Topography of the arc of aorta. Sintopia aortic arcs. Aortic arc branches.

Aortic arch, Arcus Aortae is a continuation of an intrapericedial upward aorta, Aorta Ascendens. The aortic arc begins at the level of attachment of cartilage II rib to the left edge of the sternum. The highest point of the aortic arc is projected onto the center of the handle of the sternum. From the upper semicircle of the aortic arc behind the left shoulder shoulder veins, large branches depart: the shoulder barrel, the left overall sleepy and left plug-in arteries.

The initial (right) and final (left) arc deposits are covered in front with medioched parts of parietal pleural and pleural edge-mediocked sinuses. From above and partially in front of the arc of aorta passes the left shoulder vein. To the right of the initial part of the arc aorta is the upper hollow Vienna. Medium department The arcs of the aortic in front cover the remnants of the thymus and the fatty tissue with the shoulder lymphatic nodes. The front surface of the arc on the left of the Kosos crosses the left wandering nerve, from which the left return guttural nerve, N at the level of the lower edge of the arc. Laryngeus Recurrens, enveling aortic arc from below and behind. Saint Ot wandering nerve On the front surface of the aortic arc are located the left diaphragmal nerve and the accompanying VASA Pericardiacophrenica (pericardial-diaphragmal vessels).

On the front surface The arcs of the aorta opposite the death of its upper surface of the left connector artery is the place of attachment of the arterial ligament, Lig. ARTERIOSUM, representing obliterated (infect) arterial (Botallov *) duct. In the fetus, he connects the pulmonary trunk with the aorta.

* By the time of the birth of the child, the duct usually overcomes, replacing the arterial bundle. Part of the children does not occur, and the heart disease occurs - unexpressed Botalas Doc. The reference when accessing an unaccounted in order to dress its dressing is the left diaphragmal nerve, which passes by 1-2 cm of the Keynedi from the arterial ligament. Here is the Botallov lymphatic node of arterial ligament.

Rear surface Aortic arches come into contact with the front of the trachea, forming a small pressure on it. A little left, at the level of crossing the arc of aorta to a downward aorta, behind it is the esophagus. Between the trachea and the esophagus behind the arc of the aorta lies a return guttural nerve, and at the left edge of the esophagus - Ductus Thoracicus.

From below and behind The aortic arches on the right passes the right pulmonary artery towards the goal of the right lung. Aorta plot from the place of leaving the left connector artery before the transition to the downward aorta is called aorta's cage * .

*In this place there may be a narrowing of aorta, called coarctation. Most often, coaching is congenital. At the same time, the definition of the lower half of the body is blood suited enough, and the branches of the aortic arc are expanding. A collateral blood flow occurs through the system of connectible arteries. The main role is played by a. Thoracica Interna and the front intercostal arteries derived from it, as well as a. Thoracica Lateralis. The Aorta Capaccation is currently successfully eliminated by surgical path.

The location of the Arc Arc to the descending department is projected on the left at the level of the IV breast vertebra. In this place, the aortic arc envelopes the initial part of the left bronchus in front and right left. In the circumference of the arc of the aorta and below it is located aortic and heartlessness, formed by branches of both wandering nerves and both cereals of a sympathetic nerve.

Anomalies and options

The following types of aortic arc deformations are distinguished: I. According to topographicArted type

1) right-sided arc of aorta;

Right-sided arc of aorta with left-sided descending aorta;

Right-sided arc of aorta with right-sided descending aorta and aortic diverticulum;

2) Double aortic arc. II. By type of deformation: 1) elongation (cervical arc of aorta); 2) apostasy (kining) aorta; - loop and ringing formation; - inflection;

3) Hypoplasia Aorta arc: narrowed Aorta (Aorta Angusta);

4) Lack of aortic arc.

III. Variants of branching aorta.

1) there is no shoulder barrel;

2) the left shoulder barrel, with the lack of right;

3) Right and left shoulder barrel.

4) The right and left overall carotid artery moves in one trunk.

I. . 1) Right-sided arc of aorta .

Right-sided arc of the aorta - anomaly at which it eats through the right main armor; The thoracic aorta is located to the right of the spine.

The aortic arc turns to the right, and over the right main bronchus turns back behind the heart. Or, it passes through the right side of the spine and only at the diaphragm level goes to left Or a higher chest segment will cross the spine.

