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Persistent truncus arteriosus

 

 

Truncus arteriosus (a common arterial trunk, patent truncus arteriosus) is a rare congenital heart defect.

 

In the normal state, there are two separate vessel extending from the heart – the pulmonary artery and the aorta. If a child is born with this defect, the heart has a one common large blood vessel. In addition, the two lower chambers of the heart are missing part of the wall separating them (ventricular septal defect). As a result blood poor of oxygen which should flow to the lungs, and the oxygen-rich blood which must enter the body are mixed. This creates serious circulatory problems in the child.

 

If truncus arteriosus untreated this defect can be fatal. Surgery to correct arterial trunk, made our surgeons is successful, especially if the child 2 months old.

Dr. Anat Birk – specialist in pediatric cardiology, Director of Institute for the Heart Study, children hospital Schneider

Dr. Elchanan Bruckheimer – an expert in pediatric cardiology, non-invasive surgery, Head of minimally invasive cardiac surgery, children hospital Schneider

Dr. Samuel Diamond – Director of the Department of Pediatric Cardiology, Medical Center of Dan Tel Aviv (Ichilov)

Dr. Julius Agash – Director of Children’s Cardiology Department, Hospital of Edmond and Lily Safra, Sheba Medical Center, Tel Hashomer

Professor Avraham Lorber – specialist in pediatric cardiology and pediatric cardiology, director of Pediatric Cardiology and Congenital Heart Defects, Rambam Health Care Campus

Dr. Avraham Matityahu – specialist in pediatric cardiology, Director, Department of Pediatric Cardiology, Kaplan Medical Center

Prof. Azaria Rein – expert in Pediatric Cardiology, Director of Pediatric Cardiology, Hadassah Medical Center

 

Symptoms
Signs and symptoms of arterial trunk appear in the first few weeks of life. They include: cyanosis of the skin (cyanosis), poor appetite and feeding, excessive sleepiness, poor growth, shortness of breath, rapid breathing (tachypnea), irregular heartbeat (arrhythmia), excessive sweating

 

Please contact us if you notice your child has any of the above symptoms.

 

Risk Factors
Although the exact cause of congenital heart disease, such as persistent truncus arteriosus unknown, several factors may increase the risk of having heart disease.
Among them:
1. Viral disease during pregnancy. If a woman suffered rubella or other viral diseases in early pregnancy, the risk of congenital heart defects in the child increases.
2. Poorly controlled diabetes during pregnancy. Improperly controlled diabetes increases the risk of birth defects, including heart defects.
3. Taking certain medicines during pregnancy. Many drugs are not recommended for use during pregnancy because of the potential risk to the fetus.
4. Chromosomal abnormalities. Children with the syndrome di Giorgio are at increased risk of truncus arteriosus.
5. Smoking during pregnancy. Smoking during pregnancy increases the risk that a child will be born with a heart defect.

 

Complications
Abnormal structure of the heart, such as truncus arteriosus, lead to serious circulatory problems. Since the ventricles are not separated and whole blood flow is carried from one vessel, the oxygen-rich and oxygen-poor blood are mixed and the blood does not deliver a sufficient amount of oxygen. As a result, the child has respiratory problems, high blood pressure in the lungs (pulmonary hypertension) due to pulmonary vasoconstriction, increased heart (cardiomegaly), heart failure.

Later in the child’s life may be complications such as progressive pulmonary hypertension, heart valve regurgitation, cardiac rhythm (arrhythmia).

 

Truncus arteriosus in adults
A person can live with truncus arteriosus through adulthood without treatment in very rare cases only  Nevertheless, people with this diagnosis almost certainly develop heart failure and Eisenmenger syndrome. This syndrome is caused by irreversible lung damage with pulmonary hypertension, which leads to a significant bypass of blood flow of the lung. The only treatment option in this case may be a heart and lung transplantation.

 

 

Diagnostics
Physical examination. Performed by pediatrician after birth, as well as regular monitoring in the first weeks of his life. Measurement of height, weight and head circumference to determine possible growth retardation, listening to the lungs to assess the baby’s breathing and detection of fluid in the lungs, irregular heartbeat (arrhythmia) or abnormal whistling sound caused by turbulent blood flow (heart murmur).

Echocardiography (ECHO). Shows the structure and function of the heart.

X-ray. Can determine the size of the heart, abnormalities and excess fluid in the lungs.

 

 

Persistent truncus arteriosus treatment.

The main method of treatment for a child with arterial trunk is surgery. Before the operation can be assigned to the drug in order to maintain the heart.

Surgical procedures
Most operations are done up to 3 months old. The procedures selected depend on the condition of the child. In most cases, the following operations performed:
1. Closing the hole between the two ventricles.
2. Branch upper portion of the pulmonary artery of the vessel.
3. The implant tubes and valves to connect the right ventricle to the top of the pulmonary artery – the creation of a new, high-grade pulmonary artery.
4. Reconstruction of the central vessel and creating a new full aorta.
5. Implanting new valve separating the left ventricle and the aorta, if necessary.

 

After surgical correction a child needs a lifelong monitoring and observation of the cardiologist. Cardiologist may recommend limiting physical activity, in particular, heavy competitive sports. Child may need to take antibiotics before dental procedures and other surgical procedures in order to prevent infections. In general, prophylactic antibiotics are recommended for six months after surgery correction arterial trunk.

 

Since the artificial channel does not grow with your child, you may need one or more of the following operations to replace the channel into adulthood.

 

Recently, our surgeons are increasingly use procedures such as balloon angioplasty. This procedure is performed by inserting a catheter into a vein in a child that does not require opening the chest. Cardiac catheterization with an inflatable stent allows to reveal and expand difficult or narrowed arteries, which can delay the need for further surgery.

 

Women who were operated on in infancy on the truncus arteriosus, before planning pregnancy should be examined by a cardiologist and expert on birth defects in adults, and the obstetrician who specializes in high-risk pregnancies. Depending on the level of lung injury that occurred prior to surgery, pregnancy may or may not be recommended. In addition, some medications taken for the heart, can be harmful to the fetus.

 

Prevention
In most cases, congenital heart disease, such as truncus arteriosus can not be prevented.

 

If you have a family history of heart defects or if you already have a child with congenital heart disease, before planning pregnancy, you and your partner can contact our specialists on genetic diseases, as well as a cardiologist specializing in heart diseases.

 

Before planning pregnancy it is important to take a few steps to help ensure the health of your child:
1. Make all the necessary vaccinations before pregnancy. Some viruses, such as rubella, can be very harmful during pregnancy, so it is important to make sure you are vaccinated before pregnancy.

2. Avoid taking dangerous drugs. Talk to your doctor before taking any medicine if you are pregnant or thinking about pregnancy. Many drugs are not recommended for use during pregnancy.

3. Take folic acid. One of the few steps that you can take to help prevent birth defects, including the spinal cord, brain, and possibly heart disease, is receiving 400 micrograms of folic acid per day.

4. Management of diabetes. If you are a woman with diabetes, talk to your doctor about the risks of pregnancy-related diabetes, and methods of effective management of the disease during pregnancy.

 

 

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ResultMed Team  

 

Our doctors

 

 

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