心尖部位的臨床含義
Date Issued
2003-12-31
Date
2003-12-31
Author(s)
邱英世
DOI
912314B002226
Abstract
To delineate the role of apical position (Apex) in diagnosis of coronary artery (CA) and
surgical approach to the heart.
We analyzed 873 patients of various congenital cardiac defects from 1995 to 2000. They
were divided into 4 Groups according to the ventricular looping (Loop) and Apex: Group A,
D-loop with levocardia; Group B, L-loop with dextrocardia; Group C, D-loop with
dextrocardia; Group D, L-loop with levocardia. Electron beam computed tomography was
used to define left-right and ventro-dorsal relationship of CA in the atrioventricular grooves
and surgical access to the cardiac septa and valves. Either Group C (n=21) or D (n=33) had
their morphologically right ventricle (mRV) and right CA pivoted posteriorly, irrespective of
their atrial situs, atrioventricular or ventriculoarterial connection. Surgical access into the
heart is easier via the anteriorly located morphologically left ventricle (mLV), left atrium in
atrioventricular concordance or right atrium in atrioventricular discordance than the posterior
one. Whereas in Group A (n=802) or B (n=17), mRV is pivoted anteriorly and
the-above-mentioned are reversed.
Loop-Apex determines the ventricle (mLV if contralateral, mRV if ipsilateral) that is
pivoted posteriorly, and hence its appropriate CA in the posterior atrioventricular groove. A
surgeon should stand on the opposite side of the Apex to obtain the best-exposed operation
field. Meanwhile, the anteriorly pivoted ventricle or its appropriate atrium is most accessible
and can be considered as entry route into the heart when favorable.
Subjects
Apical position
Atrial situs
Atrioventricular discordance
Ventricular looping
Surgical approach
Ventriculo-arterial discordance
Posterior atrioventricular
groove coronary artery
groove coronary artery
Publisher
臺北市：國立臺灣大學醫學院外科
Type
report
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