2. Cardiovascular 1

Question 1

When was a duplicated SVC first reported?

Answer 1

McCotter 1916

Question 2

What is the development of the SVC?

Answer 2

By week 4
- Dorsal venous system - pre-cardinal (above the heart) and post-cardinal (below the heart) - join to form the common cardinal veins which go to sinus venosus
- Double nutritional system - vitelline veins (drain yolk sac) and umbilical veins (drain from placenta to embryo)
Right common cardinal forms SVC and its tributaries
Persistence of left common cardinal - duplication of SVC

Question 3

Which paper described a duplicated aortic arch?

Answer 3

Ikenouchi et al, 2006

Question 4

What case did Ikenouchi et al, 2006 describe?

Answer 4

73 year old M
Hosp for bleed in thalamus
Complained of chest pain
Duplicated aortic arch

Question 5

What are the 3 types of duplicated aortic arch?

Answer 5

R dominated - 70%
L dominated - 25%
Co-dominant - 5%

Question 6

What are the possible symptoms of duplicated aortic arch? What causes these symptoms?

Answer 6

Resp and digestive distress

Due to vascular ring forming around trachea and oesophagus

Question 7

Development of the aortic arch?

Answer 7

2 dorsal arteries - join with umbilical
2 ventral arteries - fuse, extend, form aortic sac, over gut tube, join heart (forming 1st aortic arch)

Week 4 - connection between heart and 1st aortic arch lengthens (tunica arteriosus)

Tunica arteriosus becomes connected to dorsal aortae via 6 pairs of aortic arches

Dorsal aortae fuse to become descending aorta - T4-L4

Persistence of distal end of right dorsal aorta - duplicated aortic arch

Question 8

What did Momma et al (1991) investigate?

Answer 8

Correct migration of neural crest cells needed for correct vessel formation

Question 9

At which vertebral level do the iliac veins commonly unite?

Answer 9

L5

Question 10

What did the Natsis et al (2010) paper investigate?

Answer 10

Types of duplicated IVC

1 - same caliber trunks and pre-aortic trunk
2 - same caliber trunks but large pre-aortic trunk
3 - asymmetric trunks - R was bigger

Question 11

What are the normal 4 segments of the IVC?

Answer 11

Hepatic
Pre-renal
Renal
Infra-renal

Question 12

From which veins does the hepatic segment of the IVC arise?

Answer 12

Vitelline

Question 13

From which veins does the pre-renal segment of the IVC arise?

Answer 13

Hepatic

R subcardinal

Question 14

From which veins does the renal segment of the IVC arise?

Answer 14

Supra-subcardinal

Post- subcardinal

Question 15

From which veins does the infra-renal segment of the IVC arise?

Answer 15

R supracardinal

Question 16

What causes duplication of the IVC?

Answer 16

If both supracardinal veins persist

Question 17

Which veins form the iliac veins?

Answer 17

Posterior cardinal

Question 18

What did the Hashmi and Smarolf (2007) study show?

Answer 18

70 year old man post foot surgery
Presented SoB and cough
Bilateral pulmonary embolism
Double IVC

Question 19

Which paper investigated interrupted IVC?

Answer 19

Hardwick et al., 2011

Question 20

What did Hardwick et al., 2011 investigate?

Answer 20

CT showed large mass in R lung invading into very large, swollen azygos vein

IVC interrupted, azygos system became venous return

Question 21

What is the prevalence of agenesis of IVC?

Answer 21

0.0005 - 1% of population (up to 5% of young people who present with DVT)

Question 22

What is the prevalence of ICA? Which paper is this from?

Answer 22

<0.01%

Gil et al., 2006

Question 23

What are anomalous vessels?

Answer 23

Either vessels that do not normally exist

Or vessels that do normally exist but are not following their usual pathway

Question 24

Which paper looked at anomalous common carotid arteries?

Answer 24

Anangwe et al

Kenyan population - most common bifurcation at C3

Question 25

Which paper looked at anomalous radial arteries?

Answer 25

Nasr 2012
100 limbs
8 variants
Racial differences - axillary origin - African 5%, Caucasian 2.7%