Consensus document on optimal management of patients with common arterial trunk

Hazekamp, Mark G.; Barron, David J.; Dangel, Joanna; Homfray, Tessa; Jongbloed, Monique R.M.; Voges, Inga

doi:10.1017/s1047951121001219

Cited by 3 publications

(9 citation statements)

References 220 publications

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“…A possible means of enhancing the prenatal diagnostic rate, notably for CAT Type A4, would be to measure the size of the aorta relative to the proximal part of the common trunk (giving rise to the pulmonary branches and the large arterial duct), which would reveal if the aorta was relatively small. These data were not available in either the present or previously published studies, but this could be an interesting future approach 3 .…”

Section: Discussionmentioning

confidence: 86%

“…Anatomic classification systems with regards to CAT are numerous and several have succeeded each other since the first historical classification systems. A detailed description, with all their advantages and shortcomings, is beyond the scope of this publication, but can be found, for example, in the recent consensus statement on the management of CAT 3 . The task force of this consensus statement favored a simplified classification of CAT, published in 2011 by Russell et al 24 ,.…”

Section: Methodsmentioning

confidence: 99%

“…• CAT with aortic dominance and both pulmonary arteries arising from the trunk (Type A1-A2 of the modified Van Praagh classification); Anatomic classification systems with regards to CAT are numerous and several have succeeded each other since the first historical classification systems. A detailed description, with all their advantages and shortcomings, is beyond the scope of this publication, but can be found, for example, in the recent consensus statement on the management of CAT 3 . The task force of this consensus statement favored a simplified classification of CAT, published in 2011 by Russell et al 24 , into only two types, with either aortic or pulmonary dominance, necessitating further specifications regarding the origin of the pulmonary artery branches, as recognized in the statement 3 .…”

Section: Study Population Definitions Cat Classification and Data Col...mentioning

confidence: 99%

“…A detailed description, with all their advantages and shortcomings, is beyond the scope of this publication, but can be found, for example, in the recent consensus statement on the management of CAT 3 . The task force of this consensus statement favored a simplified classification of CAT, published in 2011 by Russell et al 24 , into only two types, with either aortic or pulmonary dominance, necessitating further specifications regarding the origin of the pulmonary artery branches, as recognized in the statement 3 . According to this simplified classification, prostaglandin-dependent Type A3 is part of the aortic-dominance type of CAT and the pulmonary-dominance type of CAT corresponds to Type A4 3,24 .…”

Section: Study Population Definitions Cat Classification and Data Col...mentioning

confidence: 99%

“…CAT is known to be associated with extracardiac and genetic abnormalities, especially DiGeorge syndrome, in one third of patients 1 . Anatomically, there is a wide variety of subtypes, differing mainly in the connection of the pulmonary arteries to the common trunk and the presence of aortic arch obstruction or interruption 2,3 . The current standard of care is neonatal repair of the defect, with reconstruction of the right ventricular outflow tract by various techniques [3][4][5] .…”

Section: Introductionmentioning

confidence: 99%

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Accuracy and impact of prenatal diagnosis of common arterial trunk

Laux

Derridj

Stirnemann

et al. 2022

Ultrasound in Obstet & Gyne

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Objectives Outcome of common arterial trunk (CAT) depends mainly on truncal valve function, presence of coronary artery abnormalities and presence of interrupted aortic arch. The main objective of this study was to evaluate the accuracy of prenatal diagnosis of CAT by analyzing prenatal vs postnatal assessment of: (1) anatomic subtypes and (2) truncal valve function. The secondary objective was to assess the potential impact of prenatal diagnosis of CAT on postnatal mortality and morbidity by comparing prenatally vs postnatally diagnosed patients. Methods This was a retrospective analysis of all CAT patients diagnosed either prenatally, with postnatal or fetopsy confirmation, or postnatally, from 2011 to 2019 in a single tertiary center. Cohen's kappa statistic was used to evaluate agreement between pre‐ and postnatal assessment of anatomic subtypes according to Van Praagh and of truncal valve function. Mortality and morbidity variables were compared between prenatally vs postnatally diagnosed CAT patients. Results A total of 84 patients (62 liveborn with prenatal diagnosis, 16 liveborn with postnatal diagnosis and six terminations of pregnancy with fetopsy) met the inclusion criteria. The accuracy of prenatal diagnosis of CAT anatomic subtype was 80.3%, and prenatal and postnatal concordance for subtype diagnosis was only moderate (κ = 0.43), with no patient with CAT Type A3 (0/4) and only half of patients with CAT Type A4 (8/17) being diagnosed prenatally. Fetal evaluation of truncal valve function underestimated the presence (no agreement; κ = 0.09) and severity (slight agreement; κ = 0.19) of insufficiency. However, four of five cases of postnatally confirmed significant truncal valve stenosis were diagnosed prenatally, with fair agreement for both presence and severity of stenosis (κ = 0.38 and 0.24, respectively). Mortality was comparable in patients with and those without prenatal diagnosis (log‐rank P = 0.87). CAT patients with fetal diagnosis underwent earlier intervention (P < 0.001), had shorter intubation time (P = 0.047) and shorter global hospital stay (P = 0.01). Conclusions The accuracy of prenatal diagnosis of CAT is insufficient to tailor neonatal management and to predict outcome. Fetal assessment of truncal valve dysfunction appears unreliable due to perinatal transition. Improvement is necessary in the fetal diagnosis of anatomic subtypes of CAT requiring postnatal prostaglandin infusion. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

