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Stenotic semilunar valve in persistent truncus arteriosus.

The clinical, hemodynamic, and pathologic findings in two newborn infants with persistent truncus arteriosus and stenosis of the truncal valve are described. In one case the anatomic features of the basic condition were classic, with a dysplastic semilunar valve which was mainly stenotic and also incompetent, while in the other the truncus arteriosus arose exclusively from the right ventricle and was almost exclusively stenotic. A ventricular septal defect was the only outlet for the left ventricle. In this case, mitral stenosis was also present and associated with a left-to-right shunt at the atrial level.

Aortic Valve Stenosis↗

Surgical experience with persistent truncus arteriosus in symptomatic infants under 1 year of age. Report of 13 consecutive cases.

Between January 1974 and November 1980, 13 symptomatic infants under 1 year of age with persistent truncus arteriosus type I or II underwent surgery. Pulmonary artery banding was performed in 10 cases, with five deaths. Among the survivors, one developed severe pulmonary vascular disease and only two underwent late intracardiac repair. Primary total correction was performed in three infants and all are well, though one required conduit replacement five and a half years after the initial procedure. Recently, antibiotic sterilised homograft conduits, rather than heterografts, have been preferred as extracardiac conduits in infancy. Early intracardiac repair followed, if necessary, by later conduit replacement appears to have significant advantages over "conventional" pulmonary artery banding and late total correction. Concern remains on the treatment of choice in infants under 3 months of age.

Age Factors↗

Diagnosis of persistent truncus arteriosus by two-dimensional echocardiography: a case study.

Two-dimensional echocardiography of a patient revealed overriding of the large aortic trunk which bifurcated above the semilunar valve, suggesting persistent truncus arterious. This diagnosis was confirmed by cardiac catheterization and angiocardiography. Surgery and autopsy also confirmed the accuracy of the two dimensional echocardiographic findings. Two-dimensional echocardiography is thus valuable in diagnosing persistent truncus arteriosus.

Angiocardiography↗

Persistent truncus arteriosus communis in a two-year-old steer.

A two-year-old Hereford-cross steer was presented for routine embalming. Dissection of the heart and great vessels revealed a persistent truncus arteriosus type A2. Despite complete mixing of pulmonary and aortic blood, this animal had survived to adulthood.

Animals↗

Calcium currents in hearts with persistent truncus arteriosus.

We have used the neural crest model of defective heart development to characterize both L- and T-type Ca2+ currents (ICa,L and ICa,T) in ventricular myocytes from embryonic chick hearts with a severe outflow tract anomaly known as persistent truncus arteriosus (PTA). Because of smaller whole embryo weights but no significant change in the weights of ventricles with PTA, the ventricle to whole embryo weight ratios from hearts with PTA were 61% larger than normal at day 11 of incubation. There was a 51% reduction in the peak magnitude of ICa,L at a test potential of +10 mV (-1.4 vs. -0.7 microA/cm2), whereas ICa,T, a proportionately large fraction of the total Ca2+ current in the embryonic chick ventricle, was unaffected. In comparison to sham-operated controls, ICa,L was otherwise not different. Half-activation occurred at about -1 and -41 mV, whereas half-inactivation occurred at -19 and -61 mV for ICa,L and ICa,T, respectively. The time for half-recovery from inactivation were not different and were 200 and 230 ms for ICa,L and ICa,T, respectively. The time for half-decay of the currents and their responses to BAY K 8644 were also similar in both sham-operated and experimental hearts. Although the dihydropyridine receptor binding experiments suggest that the total number of L-type Ca2+ channels was not different, the results from the physiological experiments indicate that the number of functional L-type channels available for opening and/or the single-channel conductance may be reduced in hearts with PTA. Finally, our results with the neural crest model indicate that it is unlikely that the development of Ca2+ currents is influenced by the onset of cholinergic innervation in the heart.

