Sizarov Aleksander, de Bakker Bernadette S, Klein Karina, Ohlerth Stefanie
Center for Congenital Heart Defects, UMC Groningen, Netherlands
Department of Anatomy, Embryology and Physiology, AMC Amsterdam, Netherlands.
Interact Cardiovasc Thorac Surg. 2014 Oct;19(4):543-51. doi: 10.1093/icvts/ivu210. Epub 2014 Jul 3.
To provide comprehensive illustrations of anatomy of the relevant vessels in large experimental animals in an interactive format as preparation for developing an effective and safe transcatheter technique of aortopulmonary and bidirectional cavopulmonary intervascular anastomoses.
Computed tomographic angiographic studies in two calves and two sheep were used to prepare 3D reconstructions of the aorta, pulmonary arteries, and caval and pulmonary veins. Based on these reconstructions, computer simulations of the creation of stent-enhanced aortopulmonary and bidirectional cavopulmonary anastomoses were made.
We observed the following major anatomical features: (i) caudal course of the main pulmonary artery and its branches with the proximal right pulmonary artery located immediately caudal to the aortic arch, and with the central left pulmonary artery lying at a substantial distance from the descending aorta; and (ii) the distal right pulmonary artery is located dorsal to the right atrium and inferior caval vein at a substantial distance from the superior caval vein. Animations showed creation of transcatheter analogues of Waterston's and Potts' aortopulmonary shunts through placement of a covered spool-shaped stent, and the transcatheter creation of bidirectional Glenn's cavopulmonary anastomosis, by placement of a long covered trumpet-shaped stent.
There are considerable differences in vascular anatomy between large experimental animals and humans. Given the need to elaborate new transcatheter techniques for intervascular anastomoses in suitable animal models before application to human, it is crucial to take these anatomical differences into account during testing and optimization of the proposed procedures.
以交互式形式全面展示大型实验动物相关血管的解剖结构，为开发有效且安全的经导管主肺动脉和双向腔肺血管吻合技术做准备。
对两只小牛和两只绵羊进行计算机断层血管造影研究，以制备主动脉、肺动脉以及腔静脉和肺静脉的三维重建模型。基于这些重建模型，对支架增强型主肺动脉和双向腔肺吻合术的创建进行计算机模拟。
我们观察到以下主要解剖特征：（i）主肺动脉及其分支的走行方向为尾侧，近端右肺动脉紧邻主动脉弓尾侧，而中央左肺动脉与降主动脉相距较远；（ii）远端右肺动脉位于右心房和下腔静脉的背侧，与上腔静脉相距较远。动画展示了通过放置带覆膜的卷轴状支架创建经导管类似Waterston分流术和Potts分流术的主肺动脉分流，以及通过放置带覆膜的长喇叭状支架经导管创建双向Glenn腔肺吻合术。
大型实验动物与人类的血管解剖结构存在显著差异。鉴于在应用于人类之前需要在合适的动物模型中精心研发新的经导管血管吻合技术，在测试和优化所提议的手术过程中考虑这些解剖差异至关重要。
