Normative Data of Optimally Placed Endotracheal Tube by Point-of-care Ultrasound in Neonates

Objective: To derive normative data of the distance betweenoptimally placed endotracheal tube tip and arch of aorta byultrasound in neonates across different weight and gestation.Design: Cross-sectional study.Setting: Tertiary care neonatal intensive care unit from April 2015to May 2016.Participants: All neonates requiring endotracheal intubation wereeligible for the study.Methods: During intubation, insertional length was determinedusing weight-based formula. The distance between endotrachealtube tip and arch of aorta was measured by ultrasound.Endotracheal tube position was confirmed by chest radiograph.Results: Out of 133 enrolled infants, 101 (75.9%) had optimallyplaced endotracheal tubes. The mean (SD) distance betweenendotracheal tube tip and arch of aorta by ultrasound was 0.78(0.21) cm in infants <1500 g and 1.04 (0.32) cm in infants ≥1500 g.The regression equation to estimate insertional length fromweight, crown heel length (CHL), occipito-frontal circumference(OFC), nasal tragus length (NTL) and sternal length (SL) wereWt(kg)+4.95, 0.15×CHL(cm)+0.57, 0.22×OFC(cm)+0.49, 0.82×NTL(cm)+1.24 and 0.75×SL(cm)+2.26, respectively.Conclusion: Our study reports normative data of the distancebetween optimally placed endotracheal tube tip and arch of aortaby ultrasound in neonates. The distance between endotrachealtube tip and arch of aorta increases with increase in weight andgestation. Insertional length correlates strongly with all theanthropometric parameters

Anomalous Left Vertebral Artery from Arch of Aorta: A Thought For Surgeons.

Arterial variations in the branching pattern of arch of aorta are uncommon and may occur as a result of developmental changes in the fusion and absorption of various pharyngeal arch arteries into the aortic sac. The present case report describes a finding in amale cadaver aged between 60- 65 years about the origin of left vertebral artery directly fromthe arch of aorta. Such variations should be kept inmind during surgical procedures in the superior mediastinum.

Study on Branching Pattern of Arch of Aorta in South Indian Population.

Background and aim:Arch of aorta is the continuation of ascending aorta lies in the superiormediastinum. The present study aims at finding the branching pattern of arch of aorta and correlate it with the embroyological and clinical significance. Materials andMethods: 30 formalin-fixed cadavers procured fromthe department of anatomy, Karpaga Vinayaga Institute ofMedical Sciences,Madhuranthagamwere dissected to study the branching pattern of arch of aorta. Results:Out of 30 cadavers 19 cadaversNormal branching pattern (Right brachiocephalic, Left common carotid and Left subclavian artery).10 cadavers showed the left common carotid arising in common with the brachiocephalic trunk. Only one showed the left vertebral artery arising directly from the aorta, the origin lying between left carotid and left subclavian arteries. Conclusion: Knowledge of normal anatomy and frequency in the variations in the branching pattern of the arch of aorta is of great importance in patients who have to undergo aortic instrumentation, four vessel angiography or supraaortic thoracic, head and neck surgery.

Brachiocephalic Trunk and Left Common Carotid Artery Arising from Aortic Arch as a Single Trunk.

Branches of aortic arch usually are brachiocephalic trunk, left common carotid artery and left subclavian artery from right to left direction. Arch of aorta show more variations in branching patterns. One among which is origin of only two branches in which brachiocephalic trunk and left common carotid artery arise together as a common trunk and other branch is left subclavian artery. The variations occur due to abnormal development of arch of aorta. During routine dissection of superior mediastinum of thoracic region, we have found the left common carotid artery and brachiocephalic trunk was arising from the arch of aorta as a common trunk. These kinds of variations are very rare and knowledge of which is very important for neck surgeons, cardiologists and interventional radiologists while doing surgeries and instrumentation procedures.

Anomalous Origin of Left Vertebral Artery.

Background: To document the unusual origin of left vertebral artery from the arch of aorta and to discuss the embryological basis and clinico-anatomical correlation of such variation. Materials and Methods: This finding was seen after thorough and meticulous dissection of the thorax in a 58 year old male cadaver in the department of anatomy, R.G.Kar Medical College. Results: There was anomalous origin of the left vertebral artery from the arch of aorta whereas the right vertebral artery took its normal origin from right subclavian artery. Conclusion: This anatomical variation can be explained in the light of embryological development .In addition knowledge of such variation is important for carrying out surgical procedures.

Anomalous Origin of Left Vertebral Artery Arising from the Arch of Aorta and Its Embryological Basis.

Background and Aim: Arterial disarrangements within the thorax are common and assume many diverse forms. The anatomic and morphologic variation of the origin and course of the prevertebral segment of the vertebral artery is necessary for vascular radiology, planning of aortic arch surgery or endovascular interventions. The present study is aimed at finding the origin and course of the left vertebral artery from the arch of aorta between left common carotid and left subclavian arteries. Materials and Methods: Present study was done on six formalin fixed cadavers during routine dissection allotted for the first year students of Kanyakumari Government Medical College Asaripallam, Nagercoil. The direct dissection method was used. A comparative analysis was done with previous studies. Result: Usually the vertebral artery arises from supero-posterior aspect of the first part of the subclavian artery. But in a 60 yrs old adult female cadaver showed a variation, that the arch of aorta gave off four branches in which the left vertebral artery arose as 3rd branch between the left common carotid and left subclavian arteries. Conclusion: Variation observed in the study is in par with variation observed in previous studies. The knowledge about the variant origin of left vertebral artery is necessary for interventional radiologists and surgeons to avoid complications in the head and neck region.

