Morphometric study of the aortic and great pulmonary arterial pathways in human foetuses.

In prenatal and pediatric cardiovascular surgery knowledge of luminal diameters of the aortic and great pulmonary pathways is essential. The internal diameters of the aortic and great pulmonary pathways in 131 human foetuses (65 male, 66 female) were studied by means of anatomical, digital and statistical methods. During foetal development the absolute diameters revealed a linear increase. Correlation coefficients between these diameters and foetal age were statistically significant (P< or =0.05) for each age group and reached following values: r1 = 0.70 for the aortic bulb, r2 = 0.79 for the ascending aorta, r3 = 0.77 for the aortic isthmus, r4 = 0.79 for the descending aorta, r5 = 0.63 for the pulmonary trunk, r6 = 0.36 for the arterial duct, r7 = 0.46 for the right pulmonary artery and r8 = 0.49 for the left one. Diameters of the aorta and the pulmonary trunk indicated the relative increase in the values. A different tendency was observed for the internal diameters of the arterial duct and both pulmonary arteries, which were relatively decreased with increased foetal age. The largest diameter was observed in the arterial duct, the intermediate--in the right pulmonary artery and the smallest--in the left pulmonary artery. The cross-sectional area of the descending aorta was equal to the sums of the sectional areas of the aortic isthmus and the arterial duct (r9 = 0.97). The cross-sectional area of the pulmonary trunk was equal to the sums of the sectional areas of the both pulmonary arteries and the arterial duct (r10 = 0.91).     

Quantitative evaluation of aortic arch development using digital-image analysis.

This study was performed on 80 spontaneously aborted human fetuses of a gestational period of between 17 and 27 weeks. The procedure was based on latex filled arteries, which were preserved in formalin, and then later dissected. Data collection was accomplished using digital imaging. The specific measurements of the aortic arch diameter, length and volume were obtained using a computer program, written solely for the purpose of this study. Results indicated that the collected figures correlated with the fetal age through 3 sets of 4-week intervals. Diameter and length of the aortic arch varied from 2.5 to 4.1 mm and from 6.7 to 10.3 mm, respectively. Both parameters showed statistically significant (p<0.05) linear growth and differences between age groups. The volumetric growth of the aortic arch followed a square root function with its values ranging from 35.7 to 136.8 mm3, which were also statistically significant (p < 0.05). The diameter of the aortic isthmus was measured and compared to the diameters of the ascending and descending aorta thus allowing an estimation ratio between those parameters. Concluding analyses suggest that the aortic isthmus becomes narrower during fetal development.     

The pulmonary artery in patients with Marfan syndrome: a cross-sectional study

PurposeThe objectives of this study were to establish the prevalence of pulmonary artery dilatation in Marfan syndrome using modern radiological methods and to correlate the diameter of the vessel with aortic disease.MethodsMagnetic resonance or computed tomography imaging of the pulmonary artery and aorta was performed in 87 patients with proven Marfan syndrome. Diameters of the root and trunk of the pulmonary artery and of the aortic root were measured perpendicular to the long axes of the vessels. Pulmonary artery diameters were measured on axial images, and aortic diameters were assessed on oblique sagittal images.ResultsAs compared with normal values in the literature, 47 of the 87 patients (54%) had widening of the trunk of the pulmonary artery (≥30 mm). Of these 47, 15% had no sign of disease of the ascending aorta. The mean (SD) ratio between the diameters of the root and trunk of the pulmonary artery was 1.18 (0.155). Multivariate analysis showed that surgery of the ascending aorta and high body surface area were associated with dilatation of the trunk of the pulmonary artery.ConclusionsPulmonary artery dilatation is present in a high proportion of patients with Marfan syndrome as assessed using cutoff values based on measurements in the normal population. Severe disease of the ascending aorta correlates significantly with pulmonary artery trunk dilatation in patients with Marfan syndrome.Genet Med 2012:14(11):922–927     

SOST expression is restricted to the great arteries during embryonic and neonatal cardiovascular development.

