許多人, 甚至有些醫師, 對漏斗胸都不甚了解, 往往誤認為漏斗胸只是單純外觀問題, 其實只要仔細評估, 多會有心肺壓迫的情形, 主要多是右心的三尖瓣及肺動脈瓣逆流及二尖瓣脫垂等等.
這一篇論文是報告一15歲男性漏斗胸病人在俯臥姿勢接受脊柱側曲手術時, 發生嚴重之低血壓, 經食道內心臟超音波檢查發現右心室(直接在凹陷的胸骨後方的心臟部分)受到壓迫. 右心室最高及平均血流入梯壓分別為7及4毫米汞柱. 但平躺時心受凹陷胸骨壓迫的情況即復原.
謹建議, 嚴重漏斗胸患者要儘量避免俯臥姿勢
原文及出處:
Congenit Heart Dis. 2009 May;4(3):193-5.
Echocardiographic diagnosis of right ventricular inflow compression associated with pectus excavatum during spinal fusion in prone position.
Galas JM, van der Velde ME, Chiravuri SD, Farley F, Parra D, Ensing GJ.
Pediatrics Cardiology, University of Michigan Health System, MI, USA. jgalas@med.umich.edu
INTRODUCTION: Pectus excavatum is commonly viewed as a benign condition. Associated alterations in hemodynamics are rare. We present an unusual case of right ventricular inflow obstruction and hemodynamic compromise as a consequence of pectus excavatum encountered during surgical intervention.
CASE: a 15-year-old male with pectus excavatum and thoracolumbar scoliosis developed severe hypotension after induction of general anesthesia and placement in the prone position for elective spinal fusion. A transesophageal echocardiogram revealed anterior compression of the right heart by the sternum with peak and mean right ventricular inflow gradients of 7 and 4 mm Hg, respectively. The gradient resolved with supine positioning and was reproduced with direct compression of the sternum.
CONCLUSIONS: Although pectus excavatum is generally a benign condition, the cardiologist should be aware of the potential for serious hemodynamic compromise related to positioning in these patients.
這一篇論文是報告一15歲男性漏斗胸病人在俯臥姿勢接受脊柱側曲手術時, 發生嚴重之低血壓, 經食道內心臟超音波檢查發現右心室(直接在凹陷的胸骨後方的心臟部分)受到壓迫. 右心室最高及平均血流入梯壓分別為7及4毫米汞柱. 但平躺時心受凹陷胸骨壓迫的情況即復原.
謹建議, 嚴重漏斗胸患者要儘量避免俯臥姿勢
原文及出處:
Congenit Heart Dis. 2009 May;4(3):193-5.
Echocardiographic diagnosis of right ventricular inflow compression associated with pectus excavatum during spinal fusion in prone position.
Galas JM, van der Velde ME, Chiravuri SD, Farley F, Parra D, Ensing GJ.
Pediatrics Cardiology, University of Michigan Health System, MI, USA. jgalas@med.umich.edu
INTRODUCTION: Pectus excavatum is commonly viewed as a benign condition. Associated alterations in hemodynamics are rare. We present an unusual case of right ventricular inflow obstruction and hemodynamic compromise as a consequence of pectus excavatum encountered during surgical intervention.
CASE: a 15-year-old male with pectus excavatum and thoracolumbar scoliosis developed severe hypotension after induction of general anesthesia and placement in the prone position for elective spinal fusion. A transesophageal echocardiogram revealed anterior compression of the right heart by the sternum with peak and mean right ventricular inflow gradients of 7 and 4 mm Hg, respectively. The gradient resolved with supine positioning and was reproduced with direct compression of the sternum.
CONCLUSIONS: Although pectus excavatum is generally a benign condition, the cardiologist should be aware of the potential for serious hemodynamic compromise related to positioning in these patients.
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我以前是沒辦法平躺耶... 在發育的時期, 國高中的時候吧! 總是聽說睡大字形最舒服, 可是我卻不行; 因為只要整個人攤平就覺得胸口壓得很不舒服, 所以一直都稍斜側一點角度, 胸腔有一點凹著才能入睡. 一直到二十幾歲才漸漸可以平躺 ,可能身體定形了吧