Descending aorta to lower body (post-ductal)

Systemic & remnants · SaO2 ~55-60% Post-ductal

Below the ductal insertion the aorta carries a mixture dominated by ductal (right ventricular) blood and supplies the abdominal viscera, kidneys and lower limbs; the common iliac arteries then give the internal iliacs from which the umbilical arteries arise.

Traced from the start

  1. Placenta
  2. Umbilical vein
  3. Ductus venosusHepatic sinusoids (portal and umbilical mixing)
  4. Right atrium to right ventricle and pulmonary trunk
  5. Foramen ovale to left atrium and left ventricle
  6. Ductus arteriosusAscending aorta and arch (pre-ductal)
  7. Descending aorta to lower body (post-ductal)

Detail

Saturation
~55-60% (PO2 ~20-25 mmHg), post-ductal
Composition
Mostly ductus arteriosus flow plus the ~10% of combined output that crosses the isthmus from the arch
Destinations
Kidneys (only ~2-3% of output; urine is mainly for amniotic fluid), gut, lower limbs, and about two-thirds onward to the placenta
Post-ductal sampling
Foot pulse oximetry in the neonate reads this blood

When it goes wrong

Umbilical arterial catheter in the neonate

Threaded umbilical artery -> internal iliac -> aorta; tip placed high (T6-T9, above the coeliac axis) or low (L3-L4, below the renal arteries) to keep it away from mesenteric and renal origins; a dusky or blanched leg or buttock means spasm or embolus and the line comes out

Pre-ductal coarctation with the duct supplying the lower body

Post-ductal saturation below pre-ductal (differential cyanosis) until the duct closes, then absent femoral pulses, oliguria and cardiogenic shock

Practise this structure

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