Rylaarsdam M, Attié F, Buendía A, Muñoz L, Calderón J, Zabal C
Departamento de Cardiología Pediátrica del Instituto Nacional de Cardiología Ignacio Chávez, México, D.F.
Arch Inst Cardiol Mex. 1990 Jul-Aug;60(4):393-9.
It is well known, that in complex congenital heart disease, the bronchial anatomy reflects the atrial situs in the majority of patients. Few exceptions to this rule have been reported in the literature. We report four patients in whom we found discordance between the anatomy of the bronchial tree and the external aspect of the atrial appendages. Two patients had bronchial situs solitus with atrial levoisomerism, the third patient had bronchial levoisomerism with atrial situs solitus and in the fourth one we found inverted bronchial anatomy with levoisomerism of the atrial appendages. In three patients, broncho-atrial discordance was diagnosed clinically by bronchial tomography and selective atrial angiography, and in the other one the diagnosis was made by anatomical study. In this last patient, external atrial anatomy was found to be of levoisomerism, with an internal atrial aspect of situs inversus. Prediction of atrial arrangement by bronchial anatomy retains its diagnostic value. However, it is necessary to bear in mind that exceptions do exist. It is discussed how to suspect these exceptions, and the final diagnostic conduct is indicated.
众所周知，在复杂先天性心脏病中，大多数患者的支气管解剖结构反映心房位置。文献中报道了该规则的少数例外情况。我们报告了4例患者，我们发现支气管树的解剖结构与心耳的外观不一致。2例患者支气管位置正常但有心房左位异构，第3例患者支气管左位异构但心房位置正常，第4例患者支气管解剖结构倒置且心耳左位异构。3例患者通过支气管断层扫描和选择性心房血管造影在临床上诊断出支气管-心房不一致，另一例通过解剖学研究做出诊断。在最后一例患者中，发现外部心房解剖结构为左位异构，而内部心房外观为反位。通过支气管解剖结构预测心房排列仍具有诊断价值。然而，必须牢记确实存在例外情况。本文讨论了如何怀疑这些例外情况，并指出了最终的诊断方法。
