Cardiovascular system
A Stewart Whitley, Jan Dodgeon, Angela Meadows, Jane Cullingworth, Ken Holmes, Marcus Jackson, Graham Hoadley, Randeep Kumar Kulshrestha in Clark’s Procedures in Diagnostic Imaging: A System-Based Approach, 2020
The thoracic aorta commences at the aortic valve and passes into the abdomen by passing through the diaphragmatic hiatus at the level of the T12 vertebral body. It is divided into the ascending aorta, aortic arch and descending aorta. Major vessels arise from the ascending aorta and arch. The right and left coronary arteries arise from the root of the ascending aorta close to the aortic valve cusps. The aortic arch gives rise to three large vessels that supply the head and neck region and the upper limbs: the brachiocephalic artery (also known as the brachiocephalic trunk or innominate artery), the left common carotid artery and the left subclavian artery. The brachiocephalic artery divides and give rise to the right common carotid and right subclavian arteries. Each common carotid artery divides into the internal and external carotid arteries. The vertebral artery arises as the first branch of the subclavian artery on each side. The subclavian artery passes laterally to continue as the axillary artery at the lateral border of the first rib. The axillary artery continues down the arm and at the inferior margin of the teres major muscle it becomes the brachial artery. At the cubital fossa the brachial artery divides into the radial and ulnar arteries, which continue down the forearm to the hand.
Thorax
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
Aorta - leaves the left ventricle of the heart, starting at the level of the aortic valve as the ascending aorta and giving off the left and right coronary arteries at this level. It ascends deep to the right side of the sternum before curving posteriorly (backwards) and to the left as the arch of the aorta (Figs.1.4, 5.4). Superiorly it gives off its main branches: the brachiocephalic trunk (which divides into the right common carotid and right subclavian arteries), the left common carotid and finally the left subclavian arteries. The arch can pass cranially as Classically, at the level of the second costal cartilage (but can be below this), it receives the azygos vein that drains intercostal spaces and arches over the right lung root.
Carotid Doppler
Swati Goyal in Essentials of Abdomino-Pelvic Sonography, 2018
Three branches of aortic arch: Brachiocephalic trunk —Right common carotid artery—Right subclavian artery—Right vertebral arteryLeft common carotid arteryLeft subclavian artery—Left vertebral artery
New Model for the Assessment of Transcatheter Aortic Valve Replacement Devices in Sheep
Published in Journal of Investigative Surgery, 2022
John P. Carney, Jill Schappa Faustich, Matthew T. Lahti, Paul E. Ashworth, Agustin P. Dalmasso, Yuriy Moklyak, Richard W. Bianco
Animals were sedated with 0.04 mg/kg atropine IM, 10 mg/kg Ketamine IM and 2–6 mg/kg propofol IV. Animals were intubated, maintained on isoflurane at 2–4% for the duration of surgery and monitored for heart rate, mean blood pressure, fixed pupil location, corneal reflex absence, and oxygen saturation to ensure proper anesthesia. Surgery was performed in the right decubitus position with left 3rd intercostal space thoracotomy to expose the heart and the aorta. The animals were anticoagulated and placed on CPB using standard techniques [13–16]. The animal was cooled to 28˚C, and the aorta was cross clamped proximal to the junction of the brachiocephalic trunk. A partial transverse aortotomy was made. The native aortic annulus was measured and the modified annuloplasty material was cut into three appropriately sized sections. These sections were then implanted directly below each of the three native aortic valve leaflets, using interrupted 3-0 braided polyester mattress stitches, as illustrated in Figure 2A. A photograph of the annuloplasty segments sewn to the aortic annulus is provided in Figure 2B. The aortotomy was closed and the animal was warmed and bypass cannulas removed. Postoperatively, the animals recovered under the care of a veterinarian and received Ketoprofen 1–2 mg/kg IM or Carprofen 2–4 mg/kg IM, as needed for pain management.
Fatal innominate artery hemorrhage in a patient with tetraplegia: Case report and literature review
Published in The Journal of Spinal Cord Medicine, 2018
Although tracheostomy is considered a minor surgery, several complications are associated with tracheostomy, some of which are potentially lethal.1–6 The most frequent causes of tracheostomy related death are obstruction and hemorrhage.2 One rare complication is involvement of the brachiocephalic trunk (innominate artery), which occurs following erosion of the anterior surface of the trachea (Figure 1).7 This leads to trachea-innominate artery fistula (TIF) formation, which is a life-threatening complication. Its reported incidence is 0.1–1%, with a peak incidence in the second week after the procedureand an associated mortality rate of up to 92.7%.3,4 Without surgical intervention, the mortality rate is almost 100% because of acute massive hemorrhage.5 Almost half of patients with profuse bleeding present without any warning signs, necessitating the institution of rapid and organized treatment.6 Delayed massive hemorrhage is less common, and is likely to occur in nonintensive care settings such as rehabilitation facilities, where the possibility of a sudden hemorrhagic event weeks or months after the procedure is not anticipated.
Current Evidence for Alternative Access Transcatheter Aortic Valve Replacement
Published in Structural Heart, 2020
J. James Edelman, Chistopher Meduri, Pradeep Yadav, Vinod H. Thourani
Transaxillary/subclavian access accounted for 34% of alternative access procedures with the S3 valve in the STS/ACC TVT Registry; this increased from 20% in 2015 to 49% in the final quarter of 2017.14 Correspondingly, there was a significant decrease in TA access in this time. In a propensity-matched analysis, mortality was lower in TAx compared with TA (5.3% vs. 8.4%, p < 0.01), but stroke was significantly higher (6.3% vs. 3.1%, p < 0.05).14 Outcomes of TAx were similar to TF access in a propensity-matched cohort of the Corevalve Pivotal and Continued Access trials, which included patients at extreme- or high-risk for aortic valve surgery.15 Mortality at 30 days was similar; an increased rate of stroke (6.5% vs. 3.5%, p = 0.165) in the TAx arm did not achieve statistical significance. Brachiocephalic artery access, either via suprasternal incision or upper hemi-sternotomy has been described in several series, with good results16–19; but has not gained widespread adoption.
Related Knowledge Centers
- Aortic Arch
- Arm
- Common Carotid Artery
- Artery
- Mediastinum
- Neck
- Costal Cartilage
- Brachiocephalic Vein
- Head
- Subclavian Artery