This development anomaly arises in such a way that the artery of the left IV-oh gill arc, from which the aorta arc arises, atrophy, and instead of the aorta arc is formed by the artery of the right IV-oh gill arc. The vessels derived from it originate in the reverse order compared to the norm. Approximately 25% of cases this development anomaly joins the tetralogy of Fallota. By itself, it does not affect blood circulation, does not cause clinical symptoms. The diagnosis is important from the point of view of operation in combined developmental anomalies. In infancy, X-ray study, this anomaly of development is more difficult to determine, and in childhood it is easy. With angiocardiography, the position of the arc of the aorta and the downward aorta can be well detected.

There are also:

Right-sided Aorta arc with left-sided descending aorta .

The aortic arc is formed from the artery of the right IV-oh gill arc, but formed from the artery with the left Vi-mâmate arc of Botalals a duct or a plug-in artery, departing from the downward aorta, before the spine between the esophagus and the trachea, a sharp gently pulls the vessel on the left side. The arc of the aorta is driving behind the esophagus on the left side, expands the median shadow and forms a deep pressure on the esophagus, well visible in both oblique positions.

Right-sided arc of aorta with right-hand downward aorta and with aortic diverticle .

Along with the right-sided arc of the aorta and downward aorta, the rudimentary left-sided root of the aorta, from which a subclavian artery departs. The diverticulus is behind the esophagus and forms a deep pressure on its back surface. If he is coming out of the esophagus, then with a sagittal study manifests itself in the form of a mediastinal shadow with a border, convex to the right.

Bending aortic arcs to the right. The variant of the vice, in which the downward aorta is located to the right of the spinal column, is often combined with other heart development defects. It occurs at about 20% of patients with Tetraja Fallo and often with a general arterial trunk. With the bend, the aortics arcs are missing with other anomalies, no symptoms are absent. It can be seen on the radiograph. In contrasting the esophagus, there is a pressure of its right circuit at the level of the aorta arc.

Vascular ring. Congenital anomalies of the structure of the aortic arc and its main branches lead to the formation of vascular rings around the trachea and esophagus, in one degree or another squeezing them. Most often found:

1) doubling aortic arc;

2) the bending of the arc of the aorta to the right in combination with the left arterial ligament;

3) anomalous debit of the right plug-in artery, which in such cases is the last large breast branch of a normally located aorta;

4) the localization of the severity of the nameless artery from the aortic arc to the left than compared to the norm;

5) the beginning of the left carotid artery to the right compared to the norm and the localization of its kinflower from the trachea;

6) Additional left pulmonary artery.

The latter departs either from the pulmonary artery trunk, which is greater than usual length, or on the right pulmonary artery. It passes between the trachea and the esophagus, squeezing them.

The clinical picture is extremely variable. In some cases, especially with an abnormal disorder of the right plug-in artery, there is no symptomatic. When squeezing with a vascular ring of the trachea and esophagus, it often appears in breast. Breathing is striated and enhanced when the child is crying, while feeding it and when the head is tilted. Laying the head facilitates breathing. It often appears vomiting, there may be a cough with a metallic tint, pneumonia is frequent. Radiographic examination of the patient with contrasting of the esophagus and aortography allow you to determine the diagnosis.

Operational treatment is shown in patients who are evident clinical signs Anomalies and radiographic signs of grave trachea or esophagus. Upon doubling, the aortic arches usually cut the vessel lying in front. When squeezed, caused by the right arc of the aorta and the left arterial bunch, cut the latter. Anomalous right-hand plug-in artery is tied up at the place of her death from the aorta. Since an abnormally existing unnamed or carotid artery cannot be tied up, eliminated by the grace of trachea caused by them by attaching the adventitization of these vessels to the sternum. The correction of the abnormal leaving of the left pulmonary artery is carried out under conditions of artificial blood circulation by dressing the artery at the place of its disheaval, the elimination of its shocks from the trachea and re-joining the trunk of the pulmonary artery. Related pronounced trachemodation exacerbates the forecast.

The aortic arc is the bending of the aortic to the left at the level of the sternum with the transition through the left bronchus.

Building and arc location Aorts

The aortic arc goes into a downward aorta with a small convexity up and bending back. There is a small narrowing in front of the arc, which is called the aortic is the cereal. This experiencing is located between the arc of the aorta and the descending aorta.

The aortic arc is directed from the second cartilage of the rib to the left 3-4 breast vertebrae. In some cases, the aortic arc branches reach the shoulder barrel and the right carotid artery, as well as the development variations in which the branches of the aortic arc and the two-shoulder branches are the right and left.

