Truncus arteriosus - Revision history

ClaireLewis at 21:11, 6 October 2019

2019-10-06T21:11:49Z

← Revisión anterior		Revisión del 21:11 6 oct 2019
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	==Background==		==Background==
	[[File:Truncus arteriosus.jpg\|thumb\|Truncus arteriosus anatomy]]		[[File:Truncus arteriosus.jpg\|thumb\|Truncus arteriosus anatomy]]
	*A cyanotic congenital heart defect		*A cyanotic [[congenital heart disease\|congenital heart defect]]
	*Blood is pumped through a single truncal valve into a truncal artery which gives rise to the aorta and the pulmonary arteries		*Blood is pumped through a single truncal valve into a truncal artery which gives rise to the aorta and the pulmonary arteries
	*Associated with large [[VSD]] in most patients		*Associated with large [[VSD]] in most patients

ClaireLewis: /* Clinical Features */

2019-09-26T18:40:27Z

Clinical Features

← Revisión anterior		Revisión del 18:40 26 sep 2019
Línea 16:		Línea 16:
	**[[hypoxemia\|Cyanosis]]		**[[hypoxemia\|Cyanosis]]
	**Pulmonary congestion and [[heart failure]]		**Pulmonary congestion and [[heart failure]]
	***Poor feeding, lethargy, signs of [[respiratory distress]] (tachypnea, costal-sternal retractions, grunting, and nasal flaring), tachycardia, hyperdynamic precordium, and hepatomegaly		***[[failure to thrive (peds)\|Poor feeding]], [[altered mental status (peds)\|lethargy]], signs of [[shortness of breath (peds)\|respiratory distress]] (tachypnea, costal-sternal retractions, grunting, and nasal flaring), [[tachycardia]], hyperdynamic precordium, and [[hepatomegaly]]
	**Cardiovascular findings		**Cardiovascular findings
	***Loud second heart sound		***Loud second heart sound

ClaireLewis: /* Management */

2019-08-18T16:48:55Z

Management

← Revisión anterior		Revisión del 16:48 18 ago 2019
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	*[[Noninvasive positive pressure ventilation]] often used in patients with respiratory distress due to pulmonary congestion		*[[Noninvasive positive pressure ventilation]] often used in patients with respiratory distress due to pulmonary congestion
	*Supportive care to correct [[metabolic acidosis]], [[hypoglycemia]], and [[anemia]] that may contribute to heart failure		*Supportive care to correct [[metabolic acidosis]], [[hypoglycemia]], and [[anemia]] that may contribute to heart failure
	*[[Prostaglandin E1]] if patient also has critical coarctation of the aorta		*[[Prostaglandin E1]] if patient also has critical [[coarctation of the aorta]]
	*Primary surgical repair during the neonatal period (less than 30 days of age)		*Primary surgical repair during the neonatal period (less than 30 days of age)
	**Improved survival rate at one year of age of >80% vs 15% in uncorrected patients <ref>Thompson LD. Neonatal repair of truncus arteriosus: continuing improvement in outcomes. Ann Thorac Surg. 2001;72(2):391-5.</ref>		**Improved survival rate at one year of age of >80% vs 15% in uncorrected patients <ref>Thompson LD. Neonatal repair of truncus arteriosus: continuing improvement in outcomes. Ann Thorac Surg. 2001;72(2):391-5.</ref>

ClaireLewis at 20:09, 11 August 2017

2017-08-11T20:09:40Z

← Revisión anterior		Revisión del 20:09 11 ago 2017
Línea 1:		Línea 1:
	==Background==		==Background==
	[[File:Truncus arteriosus.jpg\|thumb\|]]		[[File:Truncus arteriosus.jpg\|thumb\|Truncus arteriosus anatomy]]
	*A cyanotic congenital heart defect		*A cyanotic congenital heart defect
	*Blood is pumped through a single truncal valve into a truncal artery which gives rise to the aorta and the pulmonary arteries		*Blood is pumped through a single truncal valve into a truncal artery which gives rise to the aorta and the pulmonary arteries

ClaireLewis at 20:08, 11 August 2017

2017-08-11T20:08:17Z

← Revisión anterior		Revisión del 20:08 11 ago 2017
Línea 1:		Línea 1:
	==Background==		==Background==
			[[File:Truncus arteriosus.jpg\|thumb\|]]
	*A cyanotic congenital heart defect		*A cyanotic congenital heart defect
	*Blood is pumped through a single truncal valve into a truncal artery which gives rise to the aorta and the pulmonary arteries		*Blood is pumped through a single truncal valve into a truncal artery which gives rise to the aorta and the pulmonary arteries
	*Associated with large VSD in most patients		*Associated with large [[VSD]] in most patients
	*Incidence ranges from 6 to 10 per 100,000 live births, accounts for 4% of all [[congenital heart disease]] <ref>Reller MD. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr. 2008;153(6):807-13. </ref>		*Incidence ranges from 6 to 10 per 100,000 live births, accounts for 4% of all [[congenital heart disease]] <ref>Reller MD. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr. 2008;153(6):807-13. </ref>

