The common arterial trunk belongs to the category of complex congenital pathologies of the development of the cardiovascular apparatus. This anomaly is characterized by a departure from the heart of only one blood vessel, not divided into the aorta and pulmonary artery. It is he who carries the blood in a large and small circle of blood flow, which entails serious hemodynamic disturbances. This vessel during fetal development is called the common arterial trunk in the fetus.
A little information
The ICD-10 common arterial trunk code is Q20.0.
Such a complex pathology of the cardiovascular system occurs in only 2-3% of babies with congenital malformations. It is noteworthy that this phenomenon is always accompanied by a defect in the interventricular septum. Often, the common arterial trunk in the newborn is accompanied by other anomalies: pathological drainage of the respiratory tract, open atrioventricular duct, only one ventricle, coarctation of the aorta, mitral valve atresia. In addition, such a disease can be accompanied by extracardiac malformations of the skeleton, digestive tract and genitourinary system.
The common arterial trunk is a developmental disorder, which is expressed in the union of the aorta and pulmonary artery into one vessel. This kind of violation occurs during the period of intrauterine formation of the embryo. In this trunk, venous and arterial blood is combined, which as a result enters both blood flows.
Features
A similar deviation is diagnosed in newborn babies. The condition is considered extremely dangerous and can even lead to death if the child is not provided with timely assistance. After all, such a deviation entails a constantly progressive violation of the numerous functions of internal organs and systems.
The common trunk is localized either over both ventricles, or only over one of them. This pathology in 75% of all cases causes the death of the baby before he turns one year old. In 65% of cases, the child dies before six months.
Etiology of the common arterial trunk
This defect is formed during the active development of the fetus in the mother’s womb. The most dangerous period is considered the first trimester, which is the construction of the cardiovascular apparatus.
The disease can be caused by a number of different reasons, among which it is worth highlighting:
- the effects of radiation or chemicals on the body of the expectant mother;
- the effect of infections and viruses in the initial stages of pregnancy;
- the passage of a pregnant woman radiography;
- drinking alcohol and tobacco;
- autoimmune pathologies, which are a prerequisite for a conflict between the body of a woman and the embryo;
- exposure to toxins;
- diabetes;
- uncontrolled use of potent medicines during the period of bearing a child.
And this is not the whole list of possible causes that provoke the development of deviations: doctors say that not all factors have been studied.
Classification
There are four varieties of pathology. The view is determined by the place of discharge of the pulmonary arteries and the occurrence of one of the scenarios:
- 1st type of the common arterial trunk - the vessel, disconnecting from the common trunk, is divided into the right and left pulmonary arteries;
- 2nd type - both arteries are separated from the posterior wall of the trunk;
- 3rd type - arteries extend from the lateral surfaces of the trunk;
- 4th type - the arteries are completely absent, while the lungs are filled with blood through vessels separated from the aorta.
Given the placement of the trunk relative to the ventricles, 3 types of pathology are distinguished:
- mainly above the right side - in about 42% of patients;
- over both - in 42% of infants;
- mostly over the left - in about 16% of patients.
The exact type of pathology is determined by diagnostic examinations.
Hemodynamic features
In the presence of a common arterial trunk in a newborn, certain deviations occur: instead of two channels emanating from both ventricles, there is only one duct into which all blood enters.
The right section of the myocardium in this disease undergoes severe overload, since due to the connection of the ventricles, an equivalent pressure is noted in them. Normally, the pressure on the right side is reduced. In the presence of a common trunk, pressure appears in the pulmonary arteries, which, in turn, resist. So there is a threat to life.
With this pathology, several types of hemodynamic failures are noted.
An abnormal increase in pulmonary circulation and pressure in the arteries. As a result, heart failure develops. Such conditions are resistant to any therapy.
A slight increase in pulmonary circulation and a not very pronounced discharge of blood. In this situation, heart failure is absent, but cyanosis is noted.
Lowering pulmonary circulation against arterial stenosis. There is cyanosis.
All these violations carry a huge danger to the life of a newborn baby.
Symptomatology
The clinical picture of the disease is explained by a constant lack of oxygen in the blood. It is this phenomenon that provokes the occurrence of symptoms such as:
- difficulty breathing even at rest;
- blue skin of the baby;
- abnormal deformation of fingers that visually begin to resemble drumsticks;
- deviations in physical development;
- increased sweating;
- heart palpitations;
- breathing too often;
- impaired appetite;
- reduced stamina;
- constant fatigue.
The clinical picture of the disease is characterized by arterial hypoxemia, cyanosis and heart failure. The severity of all these signs is determined by the type of common arterial trunk.
So, with the first type of anomaly, cyanosis manifests itself slightly, but with other forms it is more pronounced. But the symptoms of heart failure can equally appear with different types of disease.