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Section: Discussionmentioning

confidence: 86%

Section: Methodsmentioning

confidence: 99%

Section: Study Population Definitions Cat Classification and Data Col...mentioning

confidence: 99%

Section: Study Population Definitions Cat Classification and Data Col...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Accuracy and impact of prenatal diagnosis of common arterial trunk

Laux

Derridj

Stirnemann

et al. 2022

Ultrasound in Obstet & Gyne

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JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair

Ohuchi

Kawata²,

Uemura

et al. 2022

Circ J

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9JCS 2022 Guideline on Management/Re-Intervention in ACHD comorbidity, 172 and cardiac catheterization is fundamental for its evaluation. 173 ▋ 3.4.4 Left Heart Catheterization and Coronary Angiography Echocardiography, CT, and MRI are often substituted for left ventriculography, aortography, or coronary angiography. CT precisely illustrates abnormal origins and courses of the coronary arteries in many cases, which is why coronary angiography is not recommended as a routine examination (Class III). In some patients, nonetheless, coronary angiography is quite informative beyond CT resolution; for example, anastomotic stenosis at the coronary arterial origin would be better demonstrated by catheter angiography after the arterial switch procedure. 174 ▋ 3.4.5 Endomyocardial Biopsy Endomyocardial biopsy is rarely required in patients with postoperative CHD. ▋ 3.4.6 Catheter InterventionTranscatheter closure of atrial septal defect or patent ductus arteriosus is carried out routinely in the cardiac catheterization room, as is percutaneous pulmonary angioplasty. Interventional closure of ventricular septal defect needs more evidence before becoming established in Japan.Transcatheter pulmonary valve replacement will be introduced in the near future.Electrophysiological study and catheter ablation are common practices for arrhythmias in the CHD field. Recent advances in technology and devices, such as 3D mapping systems, have contributed to notable results in anti-arrythmic treatments in patients with repaired CHD. 175

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Diagnosis, Management and Outcome of Truncus Arteriosus Communis Diagnosed during Fetal Life—Cohort Study and Systematic Literature Review

Wittek,

Plöger,

Walter

et al. 2024

JCM

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Background/Objectives: Truncus arteriosus communis (TAC) is a rare congenital heart defect characterized by a single arterial trunk that supplies systemic, pulmonary, and coronary circulations. This defect, constituting approximately 1–4% of congenital heart diseases, poses significant challenges in prenatal diagnosis, management, and postnatal outcomes. Methods: A retrospective analysis was conducted at the local tertiary referral center on cases of TAC diagnosed prenatally between 2019 and 2024. Additionally, a systematic literature review was performed to evaluate the accuracy of prenatal diagnostics and the presence of associated anomalies in fetuses with TAC and compare already published data with the local results. The review included studies that especially described the use of fetal echocardiography, the course and outcome of affected pregnancies, and subsequent management strategies. Results: The analysis of local prenatal diagnoses revealed 14 cases. Of the 11 neonates who survived to birth, the TAC diagnosis was confirmed in 7 instances. With all seven neonates undergoing surgery, the intention-to-treat survival rate was 86%, and the overall survival rate was 55%. By reviewing published case series, a total of 823 TAC cases were included in the analysis, of which 576 were diagnosed prenatally and 247 postnatally. The presence of associated cardiac and extracardiac manifestations as well as genetic anomalies was common, with a 22q11 microdeletion identified in 27% of tested cases. Conclusions: Advances in prenatal imaging and early diagnosis have enhanced the management of TAC, allowing for the detailed planning of delivery and immediate postnatal care in specialized centers. The frequent association with genetic syndromes underscores the importance of genetic counseling in managing TAC. An early surgical intervention remains crucial for improving long-term outcomes, although the condition is still associated with significant risks. Long-term follow-up studies are essential to monitor potential complications and guide future management strategies. Overall, a coordinated multidisciplinary approach from prenatal diagnosis to postnatal care is essential for improving outcomes for individuals with TAC.

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Consensus document on optimal management of patients with common arterial trunk

Cited by 3 publications

References 220 publications

Accuracy and impact of prenatal diagnosis of common arterial trunk

Accuracy and impact of prenatal diagnosis of common arterial trunk

JCS 2022 Guideline on Management and Re-Interventional Therapy in Patients With Congenital Heart Disease Long-Term After Initial Repair

Diagnosis, Management and Outcome of Truncus Arteriosus Communis Diagnosed during Fetal Life—Cohort Study and Systematic Literature Review

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