The Experts below are selected from a list of 315 Experts worldwide ranked by ideXlab platform

Damien Bonnet - One of the best experts on this subject based on the ideXlab platform.

  • Prenatal diagnosis of anomalous connection of the inferior caval vein to the left atrium associated with common Arterial Trunk.
    Journal of anatomy, 2020
    Co-Authors: Lucile Houyel, Laurence Cohen, Patrick Burlot, Anne Heitzmann, Damien Bonnet
    Abstract:

    Anomalous connection of the inferior caval vein to the left atrium is exceedingly rare, and has even been considered by some authors an anatomic and embryologic impossibility. This study demonstrates for the first time the existence of this rare malformation, diagnosed on prenatal echo, and confirmed on post-mortem examination in a 24 WG fetus, in association with a common Arterial Trunk.

  • Outcomes after common Arterial Trunk repair: Impact of the surgical technique.
    The Journal of thoracic and cardiovascular surgery, 2020
    Co-Authors: Neil Derridj, Olivier Raisky, Olivier Villemain, Zahra Belhadjer, Babak Khoshnood, Régis Gaudin, Damien Bonnet
    Abstract:

    ABSTRACT Objectives We compared the risk of mortality and re-intervention after common Arterial Trunk (CAT) repair for different surgical techniques, in particular the reconstruction of the right ventricle outflow tract (RVOT) with left atrial appendage without a monocusp (LAA). Methods The study population comprised 125 patients with repaired CAT who were followed-up at our institution between 2000 and 2018. Statistical analysis included Cox proportional hazard models. Results Median follow-up was 10.6 years. The ten-year survival rate was 88.2% [95%CI: 80.6-92.4] with the poorest outcome for CAT type IV (64.3% [95%CI:36.8-82.3]; p Conclusion For the repair of CAT, the LAA technique for RVOT reconstruction was associated with comparable survival and greater freedom from reintervention than the use of a valved conduit.

  • outcomes after common Arterial Trunk repair impact of the surgical technique
    The Journal of Thoracic and Cardiovascular Surgery, 2020
    Co-Authors: Neil Derridj, Olivier Raisky, Olivier Villemain, Zahra Belhadjer, Babak Khoshnood, Régis Gaudin, Damien Bonnet
    Abstract:

    OBJECTIVES We compared the risk of mortality and reintervention after common Arterial Trunk (CAT) repair for different surgical techniques, in particular the reconstruction of the right ventricle outflow tract with left atrial appendage (LAA) without a monocusp. METHODS The study population comprised 125 patients with repaired CAT who were followed-up at our institution between 2000 and 2018. Statistical analysis included Cox proportional hazard models. RESULTS Median follow-up was 10.6 years. The 10-year survival rate was 88.2% (95% confidence interval [CI], 80.6-92.4) with the poorest outcome for CAT type IV (64.3%; 95% CI, 36.8-82.3; P < .01). In multivariable analysis, coronary anomalies (hazard ratio [HR], 11.63 [3.84-35.29], P < .001) and CAT with interrupted aortic arch (HR, 6.50 [2.10-20.16], P = .001) were substantial and independent risk factors for mortality. Initial repair with LAA was not associated with an increased risk of mortality (HR, 0.37 [0.11-1.24], P = .11). The median age at reintervention was 3.6 years [7.3 days-13.1 years]. At 10 years, freedom from reintervention was greater in the group with LAA repair compared with the valved conduit group, 73.3% (95% CI, 41.3-89.4) versus 17.2% (95% CI, 9.2-27.4) (P < .001), respectively. Using a valved conduit for repair (HR, 4.79 [2.45-9.39], P < .001), truncal valve insufficiency (HR, 2.92 [1.62-5.26], P < .001) and DiGeorge syndrome (HR, 2.01 [1.15-3.51], P = .01) were independent and clinically important risk factors for reintervention. CONCLUSIONS For the repair of CAT, the LAA technique for right ventricle outflow tract reconstruction was associated with comparable survival and greater freedom from reintervention than the use of a valved conduit.

