Truncus arteriosus l.jpg
This presentation is the property of its rightful owner.
Sponsored Links
1 / 18

Truncus Arteriosus PowerPoint PPT Presentation


  • 1543 Views
  • Uploaded on
  • Presentation posted in: General

Truncus Arteriosus. Seoul National University Hospital Department of Thoracic & Cardiovascular Surgery. Truncus Arteriosus. 1. Definition Congenital cardiac malformation in which one great artery, arising from the base of heart by way of a single semilunar(truncal) valve,

Download Presentation

Truncus Arteriosus

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Truncus arteriosus l.jpg

Truncus Arteriosus

Seoul National University Hospital

Department of Thoracic & Cardiovascular Surgery


Truncus arteriosus2 l.jpg

Truncus Arteriosus

  • 1. Definition

  • Congenital cardiac malformation in which one great artery, arising

  • from the base of heart by way of a single semilunar(truncal) valve,

  • gives originof coronary, systemic , and one or two pulmonary

  • arteries proximal to the origin of the brachiocephalic branches.

  • Beneath the truncal valve, there is a VSD.

  • 2. History

  • Wilson : 1st description in 1798

  • Buchanan : Clinical & autopsy report in 1864

  • Collett & Edwards : Classification in 1949

  • Van Praagh : Alternative classification in 1965

  • McGoon : 1st repair with homograft in 1967


Truncus arteriosus3 l.jpg

Truncus Arteriosus

  • Pathophysiology

  • A single common artery, or truncus , overlying the ventricular septum and a nonrestrictive VSD gives rise to the coronary arteries, pulmonary arteries, and ascending aorta.

  • Complete mixing of systemic and pulmonary venous return at the VSD and truncal valve level results in moderate cyanosis.

  • As the pulmonary vascular resistance decreases after birth, significant left-to-right shunting at the truncal valve level leads to excessive pulmonary blood flow, pulmonary hypertension, and congestive heart failure.


Truncus arteriosus4 l.jpg

Truncus Arteriosus

  • Morphogenesis

  • Truncus arteriosus is called also as persistent truncus arteriosus, truncus arteriosus communis, common aorticopulmonary trunk

  • Chromosomal 22q11 deletion is present in a substantial number of patients with conotruncal abnormalities ( about one third with truncus arteriosus)

  • Many of these have additional characteristic features of DiGeorge syndrome, velocardiofacial syndrome, or conotruncal face syndrome

  • As such, their natural history may be complicated by hypocalcemia, palatal abnormalities, learning disability, or other noncardiac problems.


Morphology of truncus arteriosus l.jpg

1. Truncal artery

2. Pulmonary arteries

Type I, II : 80~90%

III, IV : 5~10%

Hemitruncus : 2%

Stenosis of origin : 10%

3. Aorta & ductus arteriosus

Wide PDA : Arch hypoplasia,

IAA or CoA(10~15%)

No PDA : majority

4. Coronary arteries

5. Semilunar valve

Tricuspid (1/2~2/3), quadricuspid,

bicuspid (5%)

Myxomatous thickening (1/3)

Truncal stenosis (20%)

6. VSD (juxtatruncal)

7. RV (absent conal septum)

8. Left ventricle ; normal

9. Associated anomalies

IAA or CoA with PDA : 10~15%

RAA : 25~35%

Anomalous branch : 10%

LSVC : 10%

ASD : 10%

DiGeorge synd. AV discordance,

situs inversus, heterotaxia,

DILV, MS, AV-canal,

tricuspid stenosis

Morphology of Truncus Arteriosus


Classification of truncus arteriosus l.jpg

Classification of Truncus Arteriosus

(Collett & Edwards)


Types of truncus arteriosus l.jpg

Types of Truncus Arteriosus


Pathology of truncus arteriosus l.jpg

Pathology of Truncus Arteriosus


Types of truncus arteriosus9 l.jpg

Types of Truncus Arteriosus


Truncus arteriosus10 l.jpg

Truncus Arteriosus

Truncal valve

VSD


Clinical features diagnosis l.jpg

Clinical Features & Diagnosis

  • 1. Symptoms

  • tachypnea, tachycardia, irritability, mild cyanosis

  • 2. Physical examination

  • signs of CHF, overactive heart

  • truncal insufficiency (systolic & diastolic murmur)

  • stenosis of PA (continuous murmur)

  • 3. Chest radiography

  • marked cardiomegaly as well as plethora

  • 4. EKG

  • RAD, biventricular hypertrophy

  • 5. Echocardiography

  • 6. Cardiac catheterization & cineangiography


Truncus arteriosus12 l.jpg

Truncus Arteriosus

  • Natural History

  • 1. Incidence

  • rare, unfavorable natural history

  • 1.7% to 2.8% of CHD

  • 2. Survival

  • 50% survival in 1 month

  • 18% survival in 6 months

  • 12% survival in 1 year

  • Others : Eisenmenger syndrome (death in 3rd decade)

  • 3. Modes of death

  • . Congestive heart failure in early life

  • . SBE, cerebral abscess, pulmonary vascular disease

  • . Survival is favorably affected by PS


Operative techniques l.jpg

Operative Techniques

  • 1. Repair with allograft valved conduit

  • 2. Repair truncus I,II with autologous tissue

  • Barbero-Marcial technique

  • 3. Repair of hemitruncus

  • Unifocalization of pulmonary artery

  • 4. Repair of truncus arteriosus with IAA


Operative indications l.jpg

Operative Indications

  • 1. Diagnosis of truncus is an indication for it’s repair;

  • because about 50% of surgically untreated patients

  • die in the 1st month of life.

  • 2. Repair should be recommended as early in life

  • as possible rather than deferring to some

  • predetermined age

  • 3. Importantly elevated PVR is a contraindication

  • in old infant (more than 6~12 months old).


Operative technique 1 l.jpg

Operative Technique (1)


Operative technique 2 l.jpg

Operative Technique (2)


Truncal valve remodeling technique l.jpg

Truncal Valve Remodeling Technique

  • Diagrams shows truncal valve repair by leaflet excision

  • and annular remodeling, usually there is one leaflet

  • that is grossly prolapsed


Surgical results of truncus arteriosus l.jpg

Surgical Results of Truncus Arteriosus

  • 1. Survival

  • Early death

  • Time-related survival

  • 2. Modes of death

  • 3. Incremental risk factors for premature death

  • 1) Age at repair 2) Functional class

  • 3) Type 4) Size of VSD

  • 5) Predominance of origin of truncal artery

  • 6) Small size of pulmonary arteries

  • 7) Truncal valve abnormalities

  • 8) Hemitruncus

  • 9) Major associated cardiac anomalies

  • 10) Pulmonary vascular disease

  • 4. Progressing truncal valve incompetence

  • 5. Conduit reoperation


  • Login