Meyer Sophie L, Jongbloed Monique R, Ho Siew Y, Bartelings Margot M, McCarthy Karen P, Uemura Hideki, Ebels Tjark
Department of Cardiothoracic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Cardiology, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
PLoS One. 2017 Nov 30;12(11):e0188048. doi: 10.1371/journal.pone.0188048. eCollection 2017.
The aim of this study was to gain better understanding of the variable anatomical features of double inlet left ventricle hearts without cavopulmonary connection that would potentially facilitate favorable streaming. Thirty-nine post-mortem specimens of double inlet left ventricle without cavopulmonary connection were investigated. The focus was on anatomical characteristics that could influence the flow and separation of deoxygenated and oxygenated blood in the ventricles. Elements of interest were the ventriculoarterial connection, the spatial relationship of the ventricles, the position and size of the great arteries, the ventricular septal defect, the presence of relative outflow tract stenosis and the relationship of the inflow and outflow tracts. The most common anatomy was a discordant ventriculoarterial connection with an anatomically left-sided morphologically right ventricle (n = 12, 31%). When looking at the pulmonary trunk/aorta ratio, 21 (72%) hearts showed no pulmonary stenosis relative to the aorta. The ventricular septal defect created a relative subpulmonary or subaortic stenosis in 13 (41%) cases. Sixteen (41%) hearts had a parallel relationship of the inflow and outflow tracts, facilitating separation of deoxygenated and oxygenated blood streams. On the other end of the spectrum were 10 (25%) hearts with a perpendicular relationship, which might lead to maximum mixing of the blood streams. The relationship of the inflow and outflow tracts as well as the presence of (sub-) pulmonary stenosis might play a crucial role in the distribution of blood in double inlet left ventricle hearts. Additional in vivo studies will be necessary to confirm this postulation.
本研究的目的是更好地了解无腔肺连接的双入口左心室心脏的可变解剖特征，这些特征可能有助于实现有利的血流分布。对39例无腔肺连接的双入口左心室尸体标本进行了研究。重点关注可能影响心室中脱氧血和氧合血流动及分离的解剖特征。感兴趣的因素包括心室动脉连接、心室的空间关系、大动脉的位置和大小、室间隔缺损、相对流出道狭窄的存在以及流入道和流出道的关系。最常见的解剖结构是心室动脉连接不一致，解剖学上左侧为形态学上的右心室（n = 12，31%）。观察肺动脉干/主动脉比值时，21颗心脏（72%）相对于主动脉无肺动脉狭窄。室间隔缺损在13例（41%）病例中造成了相对的肺动脉下或主动脉下狭窄。16颗心脏（41%）的流入道和流出道呈平行关系，有利于脱氧血流和氧合血流的分离。在另一端，10颗心脏（25%）的流入道和流出道呈垂直关系，这可能导致血流最大程度混合。流入道和流出道的关系以及（亚）肺动脉狭窄的存在可能在双入口左心室心脏的血液分布中起关键作用。需要进一步的体内研究来证实这一假设。