3-Pyridinecarboxylic acid, 1,4-dihydro-2,6-dimethy↗

Persistent truncus arteriosus and patent foramen ovale in a Simmentaler x Braunvieh calf.

A Simmentaler x Braunvieh calf had been anorexic during its first 36 hours of life, had a loud heart murmur and was suspected to have pneumonia. In the light of the results of radiographic and echocardiographic examinations, right heart catheterisation and angiography, a diagnosis of persistent truncus arteriosus and patent foramen ovale was made. The diagnosis was confirmed on postmortem examination.

Angiography↗

Current status of the surgical treatment of truncus arteriosus.

Persistent truncus asteriosus is now correctable surgically in patients with favorable anatomy. Given pulmonary arteries of reasonable size arising from any source, successful correction is possible so long as irreversible pulmonary vascular disease has not occurred. Although the majority of children with this defect demonstrate increased pulmonary blood flow, systemic-pulmonary artery shunts can be used. Also, banding of the pulmonary artery, followed subsequently by successful total correction, has been described. Recent reports of a few successful total corrections in infancy, performed with the aid of deep hypothermia and circulatory arrest, may modify the current approach. Although the majority of the reported corrections have involved aortic homograft reconstruction of the pulmonary artery, we strongly favor a synthetic prosthesis containing a heterograft valve. Based upon our clinical experience and this review of the literature, a suggested management protocol is presented.

Age Factors↗

Pathogenesis of persistent truncus arteriosus and dextroposed aorta in the chick embryo after neural crest ablation.

To investigate the contribution of cranial neural crest cells to the developing cardiovascular system in the chick embryo, cauterization of various regions of cranial neural crest was performed. Five regions may be distinguished, each of which contributes mesenchyme to pharyngeal (branchial) arches 1 through 4 and 6. Ablation of arch 3, 4, and 6 regions resulted in a high incidence of persistent truncus arteriosus (PTA) associated with anomalies of the aortic arch. Dextroposed aorta (DPA) or anomalies of the inflow tract were found in all ablation groups. Although anomalies of the aortic arch arteries were induced in all ablation groups and were usually associated with intracardiac anomalies, those of the third and right fourth aortic arch were most frequent in the arch 4 and arch 4 + 6 groups. Anomalies of the sixth aortic arch were most frequent after extensive ablations that included the arch 6 region. We speculate that PTA is a direct result of the decreased population of mesenchymal cells derived from the arch 3 through 6 neural crest regions. DPA or anomalies of the inflow tract may be related to altered hemodynamics due to anomalies induced by neural crest ablation. Anomalies of the aortic arch arteries may be caused by either the direct or indirect process.

Animals↗

Repair of persistent truncus arteriosus with interrupted aortic arch.

OBJECTIVE: The aim of our study was to analyse experience with repair of truncus arteriosus with interrupted aortic arch. METHODS: Between 1993 and 2004, eight consecutive patients underwent repair of truncus arteriosus with interrupted aortic arch. The median age was 6.5 days (range 1-85 days) and median weight was 3.2 kg (range 2.6-4.8 kg). Five patients had type A and 3 patients had type B aortic arch interruption. The repair was performed in deep hypothermia with circulatory arrest in 4 patients and isolated selective low-flow perfusion of the head and the heart in the last 4 patients. The repair consisted in aortic arch reconstruction by direct anastomosis between descending and ascending aorta, closure of ventricular septal defect and reconstruction of the right ventricular to pulmonary artery continuity using a valved conduit. RESULTS: One (12.5%) patient died from sepsis and hepato-renal failure 18 days after surgery. Seven (87.5%) patients were followed up for 2.0-11.7 years (median 2.6 years). No patient died after the discharge from hospital. In 4 patients 1-3 reinterventions were required 0.6-10.0 years after repair. Reoperations were performed for conduit obstruction in 2 patients, aortic regurgitation in 2 patients, right pulmonary artery stenosis in 2 patients and airway obstruction in 1 patient. In 2 patients concommitant aortic valve and conduit replacement was required. Balloon angioplasty for aortic arch obstruction was necessary in 1 patient, and for bilateral pulmonary branch stenosis in 1 patient. Five (28.6%) surviving patients are in NYHA class I and 2 (71.4%) patients are in NYHA class II. CONCLUSIONS: Primary repair of persistent truncus arteriosus with interrupted aortic arch can be done with low mortality and good mid-term results. Aortic arch reconstruction in isolated low-flow perfusion of the head and the heart influences favourably the postoperative recovery. The main postoperative problems are associated with conduit obstruction and aortic insufficiency.

