Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2
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Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2
Analytical description of congenitally malformed heartsCongenitally malformed hearts-----(129 )-Systems for describing congenital cardiac malformation Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2ns have frequently been based upon embryologiral concepts and theories. As useful as these systems have been, they have often had the effect of confusing the clinician, rather than clarify ing the basic anatomy of a given lesion. As far as the surgeon is concerned, the essence of a particular malfor Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2mation lies not in its presumed morphogenesis, but in the underlying anatomy. An effective system for describing this anatom) must be based upon the mEbook Wilcox’s surgical anatomy of the heart (4/E): Part 2
orphology as it is observed. At the same time, it must be capable of accounting for all congenital cardiac conditions, even those that, as yet, might Analytical description of congenitally malformed heartsCongenitally malformed hearts-----(129 )-Systems for describing congenital cardiac malformation Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2d, therefore, should be unambiguous. It should be as simple as possible. The sequential segmental approach provides such a systemparticularly when the emphasis is placed on its surgical applications2. The basis of the system is, in the first instance, to analyse individually the architectural nuke-u Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2p of the atrial chambers, the ventricular mass, and the arterial segment . Emphasis is thus given to the nature of the junctional arrangements (FigureEbook Wilcox’s surgical anatomy of the heart (4/E): Part 2
6.1). Still further attention is devoted to the interrelationships of the cardiac structures within each of the individual segments. This provides thAnalytical description of congenitally malformed heartsCongenitally malformed hearts-----(129 )-Systems for describing congenital cardiac malformation Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2is to determine the arrangement of the chambers within the atrial mass. When distinction is based on the anatomy of the appendages, which arc the most constant components of the atriums, and specifically on the extent of the pectinate muscles relative to the atrial vestibules’, atrial chambers can b Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2e of only morphologically right or morphologically left type. T he morphologically right apỊK-ndage is broad and triangular (Figure 6.2), whereas theEbook Wilcox’s surgical anatomy of the heart (4/E): Part 2
morphologically left appendage is fingerlike, ami has a much narrower neck (Figure 6.3). In most instances, it is possible to identify the appendages Analytical description of congenitally malformed heartsCongenitally malformed hearts-----(129 )-Systems for describing congenital cardiac malformation Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2scles (Figures 6.5. 6.6). This feature, of course, Ls readily visible to the surgeon once the atrial chambers have been opened.When judged on the extent of the pectinate muscles, there are only four topological ways in which the appendages can be arranged within the atrial mass (Figure 6.7). Almost Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2always, the atriumpossessing the appendage in which the pectinate muscles extend to the crux is right-sided, while the one with a smooth inferoposteriEbook Wilcox’s surgical anatomy of the heart (4/E): Part 2
or vestibule is left-sided. Illis usual arrangement is often called ‘situs solitus’. Rarely, the appendages can be disposed in mirror-image fashion, sAnalytical description of congenitally malformed heartsCongenitally malformed hearts-----(129 )-Systems for describing congenital cardiac malformation Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2dages of both chambers in the atrial mass have the same morphology. This can occur in two forms, with either morphologically right (Figure 6.8) or morphologically left (Figure 6.9) appendages on both sides. These bilaterally symmetrical topological patterns, or isomeric arrangements, have traditiona Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2lly been named according to the arrangement of the abdominal organs, particularly the spleen. This is because they usually exist with a jumbled up abdEbook Wilcox’s surgical anatomy of the heart (4/E): Part 2
ominal arrangement, an arrangement also termed visceral heterotaxy6. It is far more convenient, as well as more accurate, to designate them in terms oAnalytical description of congenitally malformed heartsCongenitally malformed hearts-----(129 )-Systems for describing congenital cardiac malformation Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2ages is usually, but not always, found with absence of the spleen. It is most often associated with right bronchial isomerism. Isomerism of the left appendages is typically found, hut again not always, with multiple spleens. TileVentriclesFig. 6.1 The cartoon shows the three segments of the heart. T Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2hese are the atriums, the ventricular mass, and the arterial trunks. The segments are joined together at the atrioventricular and ventriculoarterial jEbook Wilcox’s surgical anatomy of the heart (4/E): Part 2
