Asami I, Koizumi K
Kaibogaku Zasshi. 1989 Feb;64(1):36-45.
In 1926, Taussig reported on two instances of complete situs inversus of the heart and stated that "the main anatomical structure and the deep muscle bundles of the ventricles presented the mirror image of the normal, while the direction of the superficial muscle bundles remained unchanged". In an attempt to analyze whether her statement always held true, we examined the myocardial architecture of five specimens of situs inversus totalis. They were all from patients over sixty years of age and were diagnosed by postmortem examination. Every part of the heart and great vessels presented exact mirror images of the normal. However, the external muscle fibers of the ventricles ran clockwise from base to apex toward the center of the vortex, which had a striking resemblance to the normal rather than the mirror image pattern. Peeling off of the external layer revealed that the direction of fibers was first inverted and then changed into an approximate mirror image of the normal architecture within the deeper muscle layers, as illustrated by Taussig. The exception to this tendency was found at the posterior region of the morphologically left ventricle, in which there was no mirror imaging but a normal pattern throughout the depth of the wall. For the purpose of comparison, two hearts of corrected transposition (L-TGA) were examined. Their chambers were inverted but the external fibers followed the same clockwise course seen in the normal heart. Further dissection revealed that there was no mirror imaging of the architecture at any depth of the morphologically left ventricular wall. Thus there were regional differences and similarities in muscular architecture between these two kinds of ventricular inversion. It was concluded that the vortex layer was never reversely directed, even in situs inversus and L-loop anomaly, and that the deep layers within the sinus region of the left ventricle did not present a mirror image to the normal.
1926年，陶西格报告了两例完全性心脏位置反位的病例，并指出“心室的主要解剖结构和深层肌束呈现出正常结构的镜像，而浅层肌束的方向保持不变”。为了分析她的说法是否总是正确，我们检查了五个完全性内脏反位标本的心肌结构。这些标本均来自60岁以上的患者，经尸检确诊。心脏和大血管的各个部分都呈现出正常结构的精确镜像。然而，心室的外部肌纤维从心底向心尖呈顺时针方向延伸至涡旋中心，这与正常结构惊人地相似，而不是镜像模式。剥去外层后发现，纤维方向首先反转，然后在深层肌层内变为正常结构的近似镜像，正如陶西格所描述的那样。在形态学左心室的后部区域发现了这种趋势的例外情况，在该区域的整个壁深度内都没有镜像，而是正常模式。为了进行比较，检查了两颗矫正性大动脉转位（L-TGA）的心脏。它们的心腔是反位的，但外部纤维遵循与正常心脏相同的顺时针走向。进一步解剖发现，形态学左心室壁的任何深度都没有结构的镜像。因此，这两种心室反位在肌肉结构上存在区域差异和相似性。得出的结论是，即使在心脏位置反位和L环异常的情况下，涡旋层也从未反向，并且左心室窦区的深层与正常结构不存在镜像关系。