	===Physiology===		===Physiology===
	*PVR is high in the newborn infant, so there is little left to right shunting at birth		*PVR is high in the newborn infant, so there is little left to right shunting at birth
	*Over first several weeks of life, PVR drops, left to right shunting increases, leading to heart failure		*Over first several weeks of life, PVR drops, left to right shunting increases, leading to [[heart failure]]
	*Mixing of systemic and pulmonary blood leads to mild to moderate cyanosis		*Mixing of systemic and pulmonary blood leads to mild to moderate cyanosis
	*Pulmonary vascular obstructive disease may develop in surgically uncorrected patients		*Pulmonary vascular obstructive disease may develop in surgically uncorrected patients
Línea 13:		Línea 14:
	==Clinical Features==		==Clinical Features==
	*Most present within the first weeks of life with		*Most present within the first weeks of life with
	**Cyanosis		**[[hypoxemia\|Cyanosis]]
	**Pulmonary congestion and heart failure		**Pulmonary congestion and [[heart failure]]
	***Poor feeding, lethargy, signs of respiratory distress (tachypnea, costal-sternal retractions, grunting, and nasal flaring), tachycardia, hyperdynamic precordium, and hepatomegaly		***Poor feeding, lethargy, signs of [[respiratory distress]] (tachypnea, costal-sternal retractions, grunting, and nasal flaring), tachycardia, hyperdynamic precordium, and hepatomegaly
	**Cardiovascular findings		**Cardiovascular findings
	***Loud second heart sound		***Loud second heart sound
	***Prominent ejection click at the apex or left sternal border		***Prominent ejection click at the apex or left sternal border
	***Systolic ejection murmur at the left sternal border		***Systolic ejection [[murmur]] at the left sternal border
	***Bounding peripheral pulses		***Bounding peripheral pulses
	***Increased pulse pressure		***Increased pulse pressure
Línea 34:		Línea 35:
	**Increased pulmonary vascular markings		**Increased pulmonary vascular markings
	**May see absent thymus in patients with TA associated with [[DiGeorge syndrome]]		**May see absent thymus in patients with TA associated with [[DiGeorge syndrome]]
	*~~Echo~~		*[[Echocardiography]]

	==Management==		==Management==
Línea 41:		Línea 42:
	*Inotropic agents (eg, [[dopamine]] and [[dobutamine]]) improve myocardial contractility		*Inotropic agents (eg, [[dopamine]] and [[dobutamine]]) improve myocardial contractility
	*[[ACEI]] reduces afterload		*[[ACEI]] reduces afterload
	*Noninvasive positive pressure ventilation often used in patients with respiratory distress due to pulmonary congestion		*[[Noninvasive positive pressure ventilation]] often used in patients with respiratory distress due to pulmonary congestion
	*Supportive care to correct metabolic acidosis, hypoglycemia, and anemia that may contribute to heart failure		*Supportive care to correct [[metabolic acidosis]], [[hypoglycemia]], and [[anemia]] that may contribute to heart failure
	*[[Prostaglandin E1]] if patient also has critical coarctation of the aorta		*[[Prostaglandin E1]] if patient also has critical coarctation of the aorta
	*Primary surgical repair during the neonatal period (less than 30 days of age)		*Primary surgical repair during the neonatal period (less than 30 days of age)

Mholtz: Text replacement - "* " to "*"

2017-07-13T06:22:58Z

Text replacement - "* " to "*"

← Revisión anterior		Revisión del 06:22 13 jul 2017
Línea 1:		Línea 1:
	==Background==		==Background==
	* A cyanotic congenital heart defect		*A cyanotic congenital heart defect
	* Blood is pumped through a single truncal valve into a truncal artery which gives rise to the aorta and the pulmonary arteries		*Blood is pumped through a single truncal valve into a truncal artery which gives rise to the aorta and the pulmonary arteries
	* Associated with large VSD in most patients		*Associated with large VSD in most patients
	* Incidence ranges from 6 to 10 per 100,000 live births, accounts for 4% of all [[congenital heart disease]] <ref>Reller MD. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr. 2008;153(6):807-13. </ref>		*Incidence ranges from 6 to 10 per 100,000 live births, accounts for 4% of all [[congenital heart disease]] <ref>Reller MD. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr. 2008;153(6):807-13. </ref>

	===Physiology===		===Physiology===
Línea 12:		Línea 12:

	==Clinical Features==		==Clinical Features==
	* Most present within the first weeks of life with		*Most present within the first weeks of life with
	** Cyanosis		**Cyanosis
	** Pulmonary congestion and heart failure		**Pulmonary congestion and heart failure
	***Poor feeding, lethargy, signs of respiratory distress (tachypnea, costal-sternal retractions, grunting, and nasal flaring), tachycardia, hyperdynamic precordium, and hepatomegaly		***Poor feeding, lethargy, signs of respiratory distress (tachypnea, costal-sternal retractions, grunting, and nasal flaring), tachycardia, hyperdynamic precordium, and hepatomegaly
	** Cardiovascular findings		**Cardiovascular findings
	***Loud second heart sound		***Loud second heart sound
	***Prominent ejection click at the apex or left sternal border		***Prominent ejection click at the apex or left sternal border