unctions.-{130 )-----Wilcox's Surgical Anatomy of the HeartFig. 6.2 The computed tomogram shows the typical triangular shape of the morphologically riAnalytical description of congenitally malformed heartsCongenitally malformed hearts-----(129 )-Systems for describing congenital cardiac malformation Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2e (compare With Figure 6.2).association with left bronchial isomerism is more constant.'rhe anticipated topological arrangement of the atrial appendages can he predicted prcopcratively with a highdegree of accuracy by studying the relationships of the abdominal great vessels as determined with cross Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2-sectional ultrasonography10. When identified, know ledge of isomerism of the atrialappendages is of value in two additional ways. Firstly, it alertsEbook Wilcox’s surgical anatomy of the heart (4/E): Part 2
the surgeon to unusual dispositions of the sinus node". In right isomerism, the sinus node, being a morphologically right atrial structure, isCongenitAnalytical description of congenitally malformed heartsCongenitally malformed hearts-----(129 )-Systems for describing congenital cardiac malformation Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2ically right atrial appendage, and the narrow finger like morphologically left atrial appendageFig. 6.5 The computed tomogram shows the extensive pectinate muscles found in the roof of the morphologically right atrium. When assessed relative to the vestibule of the atrioventricular junction, they ex Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2tend to the crux of the heartduplicated. A node is found laterally in each of the terminal grooves12. In left isomerism, there are no terminal groovesEbook Wilcox’s surgical anatomy of the heart (4/E): Part 2
(Figure 6.9). In this situation, the sinus node is a poorly formed structure, withouta constant site. Usually the node is found in the anterior interAnalytical description of congenitally malformed heartsCongenitally malformed hearts-----(129 )-Systems for describing congenital cardiac malformation Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2e harbingers of complex intracardiac lesions, Hearts with isomerism of either type tend to have bilateral superior caval veins, an effectively common atrial chamber, albeit with two132)Wilcox's Surgical Anatomy of the HeartFig. 6.6 As shown in this computed tomogram, the pectinate muscles of the mor Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2phologically left appendage are confined within Use tubular component, which has a very narrow junction with Use bod)* 1 of the atrium (black double-hEbook Wilcox’s surgical anatomy of the heart (4/E): Part 2
eaded arrow).Fig. 6.7 The cartoon shows the four possible arrangements of the atrial appendages, which cannot always be distinguished on Use basis of Analytical description of congenitally malformed heartsCongenitally malformed hearts-----(129 )-Systems for describing congenital cardiac malformation Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2 crux in the morphologically right atrial appendage, but are confined around the mouth of the appendage in Use morphologically left atrial appendage, leaving a smooth posterior vestibule. Using this criterion, all congenitally malformed hearts have appendages fitting within one of the four groups sh Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2own in the cartoon.isomeric appendages, and common atrioventricular valves. Right isomerism is always associated with a totally anomalous pulmonary veEbook Wilcox’s surgical anatomy of the heart (4/E): Part 2
nous connection, even if the pulmonary veins arc joined to one nr other atrium. It is also seen most frequently with pulmonary stenosis or atresia, anAnalytical description of congenitally malformed heartsCongenitally malformed hearts-----(129 )-Systems for describing congenital cardiac malformation Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2majority of cases, is associated with interruption of theinferior caval vein, with continuation of the venous drainage from the abdomen through the azygos system of veins.THE ATRIOVENTRICULAR JUNCTIONSI lav ing established the arrangement of the atrial appendages, the next step in sequential analyst Ebook Wilcox’s surgical anatomy of the heart (4/E): Part 2s is to determine the morphology of the atrioventricularAnalytical description of congenitally malformed heartsCongenitally malformed hearts-----(129 )-Systems for describing congenital cardiac malformationGọi ngay
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