Aorta

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Aorta
Aorta segments.svg
Schematic view of the aorta and its segments
Aorta branches.svg
Branches of the aorta
Details
Pronunciation /ˈɔːrtə/
Precursor Truncus arteriosus, fourth left branchial artery, paired dorsal aortae (combine into the single descending aorta)
Source Left ventricle
BranchesAscending aorta:
Right and left coronary arteries

Arch of aorta (supra-aortic vessels):

Brachiocephalic trunk
Left common carotid artery
Left subclavian artery

Descending aorta, thoracic part:

Left bronchial arteries
Esophageal arteries to the thoracic part of the esophagus
Third to eleventh posterior intercostal arteries and the subcostal arteries

Descending aorta, abdominal part:

Parietal branches:
Inferior phrenic arteries
Lumbar arteries
Median sacral artery
Visceral branches:
Celiac trunk
Middle suprarenal arteries
Superior mesenteric artery
Renal arteries
Gonadal arteries (testicular in males, ovarian in females)
Inferior mesenteric artery

Terminal branches:

Common iliac arteries
Median sacral artery
Vein Combination of coronary sinus, superior vena cava and inferior vena cava
SuppliesThe systemic circulation
(entire body with exception of the respiratory zone of the lung which is supplied by the pulmonary circulation)
Identifiers
Latin Aorta, arteria maxima
MeSH D001011
TA98 A12.2.02.001
TA2 4175
FMA 3734
Anatomical terminology

The aorta ( /ˈɔːrtə/ ay-OR-tə) is the main and largest artery in the human body, originating from the left ventricle of the heart and extending down to the abdomen, where it splits into two smaller arteries (the common iliac arteries). The aorta distributes oxygenated blood to all parts of the body through the systemic circulation. [1]

Contents

Structure

Sections

Course of the aorta in the thorax (anterior view), starting posterior to the main pulmonary artery, then anterior to the right pulmonary arteries, the trachea and the esophagus, then turning posteriorly to course dorsally to these structures. Relations of the aorta, trachea, esophagus and other heart structures.png
Course of the aorta in the thorax (anterior view), starting posterior to the main pulmonary artery, then anterior to the right pulmonary arteries, the trachea and the esophagus, then turning posteriorly to course dorsally to these structures.

In anatomical sources, the aorta is usually divided into sections. [2] [3] [4] [5]

One way of classifying a part of the aorta is by anatomical compartment, where the thoracic aorta (or thoracic portion of the aorta) runs from the heart to the diaphragm. The aorta then continues downward as the abdominal aorta (or abdominal portion of the aorta) from the diaphragm to the aortic bifurcation.

Another system divides the aorta with respect to its course and the direction of blood flow. In this system, the aorta starts as the ascending aorta, travels superiorly from the heart, and then makes a hairpin turn known as the aortic arch. Following the aortic arch, the aorta then travels inferiorly as the descending aorta. The descending aorta has two parts. The aorta begins to descend in the thoracic cavity and is consequently known as the thoracic aorta. After the aorta passes through the diaphragm, it is known as the abdominal aorta. The aorta ends by dividing into two major blood vessels, the common iliac arteries and a smaller midline vessel, the median sacral artery. [6] :18

Ascending aorta

The ascending aorta begins at the opening of the aortic valve in the left ventricle of the heart. It runs through a common pericardial sheath with the pulmonary trunk. These two blood vessels twist around each other, causing the aorta to start out posterior to the pulmonary trunk, but end by twisting to its right and anterior side. [7] :191,204 The transition from ascending aorta to aortic arch is at the pericardial reflection on the aorta. [8] :Plate 211

At the root of the ascending aorta, the lumen has three small pockets between the cusps of the aortic valve and the wall of the aorta, which are called the aortic sinuses or the sinuses of Valsalva. The left aortic sinus contains the origin of the left coronary artery and the right aortic sinus likewise gives rise to the right coronary artery. Together, these two arteries supply the heart. The posterior aortic sinus does not give rise to a coronary artery. For this reason the left, right and posterior aortic sinuses are also called left-coronary, right-coronary and non-coronary sinuses. [7] :191

