Ligamentum arteriosum !
The ligamentum arteriosum is a short fibrous cord between the aortic arch and the pulmonary artery, the closed remnant of a fetal blood vessel.
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What it is
A short fibrous cord between the pulmonary trunk and the aortic arch: what remains of a fetal blood vessel.
What it does
No function after birth. If the fetal vessel stays open (patent ductus arteriosus), it may need closing.
Key facts
- Where
- Superior mediastinum; left recurrent laryngeal nerve hooks under aortic arch just lateral to it
- Attaches
- Origin of left pulmonary artery (pulmonary bifurcation) to underside of aortic arch
- Function
- Fibrous remnant of fetal ductus arteriosus; failure to close = patent ductus arteriosus
Relations
- Above
- Concave underside of the aortic arch, at the isthmus just beyond the origin of the left subclavian artery
- Below
- Start of the left pulmonary artery at the pulmonary bifurcation
- Lateral
- Left recurrent laryngeal nerve curving under the arch beside it, the left vagus nerve above, then the mediastinal pleura and left lung
- In front
- Superficial cardiac plexus (cardiac branches of the left vagus) and often a small lymph node, the node of the ligamentum arteriosum
- Behind
- Left main bronchus and the deep cardiac plexus, with the left recurrent laryngeal nerve curving up behind it
How to find it
Found at a left thoracotomy or in dissection in the concavity of the aortic arch: a short fibrous cord from the root of the left pulmonary artery to the underside of the arch. The left recurrent laryngeal nerve hooking under the arch right beside it is the guide, and the nerve is shown before the cord or a patent ductus is tied or clipped.
On imaging
Not seen as a cord on routine imaging; when it calcifies, CT shows a small calcified focus in the aortopulmonary window between the arch and the pulmonary artery. A patent ductus shows on echocardiography with colour Doppler as continuous flow into the pulmonary artery.
Clinical notes
- Patent ductus arteriosus: continuous machinery murmur below the left clavicle and bounding pulses; more common in premature infants and after congenital rubella
- In ductus-dependent heart defects the open ductus keeps the circulation going; prostaglandin E keeps it open, while indomethacin or ibuprofen helps close it in premature infants
- Ligation or clipping of a patent ductus can injure the left recurrent laryngeal nerve, so hoarseness after the operation is a known complication
Anatomical variants
Development
The ductus comes from the distal left 6th pharyngeal arch artery. At birth rising oxygen and falling prostaglandin levels close it within days, and it becomes a fibrous cord over the following weeks.
Related conditions
Test yourself
Think of the answer, then tap the question to see it.
What is the ligamentum arteriosum a remnant of, and what did that vessel do in the fetus?
The ductus arteriosus, which shunted blood from the pulmonary trunk to the aorta, bypassing the unexpanded lungs.
Which nerve hooks under the aortic arch beside the ligamentum arteriosum?
The left recurrent laryngeal nerve, which can be injured in ligation of a patent ductus, causing hoarseness.
What is the classic murmur of a patent ductus arteriosus?
A continuous machinery murmur below the left clavicle, with bounding pulses.
Where does the ligamentum arteriosum join the aorta, and why does this site matter clinically?
At the isthmus, just beyond the left subclavian artery: the usual site of coarctation and of traumatic aortic tears.
Educational information, not medical advice. For any symptom, see a health professional.
Its names
- Official Latin (TA2)
- ligamentum arteriosum TA2 4092
- Official Spanish (DeCS)
- Ligamento arterioso
- English (TA2)
- Ligamentum arteriosum
- Also called
- ligament of Botallo · Harvey's ligament
Related
Sources: Terminologia Anatomica (TA2); Anatomy, Thorax, Heart Great Vessels; Anatomy, Thorax, Mediastinum Superior and Great Vessels; Tratado de anatomía humana (9.ª ed.), tomo II, Libro IV, sección 2 Arterias, caps. I-III (sistema de la arteria pulmonar; aorta y ramas del cayado hasta la carótida interna).
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Representative model, for educational purposes only.