Rossdonaldson1: /* Evaluation */

2017-06-04T02:01:28Z

Evaluation

← Revisión anterior		Revisión del 02:01 4 jun 2017
Línea 30:		Línea 30:
	**May be normal		**May be normal
	**May have evidence of left or right ventricular hypertrophy		**May have evidence of left or right ventricular hypertrophy
	*Chest ~~xray~~		*[[Chest x-ray]]
	**Enlarged cardiac silhouette		**Enlarged cardiac silhouette
	**Increased pulmonary vascular markings		**Increased pulmonary vascular markings

Mholtz at 14:51, 25 May 2017

2017-05-25T14:51:31Z

← Revisión anterior		Revisión del 14:51 25 may 2017
Línea 51:		Línea 51:

	==See Also==		==See Also==
	*[[Congenital ~~Heart Disease~~]]		*[[Congenital heart disease]]

	==External Links==		==External Links==


	==References==		==References==
	<references/>		<references/>

			[[Category:Cardiology]]
			[[Category:Pediatrics]]

Lisayee25: /* Background */

2017-05-25T02:02:10Z

Background

← Revisión anterior		Revisión del 02:02 25 may 2017
Línea 2:		Línea 2:
	* A cyanotic congenital heart defect		* A cyanotic congenital heart defect
	* Blood is pumped through a single truncal valve into a truncal artery which gives rise to the aorta and the pulmonary arteries		* Blood is pumped through a single truncal valve into a truncal artery which gives rise to the aorta and the pulmonary arteries
	* Associated with large VSD in ~~mot~~ patients		* Associated with large VSD in most patients
	* Incidence ranges from 6 to 10 per 100,000 live births, accounts for 4% of all [[congenital heart disease]] <ref>Reller MD. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr. 2008;153(6):807-13. </ref>		* Incidence ranges from 6 to 10 per 100,000 live births, accounts for 4% of all [[congenital heart disease]] <ref>Reller MD. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr. 2008;153(6):807-13. </ref>

Lisayee25: Created page with "==Background== * A cyanotic congenital heart defect * Blood is pumped through a single truncal valve into a truncal artery which gives rise to the aorta and the pulmonary arte..."

2017-05-25T01:59:21Z

Created page with "==Background== * A cyanotic congenital heart defect * Blood is pumped through a single truncal valve into a truncal artery which gives rise to the aorta and the pulmonary arte..."

Página nueva

==Background==
* A cyanotic congenital heart defect
* Blood is pumped through a single truncal valve into a truncal artery which gives rise to the aorta and the pulmonary arteries
* Associated with large VSD in mot patients
* Incidence ranges from 6 to 10 per 100,000 live births, accounts for 4% of all [[congenital heart disease]] <ref>Reller MD. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. J Pediatr. 2008;153(6):807-13. </ref>

===Physiology===
*PVR is high in the newborn infant, so there is little left to right shunting at birth
*Over first several weeks of life, PVR drops, left to right shunting increases, leading to heart failure
*Mixing of systemic and pulmonary blood leads to mild to moderate cyanosis
*Pulmonary vascular obstructive disease may develop in surgically uncorrected patients

==Clinical Features==
* Most present within the first weeks of life with
** Cyanosis
** Pulmonary congestion and heart failure
***Poor feeding, lethargy, signs of respiratory distress (tachypnea, costal-sternal retractions, grunting, and nasal flaring), tachycardia, hyperdynamic precordium, and hepatomegaly
** Cardiovascular findings
***Loud second heart sound
***Prominent ejection click at the apex or left sternal border
***Systolic ejection murmur at the left sternal border
***Bounding peripheral pulses
***Increased pulse pressure

==Differential Diagnosis==
{{Congenital heart disease DDX}}

==Evaluation==
*[[ECG]]
**May be normal
**May have evidence of left or right ventricular hypertrophy
*Chest xray
**Enlarged cardiac silhouette
**Increased pulmonary vascular markings
**May see absent thymus in patients with TA associated with [[DiGeorge syndrome]]
*Echo

==Management==
*Stabilize cardiopulmonary function prior to surgery
*Diuretic therapy, (eg, [[furosemide]]) reduce preload, relieve volume overload and pulmonary congestion
*Inotropic agents (eg, [[dopamine]] and [[dobutamine]]) improve myocardial contractility
*[[ACEI]] reduces afterload
*Noninvasive positive pressure ventilation often used in patients with respiratory distress due to pulmonary congestion
*Supportive care to correct metabolic acidosis, hypoglycemia, and anemia that may contribute to heart failure
*[[Prostaglandin E1]] if patient also has critical coarctation of the aorta
*Primary surgical repair during the neonatal period (less than 30 days of age)
**Improved survival rate at one year of age of >80% vs 15% in uncorrected patients <ref>Thompson LD. Neonatal repair of truncus arteriosus: continuing improvement in outcomes. Ann Thorac Surg. 2001;72(2):391-5.</ref>

==Disposition==
*Admit

==See Also==
*[[Congenital Heart Disease]]

==External Links==

==References==
<references/>