Aortic arch

The aortic arch loops over the left pulmonary artery and the bifurcation of the pulmonary trunk, to which it remains connected by the ligamentum arteriosum, a remnant of the fetal circulation that is obliterated a few days after birth. In addition to these blood vessels, the aortic arch crosses the left main bronchus. Between the aortic arch and the pulmonary trunk is a network of autonomic nerve fibers, the cardiac plexus or aortic plexus. The left vagus nerve, which passes anterior to the aortic arch, gives off a major branch, the recurrent laryngeal nerve, which loops under the aortic arch just lateral to the ligamentum arteriosum. It then runs back to the neck.

The aortic arch has three major branches: from proximal to distal, they are the brachiocephalic trunk, the left common carotid artery, and the left subclavian artery. The brachiocephalic trunk supplies the right side of the head and neck as well as the right arm and chest wall, while the latter two together supply the left side of the same regions.

The aortic arch ends, and the descending aorta begins at the level of the intervertebral disc between the fourth and fifth thoracic vertebrae. [7] :209

Thoracic aorta

The thoracic descending aorta gives rise to the intercostal and subcostal arteries, as well as to the superior and inferior left bronchial arteries and variable branches to the esophagus, mediastinum, and pericardium. Its lowest pair of branches are the superior phrenic arteries, which supply the diaphragm, and the subcostal arteries for the twelfth rib. [9] :195

Abdominal aorta

The abdominal aorta begins at the aortic hiatus of the diaphragm at the level of the twelfth thoracic vertebra. [10] It gives rise to lumbar and musculophrenic arteries, renal and middle suprarenal arteries, and visceral arteries (the celiac trunk, the superior mesenteric artery and the inferior mesenteric artery). It ends in a bifurcation into the left and right common iliac arteries. At the point of the bifurcation, there also springs a smaller branch, the median sacral artery. [9] :331

Development

The ascending aorta develops from the outflow tract, which initially starts as a single tube connecting the heart with the aortic arches (which will form the great arteries) in early development but is then separated into the aorta and the pulmonary trunk.

The aortic arches start as five pairs of symmetrical arteries connecting the heart with the dorsal aorta, and then undergo a significant remodelling [11] to form the final asymmetrical structure of the great arteries, with the 3rd pair of arteries contributing to the common carotids, the right 4th forming the base and middle part of the right subclavian artery and the left 4th being the central part of the aortic arch. The smooth muscle of the great arteries and the population of cells that form the aorticopulmonary septum that separates the aorta and pulmonary artery is derived from cardiac neural crest. This contribution of the neural crest to the great artery smooth muscle is unusual as most smooth muscle is derived from mesoderm. In fact the smooth muscle within the abdominal aorta is derived from mesoderm, and the coronary arteries, which arise just above the semilunar valves, possess smooth muscle of mesodermal origin. A failure of the aorticopulmonary septum to divide the great vessels results in persistent truncus arteriosus.

Microanatomy

A pig's aorta cut open, also showing some branching arteries. An opened aorta.jpg
A pig's aorta cut open, also showing some branching arteries.

The aorta is an elastic artery, and as such is quite distensible. The aorta consists of a heterogeneous mixture of smooth muscle, nerves, intimal cells, endothelial cells, fibroblast-like cells, and a complex extracellular matrix. The vascular wall consists of several layers known as the tunica externa, tunica media, and tunica intima. The thickness of the aorta requires an extensive network of tiny blood vessels called vasa vasorum, which feed the tunica externa and tunica media outer layers of the aorta. [12] The aortic arch contains baroreceptors and chemoreceptors that relay information concerning blood pressure and blood pH and carbon dioxide levels to the medulla oblongata of the brain. This information is processed by the brain and the autonomic nervous system mediates the homeostatic responses.