  • Outcomes after common Arterial Trunk repair in children
    Archives of Cardiovascular Diseases Supplements, 2018
    Co-Authors: Neil Derridj, Olivier Raisky, Olivier Villemain, Zahra Belhadjer, Antoine Neuraz, Damien Bonnet
    Abstract:

    Introduction The persisting controversy on the repair of the right outflow tract in common Arterial Trunk led us to analyze the outcomes of children operated at our institution. Methods We identified 153 children diagnosed with CAT between 2000 and 2017. Six patients died before first surgery and were excluded. Types of CAT were classified according to the modified Van Praagh classification. Results We included 147 patients: CAT A1 (n = 89, 60.6%), CAT A2 (n = 32, 21.7%), CAT A3 (n = 8, 5.4%), and CAT A4 (n = 18, 12.3%). The mean follow-up was 10 ± 4.4 years. Seventeen patients (11.6%) died after surgery. Mean survival was 88.2% at 5 years. Survival of CAT A4 was significantly lower than for other types (65% at 5 years; P  Fig. 1 ). Conclusion The anatomical type of CAT did not influence the risk for reintervention after repair. Autologous reconstruction of the pulmonary artery with autologous tissue limits the risk for reintervention on the RVOT during childhood.

  • 293 Anomalies of coronary artery ostia in common Arterial Trunk
    Archives of Cardiovascular Diseases Supplements, 2011
    Co-Authors: Fanny Bajolle, Lucile Houyel, Damien Bonnet
    Abstract:

    Background Tbx1 controls outflow tract development and coronary artery patterning, with subaortic coronary-permissive and subpulmonary coronary-refractory myocardial domains. Our hypothesis is that the potential “pulmonary identity” of the common Arterial Trunk (CAT) influences coronary ostia anomalies. Material and methods We reviewed 46 heart specimens with CAT and 17 with normal anatomy (control). Position of the coronary ostia over the truncal circumference was measured in degrees as the direction from the middle of the valve orifice. Results CAT types were: 28 type I, 8 type II, 3 type III, 7 type IV. The truncal valve was bicuspid in 2, tricuspid in 36, quadricuspid in 7. Overall, 87% cases had malformations of the coronary ostia size, shape, location relative to the commissures or sinotubular junction. Left coronary ostium had abnormal shape or size in 33/46, right coronary ostium in 20/46 (p Conclusion Left coronary ostium in CAT is more frequently abnormal than right coronary ostium. This might be due to the obligatory dorsal connection of left coronary ostium because of the large coronary-refractory subpulmonary domain in the ventral left part of the CAT.

Robert H. Anderson - One of the best experts on this subject based on the ideXlab platform.

  • Systolic excursion of the leaflets of the truncal valve: An unusual mechanism for pulmonary stenosis in common Arterial Trunk
    Annals of pediatric cardiology, 2020
    Co-Authors: Saurabh Kumar Gupta, Shyam S. Kothari, Gurpreet Singh Gulati, Balram Airan, Abhinav Aggarwal, Sivasubramanian Ramakrishnan, Anita Saxena, Sanjiv Sharma, Robert H. Anderson
    Abstract:

    Background: Pulmonary stenosis in patients with common Arterial Trunk protects the pulmonary vasculature. In our recently published prospective study of common Arterial Trunk, some patients with sinusal origin of the pulmonary Arterial segment had pulmonary stenosis induced by systolic excursion of a truncal valvar leaflet. We aimed to determine the detailed morphologic characteristics of this unusual finding. Methods and Results: All 70 patients underwent echocardiography and computed tomographic angiography as per predefined study protocol. In selected cases, we also performed cardiac catheterization. Among 27 patients with aortic dominance, we found sinusal origin of the pulmonary Arterial segment. In 5 of these patients, pulmonary stenosis was induced by systolic excursion of a truncal valvar leaflet. In all these patients, the truncal valve was trisinusate, albeit with asymmetric sinuses. The pulmonary Arterial segment arose from the largest left sinus with its relatively large leaflet obstructing the pulmonary orifice during systole. In the remaining 22 patients, without pulmonary stenosis but with sinusal origin of pulmonary Arterial segment, the truncal valve was quadrisinusate in 7, bisinusate in 2, and trisinusate in 13. None of the patients with quadrisinusate and bisinusate truncal valves had pulmonary stenosis. Among the 13 patients with trisinusate valves, the sinuses of the truncal valve were symmetrical in 6, while in 7, the pulmonary orifice originated from a smaller asymmetric sinus. Conclusion: Pulmonary stenosis, produced by a relatively large leaflet of an asymmetric truncal sinus, may prevent early development of pulmonary vascular disease. Timely recognition of this unusual mechanism of pulmonary stenosis is important for optimal management.