Abnormalities, Multiple↗

Congenital levojuxtaposition of the right atrial appendage. Association with persistent truncus arteriosus, type 4.

Congenital levojuxtaposition of the right atrial appendage is a rare malformation most commonly associated with a transposition of the great arteries. We report a case of levojuxtaposition of the right atrial appendage associated with a persistant truncus arteriosus, type 4. Juxtaposition of the atrial appendage is a sign of severe cyanotic congenital heart disease, and this is best diagnosed by a selective right atriogram or superior venacavogram.

Coronary Vessel Anomalies↗

Persistent truncus arteriosus in a rhesus monkey (Macaca mulatta).

A 47-day-old female rhesus macaque (Macaca mulatta) was examined because of a severe holosystolic heart murmur (grade 5/6) and signs of congestive heart failure. Results of physical examination, thoracic radiography, and cardiac ultrasonography confirmed an advanced stage of congestive heart failure. Due to the animal's age and clinical signs of disease, a congenital heart defect was suspected. Necropsy revealed a rare congenital heart defect known as persistent (common) truncus arteriosus.

Animals↗

[Persistent truncus arteriosus. Echocardiographic study of 8 cases].

Eight patients (4 male, 4 female) with persistent truncs arteriosus diagnosed by two-dimensional echocardiography are presented. Age ranged from 1 to 19 days. Diagnosis was based on the demonstration of a single vessel giving rise to the aorta, pulmonary arteries and coronary circulation. In 6 patients we were able to define the types of the truncus: in 4 patients corresponded to type I (with partial presence of aorto-pulmonary septum) and in 2 cases corresponded to type II (without existence of septum). All cases had a dilated truncus (1.13 +/- 0.06 cm, range 1.05-1.3 cm), with moderate overriding (52% range 30%-65%) and an infundibular ventricular septal defect (0.6 +/- 0.08 cm, range 0.45-0.85 cm). In 2 cases we could also demonstrate the presence of an interruption of the aortic aorta. We conclude that two-dimensional echocardiography (specially parasternal long-short axis views and subcostal for right or leftout flow tracts axis views) gives sufficient information about this cardiac malformation, which can be completed by the use of pulsed Doppler ultrasound.

Echocardiography↗

[Fever of undetermined origin in a case of total correction of persistent truncus arteriosus with agenesis of the left pulmonary artery (author's transl)].

A 19 month-old girl diagnosed of truncus arteriosus with absence of the left pulmonary artery and severe truncal valve insufficiency underwent total correction. A non previously diagnosed severe mitral insufficiency required a new operation to implant a Bjork-Shiley supraanular mitral prosthesis. The postoperative period was hemodynamically normal, except for the presence of persistent fever of unexplained origin. The clinical picture was thought to be an infectious endocarditis due to the late appearance of an aortic prosthetic leak. Because of failure to medical treatment a reoperation was performed to replace aortic prosthesis. Patient died eight hours postoperatively. Autopsy revealed a correct surgical repair, absence of endocarditis and severe miliary disseminated tuberculosis. Authors consider of interest to present this case-report due to the rarity of: a) correction of truncus with a single pulmonary artery under two years of age; b) associated mitral insufficiency; c) the presence of tuberculosis, difficult differential diagnosis with infectious endocarditis in a patient with valvular prosthesis.

Aortic Valve↗