Clarifying the anatomy of common arterial trunk: a clinical study of 70 patients

Abstract

Aims Anatomic variations in hearts with common arterial trunk are well-known, although there is no large study of living patients. Detailed knowledge of the origins of the pulmonary and coronary arteries is vital for surgical management. We sought to clarify the variations using computed tomography. Methods and results We prospectively studied 70 consecutive patients using echocardiography and computed tomography. In 63 (90%) patients, there was aortic dominance, while 7 (10%) had dominance of the pulmonary component. In 27 (43%) patients with aortic dominance, part of the pulmonary segment arose from a truncal valvar sinus. A long confluent pulmonary channel was more common in patients with sinusal origin compared to those with non-sinusal origin of the pulmonary segment (19 vs. 0; P = 0.0005). Close proximity between the orifices of the coronary arteries and the pulmonary component was also more frequent with sinusal origin (21 vs. 6; P < 0.001) with 5 (19%) patients having pulmonary flow obstructed by a truncal valvar leaflet. Conclusion Sinusal origin of the pulmonary component is common with aortic dominance, frequently in association with a long confluent pulmonary segment, which may be in close proximity to the origin of a coronary artery. One-fifth of patients with sinusal origin of pulmonary component have a truncal valvar leaflet obstructing the pulmonary orifice. These morpho-anatomic findings have important implications for management.

Systolic excursion of the leaflets of the truncal valve: An unusual mechanism for pulmonary stenosis in common arterial trunk

“…Note that the echo images of the first patient are published as Figure 6 in our previous publication. [ 4 ]…”

“…We prospectively studied 70 patients with common arterial trunk from July 2015 to May 2018 following clearance from the institute ethics committee. From the 70 patients in our initial study,[ 4 ] we selected 27 patients with an aortic dominant common arterial trunk and sinusal origin of the PA segment for this analysis. A detailed account of methods used for physiologic and morphologic analysis is published elsewhere.…”

“…A detailed account of methods used for physiologic and morphologic analysis is published elsewhere. [ 4 ]…”

“…Based on the relative sizes of its components, the common arterial trunk can be classified as having either aortic or pulmonary dominance. [ 3 4 ]…”

“…Among these patients, 5 had a truncal valvar leaflet obstructing the flow of blood to the lungs. [ 4 ] In this study, we have sought to clarify morphologic characteristics leading to this novel mechanism of protecting the pulmonary vasculature.…”