The aortic arc is connected to three large vessels - a common carotid artery, a subclavian artery and a shoulder barrel. The largest vessel of 4 cm long is the shoulder barrel. He moves away from the arc of the aorta up at the level of the sternosterous joint and is divided into two branches - the right carotid artery and the right plug-in artery. With some features of anatomical development, a person from a shoulder vessel can retrieve lower thyroid artery.

Congenital deformation of the aortic arc

In some cases abnormal development The arcs of the aorta may appear its congenital torture, which is called deformation. This developmental anomaly occurs in 0.4-0.6% of patients with cardiovascular diseases and 3% of patients with aortic coarse.

The congenital resolutionity of the arc of the aorta is expressed in its elongation, the inflection and the pathological thinning of the walls of the vessels. In some cases, the aortic arc is compacted and has symptoms of stenosis (narrowing).

The reasons for the deformation were not identified, but medical studies have shown that this anomaly begins during the period of intrauterine development under the influence of a number of factors and hereditary predisposition.

There are two main types of deformation:

• Congenital deformation with elongation and artery bends;
• Congenital deformation, in which the aortic arc is sealed, and the walls of the vessels are narrowed.

In the future, deformation can develop in several vices:

• Pulk with the inflection between sleepy and nameless arteries;
• Pulk with the gear of the left carotance and subclavian arteries;
• Pulk with the gentle of the aorta in the place of branching the plug-in artery.

In the overwhelming number of cases during deformation of an arc of the aorta of circulatory disorders is not observed, but the load on the walls of the vessels increases and the aortic aneurysms can be formed.

With a serious deformation of the arc, the aorta may take squeezing of the esophagus, trachea and nerve trunks. For the treatment of deformation of the aorta arc, a special medical course is appointed with subsequent surgical intervention.

Diseases of arc aorta

The main diseases of the aortic arc are aneurysm and hypoplasia.

Aortic arc aneurysm is atherosclerotic or traumatic lesion vessels. The symptoms of the aortic arc aortes are lesions of the blood vessels and brain, headachepainful syndrome in chest, shortness of breath, severe pulsation in the chest, recurrent nerve pares.

For the diagnosis of aneurysm, a radiographic study and aurantography is carried out, which allows you to establish the degree of change in the wall of the aorta. Aortic arc aneurysm is treated with the help of operational prosthetic aorta and its branches.

The aortic arc hypoplasia is hypotrophy of the average elements of the aortic vessels and degenerative changes Plastic shell, which lead to the break of the aortic is the lapse.

The causes of the occurrence of hypoplasia of the aorta arc are hormonal disorders, congenital pathologies, hereditary predisposition, innervation disorders. The aortic arc hypoplasia may affect other artery, including the functioning of the renal artery.

With serious disorders caused by the aortic hypoplasia, surgery. After the operation, a partial correction of heart defect is carried out and other cardiovascular diseases. Then assigned medicia treatment glycosides and diuretics.

Arc Aorts call the middle part of the largest blood vessel in the human body.

Almost all organs and systems depend on its normal functioning.

In pathology, the blood vessel often requires serious medical measures.

About anatomy and topography

Aorta - the main trunk of the arteries in big Circle blood circulation. The beginning she takes in the cavity of the left ventricle of the heart. Consists of 3 parts:

• ascending;
• medium;
• descending.

Aortic arc - middle part. It is derived from the 4th left arterial arc. The topographically located between the sternum handle and the IV breast vertebra. Arc stroke at the same time - back and left. It then ships through the top of the left bronchus, where the descending part of the aorta begins.

Conditionally in the structure allocate 2 parts:

• concave;
• convex.

From the concave side of the arc of the aorta, blood vessels are departed, feeding bronchi and a forkry gland. From the convex part, the beginning of the 3 trunk takes, located right to left:

1. Brachiocephalus (shoulder).
2. Common carotid (sleepy) left.
3. Left connectory.

Aortic arc branches depart from its middle up. All these arteries nourish the upper half of the body, including the brain.

Anomalies, Defects and Diseases

The pathology of the blood vessel can be divided into 2 large groups:

1. Congenital.
2. Acquired.

In the first case, disorders occur at the stage of embryogenesis. It depends on the hereditary predisposition, the action of aggressive factors on early timing Pregnancy. Changes can be detected in other aorta departments. If such a situation arose, then they are talking about combined and combined vices.

