Anderson Robert H, Bamforth Simon D, Gupta Saurabh Kumar
Biosciences Institute, Newcastle University, Newcastle upon Tyne, UK.
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
Cardiol Young. 2020 Nov;30(11):1708-1710. doi: 10.1017/S1047951120003807. Epub 2020 Nov 4.
In the accompanying article appearing in this issue of the Journal, Prabhu and his colleagues, from Bengalaru in India, describe their experience with patients having a right aortic arch. They discuss the fact that the anomalous arrangements they encountered can all be interpreted on the basis of the hypothetical double arch proposed by Edwards. They point to the fact that interpretation of the developmental changes underscoring the production of the double arch is currently confused by reference to the so-called Rathke diagram, in which six sets of arteries are shown extending through the mesenchyme of the pharyngeal arches. As the authors point out, Graham and his associates have now shown that the alleged fifth set of pharyngeal arches do not exist. Based on our own observations, we endorse this statement. It means that new explanations must now be provided for the lesions previously described on the basis of persistence of the alleged artery of the fifth pharyngeal arch. We have previously claimed to have observed such an artery in a human fetus. We now believe, on the basis of our latest findings, that our earlier observation is better explained on the basis of presence of a collateral channel. We suggest that the so-called "fifth arch arteries" are themselves then best explained either on the basis of existence of such collateral channels, or remodelling of the aortic sac, which is the manifold, during development, that gives rise to the pharyngeal arch arteries.
在本期《杂志》发表的相关文章中，来自印度班加罗尔的普拉布及其同事描述了他们对右位主动脉弓患者的治疗经验。他们讨论了这样一个事实，即他们遇到的异常排列都可以根据爱德华兹提出的假设性双弓来解释。他们指出，目前对强调双弓形成的发育变化的解释因参考所谓的拉特克图而变得混乱，在该图中显示有六组动脉穿过咽弓的间充质。正如作者所指出的，格雷厄姆及其同事现已表明所谓的第五组咽弓并不存在。基于我们自己的观察，我们赞同这一说法。这意味着现在必须为以前基于所谓第五咽弓动脉持续存在而描述的病变提供新的解释。我们之前声称在一名人类胎儿中观察到了这样一条动脉。基于我们的最新发现，我们现在认为，我们早期的观察结果最好用存在一条侧支通道来解释。我们认为，所谓的“第五弓动脉”本身最好要么根据这种侧支通道的存在来解释，要么根据主动脉囊的重塑来解释，主动脉囊在发育过程中是产生咽弓动脉的多种结构。
