Type:
Educational Exhibit
Keywords:
Education and training, Catheters, Conventional radiography, Catheter venography, Catheter arteriography, Vascular, Paediatric
Authors:
S. L. Barrero Varon1, E. R. Amador González2, M. Rodríguez Eiriz2, R. Grau Sola2; 1Palma. Mallorca. Illes Balears/ES, 2Palma De Mallorca/ES
DOI:
10.1594/ecr2018/C-1462
Background
The technological advances and evolution of pediatric intensive care have led to a greater survival in preterm patients.
To care for these patients it is necessary to use catheters and other devices that sometimes give complications.
Umbilical catheters (arterial and venous),
as well as endotracheal and nasogastric tubes are routinely used in the Neonatal Intensive Care Unit (NICU).
For this reason,
it is essential that the radiologist and pediatrician know the correct position of these devices,
and know how to determine it by means of radiological studies in order to detect early malposition that may lead to complications,
and even fatal ones.
For this evaluation,
a detailed knowledge of the vascular anatomy during the fetal and neonatal period is essential.
FETAL AND NEONATAL VASCULAR ANATOMY
During the fetal period the lungs are collapsed,
filled with amniotic fluid that impedes gas exchange.
Thus,
at this period of life the placenta oxygenates the blood,
with communications between the right and left heart allowing for this exchange which,
under normal conditions,
usually closes after birth.
The fetal blood circuit is as follows ( Fig. 2 ):
- Oxygenated blood from the placenta travels through the umbilical vein (UV).
- From the UV,
it passes through the left portal vein (LPV) to the venous ductus (VD) and from there to the inferior vena cava (IVC).
- From the IVC it reaches the right atrium (RA).
- From RA,
most of the blood passes into the left atrium (LA) through the foramen ovale (FO) as there is very resistance in the pulmonary circuit and right ventricle.
- A small amount of blood passes from the RA to the RV and into the pulmonary arteries,
from where it returns to the aorta through the ductus arteriosus (DA).
- As previously mentioned most of the blood passes from the RA to the LA,
from where it passes to the left ventricle (LV) and the ascending aorta (Ao).
- The Ao bifurcates into the common iliac arteries whose branches (Internal iliac arteries) give rise to the umbilical arteries (UA),
which are directed towards the placenta,
closing the circle.
- The superior vena cava (SVC) and the inferior vena cava (IVC) also return deoxygenated blood to the RA