DeRuiter M C, Gittenberger-de Groot A C, Bogers A J, Elzenga N J
Department of Anatomy and Embryology, University of Leiden, The Netherlands.
J Thorac Cardiovasc Surg. 1994 Oct;108(4):692-9.
Now that systemic-pulmonary collateral arteries are used for unifocalization in patients with pulmonary atresia and ventricular septal defect, the question arises whether morphologic criteria of these collateral arteries could help to provide better results. In an attempt to classify the morphologic features of systemic-pulmonary collateral arteries, we studied 31 heart-lung autopsy specimens with pulmonary atresia and ventricular septal defect. The course of the systemic-pulmonary collateral arteries (origin, branching pattern, and connections with systemic and central pulmonary arteries) was related to their histologic characteristics. The results show that systemic-pulmonary collateral arteries cannot be classified according to their course related to the trachea and the main branches of the bronchi. The histologic features of these collateral arteries vary along their course to the lungs. Nearly all systemic-pulmonary collateral arteries contain a muscular or a musculoelastic segment. One type of collateral artery (complex loop anastomoses) is completely muscular and resembles a bronchial artery. Nutritive branches (bronchial arteries) arise from all histologic types of systemic-pulmonary collateral artery segments. The size and number of intimal proliferations in muscular, elastic, and musculoelastic segments did not differ significantly. In 29 of 31 cases a ductus arteriosus did not coexist with large collateral arteries (two cases unknown). It is concluded that a classification of large systemic-pulmonary collateral arteries based on morphologic features results in a highly variable system, which does not facilitate decisions for the suitability of these arteries for unifocalization procedures. The variability of the systemic-pulmonary collateral arteries corresponds with the recent embryologic finding that during development, collateral artery formation is possible during extended periods.
鉴于体肺侧支动脉用于肺动脉闭锁合并室间隔缺损患者的单心室化手术，这些侧支动脉的形态学标准是否有助于取得更好的手术效果成为一个问题。为了对体肺侧支动脉的形态学特征进行分类，我们研究了31例肺动脉闭锁合并室间隔缺损的心肺尸检标本。体肺侧支动脉的走行（起源、分支模式以及与体循环和中央肺动脉的连接）与其组织学特征相关。结果显示，体肺侧支动脉无法根据其与气管及支气管主要分支的走行进行分类。这些侧支动脉的组织学特征在其向肺部走行的过程中存在差异。几乎所有体肺侧支动脉都包含一个肌性或肌弹性段。一种类型的侧支动脉（复杂襻状吻合）完全为肌性，类似支气管动脉。营养分支（支气管动脉）起源于所有组织学类型的体肺侧支动脉段。肌性、弹性和肌弹性段内膜增生的大小和数量无显著差异。在31例中的29例中，动脉导管未与粗大的侧支动脉并存（2例情况不明）。得出的结论是，基于形态学特征对粗大的体肺侧支动脉进行分类会导致一个高度可变的系统，这不利于判断这些动脉是否适合进行单心室化手术。体肺侧支动脉的变异性与近期胚胎学研究结果相符，即在发育过程中，侧支动脉的形成在较长时期内都是可能的。