Spatial-temporal regulation of bone morphogenetic protein (BMP) and Wnt activity is essential for normal cardiovascular development, and altered activity of these growth factors causes maldevelopment of the cardiac outflow tract and great arteries. In the present study, we show that SOST, a Dan family member reported to antagonize BMP and Wnt activity, is expressed within the medial vessel wall of the great arteries containing smooth muscle cells. The ascending aorta, aortic arch, brachiocephalic artery, common carotids, and pulmonary trunk were all associated with SOST expressing smooth muscle cells, while the heart itself, including the valves, and more distal arteries, that is, pulmonary arteries, subclavian arteries, and descending aorta, were negative. SOST was expressed from embryonic day 15.5 up to the neonatal period. SOST expression, however, did not correspond with inhibition of Smad-dependent BMP activity or beta-catenin-dependent Wnt activity in the great arteries. Activity of both signaling pathways was already down-regulated before induction of SOST expression.     

超声心动图在诊断主动脉弓离断中的应用价值

目的 探讨主动脉弓离断的超声心动图特征,以提高对该疾病的认识及诊断能力。方法 回顾性分析我院16例经手术、心血管造影及双源CT证实的主动脉弓离断的超声特征。结果 超声心动图正确诊断11例（68.75%）均为A型;误诊5例（31.25%）,其中3例IAA-A型,2例IAA-B型;主动脉弓离断超声心动图特征为:主动脉弓与降主动脉之间的连续性中断,升主动脉发育不良,肺动脉明显扩张,明显增宽肺动脉通过未闭动脉导管与降主动脉连接。结论 超声心动图是诊断主动脉弓离断的首选方法,在超声检查中发现肺动脉明显扩张,升主动脉发育不良,并且肺动脉高压与心内畸形不匹配者,应警惕主动脉弓离断可能,仔细探查主动脉弓,若主动脉及分支显示不清,联合MRI、CT检查可提高诊断率。     

The site of origin of nonconfluent pulmonary arteries from a common arterial trunk or from the ascending aorta: its morphological significance

There are three possible embryological derivatives for nonconfluent pulmonary arteries which arise from a common arterial trunk or from the ascending aorta. We considered the feasibility of identifying these derivatives on the basis of the site of origin. We examined 15 specimens, in which both pulmonary arteries arose by separate orifices from a common arterial trunk (persistent truncus arteriosus), and 3 specimens, in which one pulmonary artery arose from the ascending aorta, the other being connected to the morphologically right ventricle (hemitruncus). Measurements were made for both the upper and lower margins of the orifices of the pulmonary arteries and then expressed as a percentage of the length of the ascending common trunk or aorta. The position of origin ranged from 39 to 100% for the upper margin and from 17 to 90% for the lower margin, without significant difference between left and right arteries. Since the range varied so widely, we contend that it is not possible to make a morphological identification of the pulmonary artery under consideration simply on the basis of the location of the site of origin.     

Extraordinary branching pattern of the aortic arch

A CT‐scan of a 75‐year‐old patient showed an aneurysm of the descending aorta with a maximum diameter of 4.8 cm involving the left subclavian artery. Due to the fact that the patient had several comorbidities including a severe chronic obstructive pulmonary disease he was treated only conservatively. However, there were several interesting findings on the CT‐scan: the branching pattern of the aortic arch revealed a left carotid artery arising as first side branch of the distal part of the ascending aorta. This vessel crosses the midline right in front of the trachea. Apart from that the patient did not have a brachiocephalic trunk: the right carotid artery arose as the first branch from the aortic arch and crossed the right subclavian artery anteriorly. Furthermore, the left subclavian seemed to arise from the descending aorta and not from the aortic arch. Clin. Anat. 26:1006–1007, 2013. © 2013 Wiley Periodicals, Inc.     

