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Dr.Deepak Raju
Embryology
Heart is first seen in the form of two endothelial
heart tubes-18th day of foetal life
Fusion results in a single tube with a series of
dilatations(sinus venosus ,atrium ,ventricle &bulbus
cordis) and begins to beat by 22nd day
Bulbus cordis represents arterial end of the tube-prox
part conus,distal truncus arteriosus
First arteries to appear are right and left primitive
aorta connected to the endothelial heart tubes
Portion lying ventral to foregut(ventral aorta)connected to first pharyngeal arch-to the portion
dorsal to foregut(dorsal aorta)
6TH
prox part prox pul art
distal part-ductus on left and right side involutes
History
Anomalous RSCA-Hunauld,1735
Double aortic arch-Hommel 1737
Right aortic arch Fioratti,Aglieti-1763
Interrupted aortic arch-Steidele-1788
Bayford,1787-dysphagia by vasc ringcoined term dysphagia lusoria
Gross,1945-first division of a vasc ring
Anatomical classification
Abnormalities of branching
Abnormalites of arch positioncervical arch,right arch
Supernumary arches-double aortic
arch and persistent 5th arch
IAA
Anomalous origin of pulmonary
artery branch
Clinical classification
Vascular rings
Non-ring vasc.compression
Non-compressive arch malformations
Ductal dependent arch anomalies
Symptoms Stridor,Pneumonia,bronchitis
Reflex apnoea or choking on eating
Hyperextension of neck
Increased resp distress a/w intercurrent
resp.infections
swallowing difficulty
0.5% incidence
m.c.arch anomaly
38% of downs
Disappearance of Rt 4th arch-distal Rt dorsal aorta
becomes prox RSCA
Rt 6th arch disappear
Usually asymtomatic
Barium smaller filling defect on postr aspect of
esophagus slanting upward
Angio-earlier filling of Rt carotid on aortic root
injection
Lt ao.arch,rt.desc
aorta,rt.ductus(circumflex aortic arch)
Branching pattern similar to earlierarch retroesophageal,RSCA the last
arch vessel is not retroesophageal
Desc.aorta connected to RPA by
ligamentum-forms vasc.ring
Rt arch with
retroesophageal LSCA
Similar to previous one except for the
absence of retroesophageal
diverticulum
Ductus is rt sided
No vasc ring
Involution of lt 4th and 6th
Persistent 5 arch
th
Anomalous LPA
a/w TOF in 74%
Embryonic branch pul.artery fails to join TA sac
Summary
Aortic arch anomalies and vascular
rings can be interpreted on the basis
of embryology
With the devt. Of MRI and CT 3-D
reconstruction is possible
Intervention required only when
symptomatic or when a/w other
cardiac anomalies
Thank you