Heart 09-1140 Closed
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The aorta arises from the right lateral border, parallel to the pulmonary trunk. In normal hearts, the right atria would be in this position with the aorta in more medial position, posterior to the pulmonary trunk . Please see Human Heart to compare normal heart anatomy with this specimen
The main pulmonary trunk sits next to the aorta. In normal hearts, the pulmonary trunk is anterior to the base of the aorta. This specimen shows the full length of the right pulmonary artery (see posterior view) and the left pulmonary artery at the point it is attached to the ductus arteriosus.
This 5 month old still has a prominent patent ductus arteriosus (PDA), which should have closed and shrunk in the first month of life. This PDA is allowing for mixing of oxygenated blood from the pulmonary trunk INTO the aorta with deoxygenated blood. This mixing of blood allows for some oxygen delivery to the tissues and organs of this 5 month old.
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09-1140
Critical thinking exercises to be put adjacent to the scan, akin to the patient
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the 3 branches are the brachiocephalic, left common carotid, and left subclavian arteries. Reviewhttps://clinicalanatomy.ca/thorax/HeartAnatomy/story_html5.html if desired. The aortic arch and its branches have developed appropriately, so the blood flow to the head, neck, and arms will be normal with respect to blood flow. Thus pedal pulses will be within normal range between arms and feet. Similarly, the apical pulse may be in its normal position OR displaced, dependent on whether cardiomegaly has developed.
The blood filling the aorta is venous blood from the right ventricle, with hopefully a bit of oxygenated blood to sustain life. Thus the baby will be
- Cyanotic (lack of oxygenated blood) – especially in extremities such as fingers, toes, and lips.
- Warm to touch – even though the blood is deoxygenated, it’s still in normal volume and hence, warmth. It is also possible the baby would be cool to touch if vasoconstriction of distal tissues occurs to shunt blood to the core.
- Failure to thrive such as poor weight gain, weak, and being sleepy (lack of oxygen to the tissues – esp brain and muscles) . This can manifest in poor feeding, urine output/bowel movements, and not interactive.
- No heart murmurs. Even though the vessels are in the wrong position, the valves are created properly resulting in normal S1 & S2. However, murmurs can be found due to patent ductus arteriosus and/or any septal defect.
- Fast heart and respiratory rates – even though the blood volume is normal, the systemic circuit is mostly filled with deoxygenated blood. This triggers the chemoreceptors to increase respiratory and heart rate to inhale more oxygen and mobilize that oxygenated blood. However, that oxygenated blood can’t get to the aorta.
Valves are functioning correctly, even though the arteries are attached to the wrong ventricles
Patent ductus arteriosus which allows for continuous blood flow between aorta & pulmonary arteries, regardless of whether in systole or diastole.
Even though the left heart has a mostly closed system, there is no back up of blood causing pulmonary edema.
There is some fluid back up in the lungs, possible due to the closed loop of the pulmonary circulation. This causes fluid to be pushed from the pulmonary capillaries into the alveoli = pulmonary edema.