High-resolution episcopic microscopy data-based measurements of the arteries of mouse embryos: evaluation of significance and reproducibility under routine conditions

Defining the role of genes in the genesis of congenital cardiovascular defects involves comparisons of the diameters of arteries measured in wild-type and genetically engineered mouse embryos. This study aims at evaluating the significance and reproducibility of measurements of the diameters of the great intrathoracic arteries of mouse embryos, as produced under routine conditions, by employing a recently suggested measuring method. Using high-resolution episcopic microscopy, we generated digital volume data of 60 mouse embryos (voxel size 1.07 × 1.07 × 2 μm(3)) of developmental stage 23 according to Theiler. We randomly split the 60 data sets into two groups of 30 and assigned each group to a diploma student. In addition, an experienced scientist received 12 randomly selected specimens of each group. Independently, the researchers created three-dimensional models of the intrathoracic arteries and identified comparable measurement positions along the ascending aorta, pulmonary trunk and descending aorta. At each position, they defined virtual resections cutting through the volume data perpendicular to the longitudinal axis of the artery. In the virtual resections, the researchers measured the perimeter of the lumen of the artery. The diameter was calculated from the perimeter. Then, we performed statistic comparisons of the diameters measured in micrometres and of the ratio of each measured diameter and the diameter of the ascending aorta. Comparisons of the ratios did not reveal statistically significant differences between the measurements created by the different scientists. We assume that the used measuring protocol is highly robust and produces reproducible and significant results under routine conditions.     

经皮“瓣上瓣”支架植入治疗急性主动脉瓣关闭不全的应用解剖

目的为经皮"瓣上瓣"支架植入治疗急性主动脉瓣膜关闭不全提供相关应用解剖。方法解剖5例外形大小正常的成年人心脏和升主动脉的标本;回顾性分析178例升主动脉CTA病人影像资料,其中男性131例,女性47例,以及85例主动脉瓣上造影(DSA)病人资料,其中男性45例,女性40例,测量不同位置升主动脉的内径及长度。结果根据升主动脉CTA测得D1、D2、L1、L2分别为(30.5±2.3)、(25.5±1.8)、(36.5±3.6)、(31.2±4.1)mm,经体表面积标准化后得出的SD1、SD2、SL1、SL2分别为(17.1±1.2)、(14.2±0.9)、(21.4±1.1)、(17.8±1.3)mm;根据升主动脉DSA测量得出的D1’、D2’、L1’、L2’分别为(28.7±2.8)、(24.4±2.1)、(34.3±2.9)、(29.4±3.6)mm,经体表面积标准化后得出SD1’、SD2’、SL1’、SL2’分别为(16.0±1.4)、(13.5±1.2)、(19.7±1.6)、(16.7±2.0)mm。结论经皮主动脉"瓣上瓣"支架具有成功的动物实验研究背景,可作为一种新技术用于临床,其瓣膜支架的大小和形状的设计应根据升主动脉段的内径和长度来选择。     

Development and transformation of the aortic arches in the equine embryos with special attention to the formation of the definitive arch of the aorta and the common brachiocephalic trunk

Summary The development and transformation of the aortic arches were studied in 84 equine embryos (5 to 35 mm CRL; approximately 21–49 days of gestation). The arch of the aorta and the vessels which originate from it were also examined in several fetuses (41–335 mm CRL) and in a full-term fetus.There are six pairs of aortic arches that originate from the ventral aortic root. The first and second aortic arches regress very early, while the fifth pair appears in a vestigial form relatively late in the development, when the truncus arteriosus divides into the aortic and pulmonary channels. The development of the cervical intersegmental arteries is described and the formation of the subclavian arteries is discussed. The primitive arch of the aorta appears at the earliest in the 14–15.5 mm CRL equine embryos (approximately 35 days of gestation). The segments of the aortic arches system which are incorporated in the formation of the definitive arch of the aorta are discussed.Three vessels, the innominate (brachiocephalic) artery, the left common carotid artery, and the left subclavian artery, originate from the primitive arch of the aorta. This arrangement of the vessels is regarded as the primitive mammalian pattern.Two more stages precede the development of the definitive arch of the aorta and the common brachiocephalic trunk in the equine embryos, at approximately 42 days of gestation. The secondary changes, which occur in the process of formation of the arch of the aorta and the common brachiocephalic trunk, are described and discussed. Certain anomalies of the arrangement of the vessels from the arch of the aorta are also discussed. In memoriam of Professor Dr. L. Kundzin (1855–1940).The investigation reported herein was supported by a Research Grant-in-Aid from the Washington State University.     

