进行定期儿科心脏检查。