With the acquired pathology, the aortic arc initially does not have anatomical defects and deviations. The defeat is a consequence of the underlying disease.

To congenital vices and abnormalities include:

1. Gayoplasia.
2. Atresia.
3. Pathological attorney (Kining-syndrome).
4. Capaction.
5. The defects of the system of the middle department, among which allocate:

• full double aortic arc;
• defects of the development of the right and left arc;
• anomalies of length, sizes, continuity of the stroke;
• anomalies of the pulmonary trunk and arteries.

AND since acquired diseases, the middle part amazed:

• atherosclerosis;
• firearms and knives;
• aORTOTARTERIT YOURSU;
• aneurysm.

Such a variety of possible lesions of this part blood system ensures the interest of doctors in early diagnosis and timely treatment.

Brief characteristics of individual species

Gapoplasia is a uniform tubular narrowing. Such limitation of the diameter of the blood vessel prevents a full-fledged blood outflow from the left ventricle. To be involved in the pathological process, not only the arc itself, but also downward aorta and the upward department.

In most cases, combined with other vices. Most of these patients dies in early age. Treatment only surgical.

Atresia or breaks refer to the anomaly Studel. At the same time, one of the vessel segments is completely absent. The consequence of this is that the descending part of the aorta is not reported to ascending.

They are isolated from each other. Blood supply is carried out due to open arterial duct. Children with such a vice without surgery die in the first month of life.

Pathological torture is called kinking syndrome. Its essence is that the aortic arc in the distal end is an abnormal length, bent. Complaints patients with such a vice do not prevent.

When detecting digging syndrome in children, doctors choose the expectant tactics. As the child grows, the vice can pass independently.

This anomaly is more often diagnosed in women. It is a narrowing of any part of the blood vessel. When the aortic arc branches are affected, there are several options:

1. Stenosis or atresia left connectible artery.
2. Stenosis of the right plug-in artery.
3. Anomalous debit of the right plug-in artery:

• distal;
• proximal.

The narrowing can be localized, but usually consists of a path-widespread pathological process. Often combined with others congenital anomalies. Included in the Tetrad Fallo, Turner Syndrome. Defective vice from birth.

With adequate medical support and a small degree of severity of anomaly, patients have a favorable forecast. Early surgical correction Allows you to significantly increase the lifespan (up to 35-40 years) and its quality.

Vices of the aortic arc system

This group includes anomalies of position, size, shape, stroke, ratios and continuity of arterial vessels. These vices are most often asymptomatic.

Complaints appear in pronounced changes and spread anomaly on proximal part downward department. The appearance of dysphagia or respiratory phenomena due to the close pathological contact of the arc of the aorta and its branches with the trachea, the esophagus.

It is necessary operational interventionTo prevent the development of severe complications.

Most often there is a complete double arc of aorta. Distinctive feature Such a vice - the presence of both arcs (right and left), and from which branches also depart. Then they all merge with the descending artery behind the esophagus.

Prediction for life in such patients is extremely favorable. In most cases, they do not need drug support.

Acquired villocks

The greatest value from the secondary lesions of the blood vessel has:

• atherosclerosis;
• aneurysm.

In the first case, there is a narrowing of the lumen at the expense of the forming "fat" plaques. It is easily diagnosed due to the compacted underlined contour of the vessel when the heart ultrasound is carried out, the lung radiographs.

Compliance with the principles proper nutrition And rational pharmacotherapy will help slow down the process, prevent complications.

Under the aneurysm, the expansion section of the blood vessel is implied. The consequence of this is the narrowing of the lumen of its branches at the place of their fatal. The reason for such a situation is most often the injury or atherosclerotic changes.

For a long time, pathology may not produce itself. When engaging in the process of ascending or downward aortion departments, big size The aneurysms appear the first symptoms.

The main method of treatment is surgical. The treatment regimen before the operation necessarily includes medicines that reduce arterial pressure To prevent separation or rupture aneurysm.

Top basic symptoms

Despite the diversity of pathology options in the aortic arc system and its branches, most patients note the following complaints:

• shortness of breath;
• cough;
• voting weight;
• disorders of swallowing;
• headaches;
• dizziness;
• temporary paralysis of the limbs;
• face swelling.

The listed complaints are due to the involvement in the pathological process of the main branches of the middle part of the aorta. What kind of disease or vice takes place, only a doctor can install.

For this, a whole range of various instrumental examinations is performed. Therapy schemes are selected individually taking into account the type of pathology.