Tunica media of aorta and pulmonary trunk in relation to internal calibres in transposition of great arteries,in aortic and pulmonary atresia and in normal hearts

Summary In a post mortem material of 17 cases of transposition of the great arteries (TGA) from patients with an age range from birth to two years and ten months after birth, the internal calibres of the great arteries and the ostia of the heart proved to be the same as in normal hearts. Furthermore, the media of the ascending aorta and pulmonary trunk showed no adaptation to the abnormal circulatory conditions in 15 cases of TGA with an age range from birth up to 51/2 months: in both great arteries the thickness of the tunica media and the packing density of its elastic fibres were the same as in normal hearts. However, adaptation of the tunica media of the pulmonary trunk to the abnormal circulatory conditions: increased media thickness, was found in the two remaining cases, older than 12 months.In 7 cases of pulmonary atresia (age from 1 day to 12 months) and in 9 cases of aortic atresia (age from 2 days to 37 days) the following observations were made. Vessels with reduced or absent function (ascending aorta in aortic atresia and pulmonary trunk in pulmonary atresia) showed a markedly different structure. In aortic atresia the internal calibre and thickness of the media of the ascending aorta were markedly reduced, whereas the packing density of the elastic fibres of the media remained the same as in normal hearts. In pulmonary atresia the pulmonary trunk showed large variations in internal calibre, whereas both media thickness and the packing density of its elastic fibres remained the same as in normal hearts. When the markedly enlarged single functional vessels (the pulmonary trunk in aortic atresia and the ascending aorta in pulmonary atresia) were compared no significant differences between their internal calibre, media thickness and the packing density of the elastic fibres were found indicating similar adaptation to the abnormal but comparable functional load of acting as sole arterial trunk.We are indebted to Prof. Dr. J. Moll for his help, to Dr. J.J. Willemse for statistical calculations, to Mr. P. Zondervan, M.D. (Dept. of Pathology I), for supply of material and to Mrs. L. Silvis for histo-technical assistance     

Morphometric analysis of the great vessels in early fetal life

Pathological examination of the heart and great vessels wasperformed in 61 specimens obtained after surgical terminationof pregnancy for psychosocial indications at 9–18 weeksof gestation. The aorta and pulmonary trunk were identifiedand external diameters were measured at the level of, and distalto the aortic valve and pulmonary valve, the level of the aorticisthmus and thoracic aorta, and the proximal and distal ductusarteriosus. All eight vessel diameters increased linearly withgestational age and the ratio of the diameter of the aorticisthmus to that of the aortic valve or the distal ductus arteriosusalso increased with gestation. Early pregnancy is characterizedby rapid growth of the fetal head and this may well be the consequenceof a preferential distribution of left ventricular output infavour of the head due to relative narrowing of the aortic isthmusat this gestation.     

Right-Sided Aorta: A cadaver report and brief discussion of human aortic arch anomalies

We observed an unusual right-sided aorta during routine laboratory dissection. The short aortic arch passed to the right side of the esophagus and trachea and had four branches, from proximal to distal: left common carotid, right common carotid, right subclavian, left subclavian arteries. The ligamentum arteriosum connected the pulmonary trunk to the left subclavian artery and lay to the left of the esophagus and trachea. The left recurrent laryngeal nerve passed under the ligamentum arteriosum while the right recurrent laryngeal nerve passed under the aortic arch. The descending thoracic aorta was situated near the midline, anterior to the vertebral bodies; consequently, the right posterior intercostal arteries were shorter than normal. The large veins of the thorax and the other thoracic organs appeared normal.     

