| A case of truncus arteriosus type II is reported. Truncus arterious is an uncommon congenital cardiac defect where a single great vessel exits the heart. truncus arteriosus is usually fatal, if untreated. This defect occurs when the conus arteriosus and the truncus divide erroneously in the embryo. Palliative surgery in truncus arteriosus has been unsuccessful. Pulmonary banding has been tried and was ineffective and usually fatal. We operated on a nine-month-old (6200 g) male infant with a type II (Edwards-Collett) defect and a large ventricular septal defect. The pulmonary artery average pressure was 51 mmHg. We performed a cardiopulmonary bypass in the usual manner. Pulmonary arteries were resected from the truncal root, and primary end-to-end anastomosis of the truncal root to the ascending aorta was performed. Right ventricle to pulmonary artery continuity was provided using a valveless Gore-Tex graft. We lost our patient due to intractable pulmonary hypertension on the first postoperative day. ( info) |
2/136. Transesophageal echocardiography in aortopulmonary communications. The assessment of congenital aortopulmonary communications by transthoracic echocardiography may be suboptimal, particularly postoperatively, due to limited acoustic windows. We performed intraoperative transesophageal echocardiograms in six patients with eight proven systemic-pulmonary communications. Diagnosis included truncus arteriosus (1), aortopulmonary window (1), Waterston anastomosis (3), central Gore-Tex shunt (1), and modified left Blalock-Taussig shunt (2). All communications were accurately demonstrated by transesophageal echocardiography (TEE). The transesophageal technique also provided an assessment of the size of the aortopulmonary communications and the proximal pulmonary arteries. In addition, the gradient across some of the communications could be accurately estimated utilizing the high pulse repetition frequency Doppler. On the other hand, only two of the seven aortopulmonary communications were detected by transthoracic echocardiography. Postoperatively, transesophageal imaging demonstrated unobstructed conduit in five of five patients who underwent conduit repair, as well as intact closure of aortopulmonary communications and concomitant closure of ventricular septal defects. ( info) |
3/136. Surgical ligation of a persistent arterial duct in one of conjoined thoracopagus twins prior to surgical separation. One of conjoined thoracopagus twins, with separate hearts and a common pericardial sack, presented with respiratory distress because of a persistent arterial duct causing congestive heart failure in the neonatal period. Surgical ligation of the duct was performed prior to subsequent separation, with an excellent outcome. ( info) |
4/136. A case of anomalous origin of the pulmonary arteries: right pulmonary artery from the descending aorta and the left pulmonary artery from the ascending aorta. A 3-month-old girl classified as having persistent truncus arteriosus underwent surgical correction of the anomalous origin of the pulmonary arteries; the right pulmonary artery from the descending aorta and the left pulmonary artery from the ascending aorta. The patient died on the fourth postoperative day. The definite diagnosis and choice of surgical strategies should be further examined. ( info) |
| The association of tricuspid atresia and persistent truncus arteriosus is a very rare congenital anomaly. We report a newborn with a prenatal diagnosis of tricuspid atresia, in whom associated type II persistent truncus arteriosus was found by postnatal echocardiography. The patient had mild cyanosis and developed heart failure soon after birth. Balloon septostomy was performed to enlarge the interatrial communication. However, her condition rapidly deteriorated and she died of sepsis and heart failure at the age of 14 days. ( info) |
| Severe bleeding remains the most common complication of extracorporeal membrane oxygenation (ECMO) following surgical repair of congenital heart defects. We present a case of excessive hemorrhage within the first hours on ECMO support after repair of a type I truncus arteriosus. Bleeding control was achieved by surgical repair following failure of conventional interventions to control hemorrhage despite normalization of laboratory coagulation parameters. Aspects associated with bleeding and bleeding control during extracorporeal circulation after cardiac surgery are discussed. ( info) |
7/136. Common arterial trunk associated with atrioventricular septal defect. Described are the clinical, cross-sectional echocardiographic, electrocardiographic and angiographic findings, together with the results at autopsy, in a 5-month old infant with a common arterial trunk associated with an atrioventricular septal defect. As far as is known, this is only the 13th such case to be reported in the literature. A particularly unusual feature of this case was an intact atrial component of the atrioventricular septal defect. ( info) |
| The coexistence of tricuspid atresia and common arterial trunk is extremely rare. We present a successful three-stage surgical treatment of this defect. The first stage included disconnection of the pulmonary arteries from the common trunk, atrial septectomy and systemic-to-pulmonary shunt; the second stage, a hemi-fontan procedure; and the third stage, a fenestrated Fontan completion. The child is now 8 years old and is developing well. ( info) |
9/136. Left hemitruncus associated with tetralogy of fallot: a case report. This report presents a case of a left hemitruncus and tetralogy of fallot. The diagnosis was first made by means of echocardiography and confirmed with cardiac catheterization thereafter. To the authors' knowledge, this patient is the fourth-longest-term survivor so far reported in the medical literature. A significant improvement has been observed after surgical correction of the anomaly, and the patient was free of symptoms at the 6-mo follow-up examination. ( info) |
| Case history and necropsy findings of a 5-month-old infant with a unique heart defect with features of truncus arteriosus communis and aortopulmonary defect in combination with severe tricuspid stenosis are presented. There is a wide spectrum of remarkable heart defects between truncus arteriosus communis and aortopulmonary septal defect. ( info) |