Truncus arteriosus

Overview

Truncus arteriosus is a rare congenital (at birth) heart disease. A large hole between the two ventricles (ventricular septal defect) is a universal feature of truncus arteriosus. The hole allows oxygenated blood to mix with blood that is low in oxygen. Some of this mixed blood goes to the lungs, and some goes to the rest of the body. Usually, more blood goes to the lungs. Over time, the blood vessels are permanently damaged and it becomes harder for the heart to pump blood to the lungs, resulting in pulmonary hypertension, which can be a life-threatening condition.

 

Causes

In the developing embryo, the great arteries begin as a single tube called the truncus arteriosus that eventually divides into the aorta and the pulmonary artery. Failure to divide properly, or not dividing at all, results in a single great vessel arising from the heart’s pumping chambers.

Symptoms

Because of too much blood in the lungs, extra fluid may build up in and around them, making breathing difficult. Other symptoms include:

  • Bluish skin (cyanosis)
  • Delayed growth or growth failure
  • Fatigue, lethargy
  • Poor feeding
  • Rapid breathing (tachypnea)
  • Shortness of breath (dyspnea)
  • Widening of the finger tips (clubbing)

Risk factors

Untreated cases of truncus arteriosus result in death, often during the first year of life.

Exam and tests

A physician will examine your heart with a stethoscope. Diagnostic tests include:

  • Electrocardiogram (ECG)
  • Echocardiogram
  • Heart catheterization (sometimes necessary to plan a treatment strategy)
  • Magnetic resonance imaging (MRI)
  • X-ray of the chest

Treatment

Surgery is needed to treat this condition. Surgical correction involves closure of the ventricular septal defect, separation of the pulmonary arteries from the truncus arteriosus and creation of a new aorta connecting the right ventricle to the pulmonary arteries. A new pulmonary artery is created with tissue from a different source, or with an artificial tube. Branch arteries are attached to the new artery.

Long term follow-up is required due to leaky valves, pulmonary hypertension and obstruction to right ventricular outflow. As a child grows, another procedure may be necessary, since a pulmonary artery rebuilt with tissue from another source does not grow.

 

Prevention

Truncus arteriosus cannot be prevented, but early treatment often can prevent serious complications.

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