The Great Vessels and the Pericardium

Abstract

Knowledge of the origin and course of the great vessels is a prerequisite to the comprehension of the details of the pericardial reflections. In turn, the understanding of the aorta and pulmonary trunk and arteries is dependent upon the knowledge of the spatial disposition of the trachea and proximal bronchi. The relationship of the airway to the major pulmonary vessels has great clinical implications in the pathogenesis and diagnosis of cardiac disease. As an example of the former, in children, the bronchi are small in caliber and their cartilage not fully developed. The left upper lobe bronchus is between the left main pulmonary artery and the left superior pulmonary vein. The artery is both superior and posterior; the vein is anterior to the bronchus. In addition, not infrequently, a large branch of the pulmonary artery is located between the left superior pulmonary vein and the bronchus. In the presence of large left to right shunts in infants, the pulmonary artery is dilated and under increased pressure, as may be the pulmonary veins when left ventricular failure exists. The left upper lobe bronchus may be compressed—atelectasis results. Compressive vascular forces may be exerted on the left main bronchus itself; its relationships will be noted in this regard.