Doctor Examinations
When passing the examinations, such specific signs of the common arterial trunk in children are manifested: an increase in the volume of the heart and liver, the formation of a heart hump.
During the examination of the child, a specialist can identify the following symptoms of the disease:
- increased heart rate;
- increased heart rate;
- holosystolic murmurs in the left chest;
- single loud clicks of exile of the second tone;
- the mitral valve noise heard from above in the center of the diastole.
Diagnostics
It is possible to identify the common arterial trunk of the fetus by ultrasound at approximately 23-25th week of pregnancy. Often, when confirming the presence of this anomaly, experts recommend that women terminate their pregnancy, because even an operation performed on time does not guarantee a positive result and successful correction of the vessel. In addition to this congenital heart disease, approximately half of newborn infants have extracardiac pathologies.
You can suspect the presence of a common arterial trunk in a child by identifying any of the described symptoms and making a physical examination of a small patient. To confirm the diagnosis, auxiliary examinations are prescribed:
- X-ray - the shape of the heart, the size of the pulmonary arteries and other vessels are evaluated, the presence of hypertrophy and an increase in ventricles are determined.
- ECG - helps to detect abnormalities in the work of the heart and overload of the ventricles.
- Phonocardiography - allows you to evaluate the tones and sounds in the heart.
- Echo-KG - reveals the association of pulmonary arteries.
- Catheterization - with an IPN such as a common arterial trunk, a catheter easily penetrates the desired organ, while the same pressure is detected in the vessels and ventricles, a gradient is likely.
- Angiocardiography - makes it possible to diagnose abnormalities in the structure of blood vessels, an increase in ventricles and atria.
- Aortography - is necessary to determine the degree of arterial passage and assess the condition of the valve cusps.
The most informative measure in the diagnosis of the common arterial trunk in newborns is angiocardiography, which makes it possible to determine the type of anomaly.
Conservative treatment
It should be borne in mind that this heart disease is eliminated exclusively through surgery. Conservative therapy with such a diagnosis is considered ineffective and is recommended only to maintain the normal condition of the child before surgery.
Such treatment is aimed at:
- decrease in physical activity;
- providing thermal convenience;
- decreased volume of moving blood;
- relief of signs of heart failure.
The child may be recommended:
- diuretics;
- Digoxin preparation;
- ACE inhibitors.
Treatment of a common arterial trunk should be carried out by a cardiologist or angiologist.
Surgical intervention
Surgery is the only way to eliminate the pathology. It should be carried out in the first months of the life of an infant who was diagnosed with a common arterial trunk.
As a rule, two surgical procedures are used:
- Palliative surgery. A specific event that allows you to temporarily relieve the condition of the child, but not completely relieve the defect. With this intervention, a special clip is applied to the pulmonary artery, which narrows the lumen of the channel and regulates the release of blood into the general bloodstream.
- Radical technique. This method allows you to completely get rid of the disease. Correction is carried out in several stages. First, the communication between the artery and the aorta ceases, then the atrial septal defect is blocked by a patch. In conclusion, an artificial trunk of the pulmonary artery is created. A special stent is used for this. Such an intervention is considered difficult because it is performed on an open heart. During the operation, a device for artificial blood supply is used.
It is worth noting that for small patients with insufficiency of the valve of the common arterial trunk, radical intervention is supplemented by prosthetics or plastic surgery.
Therapy Features
Radical surgery is carried out at an early age, and as the child develops, he will need repeated procedures, which include valve replacement or conduit reimplantation.
The success of surgical therapy for congenital heart disease is largely due to the timeliness, severity of pulmonary hypertension and the presence of concomitant pathologies of the cardiovascular apparatus. Children who were operated on in the 2-5th week of life can expect a more favorable prognosis. In large cardiac centers, the success rate of such surgical interventions reaches approximately 90%.
If, after surgery, there is a positive dynamics in the condition of a small patient, drugs that regulate blood circulation are prescribed.
Further forecast
Is there a chance for a baby with such a diagnosis? If you refuse timely surgical intervention, death will definitely occur during the first year.
The outcome of the disease can be successful if pronounced changes in the pulmonary arteries are not observed with congenital heart disease.
If the operation succeeds, the baby remains alive. In the future, he needs systematic qualified monitoring and taking special medications.
As for deaths during surgical treatment, their number reaches about 10-30%.
Conclusion
The main preventive measures aimed at preventing the development of a common arterial trunk are to protect the woman to the maximum from harmful effects on her body. This applies primarily to radioactive and any other harmful substances, tobacco, alcohol, all kinds of toxins. It is extremely important that there are no carriers of various viruses and infections in the environment of the pregnant woman.
The common arterial trunk is an extremely rare, but very dangerous defect that covers the myocardial area and provokes many deaths among infants with CHD. Typically, these babies do not live up to a year. Timely diagnosis and successful therapy give the newborn a chance to survive.