![]() ![]() The arch terminates at the lower border of T4 where it continues as the descending aorta, in the plane of Ludwig, a horizontal plane from the sternomanubrial angle to the T4 vertebral body. Just beyond the last branch, the aortic isthmus represents a minor narrowing at the site of the ligamentum arteriosum, which runs between the undersurface of the aortic arch and the terminal pulmonary trunk, this ligament represents the obliterated foetal ductus arteriosus and due to this attachment, this represents the site of the majority of thoracic aortic injuries when the body undergoes significant deceleration The aortic arch can be divided by the brachiocephalic trunk into "proximal" and "distal" portions 3 In order from proximal to distal the branches are:īrachiocephalic trunk or artery (innominate artery) which goes on to divide into the right subclavian and right common carotid arteries Three main branches originate from the upward convexity of the arch in the majority (75%) of patients. It courses in a narrow arch from ventral to dorsal and from right to left such that at the end of the arch it sits to the left of midline, adjacent to the thoracic vertebral column. The sternomanubrial joint is the same level as the second sternocostal articulation. The aortic arch represents the continuation of the ascending aorta and is nominally defined as starting at the level of the transthoracic plane of Ludwig, a horizontal plane from the sternomanubrial angle to the T4 vertebral body. Key relationships: trachea, pulmonary trunk and arteries Termination: adjacent to the lower border of T4 in the plane of Ludwig where it continues as the descending aorta Main branches: brachiocephalic trunk, left common carotid artery and left subclavian artery. This will require further surgery or another procedure. In 0.5% of cases there are no serious complications associated with this disease, but in older patients there is a chance that arterial hypertension may not improve after the repair. In terms of hypoplasia of the aortic arch, 5 % of those treated require further procedures due to recoarctation.Origin: continuation of the ascending aorta at the level of the sternomanubrial joint, in the plane of LudwigĬourse: an arch from right to left and front to back lies anterior and to the left of the trachea This is done by using a patch to enlarge the narrowed section of the aorta. If there is a related ventricular septal defect, this is often closed during the same surgery. Once out of the operating room the mortality rate for this disease is 1%.Ħ-10% of patients will, however, go on to develop a new narrowing of the aorta (recoarctation). Following this, a metal stent is implanted in the area of coarctation to keep the vessel at the correct calibre. Hypoplasia of the aortic arch is repaired in the first two weeks of life. If this is the case, dilatation with high pressure balloons is performed to correct the narrowing. Or in other cases interventional haemodynamics is considered. Techniques to expand the narrowed area such as fitting a patch can also be used, In older patients, surgery is the preferred option and the procedure is similar to that for new-borns. The operation consists of resectioning the narrow segment of the aorta and then joining it to the healthy segments. In the neonatal period, patients usually need surgical treatment. Hypoplasia of the aortic arch is also diagnosed prenatally via echocardiogram without the need for further tests. This is usually done with an echocardiogram, but other tests tend to be carried out such as a CT angiogram or nuclear magnetic resonance imaging to define the characteristics of the coarctation. For this reason, it is diagnosed when high arterial pressure is detected during a routine check up. In the neonatal period, diagnosis is via transthoracic echocardiogram, but after this stage patients do not show symptoms. There are between 0.2 and 0.6 cases for every thousand live births. This is a common type of heart disease representing 5-6% of all heart pathologies. Who is affected by coarctation of the aorta? These patients first need to be stabilized and then treated. When this begins to close, circulatory collapse occurs due to the excessive load on the heart and insufficient circulation in the abdominal organs. It is also associated with other cardiac alterations such as patent ductus arteriosus, bicuspid aortic valve, ventricular septal defect and anomalies in the mitral valve.ĭuring the neonatal period, some patients’ blood flow may go towards the lower body, which is dependant on the ductus arteriosus. Coarctation varies in different age groups depending the level of severity and its form. In pediatric age group (in contrast to adults), aneurysm of the ascending aorta is more common than of the descending aorta. ![]()
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