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Truncus Arteriosus
Brett W. Carter, MD; Prabhakar Rajiah, MBBS, MD, FRCR, FSCMR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            TERMINOLOGY

            • Abbreviations

              • Truncus arteriosus (TA)
            • Synonyms

              • Persistent truncus arteriosus, truncus arteriosus communis, common arterial trunk, common aorticopulmonary trunk
            • Definitions

              • Common arterial trunk arising from heart
                • Gives rise to aorta, pulmonary arteries (PAs), and coronary arteries
              • Category: Cyanotic, cardiomegaly, and increased pulmonary vascularity
              • Hemodynamics
                • Both ventricles are connected to pulmonary and systemic circulations
                • Flow admixture across ventricular septal defect (VSD) and within truncus → cyanosis
                • Postnatal drop in pulmonary vascular resistance → relative increase in pulmonary blood flow → volume overload of pulmonary circulation

            IMAGING

            • General Features

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Echocardiographic Findings

                      • Angiographic Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          Selected References

                                          1. Chikkabyrappa S et al: Common arterial trunk: Physiology, imaging, and management. Semin Cardiothorac Vasc Anesth. 1089253218821382, 2018
                                          2. Abbara S et al: SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr. 10(6):435-449, 2016
                                          3. Han BK et al: Computed Tomography Imaging in Patients with Congenital Heart Disease Part I: Rationale and Utility. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT): Endorsed by the Society of Pediatric Radiology (SPR) and the North American Society of Cardiac Imaging (NASCI). J Cardiovasc Comput Tomogr. 9(6):475-92, 2015
                                          4. Han BK et al: Computed Tomography Imaging in Patients with Congenital Heart Disease, Part 2: Technical Recommendations. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT): Endorsed by the Society of Pediatric Radiology (SPR) and the North American Society of Cardiac Imaging (NASCI). J Cardiovasc Comput Tomogr. 9(6):493-513, 2015
                                          5. Fratz S et al: Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease. J Cardiovasc Magn Reson. 15:51, 2013
                                          6. Saremi F et al: Right ventricular outflow tract imaging with CT and MRI: Part 1, Morphology. AJR Am J Roentgenol. 200(1):W39-50, 2013
                                          7. Frank L et al: Cardiovascular MR imaging of conotruncal anomalies. Radiographics. 30(4):1069-94, 2010
                                          8. François CJ et al: Unenhanced MR angiography of the thoracic aorta: initial clinical evaluation. AJR Am J Roentgenol. 190(4):902-6, 2008
                                          9. Gaca AM et al: Repair of congenital heart disease: a primer--Part 2. Radiology. 248(1):44-60, 2008
                                          10. Gaca AM et al: Repair of congenital heart disease: a primer-part 1. Radiology. 247(3):617-31, 2008
                                          11. Warnes CA et al: ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). Circulation. 118(23):2395-451, 2008
                                          12. Dorfman AL et al: Magnetic resonance imaging evaluation of congenital heart disease: conotruncal anomalies. J Cardiovasc Magn Reson. 8(4):645-59, 2006
                                          13. Vida VL et al: Anomalous origin of one pulmonary artery from the ascending aorta. Cardiol Young. 15(2):176-81, 2005
                                          14. Muhler MR et al: Truncus arteriosus communis in a midtrimester fetus: comparison of prenatal ultrasound and MRI with postmortem MRI and autopsy. Eur Radiol. 14(11):2120-4, 2004
                                          15. Razavi R et al: Diagnosis of hemi-truncus arteriosis by three-dimensional magnetic resonance angiography. Circulation. 109(3):E15-6, 2004
                                          16. Mavroudis C et al: Truncus arteriosus. In Mavroudis C et al. Pediatric cardiac surgery. 3rd ed. Philadelphia: Mosby. 339-52, 2003
                                          17. Lim C et al: Truncus arteriosus with coarctation of persistent fifth aortic arch. Ann Thorac Surg. 74(5):1702-4, 2002
                                          18. Murashita T et al: Giant pseudoaneurysm of the right ventricular outflow tract after repair of truncus arteriosus: evaluation by MR imaging and surgical approach. Eur J Cardiothorac Surg. 22(5):849-51, 2002
                                          19. Taylor JFN: Persistent truncus arteriosus. In Moller JH et al. Pediatric cardiovascular medicine. 1st ed. Philadelphia: Churchill Livingstone. 499-510, 2000
                                          20. Jacobs ML: Congenital Heart Surgery Nomenclature and Database Project: truncus arteriosus. Ann Thorac Surg. 69(4 Suppl):S50-5, 2000
                                          21. Rajasinghe HA et al: Long-term follow-up of truncus arteriosus repaired in infancy: a twenty-year experience. J Thorac Cardiovasc Surg. 113(5):869-78; discussion 878-9, 1997
                                          22. Donnelly LF et al: MR imaging of conotruncal abnormalities. AJR Am J Roentgenol. 166(4):925-8, 1996
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Truncus arteriosus (TA)
                                                    • Synonyms

                                                      • Persistent truncus arteriosus, truncus arteriosus communis, common arterial trunk, common aorticopulmonary trunk
                                                    • Definitions

