Persistent truncus arteriosus
Template:DiseaseDisorder infobox
| Cardiology Network |
 Discuss Persistent truncus arteriosus further in the WikiDoc Cardiology Network |
| Adult Congenital |
|---|
| Biomarkers |
| Cardiac Rehabilitation |
| Congestive Heart Failure |
| CT Angiography |
| Echocardiography |
| Electrophysiology |
| Cardiology General |
| Genetics |
| Health Economics |
| Hypertension |
| Interventional Cardiology |
| MRI |
| Nuclear Cardiology |
| Peripheral Arterial Disease |
| Prevention |
| Public Policy |
| Pulmonary Embolism |
| Stable Angina |
| Valvular Heart Disease |
| Vascular Medicine |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-in-Chief: Keri Shafer, M.D. [2]
Please Join in Editing This Page and Apply to be an Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [3] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Overview
Persistent truncus arteriosus (or Truncus arteriosus) is a rare form of congenital heart disease that presents at birth. In this condition, the embryological structure known as the truncus arteriosus never properly divides into the pulmonary artery and aorta.
Classification
The most well-known classification was the fourfold system developed by Collett and Edwards in 1949.[1] Collett/Edwards Types I, II, and III are distinguished by the branching pattern of the pulmonary arteries:[2][3]
- Type I: truncus -> one pulmonary artery -> two lateral pulmonary arteries
- Type II: truncus -> two posterior/posterolateral pulmonary arteries
- Type III: truncus -> two lateral pulmonary arteries
The "Type IV" proposed in 1949 is no longer considered a form of PTA by most modern sources.[3]
Another well-known classification was defined by Van Praaghs in 1965.[4][3]
Causes
Most of the time, this defect occurs spontaneously. Genetic disorders, and teratogens (viruses, metabolic imbalance, and industrial or pharmacological agents) have been associated as possible causes. Up to 50% (varies in studies) of cases are associated with chromosome 22q11 deletions. The neural crest, specifically a population known as the cardiac neural crest, directly contributes to the aorticopulmonary septum.[5] [6]
Microablation of the cardiac neural crest in developing chick embryos and genetic anomalies affecting this population of cells in rodents results in persistent truncus arteriosus.[7] [8] [9]
Numerous perturbations affecting the cardiac neural crest have been associated with persistent truncus arteriosus, some of which include growth factors (fibroblast growth factor 8 and bone morphogenetic protein), transcription factors (T-box, Pax, Nkx2-5, GATA-6, and Forkhead), and gap junction proteins (Connexin). The cardiac neural crest also contributes the smooth muscle of the great arteries.
Anatomical changes
Anatomical changes associated with this disorder includes:
- single artery arising from the two ventricles which gives rise to both the aortic and pulmonary vessels
- abnormal truncal valve
- right sided aortic arch in about 30% of cases (not shown)
- large ventricular septal defect
- pulmonary hypertension
- complete mixing occurring at level of the great vessel
Clinical manifestations
- Cyanosis presents at birth
- Heart failure occurs within weeks
- Systolic ejection murmur is heard at the left sternal border
- Widened pulse pressure
- Bounding arterial pulses
- Loud second heart sound
- Biventricular hypertrophy
- Cardiomegaly
- Increased pulmonary vascularity
- Hypocalcemia (if associated with DiGeorge syndrome)
Diagnosis
Echocardiography
- Truncus Arteriosus Type I 1
<googlevideo>8970669383266720423&hl=en</googlevideo>
- Truncus Arteriosus Type I 2
<googlevideo>564681477766752717&hl=en</googlevideo>
- Truncus Arteriosus Type I 3
<googlevideo>564681477766752717&hl=en</googlevideo>
- Truncus Arteriosus Type I 4
<googlevideo>-3202146762215926147&hl=en</googlevideo>
- Truncus Arteriosus Type I 5
<googlevideo>5568593693292079875&hl=en</googlevideo>
- Truncus Arteriosus Type I 6
<googlevideo>-1383871098920679580&hl=en</googlevideo>
Treatment
Treatment is with neonatal surgical repair.[10] The ventricular septal defect is closed with a patch. The pulmonary arteries are then detached from the common artery (truncus arteriosus) and connected to the right ventricle using a tube (a conduit or tunnel).
References
- ↑ Collett RW, Edwards JE: Persistent truncus arteriosus: a classification according to anatomic types. Surg Clin North Am 1949; 29: 1245-70.
- ↑ "Persistent Truncus Arteriosus: Congenital Cardiovascular Anomalies: Merck Manual Professional". Retrieved 2007-11-04.
- ↑ 3.0 3.1 3.2 "eMedicine - Truncus Arteriosus : Article by Doff McElhinney, MD". Retrieved 2007-11-04.
- ↑ Van Praagh R, Van Praagh S (1965). "The anatomy of common aorticopulmonary trunk (truncus arteriosus communis) and its embryologic implications. A study of 57 necropsy cases". Am. J. Cardiol. 16 (3): 406–25. PMID 5828135.
- ↑ Kirby ML, Gale TF, and Stewart DE. (1983). "Neural crest cells contribute to normal aorticopulmonary septation". Science. 220 (4061): 1059–61. PMID 6844926.
- ↑ Jiang X, Rowitch DH, Soriano P, McMahon AP, Sucov HM.. (2000). "Fate of the mammalian cardiac neural crest...journal = Development". 127 (8): 1607–16. PMID 10725237.
- ↑ Hutson MR, Kirby ML.. (2003). "Neural crest and cardiovascular development: a 20-year perspective". Birth Defects Res C Embryo Today. 69 (1): 2–13. PMID 12768653.
- ↑ Waller BR 3rd, McQuinn T, Phelps AL, Markwald RR, Lo CW, Thompson RP, Wessels A. (2000). "Conotruncal anomalies in the trisomy 16 mouse: an immunohistochemical analysis with emphasis on the involvement of the neural crest". Anat. Rec. 260 (3): 279–93. PMID 11066038.
- ↑ Franz T. (1989). "Persistent truncus arteriosus in the Splotch mutant mouse". Anat. Embryol. (Berlin). 180 (5): 457–64. PMID 2619088.
- ↑ Rodefeld M, Hanley F. "Neonatal truncus arteriosus repair: surgical techniques and clinical management". Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 5: 212–7. PMID 11994881.
External links
- Truncus Arteriosus Cincinnati Children's Medical Center
- Truncus Arteriosus information from Seattle Children's Hospital Heart Center
- Template:Chorus
- Diagram at kumc.edu
- Diagram at lpch.org
- surgical repair, at wustl.edu
- Overview at University of Michigan