  • Neonatal repair of common Arterial Trunk with intact ventricular septum.
    World journal for pediatric & congenital heart surgery, 2014
    Co-Authors: Pankaj Garg, Amit Mishra, Ritesh Shah, Divyakant Parmar, Robert H. Anderson
    Abstract:

    We report a rare case of common Arterial Trunk with intact ventricular septum, a large patent Arterial duct, and normally developed aortic arch. We discuss its possible embryology, emphasizing the phenotypic differences from aortopulmonary window, and describe our surgical management.

  • Rationalising the nomenclature of common Arterial Trunk.
    Cardiology in the young, 2012
    Co-Authors: Marshall L. Jacobs, Robert H. Anderson
    Abstract:

    Hearts having a common Arterial Trunk belong to a family of congenital cardiac malformations for which traditional systems of classification and nomenclature are plagued by internal paradoxes, incompatibility between systems due to the lack of potential for identification of synonyms, or irreconcilable inconsistencies with our current knowledge of cardiac development and morphology. A simplified categorisation that classifies these hearts on the basis of pulmonary or aortic dominance reconciles the existing disparate categorisations, is in keeping with recent findings concerning cardiac development, and emphasises the principal morphologic determinant of surgical outcome.

  • a simplified categorization for common Arterial Trunk
    The Journal of Thoracic and Cardiovascular Surgery, 2011
    Co-Authors: Hyde M Russell, Robert H. Anderson, Diane E. Spicer, Marshall L. Jacobs, Constantine Mavroudis, Eowyn Corcrain, Carl L Backer
    Abstract:

    Objective A common Arterial Trunk is a solitary Trunk that exits the heart through a common ventriculo-Arterial junction and supplies directly the systemic, pulmonary, and coronary Arterial pathways. It remains to be determined, however, how best to subclassify those hearts fulfilling this definition. The time-honored classification is based on the morphology of the pulmonary arteries, but an alternative approach also places emphasis on the nature of the systemic pathways. We evaluated our experience to establish whether these different approaches can be reconciled. Methods We examined 28 autopsied hearts with common Arterial Trunks; the specimens were drawn from the archives of three institutions. Based on our analysis, we simplified classification into hearts with aortic or pulmonary dominance. We used this approach to categorize 42 patients who had undergone surgical correction at Children's Memorial Hospital in Chicago. Results All autopsied hearts could be assigned to groups with either aortic or pulmonary dominance of the common Arterial Trunk, with 20 and 8 specimens, respectively, fitting into these categories. Pulmonary dominance was found only when the aortic component of the Trunk was hypoplastic and an Arterial duct supplied the majority of flow to the descending aorta. Only in this setting did we observe pulmonary arteries arising from the sides of the major pathway, and only in this setting was the aortic component discrete from the pulmonary component within the pericardial cavity. Conclusions This simple approach to classification reconciles the existing disparate categorizations of patients having common Arterial Trunks and it emphasizes the principal morphologic determinant of surgical outcome.

  • A simplified categorization for common Arterial Trunk
    The Journal of thoracic and cardiovascular surgery, 2010
    Co-Authors: Hyde M Russell, Robert H. Anderson, Diane E. Spicer, Marshall L. Jacobs, Constantine Mavroudis, Eowyn Corcrain, Carl L Backer
    Abstract:

    A common Arterial Trunk is a solitary Trunk that exits the heart through a common ventriculo-Arterial junction and supplies directly the systemic, pulmonary, and coronary Arterial pathways. It remains to be determined, however, how best to subclassify those hearts fulfilling this definition. The time-honored classification is based on the morphology of the pulmonary arteries, but an alternative approach also places emphasis on the nature of the systemic pathways. We evaluated our experience to establish whether these different approaches can be reconciled. We examined 28 autopsied hearts with common Arterial Trunks; the specimens were drawn from the archives of three institutions. Based on our analysis, we simplified classification into hearts with aortic or pulmonary dominance. We used this approach to categorize 42 patients who had undergone surgical correction at Children's Memorial Hospital in Chicago. All autopsied hearts could be assigned to groups with either aortic or pulmonary dominance of the common Arterial Trunk, with 20 and 8 specimens, respectively, fitting into these categories. Pulmonary dominance was found only when the aortic component of the Trunk was hypoplastic and an Arterial duct supplied the majority of flow to the descending aorta. Only in this setting did we observe pulmonary arteries arising from the sides of the major pathway, and only in this setting was the aortic component discrete from the pulmonary component within the pericardial cavity. This simple approach to classification reconciles the existing disparate categorizations of patients having common Arterial Trunks and it emphasizes the principal morphologic determinant of surgical outcome. Copyright © 2011 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

Frank L. Hanley - One of the best experts on this subject based on the ideXlab platform.

