This document discusses the use of echocardiography to evaluate truncus arteriosus, a rare congenital heart defect where a single arterial trunk arises from the heart and gives rise to the pulmonary and systemic circulations. It describes the four types of truncus arteriosus based on the anatomy of the pulmonary arteries. Key echocardiography views and measurements needed to characterize the defect and associated anomalies are provided. The document also briefly discusses surgical repair and additional imaging that may be used.

1. Echo evaluation of
Truncus arteriosus
common arterial trunk
By
Dr.Aliaa Shaban
Lecturer of Cardiology
TANTA UNIVERSITY
Egypt
4/27/2020

2. • Only a single arterial trunk with a truncal
valve leaves the heart and gives rise to the
pulmonary, systemic, and coronary
circulations.
• The pulmonary valve cannot be imaged; only
one semilunar valve (i.e., truncal valve) is
imaged
• A large perimembranous, infundibular VSD is
present directly below the truncus .
• The truncal valve may be bicuspid, tricuspid,
or quadricuspid, and it is often incompetent4/27/2020

3. 4/27/2020

4. 4/27/2020

5. Types
• In type I, the main
pulmonary artery
(PA) arises from the
truncus and then
divides into the right
(RPA) and left
pulmonary artery
(LPA) branches.
(there is short MPA)
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6. Type II
• In type II, the
pulmonary
arteries arise from
the posterior
aspect of the
truncus (very close to
each other )
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7. Type III
• In type III, the
pulmonary arteries
arise from the
lateral aspects of
the truncus.
• Two orifices of the PAs are more distant
from the truncal valve .
• more distant from each other as
compared with type II.
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8. Type IV …X
• In type IV, or
pseudotruncus
arteriosus, arteries
arising from the
descending aorta
(AO) supply the
lungs.
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9. Echo views
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10. 1- Parasternal long axis
• Dilated single great artery, in continuity with
the mitral valve, arising from the base of the
heart, overriding the interventricular septum
• with a outlet malalignment type VSD
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13. Truncal valve incompetece
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15. 2- Parasternal short axis
• Truncal valve morphology and number of
leaflets
• the VSD in the outlet septum.
• The pulmonary valve, main pulmonary artery,
and branches are absent from their usual
location.
• pulmonary arteries arising from the common
truncus is a key finding in differentiating this
anomaly from pulmonary atresia with VSD
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16. Type I
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17. Type III
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18. 4/27/2020

19. Other views:
The apical and subcostal views allow evaluation
of:
• the VSD, the degree of truncal override,
• the ventricular sizes,
• and the origin of the main and/or branch
pulmonary arteries
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20. 4/27/2020

21. Supra sternal view
• Aortic arch anomalies are common in patients
with truncus arteriosus:
 right aortic arch ( the most common.)
interrupted aortic arch
• pulmonary branch stenosis.
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22. Evaluation list
1-Type of truncus arteriosus
2. Pulmonary artery anatomy and size (small)
3. Ventricular septal defect, size, and location
(other)
4. Coronary artery anatomy
5. Truncal valve morphology and degree of
truncal overriding
a. Severity of truncal valve stenosis
b. Severity of truncal valve regurge.
6. Associated cardiac anomalies 4/27/2020

23. operation
• Patch closure of the VSD,
• Truncal septation (between the ascending
aorta and origin of he PA)
• and placement of a tube graft between the RV
and PA. ( VALVED CONDUIT )
( Rastelli )
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24. Additional imaging
• Cardiac cath (PAP)……early developed (6m-2y )
• CT , MRI (ANATOMY)
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25. Assessment of complications
• Eisenmenger Syndrome. (PAP)
• Truncal valve stenosis, regurge
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