心尖部位在先天已矯正的大動脈轉位對左心室出口阻塞之影響
Date Issued
2004-10-31
Date
2004-10-31
Author(s)
邱英世
DOI
922314B002245
Abstract
Apical position (Apex) is alleged to be independent of sequential segmental analysis,
thus its clinical role was neglected. The right ventricle in congenitally corrected transposition
with apicocaval ipsilaterality might wrap around the left ventricular outflow tract (LVOT). To
delineate LVOT was compressed or not by the systematic ventricle in this setting, we carried
out the following study. We analyzed 65 patients of congenital congenitally corrected
transposition with various apical positions from 1981 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, the direction of Loop and Apex are opposite to
each other; Group C, D-loop with dextrocardia; Group D, L-loop with levocardia, the
direction of Loop and Apex are to the same direction. Electron beam computed tomography
was used to define left-right and ventro-dorsal relationship of left and right ventricular
outflow tracts. Apicocaval ipsilaterality was found in 31 patients. (Group A, n = 15; Group B,
n = 16), the right ventricle wrapped around LVOT in all cases. Among them, 93.5% (n = 29)
2
had LVOT obstruction (pulmonary atresia or stenosis). Whereas 73.5% of 34 patients without
apicocaval ipsilaterality (Group C, n = 9; Group D, n = 25) had LVOT obstruction. The
difference was statistically significant (p = 0.03).Further analysis found that this difference is
more significant in the setting of situs solitus (Group B & D, p = 0.01) than situs inversus
(Group A & C, p = N.S.). We concluded that LVOT obstruction is prone to occur in
congenitally corrected transposition with situs solitus and (Group B) and apicocaval
ipsilaterality, whereas in Group D, LVOT was not wrapped around by the systemic-pressured
right ventricle had less incidence of LVOT obstruction. In the latter setting, to perform a
double switch without exchanging ventricular outflow tract should be reconsidered.
Subjects
Apical position
Atrioventricular discordance
Ventricular looping
Ventriculo-arterial discordance
Situs solitus
Apicocaval ipsilaterality
Left
Ventricular Outflow tract obstruction
Ventricular Outflow tract obstruction
Publisher
臺北市：國立臺灣大學醫學院外科
Type
report
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