  • Unilateral Branch Pulmonary Artery Origin From a Solitary Arterial Trunk With Major Aortopulmonary Collaterals to the Contralateral Lung: Anatomic and Developmental Considerations.
    Seminars in thoracic and cardiovascular surgery, 2020
    Co-Authors: Gregory T. Adamson, Doff B. Mcelhinney, Frank L. Hanley, Lucile Houyel, Shiraz A. Maskatia, Leo Lopez
    Abstract:

    In both truncus arteriosus communis (TAC) and tetralogy of Fallot (TOF), there is a rare phenotype that includes a single branch pulmonary artery (PA) arising from a solitary great artery and major aortopulmonary collaterals (MAPCAs) supplying the contralateral lung. We describe the intracardiac and great vessel anatomy of infants with this phenotype, consider rationale for classifying patients as TOF vs TAC, and describe surgical outcomes. Our institution's surgical database was reviewed for patients with a single branch PA from a solitary Arterial Trunk and contralateral MAPCAs from 2007 to 2019. Demographic, imaging, and surgical data were collected and described. All 11 patients underwent complete repair with a median right ventricular to aortic pressure ratio of 0.36 (range 0.26-0.50). At 0.1-9.1 years after repair (median 0.8 years) there was approximately balanced left-right lung perfusion (median 52% to the right lung, range 34-74%). The MAPCA lungs exemplified the full spectrum of PA and MAPCA anatomy, from absent intrapericardial PAs with all single supply MAPCAs to a normally arborizing PA with all dual supply MAPCAs and present pulmonary valve leaflet tissue. All patients had a systemic semilunar valve with 3 thin and similarly sized leaflets and fibrous continuity with the tricuspid valve, and all had coronary origins and outflow tract morphology more consistent with TOF. It is appropriate to classify all patients with a single anomalous PA from a solitary Arterial Trunk and MAPCAs to the contralateral lung as TOF rather than TAC Type A3. All variants were amenable to surgical repair.

  • reinterventions after repair of common Arterial Trunk in neonates and young infants
    Journal of the American College of Cardiology, 2000
    Co-Authors: Doff B. Mcelhinney, Hiranya A. Rajasinghe, Bassem N Mora, Norman H. Silverman, Mohan V Reddy, Frank L. Hanley
    Abstract:

    OBJECTIVES To determine rates of reintervention after repair of common Arterial Trunk in the neonatal and early infant periods. BACKGROUND With improving success in the early treatment of common Arterial Trunk, the need for reinterventional procedures in older children, adolescents and adults will become an increasingly widespread concern in the treatment of these patients. METHODS We reviewed our experience with 159 infants younger than four months of age who underwent complete primary repair of common Arterial Trunk at our institution from 1975 to 1998, with a focus on postoperative reinterventions. RESULTS Of 128 early survivors, 40 underwent early reinterventions for persistent mediastinal bleeding or other reasons. During a median follow-up of 98 months (range, 2 to 235 months), 121 reinterventions were performed in 81 patients. Actuarial freedom from reintervention was 50% at four years, and freedom from a second reintervention was 75% at 11 years. A total of 92 conduit reinterventions were performed in 75 patients, with a single reintervention in 61 patients, 2 reinterventions in 11 patients and 3 reinterventions in 3 patients. Freedom from a first conduit reintervention was 45% at five years. The only independent variable predictive of a longer time to first conduit replacement was use of an allograft conduit at the original repair (p = 0.05), despite the significantly younger age of patients receiving an allograft conduit (p < 0.001). Reintervention on the truncal valve was performed on 22 occasions in 19 patients, including 21 valve replacements in 18 patients and repair in 1, with a freedom from truncal valve reintervention of 83% at 10 years. Surgical (n = 29) or balloon (n = 12) reintervention for pulmonary artery stenosis was performed 41 times in 32 patients. Closure of a residual ventricular septal defect was required in 13 patients, all of whom underwent closure originally with a continuous suture technique. Eight of 16 late deaths were related to reintervention. CONCLUSIONS The burden of reintervention after repair of common Arterial Trunk in early infancy is high. Although conduit reintervention is inevitable, efforts should be made at the time of the initial repair to minimize factors leading to reintervention, including prevention of branch pulmonary artery stenosis and residual interventricular communications.

