Arlettaz R, Archer N, Wilkinson A R
Department of Paediatrics, University of Oxford, John Radcliffe Hospital.
Arch Dis Child Fetal Neonatal Ed. 1998 May;78(3):F166-70. doi: 10.1136/fn.78.3.f166.
To define the origin and the natural history of innocent heart murmurs in newborn infants.
Fifty healthy babies born at term with the clinical diagnosis of an innocent heart murmur and 50 controls without a murmur were studied. Each baby had a complete two dimensional and pulsed Doppler echocardiogram and those with any abnormality were followed up at 6 weeks, 3 months, and 6 months until the murmur had disappeared or the heart was totally normal. Babies with congenital heart disease were excluded from the study.
Pulmonary branch stenosis (PBS) was found in 25 (50%) of the study group and in six (12%) controls; patent ductus arteriosus (PDA) in 30 (60%) subjects and in six (12%) controls; and a patent foramen ovale (PFO) in 50 (100%) subjects and in 41 (82%) controls. At 6 weeks the murmur had disappeared in 64% of babies. PBS was still present in eight of 22 (36%) babies at 6 weeks, in 12% at 3 months, but in none at 6 months. At 6 weeks, seven of the eight with PBS still had a murmur compared with two of 14 (14%) babies in which the PBS had resolved (P < 0.005). At 6 weeks the PDA had closed in all patients but the foramen ovale was still patent in 29 of 44 (66%) subjects and nine of 33 (27%) controls. The closure of the PFO was not influenced by its size at birth.
An innocent heart murmur in a baby born at term is often related to PBS, particularly if the murmur is still present after 24 hours of age, when most PDA have closed. At 6 weeks the murmur had disappeared and the PBS had resolved in 64% of the babies. PBS had resolved in all babies at 6 months.
明确新生儿无害性心脏杂音的起源及自然病程。
对50例临床诊断为无害性心脏杂音的足月健康婴儿和50例无杂音的对照婴儿进行研究。每个婴儿均接受完整的二维及脉冲多普勒超声心动图检查，对有任何异常的婴儿在6周、3个月和6个月时进行随访，直至杂音消失或心脏完全正常。先天性心脏病婴儿被排除在研究之外。
研究组中25例（50%）发现肺动脉分支狭窄（PBS），对照组中有6例（12%）；30例（60%）受试者发现动脉导管未闭（PDA），对照组中有6例（12%）；50例（100%）受试者发现卵圆孔未闭（PFO），41例（82%）对照组中有此情况。6周时，64%的婴儿杂音消失。22例中有8例（36%）婴儿在6周时PBS仍存在，3个月时为12%，但6个月时均无。6周时，8例中有PBS的婴儿中有7例仍有杂音，而14例PBS已消退的婴儿中有2例（14%）有杂音（P<0.005）。6周时所有患者的PDA均已闭合，但44例中有29例（66%）受试者和33例中有9例（27%）对照组的卵圆孔仍未闭。PFO的闭合不受其出生时大小的影响。
足月出生婴儿的无害性心脏杂音常与PBS有关，特别是如果杂音在出生24小时后仍存在，此时大多数PDA已闭合。6周时，64%的婴儿杂音消失且PBS已消退。6个月时所有婴儿的PBS均已消退。
