medical and biological sciences - Collegium Medicum - Uniwersytet ...

68Michał Szpinda, Marcin Daroszewskiwo podczas ciąży. 3. Krzywe prawidłowego wzrostu średnicrozwijających się gałęzi łuku aorty pozwalają na diagnostykęprenatalną nieprawidłowości łuku aorty, zwłaszcza koarktacjiaorty.Key words: original external diameter, brachiocephalic trunk, left common carotid artery, left subclavian artery, brachiobicarotidtrunk, digital image analysisSłowa kluczowa: początkowa średnica zewnętrzna, pień ramienno-głowowy, tętnica szyjna wspólna lewa, tętnica podobojczykowalewa, pień ramienno-dwuszyjny, cyfrowa analiza obrazuINTRODUCTIONKnowledge of normal dimensions of the aortic archbranches and their relationship to one another is importantin the management of children with congenitalheart disease. During fetal development the morphometricdata of the aorta presented the proportionalincrease in the diameter, closely correlated to the linearfunction [1-5]. However, reference data for dimensionsof the aortic arch branches are scarce in fetuses andchildren. Generally, the growth of arteries is proportionalto the amount of blood carried by them [6].This study was undertaken to clarify the relationshipbetween both the absolute or relative diameters ofthe aortic arch branches and gestational age. The objectivesfor the present study were set to examine, asfollows:- the normal values for the original external diametersof the aortic arch branches at varyinggestational age,- the influence of sex on the value of the diametersexamined,- the growth curves for the absolute diametersof the aortic arch branches during gestation,- the developmental trend of the relative diametersof the aortic arch branches (aortic archbranch-to-aortic root diameter ratio).MATERIAL AND METHODSThe examinations were carried out on 128 humanfetuses of both sexes (63 males, 65 females) fromspontaneous abortions or stillbirths. The present studywas approved by the Ludwik Rydygier UniversityResearch Ethic Committee (KB/217/2006). In no casewas the cause of fetal death related to congenital cardiovascularor non-cardiovascular anomalies. The fetalage ranged from 15 to 34 weeks (Table I). The fetalages of the specimens were calculated on the basis ofthe following criteria: 1) gestational age based onmeasurement of crown-rump length [7], 2) known dateof the beginning of the last normal menstrual period,and 3) in some cases corrections regarding fetal agewere established by measuring of their humeral andfemoral bones using USG equipment [8]. Fetuses weregrouped into six monthly cohorts, corresponding to the4-9th month of gestation.Table I. Distribution of fetuses studiedFetal ageSexmonths weeksCrown-rump length (mm) Numbermale female(Hbdlife)mean SD min max15 89.4 6.1 85.0 92.0 10 5 54 16 103.7 6.1 95.0 106.0 7 3 4567817 114.9 8.2 111.0 121.0 6 4 218 129.3 6.6 124.0 134.0 8 3 519 142.7 7.7 139.0 148.0 6 3 320 155.3 5.8 153.0 161.0 4 1 321 167.1 4.7 165.0 173.0 3 2 122 178.1 6.9 176.0 186.0 7 4 323 192.3 6.3 187.0 196.0 9 4 524 202.9 5.7 199.0 207.0 11 6 525 215.2 4.8 211.0 218.0 7 5 226 224.7 5.2 220.0 227.0 7 4 327 234.1 4.3 231.0 237.0 4 0 428 244.2 5.1 240.0 246.0 5 2 329 253.8 4.5 249.0 255.0 6 1 530 262.7 3.1 260.0 264.0 6 5 131 270.7 5.2 268.0 275.0 4 1 332 281.4 3.7 279.0 284.0 5 4 133 290.3 6.1 286.0 293.0 9 4 59 34 301.4 3.2 296.0 302.0 4 2 2Total 128 63 65The fetal arteries were filled with white latex LBS3060, without over-distention of the perfused vessels,through a catheter Stericath (diameter of 0.5-1.0 mm),which was introduced by lumbar access into the abdominalaorta. The arterial bed filling was performedunder controlled pressure of 50-60 mm Hg, usinga syringe infusion pump SEP 11S (Ascor S.A., MedicalEquipment, Warsaw 2001). The specimens were immersedin a 10% neutral formalin solution for 4-24months for preservation, and then dissected undera stereoscope with Huygens ocular at a magnificationof 10.