title: Building foundations for transcatheter intervascular anastomoses: 3D anatomy of the great vessels in large experimental animals.
abstract: OBJECTIVE
  To provide comprehensive illustrations of anatomy of the relevant vessels in large experimental animals in an interactive format as preparation for developing an effective and safe transcatheter technique of aortopulmonary and bidirectional cavopulmonary intervascular anastomoses.
  
  
  METHODS
  Computed tomographic angiographic studies in two calves and two sheep were used to prepare 3D reconstructions of the aorta, pulmonary arteries, and caval and pulmonary veins. Based on these reconstructions, computer simulations of the creation of stent-enhanced aortopulmonary and bidirectional cavopulmonary anastomoses were made.
  
  
  RESULTS
  We observed the following major anatomical features: (i) caudal course of the main pulmonary artery and its branches with the proximal right pulmonary artery located immediately caudal to the aortic arch, and with the central left pulmonary artery lying at a substantial distance from the descending aorta; and (ii) the distal right pulmonary artery is located dorsal to the right atrium and inferior caval vein at a substantial distance from the superior caval vein. Animations showed creation of transcatheter analogues of Waterston's and Potts' aortopulmonary shunts through placement of a covered spool-shaped stent, and the transcatheter creation of bidirectional Glenn's cavopulmonary anastomosis, by placement of a long covered trumpet-shaped stent.
  
  
  CONCLUSIONS
  There are considerable differences in vascular anatomy between large experimental animals and humans. Given the need to elaborate new transcatheter techniques for intervascular anastomoses in suitable animal models before application to human, it is crucial to take these anatomical differences into account during testing and optimization of the proposed procedures.
authors.affiliation: Center for Congenital Heart Defects, UMC Groningen, Netherlands a.sizarov@umcg.nl.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Sizarov
authors.affiliation: Department of Anatomy, Embryology and Physiology, AMC Amsterdam, Netherlands.
authors.forename: Bernadette S
authors.initials: BS
authors.lastname: de Bakker
authors.affiliation: Musculoskeletal Research Unit, Vetsuisse Faculty, University of Zurich, Switzerland.
authors.forename: Karina
authors.initials: K
authors.lastname: Klein
authors.affiliation: Section of Diagnostic Imaging, Vetsuisse Faculty, University of Zurich, Switzerland.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Ohlerth
mesh_terms: D000367:Age Factors; D000818:Animals; D000831:Animals, Newborn; D001027:Aortography / Q000379:methods*; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D002417:Cattle; D003198:Computer Simulation; D018729:Fontan Procedure / Q000295:instrumentation / Q000379:methods*; D021621:Imaging, Three-Dimensional / Q000379:methods*; D008953:Models, Anatomic; D023421:Models, Animal; D008955:Models, Cardiovascular; D010690:Phlebography / Q000379:methods*; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011667:Pulmonary Veins / Q000000981:diagnostic imaging*; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000379:methods*; D012756:Sheep; D013045:Species Specificity; D015607:Stents; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging*; D014683:Vena Cava, Superior / Q000000981:diagnostic imaging*
keywords: Aortopulmonary shunt; Cavopulmonary anastomosis; Experimental animals; Stent; Vascular anatomy