Pulmonary artery

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Pulmonary artery
Right ventricle Left ventricle Aortic valve Mitral valve Left atrium Right atrium Aorta Pulmonary valve Tricuspid valve Inferior vena cava Superior vena cava Pulmonary artery Pulmonary veinDiagram of the human heart (cropped).svg
About this image
Details
Precursor truncus arteriosus
System Cardiovascular, Respiratory
Source right ventricle
Identifiers
Latin arteria pulmonalis
MeSH A07.231.114.715
Dorlands
/Elsevier
t_20/12826098
FMA 45842
Anatomical terminology

A pulmonary artery is an artery in the pulmonary circulation that carries deoxygenated blood from the heart to the lungs. The largest pulmonary artery is the main pulmonary artery from the heart, and the smallest ones are located by the pulmonary alveoli.

Pulmonary arterial tree[edit]

3D rendering of a high resolution computed tomography of the thorax. The anterior thoracic wall, the airways and the pulmonary vessels anterior to the root of the lung have been digitally removed in order to visualize the different levels of the pulmonary circulation.

In order of blood flow, the pulmonary arteries start as the pulmonary trunk or main pulmonary artery. The main pulmonary artery begins at the base of the right ventricle. It is short and wide—approximately 5 centimetres (2.0 in) in length and 3 centimetres (1.2 in) in diameter.

The main pulmonary artery splits into the right and the left main pulmonary artery.[1] The left main pulmonary artery is shorter and somewhat smaller than the right, passes horizontally in front of the descending aorta and left bronchus to the root of the left lung. Above, the left main pulmonary artery is connected to the concavity of the proximal descending aorta by the ligamentum arteriosum.[2] Below, the left main pulmonary artery is joined to the upper left pulmonary vein by the ligament of the left vena cava. It divides into two lobar arteries, one for each lobe of the left lung. The right main pulmonary artery follows a longer and more horizontal course as it crosses the mediastinum. It passes underneath the aortic arch, behind the ascending aorta, and in front of the descending aorta. It courses posterior to the superior vena cava and in front of the right bronchus. Upon reaching the right pulmonary hila, the right main pulmonary artery divides into two branches:

  • truncus anterior — supplies blood to the right upper lobe.
  • interlobar artery — inferior and larger branch, supplies blood to the middle and inferior lobes of the lung.
At the far end, pulmonary arteries (labeled at bottom) become capillaries at the pulmonary alveoli.

The right and left main pulmonary artery give off branches that roughly correspond to the lung lobes, and can in such cases be termed lobar arteries. The lobar arteries branch into segmental arteries (roughly 1 for each lobe segment), which in turn branch into subsegmental pulmonary arteries.[3] These eventually form intralobular arteries.[4]

Embryology[edit]

The pulmonary arteries originate from the truncus arteriosus and the sixth pharyngeal arch. The truncus arteriosis is a structure that forms during the development of the heart as a successor to the conus arteriosus. [5]

By the third week of embryological life, the endocardial tubes have developed a swelling in the part closest to the heart. The swelling is known as the bulbus cordis and the upper part of this swelling develops into the truncus arteriosus [6] The structure is ultimately mesodermal in origin.[5] During development of the heart, the heart tissues undergo folding, and the truncus arteriosus is exposed to what will eventually be both the left and right ventricles. As a septum develops between the two ventricles of the heart, two bulges form on either side of the truncus arteriosus. These progressively enlarge until the trunk splits into the aorta and pulmonary arteries. [7]

During embryological life, the ductus arteriosis connects the pulmonary trunk and the aortic arch, allowing blood to bypass the lungs.[8]

Function[edit]

The pulmonary artery carries deoxygenated blood from the right ventricle to the lungs. The blood here passes through capillaries adjacent to alveoli and becomes oxygenated as part of the process of respiration.[citation needed]

In contrast to the pulmonary arteries, the bronchial arteries supply nutrition to the lungs themselves.[9]