Within the tunica media, smooth muscle and the extracellular matrix are quantitatively the largest components of the aortic vascular wall. The fundamental unit of the aorta is the elastic lamella, which consists of smooth muscle and elastic matrix. The medial layer of the aorta consist of concentric musculoelastic layers (the elastic lamella) in mammals. The smooth muscle component does not dramatically alter the diameter of the aorta but rather serves to increase the stiffness and viscoelasticity of the aortic wall when activated. The elastic matrix dominates the biomechanical properties of the aorta. The elastic matrix forms lamellae, consisting of elastic fibers, collagens (predominately type III), proteoglycans, and glycoaminoglycans. [13]

Variation

Variations may occur in the location of the aorta, and the way in which arteries branch off the aorta. The aorta, normally on the left side of the body, may be found on the right in dextrocardia, in which the heart is found on the right, or situs inversus, in which the location of all organs are flipped. [9] :188

Variations in the branching of individual arteries may also occur. For example, the left vertebral artery may arise from the aorta, instead of the left common carotid artery. [9] :188

In patent ductus arteriosus, a congenital disorder, the fetal ductus arteriosus fails to close, leaving an open vessel connecting the pulmonary artery to the proximal descending aorta. [14]

Function

Major aorta anatomy displaying ascending aorta, brachiocephalic trunk, left common carotid artery, left subclavian artery, aortic isthmus, aortic arch, and descending thoracic aorta Aorta Anatomy.jpg
Major aorta anatomy displaying ascending aorta, brachiocephalic trunk, left common carotid artery, left subclavian artery, aortic isthmus, aortic arch, and descending thoracic aorta

The aorta supplies all of the systemic circulation, which means that the entire body, except for the respiratory zone of the lung, receives its blood from the aorta. Broadly speaking, branches from the ascending aorta supply the heart; branches from the aortic arch supply the head, neck, and arms; branches from the thoracic descending aorta supply the chest (excluding the heart and the respiratory zone of the lung); and branches from the abdominal aorta supply the abdomen. The pelvis and legs get their blood from the common iliac arteries.

Blood flow and velocity

The pulsatile nature of blood flow creates a pulse wave that is propagated down the arterial tree, and at bifurcations reflected waves rebound to return to semilunar valves and the origin of the aorta. These return waves create the dicrotic notch displayed in the aortic pressure curve during the cardiac cycle as these reflected waves push on the aortic semilunar valve. [15] With age, the aorta stiffens such that the pulse wave is propagated faster and reflected waves return to the heart faster before the semilunar valve closes, which raises the blood pressure. The stiffness of the aorta is associated with a number of diseases and pathologies, and noninvasive measures of the pulse wave velocity are an independent indicator of hypertension. Measuring the pulse wave velocity (invasively and non-invasively) is a means of determining arterial stiffness. Maximum aortic velocity may be noted as Vmax or less commonly as AoVmax.

Mean arterial pressure (MAP) is highest in the aorta, and the MAP decreases across the circulation from aorta to arteries to arterioles to capillaries to veins back to atrium. The difference between aortic and right atrial pressure accounts for blood flow in the circulation. [16] When the left ventricle contracts to force blood into the aorta, the aorta expands. This stretching gives the potential energy that will help maintain blood pressure during diastole, as during this time the aorta contracts passively. This Windkessel effect of the great elastic arteries has important biomechanical implications. The elastic recoil helps conserve the energy from the pumping heart and smooth out the pulsatile nature created by the heart. Aortic pressure is highest at the aorta and becomes less pulsatile and lower pressure as blood vessels divide into arteries, arterioles, and capillaries such that flow is slow and smooth for gases and nutrient exchange.

Clinical significance

Other animals

All amniotes have a broadly similar arrangement to that of humans, albeit with a number of individual variations. In fish, however, there are two separate vessels referred to as aortas. The ventral aorta carries de-oxygenated blood from the heart to the gills; part of this vessel forms the ascending aorta in tetrapods (the remainder forms the pulmonary artery). A second, dorsal aorta carries oxygenated blood from the gills to the rest of the body and is homologous with the descending aorta of tetrapods. The two aortas are connected by a number of vessels, one passing through each of the gills. Amphibians also retain the fifth connecting vessel, so that the aorta has two parallel arches. [19]

History

The word aorta stems from the Late Latin aorta from Classical Greek aortē (ἀορτή), from aeirō, "I lift, raise" (ἀείρω) [20] This term was first applied by Aristotle when describing the aorta and describes accurately how it seems to be "suspended" above the heart. [21]

The function of the aorta is documented in the Talmud, where it is noted as one of three major vessels entering or leaving the heart, and where perforation is linked to death. [22]

Related Research Articles

Artery Blood vessels that carry blood away from the heart

An artery is a blood vessel in humans and most other animals that takes blood away from the heart to one or more parts of the body. Most arteries carry oxygenated blood; the two exceptions are the pulmonary and the umbilical arteries, which carry deoxygenated blood to the organs that oxygenate it. The effective arterial blood volume is that extracellular fluid which fills the arterial system.

