A heart on the right can be more complex than it first appears.
A heart on the right can be more complex than it first appears.
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DOI：
10.1136/bcr-2013-201046
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发表时间：
2013-09-19
期刊：
影响因子：
0.9
通讯作者：
Dubrey, S W
中科院分区：
文献类型：
--
作者：
Haththotuwa, H R;Dubrey, S W
乍一看，这些胸片看起来很相似。近距离检查提示“心绞痛”（图1A）和“体位”（图1B）。如果描述了心脏在胸腔内的位置和心尖的方向点，则有助于混淆术语。左心和心尖称为左心，中心心和中线心尖称为中心，右心和心尖称为右心。右位是指心脏位于右侧，心尖位于左侧，继发于心外原因（右肺发育不全、肺切除术或疝气）。相反，心绞痛是由心腔紊乱引起的。2“右位心”（患病率约为1/12000）2根据心房和内脏的“位置”（左或右方向）分为三种类型。心房和内脏的正常方向称为“孤立部位”（即左心房、脾脏和左侧的两叶肺）。在“逆位”中，正常的左右方向颠倒为镜像。当其他脏器受累时，如我们的病人（图1A），称为“全逆位”（即脾和胃在右，三叶肺在左）。在“位置不明确”（患病率约1/20 000）2，心脏采用左侧或右侧（异构）。在左异构中，两个心房在形态上是左的，具有多个脾，中线肝和两个肺是两叶的。在右同形异构中，两个心房在形态上都是右的，具有中线肝，双侧三叶肺，
At first glance these chest radiographs appear similar. Closer inspection suggests ‘dextrocardia’(figure 1A) and ‘dextroposition’(figure 1B). Confusing terminology is helped if the heart’s position within the thorax and point of direction of the apex is described. 1 A heart and apex on the left is termed ‘levocardia’, a central heart with midline apex as ‘mesocardia’and a right-sided heart and apex as ‘dextrocardia’. Dextroposition describes a heart on the right with an apex to the left, secondary to extracardiac causes (right lung hypoplasia, pneumonectomy or diaphragmatic hernia). In contrast, dextrocardia results from cardiac chamber disarrangement. 2 ‘Dextrocardia’(prevalence around 1/12000) 2 comprises three types, depending on the ‘situs’(left or right orientation) of the atria and viscera. Normal orientation of the atria and viscera is termed ‘situs solitus’(ie, left atrium, spleen and two-lobed lung on left).In ‘situs inversus’ the normal left and right orientation is reversed as a mirror image. When other viscera are involved, as in our patient (figure 1A), it is termed ‘situs inversus totalis’(ie, spleen and stomach on the right and three-lobed lung on the left). In ‘situs ambiguous’(prevalence around 1/20 000) 2 the heart adopts left or right sidedness (isomerism). In left isomerism, both atria are morphologically left with multiple spleens, midline liver and both lungs are two-lobed. In right isomerism both atria are morphologically right with a midline liver, bilateral three-lobed lungs and no