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    Truncus Arteriosus

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    kemalahmad
    Truncus arteriosus is a congenital heart defect where a single arterial trunk arises from the heart and gives rise to the pulmonary, systemic, and coronary circulations. It is usually associated with a ventricular septal defect. There are three types depending on where the pulmonary arteries arise from the trunk. Surgical repair is usually done in infancy to separate the pulmonary and systemic circulations and close the ventricular septal defect.

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    Truncus Arteriosus

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    kemalahmad
    155 views4 pages
    Truncus arteriosus is a congenital heart defect where a single arterial trunk arises from the heart and gives rise to the pulmonary, systemic, and coronary circulations. It is usually associated with a ventricular septal defect. There are three types depending on where the pulmonary arteries arise from the trunk. Surgical repair is usually done in infancy to separate the pulmonary and systemic circulations and close the ventricular septal defect.

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    trunkus arteriosus pada anak

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    Truncus-Arteriosus

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    Truncus arteriosus is a congenital heart defect where a single arterial trunk arises from the heart and gives rise to the pulmonary, systemic, and coronary circulations. It is usually associated with a ventricular septal defect. There are three types depending on where the pulmonary arteries arise from the trunk. Surgical repair is usually done in infancy to separate the pulmonary and systemic circulations and close the ventricular septal defect.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    155 views4 pages

    Truncus Arteriosus

    Uploaded by

    kemalahmad
    Truncus arteriosus is a congenital heart defect where a single arterial trunk arises from the heart and gives rise to the pulmonary, systemic, and coronary circulations. It is usually associated with a ventricular septal defect. There are three types depending on where the pulmonary arteries arise from the trunk. Surgical repair is usually done in infancy to separate the pulmonary and systemic circulations and close the ventricular septal defect.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 4

    Truncus Arteriosus

    Sandra Staveski RN, MS, CPNP-AC/PC, CNS, CCRN


    Cardiovascular ICU Nurse Practitioner
    Lucile Packard Childrens Hospital at Stanford
    Palo Alto, California

    I. Embryology
    A. During embryonic life, the truncus arteriosus normally begins to separate and
    spiral into a pulmonary artery and aorta
    B. Neural crest cells develops into the pharyngeal pouches (thymus and
    parathyroid glands) this association could explain the prevalence of DiGeorge
    syndrome (micro deletion of chromosome 22 q 11)
    II. Anatomy
    A. Single arterial trunk
    1. Arises from the base of the heart (As indicated by #1 in Illustration below)
    2. Gives rise to pulmonary, systemic, and coronary circulations
    B. Ventricular septal defect (VSD) (As indicated by #3 in Illustration below)
    C. Single semilunar valve (As indicated by #2 in Illustration below)

    Truncus Arteriosus Type I

    Illustrations reprinted from PedHeart Resource.


    Scientific Software Solutions, 2010. All rights reserved

    D. Three types of truncus arteriosus


    1. Type I: Pulmonary trunk arises from truncus (As illustrated above)
    2. Type II: Right pulmonary artery (RPA) and left pulmonary artery (LPA)
    arise separately but close to one another from the left posterolateral aspect of
    the truncus
    3. Type III: Pulmonary arteries each arise from respective lateral aspects of the
    truncus
    C. Associated conditions
    1. Skeletal deformities
    2. Hydroureter
    3. Bowel malrotation
    4. DiGeorge Syndrome
    a. Hypoglycemia
    b. Thymic dysfunction
    c. Mental retardation
    III. Physiology
    A. Large left-to-right shunt
    1. Overwhelming abnormal finding
    2. Increases as neonatal pulmonary vascular resistance (PVR) falls
    3. Results in pulmonary overcirculation
    B. Truncal valve regurgitation
    1. Present in ~ 50% of patients
    2. May result in alterations in ventricular function from volume overload
    C. Pulmonary vascular obstructive disease with later repair (Beyond infancy)

    IV. Types of Repairs


    A. PA Band in neonatal period if risk of repair is prohibitive
    B. Correction during infancy
    C. Total correction (Rastelli Procedure)
    1. Patch closure of VSD
    2. Place a conduit between the right ventricle (RV) and pulmonary arteries (PA)

    Rastelli Procedure

    Illustrations reprinted from PedHeart Resource.


    .
    Scientific Software Solutions, 2010. All rights reserved
    D. Truncal valve repair/replacement (See Problem Section on Valve
    Repair/Replacement for further discussion and management)
    V. Long-term Complications
    A. Conduit stenosis/replacement
    B. Truncal valve insufficiency /Aortic regurgitation
    1. Valve repair
    2. Valve replacement
    C. Pulmonary vascular disease (Refer to Problem Section on Pulmonary Hypertension
    for further discussion and management.)
    D. Progressive myocardial failure (Refer to Problem Sections on Systemic and
    Pulmonary Ventricular Failure for further discussion and management.)
    VI. Pregnancy (See Problem Section on Pregnancy in ACHD for further discussion and
    management)
    A. Requires cardiology evaluation prior to pregnancy
    B. Requires careful multidisciplinary coordination
    C. Successful pregnancy and delivery has been achieved after complete repair
    D. Increased risk to both woman and fetus (See Problem Sections for the complications
    listed below for further discussion and management)
    1. Pulmonary vascular disease
    2. Pulmonary hypertension
    3. Prosthetic valves

    References:
    Emmanouilides, et al: Clinical Synopsis of Moss and Adams Heart Disease in Infants, Children,
    and Adolescents: Including fetus and young adults, Philadelphia, 1998, Lippincott, Williams &
    Wilkins.
    Gatzoulis M.A, et al: Diagnosis and Management of ACHD, Churchill, 2003, Livingstone.
    Mavroudis C & Backer CL, Editors. Pediatric Cardiac Surgery, ed. 3, St. Louis, 2003, Mosby.

    7/2011

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