Topic:
ফেটাল কার্ডিওলজিতে Truncus Arteriosus
🔹 Definition
Truncus arteriosus হলো একটি complex congenital heart disease যেখানে একটি single great artery হৃদপিণ্ড থেকে বের হয় এবং তা systemic, pulmonary ও coronary circulation-এ রক্ত সরবরাহ করে।
👉 Normally aorta এবং pulmonary artery আলাদা থাকে, কিন্তু truncus arteriosus-এ তারা পৃথকভাবে develop হয় না।
🔹 Embryology
Normal embryonic development-এ:
✔ Truncus arteriosus septation হয়ে
➡ Aorta এবং Pulmonary artery তৈরি হয়।
Truncus arteriosus এ:
✔ Conotruncal septation failure হয়।
🔹 Anatomy
Main Features:
✔ Single arterial trunk
✔ Large subtruncal VSD
✔ Single truncal valve
✔ Pulmonary arteries trunk থেকে arise করে
🔹 Physiology
কারণ systemic ও pulmonary circulation একই trunk share করে:
✔ Complete mixing of blood হয়
✔ Pulmonary overcirculation develops
✔ Heart failure হতে পারে
🔹 Classification (Collett & Edwards)
Type I
✔ Main pulmonary artery trunk থেকে arise করে
Type II
✔ Right ও left pulmonary artery posteriorly পৃথকভাবে arise করে
Type III
✔ Pulmonary arteries laterally পৃথকভাবে arise করে
Type IV
বর্তমানে pseudotruncus হিসেবে বিবেচিত
🔹 Associated Abnormalities
✔ DiGeorge syndrome (22q11 deletion)
✔ Right aortic arch
✔ Interrupted aortic arch
✔ Coronary anomalies
🔹 Fetal Echocardiographic Findings
🔹 Key Diagnostic Features
✔ Single great vessel overriding VSD
✔ Absence of separate pulmonary artery and aorta
✔ Large VSD
✔ Single semilunar valve
🔹 Four Chamber View
Findings:
✔ Often normal chamber size
✔ Large VSD may be visualized
🔹 Outflow Tract Views
Most important views
✔ Only one great artery identified
✔ Single vessel overriding interventricular septum
🔹 Three Vessel View (3VV)
Findings:
✔ Abnormal appearance
✔ Only one large vessel visualized
🔹 Color Doppler Findings
✔ Mixed systemic and pulmonary flow
✔ Truncal valve regurgitation may occur
🔹 Truncal Valve Assessment
Evaluate:
✔ Number of cusps
✔ Regurgitation
✔ Stenosis
Important:
✔ Significant truncal regurgitation worsens prognosis
🔹 Differential Diagnosis
Differentiate from:
| Disease | Key Difference |
|---|---|
| TOF with pulmonary atresia | Separate aorta present |
| DORV | Two great arteries present |
| TGA | Parallel great arteries |
🔹 Associated Genetic Syndrome
Strong association:
✔ 22q11 deletion syndrome
👉 Genetic counseling recommended
🔹 Prognosis
Depends on:
✔ Truncal valve function
✔ Associated anomalies
✔ Pulmonary blood flow
Without surgery:
❌ High mortality
🔹 Postnatal Management
✔ Early neonatal surgery required
✔ VSD closure
✔ RV-PA conduit repair
🔹 Surgical Timing
Usually:
✔ First few weeks of life
🔹 Important Fetal Counseling Points
Parents should be informed about:
✔ Need for surgery
✔ Possible genetic syndrome
✔ Neonatal cardiac care
✔ Long-term follow-up
🔹 Key Learning Points
✔ Truncus arteriosus = single arterial trunk
✔ Large VSD almost always present
✔ Best diagnosed in outflow tract views
✔ 3VV abnormal
✔ Frequently associated with 22q11 deletion
👨⚕️ ডা. মোহাম্মদ নিজাম উদ্দিন
এমবিবিএস, বিসিএস (স্বাস্থ্য), এমডি (কার্ডিওলজি)
কার্ডিয়াক ইন্টারভেনশনে পোস্ট ডক্টরাল ট্রেনিং
ফেটাল কার্ডিওলজি ও ইন্টারভেনশনে অ্যাডভান্সড ফেলোশিপ
সহযোগী অধ্যাপক ও সিনিয়র কনসালট্যান্ট (কার্ডিওলজি)
ক্লিনিক্যাল ও ইন্টারভেনশনাল কার্ডিওলজিস্ট
বাংলাদেশের অগ্রণী ফেটাল কার্ডিওলজিস্ট ও ফেটাল ইকোকার্ডিওগ্রাফি বিশেষজ্ঞ
Truncus Arteriosus in Fetal Cardiology
🔹 Definition
Truncus arteriosus is a complex congenital heart disease in which a single arterial trunk arises from the heart and supplies systemic, pulmonary, and coronary circulation.