  • Reinterventions after repair of common Arterial Trunk in neonates and young infants
    Journal of the American College of Cardiology, 2000
    Co-Authors: Doff B. Mcelhinney, Hiranya A. Rajasinghe, Bassem N Mora, V. Mohan Reddy, Norman H. Silverman, Frank L. Hanley
    Abstract:

    To determine rates of reintervention after repair of common Arterial Trunk in the neonatal and early infant periods. With improving success in the early treatment of common Arterial Trunk, the need for reinterventional procedures in older children, adolescents and adults will become an increasingly widespread concern in the treatment of these patients. We reviewed our experience with 159 infants younger than four months of age who underwent complete primary repair of common Arterial Trunk at our institution from 1975 to 1998, with a focus on postoperative reinterventions. Of 128 early survivors, 40 underwent early reinterventions for persistent mediastinal bleeding or other reasons. During a median follow-up of 98 months (range, 2 to 235 months), 121 reinterventions were performed in 81 patients. Actuarial freedom from reintervention was 50% at four years, and freedom from a second reintervention was 75% at 11 years. A total of 92 conduit reinterventions were performed in 75 patients, with a single reintervention in 61 patients, 2 reinterventions in 11 patients and 3 reinterventions in 3 patients. Freedom from a first conduit reintervention was 45% at five years. The only independent variable predictive of a longer time to first conduit replacement was use of an allograft conduit at the original repair (p = 0.05), despite the significantly younger age of patients receiving an allograft conduit (p < 0.001). Reintervention on the truncal valve was performed on 22 occasions in 19 patients, including 21 valve replacements in 18 patients and repair in 1, with a freedom from truncal valve reintervention of 83% at 10 years. Surgical (n = 29) or balloon (n = 12) reintervention for pulmonary artery stenosis was performed 41 times in 32 patients. Closure of a residual ventricular septal defect was required in 13 patients, all of whom underwent closure originally with a continuous suture technique. Eight of 16 late deaths were related to reintervention. The burden of reintervention after repair of common Arterial Trunk in early infancy is high. Although conduit reintervention is inevitable, efforts should be made at the time of the initial repair to minimize factors leading to reintervention, including prevention of branch pulmonary artery stenosis and residual interventricular communications.

Hideki Uemura - One of the best experts on this subject based on the ideXlab platform.

  • common Arterial Trunk with atrioventricular septal defect new observations pertinent to repair
    The Annals of Thoracic Surgery, 2009
    Co-Authors: Iki Adachi, Margot M Bartelings, Karen P. Mccarthy, Anna N. Seale, Hideki Uemura
    Abstract:

    Background. The coexistence of abnormalities in both atrioventricular and ventriculoArterial junctions occasionally represents a formidable challenge to the surgeon. The association of common Arterial Trunk with atrioventricular septal defect is such an example. To date, only two reports have described successful operative outcome. This paucity of success might reflect the anatomical complexity that could prevent favorable results. Methods. We reviewed six specimens with common Arterial Trunk and atrioventricular septal defect, focusing on how to establish a nonobstructed connection between the left ventricle and the truncal valve. Results. In all cases, the common Trunk arose exclusively from the right ventricle, and the only exit from the left ventricle was the ventricular component of the septal deficiency. In particular, the preferential route was limited to a space below the superior bridging leaflet that did not have any tendinous cords inserting onto the ventricular crest, in contrast to the inferior bridging leaflets that were always tethered to the crest with many short cords. Accordingly, the size of potential left ventricular outflow depended on the shape of the anterosuperior margin of the ventricular crest below the superior bridging leaflet. The potential outflow was narrower than the truncal valvar area in all hearts but one having extensive anterosuperior excavation of the ventricular crest, suggesting the necessity of septal enlargement had anatomical repair been attempted during life. Conclusions. Owing to the unique ventriculoArterial connection, the surgeon, considering anatomical repair, needs to pay attention to the anterosuperior margin of the ventricular scoop, which determines the adequacy of left ventricular outflow size.