Heart Organ found inside most animals

The heart is a muscular organ in most animals that pumps blood through the blood vessels of the circulatory system. The pumped blood carries oxygen and nutrients to the body, while carrying metabolic waste such as carbon dioxide to the lungs. In humans, the heart is approximately the size of a closed fist and is located between the lungs, in the middle compartment of the chest.

Circulatory system Organ system for circulating blood in animals

The blood circulatory system, is a system of organs that includes the heart, blood vessels, and blood which is circulated throughout the entire body of a human or other vertebrate. It includes the cardiovascular system, or vascular system, that consists of the heart and blood vessels. The circulatory system has two divisions, a systemic circulation or circuit, and a pulmonary circulation or circuit. Some sources use the terms cardiovascular system and vascular system interchangeably with the circulatory system.

Coronary circulation

Coronary circulation is the circulation of blood in the blood vessels that supply the heart muscle (myocardium). Coronary arteries supply oxygenated blood to the heart muscle. Cardiac veins then drain away the blood after it has been deoxygenated. Because the rest of the body, and most especially the brain, needs a steady supply of oxygenated blood that is free of all but the slightest interruptions, the heart is required to function continuously. Therefore its circulation is of major importance not only to its own tissues but to the entire body and even the level of consciousness of the brain from moment to moment. Interruptions of coronary circulation quickly cause heart attacks, in which the heart muscle is damaged by oxygen starvation. Such interruptions are usually caused by coronary ischemia linked to coronary artery disease, and sometimes to embolism from other causes like obstruction in blood flow through vessels.

Heart valve A flap of tissue that prevent backflow of blood around the heart

A heart valve is a one-way valve that allows blood to flow in one direction through the chambers of the heart. Four valves are usually present in a mammalian heart and together they determine the pathway of blood flow through the heart. A heart valve opens or closes according to differential blood pressure on each side.

Aortic valve Valve in the human heart between the left ventricle and the aorta

The aortic valve is a valve in the heart of humans and most other animals, located between the left ventricle and the aorta. It is one of the four valves of the heart and one of the two semilunar valves, the other being the pulmonary valve. The aortic valve normally has three cusps or leaflets, although in 1–2% of the population it is found to congenitally have two leaflets. The aortic valve is the last structure in the heart the blood travels through before stopping the flow through the systemic circulation.

Subclavian artery Major arteries of the upper thorax, below the clavicle

In human anatomy, the subclavian arteries are paired major arteries of the upper thorax, below the clavicle. They receive blood from the aortic arch. The left subclavian artery supplies blood to the left arm and the right subclavian artery supplies blood to the right arm, with some branches supplying the head and thorax. On the left side of the body, the subclavian comes directly off the aortic arch, while on the right side it arises from the relatively short brachiocephalic artery when it bifurcates into the subclavian and the right common carotid artery.

Thoracic duct

In human anatomy, the thoracic duct is the larger of the two lymph ducts of the lymphatic system. It is also known as the left lymphatic duct, alimentary duct, chyliferous duct, and Van Hoorne's canal. The other duct is the right lymphatic duct. The thoracic duct carries chyle, a liquid containing both lymph and emulsified fats, rather than pure lymph. It also collects most of the lymph in the body other than from the right thorax, arm, head, and neck. The thoracic duct usually starts from the level of the twelfth thoracic vertebra (T12) and extends to the root of the neck. It drains into the systemic (blood) circulation at the junction of the left subclavian and internal jugular veins, at the commencement of the brachiocephalic vein.