The aortic arc occupies an important place in the process of blood supply to organs and systems. The presence of a vice or disease of its system can lead to severe consequences, death.

Therefore, it is important to undergo dispensarization, in a timely manner to contact a specialist, comply with all its recommendations.

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When saving after birth, the right IV gill arc is formed right-sided arc of aorta. It is detected as the only anomaly, as well as in combination with a mirror arrangement by the organ, p. With this anomaly, the ascending aorta goes up and right from the trachea and esophagus, turns through the right bronchus, heading down either to the right, or, passing behind the esophagus, to the left of the spine. Right-sided Aort is often manifested without pathological symptoms. In these cases, the arterial bunch is located in front of the trachea and not stretched, and if it passes behind the esophagus, it happens long. If the arterial bunch or unexecretive arterial duct passes from the pulmonary artery to the aorta to the left of the trachea and behind the esophagus, it is formed a ring surrounding the esophagus and a trachea. Arterial bundle presses on the esophagus and trachea. The left plug-in artery in one case passes ahead of the trachea or the diverticule of the residual IV left gill arc. The diverticulus is located at the site of merging the right arc with a downward aorta. Diverticulus - the remnants of the left IV gill arc with various options for the disheaval of the connective arteries.

Clinical symptoms

In children, the right-sided arc of the aorta may cause constant icotes. In the absence of a narrowing ring closed by arterial bond, the course of the disease is asymptomatic. In adults, in the sclerosis, the aortic phenomenon of dysphagia is enhanced. Respiratory disorders are strengthened after eating.

Described in the literature of varieties

The arc of the aorta turns through the right main armor and descends on the right side of the spine as a downward aorta. From the nameless artery, the left overall sleepy and left plug-in arteries are departed. The arterial bunch is attached to the nameless artery.

The right-handed arc of the aorta is located on the neck, at the level of the thyroid cartilage, on the right side of the larynx. Aortic arc is formed in this case from III couple Right gill arc. Public arterial duct flows into a downward aorta against the left connector artery. Left total carotid artery Departs from the ascending aorta and rises upward and left from the trachea. Arterial duct participates in the vascular ring, squeezing the trachea and the esophagus.

1. Radiological data. When inhaling - insufficient aeration of the lungs, with exhalation - hypeoary. Signs of infection in the lungs. The ledge of the aorta is visible on the right side of the mediastinum, and there is no normal aortic arc on the left. On the left side, a shadow image of the diverticulus is often revealed, located where the aortic protrusion is normal. The downward aorta is sometimes shifted in the direction of the pulmonary fields. In the first oblique position, the trachea is shifted forward, and the shadow of the diverticulus is detected at the level of the arc between the trachea and the spine. In the left braid position, the downward aorta gives bending. On lateral radiographs, a trachea is visible, filled with air in the upper normal part and distinctly narrowed bottom.
2. Research of the esophagus. Barium sip discovers a sharp narrowing of the esophagus and compress its left side and rear surface if there is a diverticulous or arterial bunch in a closed ring. Above the recess on the rear surface of the esophagus is determined by the spit-up and left separate defect. It is caused by the squeezing of the left connector artery, behind the esophagus turning to the left key. The shadow of the left plug-in artery, passing behind the esophagus, is located above the shadow of the arc of the right-hand aorta. The pulsating left diverticulus aorta is detected behind the esophagus. The esophagus is dismissed by a kepenta.
3. Investigation of trachea lipoidol. In the presence of symptoms of the trachea, the contrast study shows it to localize the aortic ring. Introduction to the trachea of \u200b\u200blipoidol reveals an elongated remission on the right wall of the trachea, caused by a number of arc aorta, a recess on the front wall of the trachea from compression pulmonary artery And the pressure on the left wall of the trachea is from the arterial ligament. If there is no grateing of the trachea, then it makes no sense to explore it with lipoidol.
4. Angiocardiography. It is produced by combining the right-handed arc of aorta with others congenital defects Hearts.

Differential diagnosis

Right-sided aortic arc can cause a picture similar to the observed. In the forefront, the right-sided arc of aortic in children, if there is an increased shadow of the fork gland, it is not clearly detected. However, iron does not shift the esophagus forward. The tumors in the backyard of the upper mediastinum can simulate the right aortic arc, but they are not pulsed. The normal protrusion of the aorta arc to the left is preserved. With the aneurysms of the nameless artery or the downlink left aorta, the shadow of the downward aorta is always detected.