Aneurysm in the sequestrated lung and aortitis associated with the malignant rheumatoid arthritis

A scar phase of rheumatoid aortitis and aneurysms in the sequestrated lung with a lesion continuous to an aortic lesion was found in autopsy specimens from a 50 year-old-woman, who had suffered from generally disseminated carcinoma of the breast. The aorta revealed a scar phase of granulomatous panaortitis continuously from the ascending to the descending thoracic aorta. The media and adventitia of the aorta were largely replaced by scar tissue, although the aortic valve was spared. The systemic arteries in the sequestrated lung were destroyed completely by the necrotizing angiitis and showed saccular aneurysm filled with organizing fibrin thrombus. The pulmonary artery was intact. These findings suggest that the saccular aneurysm in the sequestrated lung was produced by necrotizing angiitis, in association with rheumatoid aortitis.     

The topographic relationships of the unpaired visceral branches of the aorta

We examined the metric relationship among the origins of the unpaired visceral branches of the aorta, their relationship to the total descending aorta (TDA), and the relationship between the TDA and stature to see whether a graft for the TDA, e.g., from the left subclavian artery to the aortic bifurcation, which includes its visceral branches, could be pre-constructed. These proportions were compared between the genders and between adults and children to see whether any differences exist. Thirty-four adult aortae and eight juvenile aortae were examined. These segments—TDA, aortic bifurcation to celiac artery, aortic bifurcation to superior mesenteric artery, and aortic bifurcation to inferior mesenteric artery, were defined as the distances between the origins of the left subclavian, celiac, superior mesenteric, and inferior mesenteric arteries, respectively, to the aortic bifurcation. Stature was known only in 15 adult cadavers. The absolute lengths of the segments were correlated to each other and the ratios of these absolute lengths (proportional lengths) were calculated. The statistical significance was examined by Student's T-test and variability by the F test. The TDA correlated well with aortic bifurcation to celiac artery and aortic bifurcation to superior mesenteric artery, whereas a weaker correlation existed with aortic bifurcation to inferior mesenteric artery. The ratio aortic bifurcation to celiac artery and aortic bifurcation to superior mesenteric artery to TDA was less variable than the ratio aortic bifurcation to inferior mesenteric artery to TDA. The abdominal aorta measured approximately a one-third of TDA. No differences in correlation nor in ratio were found between genders and between adults and children. No correlation between stature and TDA was found. The two upper unpaired visceral branches originate from the aorta in a prefixed site, which correlates closely with the length of the descending aorta, whereas the lower one has a more variable point of origin. This is true for all ages and for both genders. Aortic length does not correlate with stature. It is not possible thus to predict the length of the descending aorta by stature. However, a model of the descending aorta can be constructed, but with less accuracy, for the inferior mesenteric artery. Clin. Anat. 11:304–309, 1998. © 1998 Wiley-Liss, Inc.     

Increased nuchal translucency in trisomy 21 fetuses: relationship to narrowing of the aortic isthmus

Pathological examination of the great vessels was performedin 34 trisomy 21 fetuses after surgical termination of pregnancyat 11–16 weeks of gestation. In each case, the externaldiameters of eight segments of the great vessels were measured.The aortic valve and the ascending aorta were wider than innormal fetuses, whilst the aortic isthmus was narrower. Thedegree of narrowing of the isthmus was significantly greaterin fetuses with high nuchal translucency thickness and it ispossible that there is a causal association between the two.     