The pulmonary artery pressure (PA pressure) is a measure of the blood pressure found in the main pulmonary artery. This is measured by inserting a catheter into the main pulmonary artery.[10] :190–191 The mean pressure is typically 9 - 18 mmHg,[11] and the wedge pressure measured in the left atrium may be 6-12mmHg. The wedge pressure may be elevated in left heart failure,[10]:190–191 mitral valve stenosis, and other conditions, such as sickle cell disease.[12]

Clinical significance[edit]

The pulmonary artery is relevant in a number of clinical states. Pulmonary hypertension is used to describe an increase in the pressure of the pulmonary artery, and may be defined as a mean pulmonary artery pressure of greater than 25mmHg.[10]:720 As can be measured on a CT scan, a diameter of more than 29 mm diameter is often used as a cut-off to indicate pulmonary hypertension.[13] This may occur as a result of heart problems such as heart failure, lung or airway disease such as COPD or scleroderma, or thromboembolic disease such as pulmonary embolism or emboli seen in sickle cell anaemia.[10]:720–721

Pulmonary embolism refers to an embolus that lodges in the pulmonary circulation. This may arise from a deep venous thrombosis, especially after a period of immobility. A pulmonary embolus is a common cause of death in patients with cancer and stroke.[10]:720–721 A large pulmonary embolus affecting the pulmonary trunk is called a saddle embolus.[citation needed]

Additional images[edit]

See also[edit]

References[edit]

  1. ^ "Pulmonary Vasculature". University of Virginia School of Medicine. 2013. Retrieved 2017-06-24. 
  2. ^ D. Cheitlin, Melvin; C. Ursell, Philip (2011). "Cardiac Anatomy". In Chatterjee, Kanu. Cardiology: An Illustrated Textbook. JP Medical Ltd. p. 6. ISBN 9789350252758. 
  3. ^ "Pulmonary Artery Anatomy". University of Virginia School of Medicine. 2013. Retrieved 2017-06-24. 
  4. ^ Takahashi M, Fukuoka J, Nitta N, Takazakura R, Nagatani Y, Murakami Y, Otani H, Murata K (2008). "Imaging of pulmonary emphysema: a pictorial review". Int J Chron Obstruct Pulmon Dis. 3 (2): 193–204. PMC 2629965Freely accessible. PMID 18686729. 
  5. ^ a b Larsen 2009, p. 157.
  6. ^ Larsen 2009, pp. 159-160.
  7. ^ Larsen 2009, pp. 176-179.
  8. ^ Braunwald, Eugene. Heart Disease: A Textbook of Cardiovascular Medicine (Fourth ed.). p. 791. 
  9. ^ Braunwald, Eugene. Heart Disease: A Textbook of Cardiovascular Medicine (4th ed.). p. 790. 
  10. ^ a b c d e edited by Nicki R. Colledge, Brian R. Walker, Stuart H. Ralston ; illustrated by Robert Britton (2010). Davidson's principles and practice of medicine. (21st ed.). Edinburgh: Churchill Livingstone/Elsevier. ISBN 978-0-7020-3084-0. 
  11. ^ Edwards Lifesciences LLC > Normal Hemodynamic Parameters – Adult 2009
  12. ^ Pashankar FD, Carbonella J, Bazzy-Asaad A, Friedman A (April 2008). "Prevalence and risk factors of elevated pulmonary artery pressures in children with sickle cell disease". Pediatrics. 121 (4): 777–82. PMID 18381543. doi:10.1542/peds.2007-0730. 
  13. ^ Prof Frank Gaillard; et al. "Pulmonary hypertension". Radiopaedia. Retrieved 2017-05-27. 
  • Schoenwolf ... [et al.], Gary C. (2009). Larsen's human embryology (4th ed., Thoroughly rev. and updated. ed.). Philadelphia: Churchill Livingstone/Elsevier. pp. "Development of the Urogenital system". ISBN 9780443068119. 

External links[edit]