Normally, the aorta and pulmonary artery develop separately, but in truncus arteriosus, separation fails.
🔹 Embryology
Normally:
✔ The truncus arteriosus septates into:
- Aorta
- Pulmonary artery
In truncus arteriosus:
✔ Failure of conotruncal septation occurs.
🔹 Anatomy
Main Features:
✔ Single arterial trunk
✔ Large subtruncal VSD
✔ Single truncal valve
✔ Pulmonary arteries arise from truncal vessel
🔹 Physiology
Because pulmonary and systemic circulations share a common trunk:
✔ Complete blood mixing occurs
✔ Pulmonary overcirculation develops
✔ Congestive heart failure may occur
🔹 Classification (Collett & Edwards)
Type I
✔ Main pulmonary artery arises from truncus
Type II
✔ Right and left pulmonary arteries arise separately posteriorly
Type III
✔ Pulmonary arteries arise separately laterally
🔹 Associated Abnormalities
✔ DiGeorge syndrome (22q11 deletion)
✔ Right aortic arch
✔ Interrupted aortic arch
✔ Coronary anomalies
🔹 Fetal Echocardiographic Findings
Key Features:
✔ Single overriding great vessel
✔ Large VSD
✔ Absence of separate pulmonary artery and aorta
✔ Single semilunar valve
🔹 Four Chamber View
Findings:
✔ Often normal chamber symmetry
✔ Large VSD may be visible
🔹 Outflow Tract Views
Most important diagnostic views
✔ Only one great artery identified
✔ Single vessel overriding septum
🔹 Three Vessel View (3VV)
Findings:
✔ Abnormal
✔ Only one large vessel visualized
🔹 Color Doppler
✔ Mixed systemic and pulmonary flow
✔ Possible truncal valve regurgitation
🔹 Truncal Valve Assessment
Assess:
✔ Number of cusps
✔ Regurgitation
✔ Stenosis
Significant truncal regurgitation worsens prognosis.
🔹 Differential Diagnosis
| Condition | Difference |
|---|---|
| TOF with pulmonary atresia | Separate aorta present |
| DORV | Two great arteries |
| TGA | Parallel great arteries |
🔹 Genetic Association
Strong association with:
✔ 22q11 deletion syndrome
Genetic counseling is recommended.
🔹 Prognosis
Depends on:
✔ Truncal valve function
✔ Associated anomalies
✔ Pulmonary blood flow
Without surgery:
❌ High mortality
🔹 Postnatal Management
✔ Early neonatal surgical repair
✔ VSD closure
✔ RV-to-PA conduit placement
🔹 Important Counseling Points
Parents should understand:
✔ Need for surgery
✔ Possible genetic syndromes
✔ Neonatal cardiac care
✔ Lifelong follow-up
🔹 Key Learning Points
✔ Truncus arteriosus has a single arterial trunk
✔ Large VSD almost always present
✔ Outflow tract views are essential
✔ 3VV is abnormal
✔ Frequently associated with 22q11 deletion
👨⚕️ Dr. Mohammed Nizam Uddin
MBBS, BCS (H), MD (Cardiology)
Post Doctoral Training in Cardiac Intervention
Advanced Fellowship in Fetal Cardiology & Intervention
Associate Professor & Senior Consultant (Cardiology)
Clinical & Interventional Cardiologist
Pioneer Fetal Cardiologist & Fetal Echocardiography Expert