排除标准 Exclusion Criteria

• 患者具有症状
• 患者有异常的第二心音
• 患者具有舒张期隆隆（diastolic flow rumble）
• 患者具有主动脉孔狭窄的杂音
• 患者具有异常的胸部X线
• 患者具有异常心电图
• 患者具有脊上型出口或入口室间隔缺损（supraacristal outlet or inlet ventricular septal defect）
• 患者具有主动脉瓣脱垂（prolapsed aortic valve cusp）
• 患者左心室容量增大（left ventricular volume enlargement）
• 多普勒显示明显的主动脉瓣关闭不全、二尖瓣关闭不全或者右心室或肺动脉高压（Doppler evidence of significant aortic or mitral insufficiency or evidence of right ventricular or pulmonary arterial hypertension.）
• 患者具有关联的先天性心脏缺陷

临床协议说明

For this algorithm, "Time 0" is the initial evaluation by an experienced pediatric cardiologist. There was considerable debate among committee members as to whether echocardiographic definition of a small ventricular septal defect was necessary to exclude other conditions that could mimic the physical findings of a small ventricular septal defect or associated problems such as prolapse of an aortic valve cusp. After considerable discussion, it was decided to construct the algorithm for patients with a small ventricular septal defect in whom an echocardiogram had been done. However, the committee recognized that some pediatric cardiologists diagnose a small ventricular septal defect without echocardiographic confirmation of the defect or echocardiographic exclusion of associated problems. The committee agreed that diagnosis and management of patients with a small ventricular septal defect without echocardiographic confirmation was acceptable. Under these circumstances, it is incumbent on the clinician to provide appropriate ongoing evaluation to detect and manage conditions that could mimic the physical findings of a small ventricular septal defect or the problems associated with it.