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Eur Heart J Cardiovasc Imaging. 2019 Oct 19. pii: jez255. doi: 10.1093/ehjci/jez255. [Epub ahead of print]

Clarifying the anatomy of common arterial trunk: a clinical study of 70 patients.

Author information

1
Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India.
2
Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India.
3
Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India.
4
Division of Genetics, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
5
Institute of Genetic Medicine, University of Newcastle, Newcastle upon Tyne, UK.

Abstract

AIMS:

Anatomic variations in hearts with common arterial trunk are well-known, although there is no large study of living patients. Detailed knowledge of the origins of the pulmonary and coronary arteries is vital for surgical management. We sought to clarify the variations using computed tomography.

METHODS AND RESULTS:

We prospectively studied 70 consecutive patients using echocardiography and computed tomography. In 63 (90%) patients, there was aortic dominance, while 7 (10%) had dominance of the pulmonary component. In 27 (43%) patients with aortic dominance, part of the pulmonary segment arose from a truncal valvar sinus. A long confluent pulmonary channel was more common in patients with sinusal origin compared to those with non-sinusal origin of the pulmonary segment (19 vs. 0; P = 0.0005). Close proximity between the orifices of the coronary arteries and the pulmonary component was also more frequent with sinusal origin (21 vs. 6; P < 0.001) with 5 (19%) patients having pulmonary flow obstructed by a truncal valvar leaflet.

CONCLUSION:

Sinusal origin of the pulmonary component is common with aortic dominance, frequently in association with a long confluent pulmonary segment, which may be in close proximity to the origin of a coronary artery. One-fifth of patients with sinusal origin of pulmonary component have a truncal valvar leaflet obstructing the pulmonary orifice. These morpho-anatomic findings have important implications for management.

KEYWORDS:

common arterial trunk; computed tomography; virtual dissection

PMID:
31628808
DOI:
10.1093/ehjci/jez255

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