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J Thorac Cardiovasc Surg 2009;137:753-755
© 2009 The American Association for Thoracic Surgery

Brief Communication

Diagnosis and management of tritruncal heart in an infant

^a Department of Surgery, Drexel University College of Medicine, Philadelphia, Pa
^b Section of Cardiothoracic Surgery, St Christopher's Hospital for Children, Philadelphia, Pa
^c Department of Pediatrics, Division of Pediatric Cardiology, University of Miami Leonard M. Miller School of Medicine, Miami, Fla

Received for publication December 4, 2007; accepted for publication March 13, 2008.

^_* Address for reprints: Glenn J. Pelletier, MD, Section of Cardiothoracic Surgery, Saint Christopher's Hospital for Children, Erie Avenue at Front St, Philadelphia, PA 19134-1095. (Email: gpelleti@drexelmed.edu).

The first 20% of the full text of this article appears below.

Ventriculoarterial connections are typically arranged with the aorta and main pulmonary artery (MPA) joined to the left ventricle (LV) and right ventricle (RV), respectively. Until 1982, when Díaz-Góngora and colleagues¹ reported an autopsy case in which 3 separate arteries arose from the base of the ventricles, tritruncal heart was an unknown defect. The third artery was an intermediate trunk that arose from the LV and continued on as the right pulmonary artery (RPA). We report the diagnosis and management of the first known living child to undergo successful repair of a tritruncal heart.

Clinical Summary

The patient was a male twin born at term. At 10 days after his birth, a heart murmur was detected. At presentation, the patient appeared well; however, the oxygen saturations recorded by noninvasive measurement varied from 83% to 97% when the patient was breathing ambient air. An echocardiogram demonstrated 3 arterial trunks originating from the base of the heart. The MPA (11 mm) arose from the RV and continued distally exclusively as the left pulmonary artery (LPA, 5 mm). The aorta (8 mm) arose from the LV in the usual fashion. The third artery, the IT (3 mm), originated from the LV and continued as the RPA. At the base of the IT, a semilunar valve was seen through which antegrade flow into the RPA and regurgitant flow into the LV occurred (Figure 1, A ). The RV pressure was estimated to be suprasystemic. There was predominantly right-to-left shunting through a patent foramen ovale. The LV was normal in size and function.

View larger version (52K):   Figure 1. A, Transthoracic echocardiogram shows regurgitant flow (asterisk) through intermediate trunk into left ventricle (LV). Aortic valve (AV) is adjacent to but separate from this intermediate vessel. RV, Right ventricle. B, In left . . . [Full Text of this Article]