Left Common Carotid Artery Arising From Brachiocephalic Trunk.

Arch of aorta branches into three – the Brachiocephalic trunk, the left common carotid artery and the left subclavian artery. The variations in the branching pattern of arch of aorta are usually incidental findings during surgeries and imaging studies and are important in aortic instrumentaion and head and neck surgeries. In the present case report the left common carotid artery originating from the brachiocephalic trunk and its significance is discussed.

A study of variant origin of vertibral artery.

Background: Vertebral artery is the first branch of subclavian artery .It is an important source of blood supply to the brain. Accurate knowledge of normal and variant arterial anatomy of vertebral artery is important for clinical procedures and vascular radiology as its injury may occur at the time of cervical fracture or dislocation. The present study was done to study variant origins of vertebral artery. Aims & Objective: To study the variant origins of vertebral artery. Materials and Methods: The present study was done on thirty human cadavers to know the variant origin of vertebral arteries by Dissection method. Results: In the present study, variant origin of Left Vertebral Artery (LVA) was found in one male (3.33%) cadaver out of 30 cadavers. There was aortic origin of Left Vertebral Artery (LVA) instead of left subclavian artery. Conclusion: An understanding of anomalous origin of vertebral artery is very much important while performing diagnostic and interventional angiography & clinical improvements before vascular surgeries of supraaortic arteries.

International Classification of Headache Disorders, 3rd Edition: What the Pediatrician Needs to Know.

Objective: To compare ultrasonography with chest radiograph to detect the level of endotracheal tube tip in intubated neonates. Design: Observational. Setting: Neonatal care unit of a teaching hospital. Participants: 53 neonates selected by convenience sampling. Intervention: Ultrasonography of chest was done with probe of 5 to 8 MHz using high parasternal view. The distance of the endotracheal tube tip to the arch of aorta on ultrasonography was compared with level of endotracheal tube tip in radiograph. Primary Outcome: Distance of endotracheal tube tip from the upper border of the arch of aorta on ultrasonography. Results: Endotracheal tube tip was visualised on ultrasonography within 0.5 - 1.0 cm distance from upper border of arch of aorta in 48 out of 53 neonates. This corresponded with the normal position of endotracheal tip in radiograph at T2 to T3. In 5 neonates, endotracheal tube tip was not visualized on ultrasonography and in all these newborns it was at higher level in radiograph. Conclusions: Distance of endotracheal tip to arch of aorta as measured on ultrasonography is helpful in early identification of the level of endotracheal tube tip.

Point of Care Ultrasonography for Position of tip of Endotracheal Tube in Neonates.

Objective: To compare ultrasonography with chest radiograph to detect the level of endotracheal tube tip in intubated neonates. Design: Observational. Setting: Neonatal care unit of a teaching hospital. Participants: 53 neonates selected by convenience sampling. Intervention: Ultrasonography of chest was done with probe of 5 to 8 MHz using high parasternal view. The distance of the endotracheal tube tip to the arch of aorta on ultrasonography was compared with level of endotracheal tube tip in radiograph. Primary Outcome: Distance of endotracheal tube tip from the upper border of the arch of aorta on ultrasonography. Results: Endotracheal tube tip was visualised on ultrasonography within 0.5 - 1.0 cm distance from upper border of arch of aorta in 48 out of 53 neonates. This corresponded with the normal position of endotracheal tip in radiograph at T2 to T3. In 5 neonates, endotracheal tube tip was not visualized on ultrasonography and in all these newborns it was at higher level in radiograph. Conclusions: Distance of endotracheal tip to arch of aorta as measured on ultrasonography is helpful in early identification of the level of endotracheal tube tip.

Morphological Study on the Development of Medial Lamellar Unit in the Wall of Aorta and its Major Branches in Human Fetuses / 대한해부학회지

The structure of the arterial wall is formed and controlled by various hemodynamic factors in the adults and fetuses. Furthermore, recent studies of human fetuses at varying stages confirmed that the number of elastic medial lamellar unit (MLU) increased with age and decreased along it length from arch to lower abdominal aorta. Using human fetuses between 9 to 28 week of development, we traced the change in the number of MLU along the arch of aorta from which 3 major branches, the brachiocephalic trunk, left common carotid artery, left subclavian artery, arose. The number of MLU along the arch of aorta increased with age, but there were regional differences in the increase. Increase in the number of MLU was prominent in the proximal part of the arch before 15 week of development, but in the distal part after 15 week of development. Branch with greater diameter had more MLU. So the brachiocephalic trunk had the most MLU among 3 branches. When compare the sum of number of MLU in one branch (A) and in the arch after origin of branch (B) to the number of MLU in the arch before origin of brahch (C), A+B was always greater than C. This means that the MLU does not form a complete sheet along the aorta and new MLU is added to the wall of branch probably due to shear stress.