Tue, Jun 18, 2013 - Page 11 News List

Asia’s first successful heart transplant for dextrocardia
三總完成亞洲首例鏡像異位右心換心手術

Tsai Chien-sung, director of the Department of Surgery at Tri-Service Hospital, left, and a woman surnamed Tseng with dextrocardia situs inversus totalis pose at Tri-Service Hospital in Taipei on May 23.
三總外科主任蔡建松(左)與有鏡像異位右心的曾太太五月二十三日於台北的三總醫院合照。

Photo: Wei Yi-chia, Liberty Times
照片:自由時報記者魏怡嘉

The human heart, typically located on the left side of the body, was positioned at the right side of a 60-year-old woman surnamed Tseng. All of her visceral organs were also “mirrored,” or located on the opposite side of their normal location, a rare case in which the major organs are inverted. Tseng had to receive a heart transplant due to congestive heart failure, but since the location of her heart and blood vessels were the opposite of the donor, it was very difficult to connect the vessels without causing them to become tangled. Tri-Service General Hospital spent seven hours performing the surgery, making Tseng the first patient in Asia to receive a successful heart transplant to treat dextrocardia situs inversus totalis.

Tseng was released from the hospital a month after having the surgery. She says that she seldom went to the doctor growing up and as an adult, and that although she was aware her heart was slightly different from other people, she never knew exactly how. It was not until she was recently hospitalized after experiencing heart pains that she found out her heart and major organs were reversed. Tseng’s liver was on her left side, her stomach was on her right side, a medical condition called dextrocardia situs inversus totalis.

Tri-Service General Hospital Surgery Department director Tsai Chien-sung says that between the 22nd and 23rd day of embryonic development, the tip of the heart usually slants to the right, but then normally slants back to the left between the 32nd and 34th day. However, if the tip of the heart does not slant back to the left, it results in dextrocardia, Tsai says.

Dextrocardia occurs in one in 10,000 births, and the chance of being born with dextrocardia situs inversus totalis is about one in a billion, Tsai says, adding that dextrocardia is not believed to be passed down genetically. However, if one family member has dextrocardia — or if one of the parents have the condition — the chances of being born with the condition is between 2 percent and 4 percent, roughly the same as the risk of developing congenital heart disease, he says.

(Liberty Times, Translated by Kyle Jeffcoat)

正常人的心臟在左側,但六十六歲曾太太的心臟卻在右側,即俗稱的「右心症」,不僅如此,她的體內器官位置也完全跟正常人相反,是相當罕見的器官轉位病例。曾太太因心臟衰竭,必須進行心臟移植,又因她心臟位置及血管跟捐心人完全相反,要接好血管,又不產生扭轉,非常艱難,三軍總醫院歷經七小時手術,才完成亞洲首例鏡像異位右心的換心手術。

曾太太手術後住院一個月才出院。曾太太說,從小到大,很少看醫生,只知道自己的心臟跟別人「有點不一樣」,但從不知道那裡不一樣,直到這次心臟不舒服住院,才知道不僅是心臟,內臟器官「整組」都跟一般人不同,她的「肝在身體左側」、「胃在身體右側」,學名叫做「鏡像異位右心合併完全器官轉位」。

三總外科部主任蔡建松表示,一般心臟在胚胎發育的第二十二至二十三天,心管會朝向右側,再十至十二天後,心尖才慢慢從右側移到正常的左側,如果心尖沒有移到左側,就成為所謂的右位心。

建松表示右位心發生的機率約為萬分之一,若再加上全身器官反轉,機率是幾十億分之一,右位心並沒有明顯的遺傳因素,家族中如果有一個右位心,或父母當中有一個右位心,那隨後會再出現一個右位心的機會是百分之二至四,與一般先天性心臟病再發率差不多。

(自由時報記者魏怡嘉)

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