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Anatomy
Published in Michael Stolberg, Gabrielle Falloppia, 1522/23–1562, 2023
In the anatomy of the heart and the major vessels, Falloppia’s primarily contributed to a better understanding of the fetal vessels.176 He discovered – or rather rediscovered – the ductus arteriosus, a short vascular shunt through which, according to our modern understanding, part of the blood from the fetal pulmonary artery flows directly into the aorta rather than passing through the lungs. It usually closes after birth, leaving the ligamentum arteriosum behind. The discovery has been widely ascribed to Leonardo Botalli (1519–1587) and is known today also as the ductus arteriosus Botalli; its discovery has also been attributed to Giulio Cesare Aranzi (1530–1589). When these two published their discoveries, however, Falloppia had already provided an account of the ductus arteriosus in his Observationes anatomicae.177 He did not claim the discovery for himself: Galen, he declared, had already mentioned it, though with only a few words.178 Without explicitly naming Vesalius, he expressed his astonishment, however, that almost all anatomists had been negligent and overlooked this artery or canal (“canalis”). The blood flowed through it in utero and later it dried up and was so thick had it could not escape the senses.179
Miscellaneous
Published in Bobby Krishnachetty, Abdul Syed, Harriet Scott, Applied Anatomy for the FRCA, 2020
Bobby Krishnachetty, Abdul Syed, Harriet Scott
Ductus arteriosusWhen: closes almost immediately following birth. The physiological closure is complete in 1–4 days. Complete obliteration into a fibrous remnant, the ligamentum arteriosum, occurs in the months following birth.How: lung expansion leads to increased bradykinin and decreased PGE2 levels whichcause contraction of the muscular wall of the ductus arteriosus and subsequent closure of the vessel.
Interventions for congenital heart disease
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
The same technology that has been used for atrial and ventricular septal defects has been used for closure of PDA defects. The ductus arteriosus connects the pulmonary artery to the descending aorta at the level of the origin of the subclavian artery. During fetal life, venous blood is shunted from the pulmonary artery through the ductus to the arterial circulation, bypassing the developing pulmonary circulation. After birth, the ductus usually closes to form the ligamentum arteriosum. In children in whom the ductus remains patent, a left-to-right shunt develops after birth, with oxygenated blood passing from the aorta to the pulmonary artery. Severe pulmonary hypertension may occur and cause shunt reversal and Eisenmenger’s syndrome.
Aberrant right subclavian artery: the association with chromosomal defects and the related post-natal outcomes in a third level referral centre
Published in Journal of Obstetrics and Gynaecology, 2022
Maddalena Morlando, Carmela Morelli, Fortuna Del Gaizo, Adelaide Fusco, Federica De Fazio, Laura Di Pietto, Gianfranco Moccia, Ludovica Spinelli Barrile, Antonio Schiattarella, Pasquale De Franciscis, Nicola Colacurci, Maria Giovanna Russo
None of the fetuses of this series needed referral after birth due to symptoms related with ARSA. In the absence of studies dealing with the optimal management at birth of fetuses antenatally diagnosed with ARSA, our findings may help in guiding the postnatal management of these infants. Previous studies conducted on older infants reported the presence of ARSA to be asymptomatic in most cases, especially if the absence of additional aortic vessel abnormalities. Respiratory symptoms can be observed in infancy and dysphagia can occur when solid are introduced (Polguj et al. 2014). In contrast, airway compression symptoms have been reported more frequently in fetuses with a right aortic arch and an associated aberrant left subclavian artery (ALSA): this condition can be associated with a left ligamentum arteriosum that forms a complete vascular ring and leads to airway compression (Donnelly et al. 2002). Neonatal respiratory symptoms have been also reported in a recent study on infants with concomitant right aortic arch and right ductal arch; in one of them an ALSA forming a vascular ring was identified and in two cases symptoms were probably due to bronchial compression or anomalous development (Cavoretto et al. 2020). In the presence of a regular left aortic arch associated with the presence of an ARSA, it has been speculated that severe tracheoesophageal compression can occur mostly when the right and left carotid arteries arise from the aortic arch too close together or have a common origin. This can lead to compression of the trachea due to inability of the trachea to mobilise or escape the compression (Klinkhamer 1966).
Applications of computational fluid dynamics to congenital heart diseases: a practical review for cardiovascular professionals
Published in Expert Review of Cardiovascular Therapy, 2021
Gianluca Rigatelli, Claudio Chiastra, Giancarlo Pennati, Gabriele Dubini, Francesco Migliavacca, Marco Zuin
Coarctation of the aorta (CoA) is a narrowing of the upper descending thoracic aorta, generally distal to the origin of the left subclavian artery near the insertion of the ligamentum arteriosum. CoA accounts for approximately 5%–8% of all CHDs [41]. The diagnostic imaging tools currently used in clinical practice provide dimensions, velocities, and pressure gradients, but cannot characterize the aortic blood flow and its effects on the aortic wall. CFD coupled with cardiac MRI can offer a more comprehensive evaluation of the transaortic gradient, which is usually uncorrected in sedated patients, and blood flow patterns inside the aorta and anticipating the potential effects of stenting or surgical repair [42]. CFD has been used for surgical planning in patients to aid surgeons and physicians in clinical decision making [43,44]. Models of the patient’s anatomy after several different types of surgery or stenting can be generated, and CFD analyses based on patient-specific boundary conditions can be performed to assess the expected hemodynamic after surgery. Capelli et al. [45] used CFD tools to identify the maximum expansion diameter of the aorta allowed for the covered stent at the level of the narrowing in the descending aorta in order to avoid obstruction of the origin of the aberrant right subclavian artery and compression of the bronchi. The CFD analyses quantified a decrease in the peak velocity as well as the pressure gradient, which in all the virtually treated CoA dropped from an average of 15.5 mmHg pre-implant to 1.9 mmHg after stenting, anticipating the results obtained in the real patients in the cath-lab (Figure 4).
A numerical design of experiment approach to understand aortic dissection onset and propagation
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2019
J. Brunet, B. Pierrat, P. Badel
The geometry of the aortic lumen, during diastolic phase, from a patient prior to ascending thoracic aortic aneurysm surgical repair was obtained (Trabelsi et al. 2018). The mean thickness of the aortic wall was 1.52 mm. Thus a mesh was created with a constant thickness corresponding to this value (Figure 1). A tear was introduced in the medial layer, near the most common locations of aortic dissection: along the righ lateral wall and below the ligamentum arteriosum, successively (Roberts 1981). The model was then inflated and the critical pressure was assessed.