Post-Vagotomy Mechanical Characteristics and Structure of the Thoracic Aortic Wall

This study assessed the long-term effect of vagotomy on the structure and passive mechanical characteristics of the thoracic aorta under a wide range of stresses in vitro. Eight healthy Landrace pigs underwent bilateral vagotomy distal to the origin of the recurrent laryngeal nerve, and 10 pigs were sham-operated. Three months post-surgery, the aorta was excised and specimens from the ascending aorta, arch, and descending thoracic aorta were subjected to histomorphometrical evaluation and uniaxial tensile-testing until failure. Elastic modulus-stress data were plotted and submitted to regression analysis. Structural remodeling after vagotomy was characterized as vascular growth in the ascending aorta and arch, and as thinning in the descending thoracic aorta. In the aortic segments of vagotomized animals, the area density of elastin and collagen was increased, but smooth muscle density was decreased. Similar differences in regression parameters and failure strength between groups were found in all aortic segments, indicating that the vessel wall was stiffer and stronger in vagotomized animals. In the clinical setting, disease states or drugs blocking the regulatory role of the vagi nerves on the aortic wall may have undesirable consequences on the mechanical performance of the thoracic aorta, and therefore on hemodynamic homeostasis.     

Two case reports of the right-sided aortic arch

Two cases of right aortic arch with the left subclavian artery as its last branch were found in cadavers of 66- and 80-year-old Japanese males during the 1995 and 1996 dissection for students at Tokyo Dental College. In both cases, the esophagus and trachea were surrounded by a vascular ring which consisted of the aortic arch and arterial ligament. The left common carotid artery arose from the ascending aorta as the first branch and crossed ventral to the trachea in a left cephalic direction. In The second branch of the aorta, which was the right common carotid artery, the aortic arch ran in a dorsal direction, passing between the esophagus and vertebra after branch out the right subclavian artery. The left subclavian artery arose dorsal to the esophagus, and there was an aortic diverticulum between the left subclavian artery and the descending aorta. The arterial ligament communicated between the left pulmonary artery and the arterial diverticulum. The trachea and esophagus were consequently encircled by the vascular ring. Both of the present cases were of the N-type, according to the classification by Adachi-Williams-Nakagawa (Group IIIB1 type by Stewart, 1964).     

Morphometric study of the ascending aorta in human fetuses.

The present study was performed on 128 spontaneously aborted human fetuses, aged 15-34 weeks, to compile normative data for ascending aorta dimensions at varying gestational age. Using anatomical dissection, digital-image analysis (system of Leica QWin Pro 16) and statistical analysis (ANOVA, regression analysis) a range of measurements (Length, original and terminal external diameters, volume) for the ascending aorta during gestation was examined. No significant gender differences were found (P > 0.05). The growth curves of the best fit for the plot for each morphometric feature against gestational age were generated. Both the Length and external diameters of the ascending aorta were found to increase in a linear fashion throughout gestation. The Length ranged from 2.63 +/- 0.42 to 10.80 +/- 1.49mm, according to the linear function y = -4.678 + 0.4647x +/- 0.8447 (r = 0.95). The original external diameter ranged from 2.02 +/- 0.26 to 6.84 +/- 0.63 mm, according to the linear model y = -2.103 + 0.2684x +/- 0.3958 (r = 0.97). The terminal external diameter ranged from 1.73 +/- 0.20 to 6.29 +/- 0.52 mm, with accordance to the linear function y = -2.354 + 0.2567x +/- 0.3826 (r = 0.97). The ascending aorta volume ranged from 7.56 +/- 2.65 to 370.99 +/- 105.42 mm3, according to the quadratic function y = 373.1 - 43.38x + 1.30x(2) +/- 24.51 (R2 = 0.89). The growth curves generated from my data might be useful as a reference for fetal echocardiographers in the detection of some congenital cardiovascular abnormalities.     

左侧肋间后动脉用于冠状动脉搭桥术的应用解剖

目的：为左侧肋间后动脉冠状动脉搭桥术提供解剖学基础。方法：在３０具成人尸体标本上,对左侧肋间后动脉及心脏冠状动脉的后降支和左缘支进行了观察。结果：左侧第８、９、１０肋间动脉到后降支（房窒交点下方１ｃｍ处＿平均外径分别为２．５、２．６、２．８ｍｍ,与冠状动脉后降支此点处外径（２．５ｍｍ）较为接近;到左缘支点处的平均外径为２．７、２．８、２．６ｍｍ,与左缘地此点处外径（２．１ｍｍ）较为接近;到后降支中