Moorjani N, Burrell C, Kuo J
Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth, UK.
J Cardiovasc Surg (Torino). 2006 Oct;47(5):589-91.
Adult cardiac surgery in patients with malrotation of the heart is rare. A 60 year-old lady, with known cardiac dextroversion, presented with dyspnoea and pre-syncopal attacks. Echocardiographical and radiological investigation confirmed the dextroversion, with clockwise rotation of the heart through its longitudinal axis. This resulted in the right ventricular outflow tract and pulmonary artery being wrapped anteriorly around the aorta, with posterior displacement of the right atrium. The presence of a heavily calcified, bicuspid aortic valve and dilated ascending aorta was also demonstrated. At surgery, venous cannulation was established by rotating the heart anticlockwise and access to the aortic valve gained with a more superior oblique aortotomy. In the presence of a dilated ascending aorta with a calcified, bicuspid aortic valve, the aortic root was replaced with a valved conduit. To the authors' knowledge, this is the first report of an aortic root replacement in a patient with cardiac dextroversion.
心脏旋转不良的成年患者进行心脏手术很少见。一名60岁已知心脏右位的女性，出现呼吸困难和晕厥前发作。超声心动图和放射学检查证实了心脏右位，心脏沿其纵轴顺时针旋转。这导致右心室流出道和肺动脉向前环绕主动脉，右心房向后移位。还显示存在重度钙化的二叶式主动脉瓣和扩张的升主动脉。手术时，通过逆时针旋转心脏建立静脉插管，并通过更向上倾斜的主动脉切口进入主动脉瓣。在存在扩张的升主动脉和钙化的二叶式主动脉瓣的情况下，用带瓣管道替换主动脉根部。据作者所知，这是心脏右位患者进行主动脉根部置换的首例报告。