Pulmonary artery Artery in the pulmonary circulation that carries deoxygenated blood from the heart to the lungs

A pulmonary artery is an artery in the pulmonary circulation that carries deoxygenated blood from the right side of the heart to the lungs. The largest pulmonary artery is the main pulmonary artery or pulmonary trunk from the heart, and the smallest ones are the arterioles, which lead to the capillaries that surround the pulmonary alveoli.

Descending aorta

The descending aorta is part of the aorta, the largest artery in the body. The descending aorta begins at the aortic arch and runs down through the chest and abdomen. The descending aorta anatomically consists of two portions or segments, the thoracic and the abdominal aorta, in correspondence with the two great cavities of the trunk in which it is situated. Within the abdomen, the descending aorta branches into the two common iliac arteries which serve the pelvis and eventually legs.

Persistent truncus arteriosus Medical condition

Persistent truncus arteriosus (PTA), often referred to simply as truncus arteriosus, is a rare form of congenital heart disease that presents at birth. In this condition, the embryological structure known as the truncus arteriosus fails to properly divide into the pulmonary trunk and aorta. This results in one arterial trunk arising from the heart and providing mixed blood to the coronary arteries, pulmonary arteries, and systemic circulation. For the International Classification of Diseases (ICD-11), the International Paediatric and Congenital Cardiac Code (IPCCC) was developed to standardize the nomenclature of congenital heart disease. Under this system, English is now the official language, and persistent truncus arteriosus should properly be termed common arterial trunk.

Descending thoracic aorta

The descending thoracic aorta is a part of the aorta located in the thorax. It is the third and last part of the thoracic aorta and is a continuation of the aortic arch. It is located within the posterior mediastinal cavity, but frequently bulges into the left pleural cavity. The descending thoracic aorta begins at the lower border of the fourth thoracic vertebra and ends in front of the lower border of the twelfth thoracic vertebra, at the aortic hiatus in the diaphragm where it becomes the abdominal aorta.

Aortic arch

The aortic arch, arch of the aorta, or transverse aortic arch is the part of the aorta between the ascending and descending aorta. The arch travels backward, so that it ultimately runs to the left of the trachea.

Ascending aorta Part of the heart

The ascending aorta (AAo) is a portion of the aorta commencing at the upper part of the base of the left ventricle, on a level with the lower border of the third costal cartilage behind the left half of the sternum.

Intercostal arteries Arteries supplying the space between the ribs

The intercostal arteries are a group of arteries that supply the area between the ribs ("costae"), called the intercostal space. The highest intercostal artery is an artery in the human body that usually gives rise to the first and second posterior intercostal arteries, which supply blood to their corresponding intercostal space. It usually arises from the costocervical trunk, which is a branch of the subclavian artery. Some anatomists may contend that there is no supreme intercostal artery, only a supreme intercostal vein.

Interrupted aortic arch is a very rare heart defect in which the aorta is not completely developed. There is a gap between the ascending and descending thoracic aorta. In a sense it is the complete form of a coarctation of the aorta. Almost all patients also have other cardiac anomalies, including a ventricular septal defect (VSD), aorto-pulmonary window, and truncus arteriosus. There are three types of interrupted aortic arch, with type B being the most common. Interrupted aortic arch is often associated with DiGeorge syndrome.

Truncus arteriosus

The truncus arteriosus is a structure that is present during embryonic development. It is an arterial trunk that originates from both ventricles of the heart that later divides into the aorta and the pulmonary trunk.

Coronary artery anomalies are variations of the coronary circulation, affecting <1% of the general population. Symptoms include chest pain, shortness of breath and syncope, although cardiac arrest may be the first clinical presentation. Several varieties are identified, with a different potential to cause sudden cardiac death.

Outline of human anatomy Overview of and topical guide to human anatomy

The following outline is provided as an overview of and topical guide to human anatomy:

The heart is a muscular organ situated in the mediastinum. It consists of four chambers, four valves, two main arteries, and the conduction system. The left and right sides of the heart have different functions: the right side receives de-oxygenated blood through the superior and inferior venae cavae and pumps blood to the lungs through the pulmonary artery, and the left side receives saturated blood from the lungs.

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