Fundamentals
Arvind Kumar Bansal, Javed Iqbal Khan, S. Kaisar Alam in Introduction to Computational Health Informatics, 2019
Heart is a complex pumping muscle with four chambers and four valves as shown in Figure 2.45. Right-side of a heart is separated from the left-side of the heart using a thick muscle called a septum. Heart chambers are covered by thick muscles. The upper chambers are called atria, and the lower chambers are called ventricles. Right-ventricle is connected to lungs via a pulmonary artery to carry oxygen-depleted blood to lungs. Right-atrium is connected to the rest to the body via two major veins that carry oxygen-depleted blood to heart. Left-atrium is connected with the lungs via pulmonary veins that carry oxygen-rich blood from the lungs to the heart. Left-ventricle is connected with the body through the aorta – the major artery connecting a heart to the rest to the body.
Vascular rings
Prem Puri in Newborn Surgery, 2017
Typically, the left pulmonary artery arises directly from the right pulmonary artery and passes leftward between the trachea and the esophagus (Figure 39.4).8 The ligamentum arteriosum passes posteriorly from the origin of the right pulmonary artery, where it arises from the main pulmonary artery to the undersurface of the aortic arch, thus creating a vascular ring surrounding the trachea but not the esophagus. The left pulmonary artery is often relatively hypoplastic. In contrast, the right pulmonary artery appears larger than normal and almost like a direct extension of the main pulmonary artery. The small calibre of the left pulmonary artery may explain the high incidence of anastomotic problems that have been observed in the past with attempts to reimplant the vessel at the main pulmonary artery.
Right-sided pulmonary resections
Larry R. Kaiser, Sarah K. Thompson, Glyn G. Jamieson in Operative Thoracic Surgery, 2017
The right pulmonary artery and superior vena cava are connected by a fibrous membrane at the bifurcation of the upper and lower branches of the pulmonary artery. This membrane is a part of the pericardium. Division of this membrane makes central dissection of the anterior aspect of the right pulmonary artery easy. As the posterior wall of the right pulmonary artery is covered by a fibrous portion of the pericardium attaching the trachea and both main bronchi, this fibrous portion should be divided from the bronchus to expose the artery completely. This is particularly important for very proximal lesions where safe division of the artery requires obtaining adequate length. The safest move to execute division of the pulmonary artery employs the use of a vascular stapler. When the stapler is used to divide the pulmonary artery, ideally a vascular clamp should be placed, in case of the very rare occurrence of the stapler cutting without laying down staples. After the artery is cut, the central stump should be dissected from neighboring structures to render the stump free from tension to avoid tearing near the staples. (See Figure 12.7a and b).
Monochorionic Twin Discordance for Horseshoe Lung and Tricuspid Atresia
Published in Fetal and Pediatric Pathology, 2022
Marina Sousa Gomes, José Monterroso, Otília Brandão, Carla Ramalho
Despite maceration due to 6 weeks of intra-uterine retention, the autopsy of the female fetus confirmed some anomalies previously seen by ultrasound and identified others. A complex heart malformation was confirmed: dextrorotation, partial anomalous systemic venous return (hypoplastic right superior vena cava, persistent left superior vena cava draining to the right atrium via the coronary sinus, inferior vena cava draining to the coronary sinus and azygos vein draining into left superior vena cava), hypoplastic right pulmonary vein draining into the left atrium, small right atrium and normal left atrium, atrial septal defect, tricuspid atresia, and right ventricle without inlet chamber with a small outlet chamber (Figure 2). The left main pulmonary artery emerges from this small chamber. The right pulmonary artery emerged from the left artery just before entering the lung hilum. The pulmonary artery and its bronchial relationship on the left were normal. There was a horseshoe lung with hypoplasia of the right lung (Figure 3). There was a unilateral right cleft lip and palate. A normal left kidney and a small right pelvic kidney were identified (Figure 4). The placental examination confirmed a monochorionic gestation, with a paraseptal insertion of the umbilical cord in the abnormal fetus and marginal insertion of the umbilical cord in the normal fetus. The karyotype of the abnormal fetus, obtained from an amniotic fluid sample, was 46, XX.
Prenatal diagnosis of truncus arteriosus in the first trimester with a high frequency curved transducer
Published in Journal of Obstetrics and Gynaecology, 2018
Yan Yi, Tong Tong, Tao Liu, Qi Lin, Yi Xiong, Jinfeng Xu
A healthy 27-year-old nulliparous pregnant woman attended our routine first trimester ultrasonography examination. During the first trimester scan, only one artery was revealed in the three-vessel and tracheal view. She was referred to undergo first trimester foetal echocardiography. Detailed cardiac examination revealed a common arterial trunk originating from the ventricles and giving rise to both the aortic and pulmonary branches at 13 and 16 weeks’ follow-up echocardiographic examinations (Figure 1). The four-chamber view seemed normal, but the three-vessel and tracheal view were abnormal. It showed only one artery in the three-vessel and tracheal view (Figure 2). No ductus arteriosus with reverse flow was detected in the three-vessel and tracheal view, which is useful for differentiating from pulmonary atresia. The pulmonary artery originated from the common artery, just above the common arterial valve, and then gave rise to the left and right pulmonary arteries. Therefore, a diagnosis of type I truncus arteriosus was made. However, the shape and echogenicity of the common arterial valve seemed normal, and no regurgitation was detected on the 13-week imaging scan. However, thickened and hyperechogenic common arterial valve and valvular regurgitation were detected on the 16-week follow-up scan. The couple was counselled, and they decided to terminate the pregnancy. The diagnosis was confirmed by performing autopsy with the formal consent of the parents. The machine used was the Philips EPIQ 7 colour Doppler system with a C9-2 pure waved transducer, with a frequency range from 9 to 2 MHz.
Management of congenitally corrected transposition from fetal diagnosis to adulthood
Published in Expert Review of Cardiovascular Therapy, 2023
Ewa Kowalik
Congenitally corrected transposition of the great arteries (ccTGA) is a complex congenital heart disease first described from an autopsy by a Bohemian pathologist working in Vienna, Karl von Rokitansky, in 1875 [1]. The anomaly is characterized by atrioventricular and ventriculo-arterial discordance [2]. Deoxygenated blood from the right atrium flows through the mitral valve into the morphological left ventricle, which gives rise to the pulmonary artery. Then, oxygenated blood flows into the left atrium that communicates with the morphological tricuspid valve and right ventricle, that is connected to the aorta. The aorta is located usually anterior and to the left. Consequently, the double discordance results in hemodynamic compensation, but the morphologically right ventricle works as systemic ventricle (systemic right ventricle, sRV). The most common anomalies are ventricular septal defect, pulmonary or subpulmonary stenosis, and systemic atrioventricular (morphological tricuspid) valve abnormalities [3] (Table 1). Additionally, cardiac malposition (dextrocardia or mesocardia) occurs in up to one-third of the patients. Associated malformations, especially the Ebstein-like anomaly of the systemic atrioventricular valve, have a significant impact on the clinical course of the disease. Conduction disturbances, including complete atrio-ventricular block, are another common cause of increased morbidity in ccTGA patients and might be the first manifestation of the disease.
Related Knowledge Centers
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- Circulatory System
- Heart
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- Blood Vessel
- Artery
- Pulmonary Alveolus