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Cardiorespiratory system
Published in Helen Butler, Neel Sharma, Tiago Villanueva, Student Success in Anatomy - SBAs and EMQs, 2022
11 Which of the following statements concerning the great vessels is correct? Branches of the aortic arch include the right common carotid, right subclavian and left brachiocephalic arteries.Ligamentum arteriosum is an embryological remnant of the foramen ovale.The right recurrent laryngeal nerve wraps around the ligamentum arteriosum, which is attached to the superior surface of the pulmonary trunk.The common carotid arteries bifurcate into internal and external branches at the level of the superior border of the thyroid cartilage.The external carotid artery lies posteriorly in the carotid sheath and its branches include the ophthalmic and inferior hypophyseal arteries.
Congenital Heart Disease in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Aortic coarctation (CoA) is a focal narrowing of the aorta, almost always at the junction of the distal aortic arch and descending aorta, just below the origin of the left subclavian artery. It is associated with a generalized arteriopathy and hypertension. CoA accounts for 5%–8% of congenital cardiac disease and is associated with bicuspid aortic valves in approximately 70% of patients, ventricular septal defects, and mitral valve abnormalities. Intracranial aneurysms, typically berry aneurysms of the circle of Willis, are seen in 3%–5% of patients with CoA. Treatment of CoA in childhood in infants and small children is typically surgical; in older children, adolescents, and adults, angioplasty and stent implantation is preferred in patients with suitable anatomy. Residua and sequelae include hypertension due the underlying arteriopathy, residual focal narrowing after stenting or surgical repair, or saccular aneurysms at suture lines after surgical repair.
Diagnosis, Management, and Treatment of Systemic Hypertension in Youth, Updates from the 2017 American Academy of Pediatrics Clinical Practice Guideline
Published in James M. Rippe, Lifestyle Medicine, 2019
Carissa M. Baker-Smith, Samuel Gidding
Coarctation of the aorta is a congenital abnormality with narrowing of the aorta within the juxtaductal region of the aortic arch. Persons with coarctation of the aorta may have evidence of hypoplasia of the aortic arch or other congenital defects of the heart. Coarctation of the aorta is associated with physical examination findings of diminished pulse value in the lower extremities. Patients with coarctation of the aorta may also have an elevated arm-to-leg BP difference with a gradient of at least 20 mmHg. Repair is ideally performed during infancy. However, post-repair, individuals remain at risk for re-coarctation and systemic hypertension. The estimated prevalence of HTN post repair ranges from 17–77%.42 Routine office-based assessment of BP is often insufficient, as the prevalence of MH may be higher than initially appreciated.43
Dysphagia lusoria in a young woman with chest pain
Published in Baylor University Medical Center Proceedings, 2022
Busara Songtanin, Roy Jacob, Neha Mittal
Adachi and Williams classified patients based on types of variant aortic arches, noting that about 80% of aortic arches give rise to three vessels, which include the brachiocephalic trunk, left subclavian artery, and left common carotid artery. Most cases with aberrant vessels are asymptomatic.2,3 Symptom onset usually occurs in the fourth to fifth decades of life due to atherosclerotic changes, and a decrease in esophageal mobility with dysphagia is the most common symptom.3 Other symptoms include dyspnea, retrosternal pain, and chest pain due to arterial compression of the esophagus or trachea.4 Although this patient developed choking later in her clinical course secondary to compression of the proximal esophagus, she did not have a cough. Stenosis of arteria lusoria can also present with claudication, differences in the blood pressures in the arms, and Raynaud’s phenomenon of the right hand.5
Tricuspid Valve Dysplasia at Fetal Autopsy
Published in Fetal and Pediatric Pathology, 2022
Sumathi Shanmugam, Usha Nandhini Sennaiyan, Mani Ram Krishna
The autopsy was performed according to published guidelines [2]. There were no external anomalies. There was usual arrangement of the lungs and bronchial tree. The anterior abdomen was occupied by an enlarged liver. The thoracic cavity was dominated by an enlarged atrium. Both the lungs were pushed to the side (Fig. 1). On segmental analysis of the heart, the superior and inferior caval veins drained into an enlarged morphological right atrium with a pyramidal atrial appendage and extension of pectinate muscles beyond the appendage and all the way to the atrio-ventricular (A-V) groove (Fig. 2A). The pulmonary veins drained into the more posterior and left atrium with no pectinate muscle extension beyond the atrial appendage. There was a moderate sized atrial communication. The atrio-ventricular connections were concordant and there was right handed topology of the ventricles. The right A-V valve annulus was dilated. The anterior-superior, inferior and septal leaflets were not displaced from the A-V groove. However the leaflets were thickened with rolled-up edges (Fig. 2B). The left A-V valve was normal with morphologically normal aortic and mural leaflets. The inter-ventricular septum was intact and there was pulmonary valve aplasia. The aortic arch was left sided with normal branching pattern and an arterial duct was seen arising from the under surface of the arch to the pulmonary confluence. A diagnosis of tricuspid valve dysplasia with pulmonary artery atresia was established.
Type 2 persistent primitive proatlantal intersegmental artery, a rare variant of persistent carotid-vertebrobasilar anastomoses
Published in Baylor University Medical Center Proceedings, 2019
Gagandeep Choudhary, Narendra Adhikari, Jad Chokr, Nishant Gupta
There was a three-vessel aortic arch. The right vertebral artery (VA) was hypoplastic arising from the subclavian artery and ended as a posterior inferior cerebellar artery. The left VA was absent. Both common carotid arteries, carotid bulbs, ICAs, and external carotid arteries were patent. An anomalous artery equal to the caliber of the ICA was seen arising from the proximal left external carotid artery at the origin of the lingual artery at the C2 vertebral level (Figure 1). The anomalous vessel coursed cranially and entered the foramen magnum coursing between the C1 arch and the occiput, without passing through the transverse foramina of the cervical vertebrae. Intracranially, it had a tortuous course and continued as a basilar artery, which terminated in posterior cerebral arteries. The right-sided posterior communicating artery was present but small in caliber, and the left posterior communicating artery was not seen. Both intracranial ICAs and proximal middle cerebral arteries, the anterior cerebral arteries, and the anterior communicating artery were present and unremarkable. The patient did not have any symptoms attributable to this vascular variant. He was discharged in stable condition with a short course of pain medication.