                                                      • Common arterial trunk arising from heart
                                                        • Gives rise to aorta, pulmonary arteries (PAs), and coronary arteries
                                                      • Category: Cyanotic, cardiomegaly, and increased pulmonary vascularity
                                                      • Hemodynamics
                                                        • Both ventricles are connected to pulmonary and systemic circulations
                                                        • Flow admixture across ventricular septal defect (VSD) and within truncus → cyanosis
                                                        • Postnatal drop in pulmonary vascular resistance → relative increase in pulmonary blood flow → volume overload of pulmonary circulation

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Echocardiographic Findings

                                                              • Angiographic Findings

                                                                • Imaging Recommendations

                                                                  DIFFERENTIAL DIAGNOSIS

                                                                    PATHOLOGY

                                                                    • General Features

                                                                      • Staging, Grading, & Classification

                                                                        • Gross Pathologic & Surgical Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  Selected References

                                                                                  1. Chikkabyrappa S et al: Common arterial trunk: Physiology, imaging, and management. Semin Cardiothorac Vasc Anesth. 1089253218821382, 2018
                                                                                  2. Abbara S et al: SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: A report of the society of Cardiovascular Computed Tomography Guidelines Committee: Endorsed by the North American Society for Cardiovascular Imaging (NASCI). J Cardiovasc Comput Tomogr. 10(6):435-449, 2016
                                                                                  3. Han BK et al: Computed Tomography Imaging in Patients with Congenital Heart Disease Part I: Rationale and Utility. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT): Endorsed by the Society of Pediatric Radiology (SPR) and the North American Society of Cardiac Imaging (NASCI). J Cardiovasc Comput Tomogr. 9(6):475-92, 2015
                                                                                  4. Han BK et al: Computed Tomography Imaging in Patients with Congenital Heart Disease, Part 2: Technical Recommendations. An Expert Consensus Document of the Society of Cardiovascular Computed Tomography (SCCT): Endorsed by the Society of Pediatric Radiology (SPR) and the North American Society of Cardiac Imaging (NASCI). J Cardiovasc Comput Tomogr. 9(6):493-513, 2015
                                                                                  5. Fratz S et al: Guidelines and protocols for cardiovascular magnetic resonance in children and adults with congenital heart disease: SCMR expert consensus group on congenital heart disease. J Cardiovasc Magn Reson. 15:51, 2013
                                                                                  6. Saremi F et al: Right ventricular outflow tract imaging with CT and MRI: Part 1, Morphology. AJR Am J Roentgenol. 200(1):W39-50, 2013
                                                                                  7. Frank L et al: Cardiovascular MR imaging of conotruncal anomalies. Radiographics. 30(4):1069-94, 2010
                                                                                  8. François CJ et al: Unenhanced MR angiography of the thoracic aorta: initial clinical evaluation. AJR Am J Roentgenol. 190(4):902-6, 2008
                                                                                  9. Gaca AM et al: Repair of congenital heart disease: a primer--Part 2. Radiology. 248(1):44-60, 2008
                                                                                  10. Gaca AM et al: Repair of congenital heart disease: a primer-part 1. Radiology. 247(3):617-31, 2008
                                                                                  11. Warnes CA et al: ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: Executive Summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to develop guidelines for the management of adults with congenital heart disease). Circulation. 118(23):2395-451, 2008
                                                                                  12. Dorfman AL et al: Magnetic resonance imaging evaluation of congenital heart disease: conotruncal anomalies. J Cardiovasc Magn Reson. 8(4):645-59, 2006
                                                                                  13. Vida VL et al: Anomalous origin of one pulmonary artery from the ascending aorta. Cardiol Young. 15(2):176-81, 2005
                                                                                  14. Muhler MR et al: Truncus arteriosus communis in a midtrimester fetus: comparison of prenatal ultrasound and MRI with postmortem MRI and autopsy. Eur Radiol. 14(11):2120-4, 2004
                                                                                  15. Razavi R et al: Diagnosis of hemi-truncus arteriosis by three-dimensional magnetic resonance angiography. Circulation. 109(3):E15-6, 2004
                                                                                  16. Mavroudis C et al: Truncus arteriosus. In Mavroudis C et al. Pediatric cardiac surgery. 3rd ed. Philadelphia: Mosby. 339-52, 2003
                                                                                  17. Lim C et al: Truncus arteriosus with coarctation of persistent fifth aortic arch. Ann Thorac Surg. 74(5):1702-4, 2002
                                                                                  18. Murashita T et al: Giant pseudoaneurysm of the right ventricular outflow tract after repair of truncus arteriosus: evaluation by MR imaging and surgical approach. Eur J Cardiothorac Surg. 22(5):849-51, 2002
                                                                                  19. Taylor JFN: Persistent truncus arteriosus. In Moller JH et al. Pediatric cardiovascular medicine. 1st ed. Philadelphia: Churchill Livingstone. 499-510, 2000
                                                                                  20. Jacobs ML: Congenital Heart Surgery Nomenclature and Database Project: truncus arteriosus. Ann Thorac Surg. 69(4 Suppl):S50-5, 2000
                                                                                  21. Rajasinghe HA et al: Long-term follow-up of truncus arteriosus repaired in infancy: a twenty-year experience. J Thorac Cardiovasc Surg. 113(5):869-78; discussion 878-9, 1997
                                                                                  22. Donnelly LF et al: MR imaging of conotruncal abnormalities. AJR Am J Roentgenol. 166(4):925-8, 1996