Elsevier

Clinical Imaging

Volume 39, Issue 6, November–December 2015, Pages 938-944
Clinical Imaging

Review Article
3D MDCT angiography for the preoperative assessment of truncus arteriosus

https://doi.org/10.1016/j.clinimag.2015.07.019Get rights and content

Abstract

Truncus arteriosus is an uncommon conotruncal anomaly, which is amenable to surgical correction. The systemic, pulmonary, and coronary circulations originate from a single arterial vessel that arises from the ventricular part of the heart and overrides the ventricular septum. The value of multidetector computed tomography with three-dimensional postprocessing lies in the detailed assessment of the presence or absence of the pulmonary arteries, including the number, origin, and branching patterns of major aortopulmonary collateral arteries, and extracardiac abnormalities such as aortic arch interruption. This article reviews the various imaging spectra of truncus arteriosus, which are especially important in the surgical planning.

Introduction

Persistent truncus arteriosus is a relatively uncommon conotruncal anomaly, and it accounts for approximately 1–4% of all congenital cardiac malformations. It occurs as a result of the failure of the conotruncal septation, during fetal development, and is related to both the chromosome 22q11 deletion and DiGeorge syndrome. It is characterized by a single arterial trunk that originates from the ventricular part of the heart, overrides the ventricular septum, and supplies branches to the systemic, pulmonary, and coronary circulations [1]. The truncal valve is often dysplastic, with thickened cusps and supernumerary leaflets, usually with two to five cusps that are usually either stenotic or regurgitant. An interrupted aortic arch is a commonly associated lesion (11%–14% of patients) and is usually situated between the left carotid and subclavian arteries [2], [3]. A ventricular septal defect (VSD) is present in almost all of the patients just below the common arterial trunk due to absence of the right ventricular infundibular septum.

The coronary arteries stem from the sinuses of Valsalva. The left and right coronary arteries often originate from the left posterior cusp and right anterior cusp, respectively [4]. Other cardiac anomalies include secundum atrial septal defect, right aortic arch, aberrant subclavian artery persistent left superior vena cava, and tricuspid stenosis.

An exact preoperative diagnosis is very important because the optimal timing and procedure for truncus arteriosus repair are decided on the basis of the morphological characteristics. The presence of interruption of the aortic arch is one of the factors that influence the outcome and mortality [5], [6].

The purpose of this pictorial review is to illustrate multidetector computed tomography (MDCT) angiography imaging, with three-dimensional (3D) postprocessing to evaluate the preoperative anatomic features of truncus arteriosus.

Section snippets

Classification

Historically, there are two major classification systems for truncus arteriosus: that by Collett and Edwards and that by Van Praagh and Van Praagh [7], [2]. The Collett and Edwards classification is based on the origin of the pulmonary arteries. In the Collett–Edwards system, Type 1 is characterized by a single pulmonary artery (PA) trunk arising from the proximal left lateral aspect of the common trunk. This is the most common type (48–68% of cases). Type 2 is characterized by the absence of

Surgical repair

The surgical repair of truncus arteriosus was first developed approximately 30 years ago, and now most patients undergo correction within the first few weeks after birth. Surgical repair of truncus arteriosus includes VSD patch closure and detachment of the pulmonary arteries from the arterial trunk with formation of a right ventricle to PA conduit. The truncal valve may also require repair, and aortic arch interruption or coarctation is repaired at the same time. Lifelong surveillance is

MDCT findings

In children with congenital heart disease, MDCT angiography has been increasingly used [9], [10], [11]. Echocardiography is almost always the primary imaging modality for patients with truncus arteriosus, but it is an operator-dependent imaging modality and is also inadequate for the visualization of extracardiac structures [12]. It has limited ability in the evaluation of anomalous vessel anatomy, origin, and branching of the arterial trunk. MRI also has several disadvantages compared with

Conclusion

MDCT angiography is a good modality for preoperative determination of the anatomical classification of truncus arteriosus. MDCT angiography is also useful for the evaluation of associated cardiovascular anatomic anomalies.

References (18)

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