國立臺灣大學醫學院外科邱英世2006-07-262018-07-112006-07-262018-07-112003-12-31http://ntur.lib.ntu.edu.tw//handle/246246/24491心尖部位一直被認為與依序分節診斷無關，其臨床意義只停留在心尖部位之觸摸， 心電圖或超音波檢查需要在右位心或左位心之上進行檢查之階段而已。但實際上複雜性 先天性心臟病常伴隨心尖部位之異常位置，其含義不為人所知。我們利用極快速電腦斷 層掃描分析比較各種複雜性先天性心臟病合併心尖部位異常，配合臨床及血管造影之觀 察，發現心尖部位與冠狀動脈類型及外科手術由那個部位進行切開術有關連。在先天已 矯正之大動脈轉位之雙轉換手術日益流行的今天，這些結果在臨床上有實際上的應用價 值。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.application/pdf129366 bytesapplication/pdfzh-TW國立臺灣大學醫學院外科心尖部位心房位房室連接反常心室環外科手術路徑心室大動脈連接 反常後側房室溝冠狀動脈Apical positionAtrial situsAtrioventricular discordanceVentricular loopingSurgical approachVentriculo-arterial discordancePosterior atrioventricular groove coronary arteryreporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/24491/1/912314B002226.pdf