  • relationship between orifices of pulmonary and coronary arteries in common Arterial Trunk
    European Journal of Cardio-Thoracic Surgery, 2009
    Co-Authors: I Adachi, Hideki Uemura, Karen P. Mccarthy, Anna N. Seale
    Abstract:

    Objective: Variability in pulmonary Arterial and coronary Arterial origins in common Arterial Trunk has been investigated previously but only as separate entities. We hypothesise that combinations of relationships between the two Arterial structures have important clinical implications. Methods:We identifiedpulmonaryArterialand coronaryArterialoriginsin56heartspecimens.Theorificeswere plottedaccordingto the location on the circumference of the common Trunk and distance from the level of the sinutubular junction. Results: Pulmonary orifice was sinusal when thelowestmarginoftheorificewasbelowthesinutubularjunction(n = 12,21%).Itwasdefinedaslowwhenlocated2 mmabovethesinutubular junction (n = 11, 20%). Pulmonary origin >2 mm above the sinutubular junction was designated as normal (n = 33, 59%). Circumferentially, there was a distinct predilection for sinusal origin to be located within the left-anterior segment of the common Trunk, as opposed to low and normal origins that almost always resided within the left-posterior segment. Furthermore, hearts with sinusal origin (75%; 9 hearts out of 12) had significantly higher prevalence of proximity (defined as a distance of 2 mm) between pulmonary and coronary orifices than those with low origin (27%; 3 hearts out of 11) and normal origin (3%; 1 heart out of 33) (p = 0.039 and p < 0.001, respectively). Conclusions: Owing to its unique location, frequently close to a coronary orifice, hearts with sinusal origin warrant special attention in both diagnostic and surgical management. At the same time, however, its peculiar pulmonary arrangement may facilitate direct right ventricular-pulmonary connection and dispense with the need for augmentation with an external conduit that inevitably will be outgrown by the patient. # 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  • Common Arterial Trunk with atrioventricular septal defect: new observations pertinent to repair.
    The Annals of thoracic surgery, 2009
    Co-Authors: Iki Adachi, Margot M Bartelings, Karen P. Mccarthy, Anna N. Seale, Hideki Uemura
    Abstract:

    The coexistence of abnormalities in both atrioventricular and ventriculoArterial junctions occasionally represents a formidable challenge to the surgeon. The association of common Arterial Trunk with atrioventricular septal defect is such an example. To date, only two reports have described successful operative outcome. This paucity of success might reflect the anatomical complexity that could prevent favorable results. We reviewed six specimens with common Arterial Trunk and atrioventricular septal defect, focusing on how to establish a nonobstructed connection between the left ventricle and the truncal valve. In all cases, the common Trunk arose exclusively from the right ventricle, and the only exit from the left ventricle was the ventricular component of the septal deficiency. In particular, the preferential route was limited to a space below the superior bridging leaflet that did not have any tendinous cords inserting onto the ventricular crest, in contrast to the inferior bridging leaflets that were always tethered to the crest with many short cords. Accordingly, the size of potential left ventricular outflow depended on the shape of the anterosuperior margin of the ventricular crest below the superior bridging leaflet. The potential outflow was narrower than the truncal valvar area in all hearts but one having extensive anterosuperior excavation of the ventricular crest, suggesting the necessity of septal enlargement had anatomical repair been attempted during life. Owing to the unique ventriculoArterial connection, the surgeon, considering anatomical repair, needs to pay attention to the anterosuperior margin of the ventricular scoop, which determines the adequacy of left ventricular outflow size.

  • Tricuspid atresia with common Arterial Trunk: successful treatment using Fontan procedure
    Interactive cardiovascular and thoracic surgery, 2004
    Co-Authors: Satoshi Numata, Hideki Uemura, Koji Kagisaki, Toshikatsu Yagihara
    Abstract:

    Tricuspid atresia (TA) coexisting with common Arterial Trunk (CAT) is extremely rare, and successful surgical treatment has been reported in only one case until now. We have recently performed surgical treatment for TA with CAT on a 6-year-old boy using the staged Fontan procedure.

  • Case report - Congenital Tricuspid atresia with common Arterial Trunk: successful treatment using Fontan procedure
    2004
    Co-Authors: Satoshi Numata, Hideki Uemura, Koji Kagisaki, Toshikatsu Yagihara
    Abstract:

    Tricuspid atresia (TA) coexisting with common Arterial Trunk (CAT) is extremely rare, and successful surgical treatment has been reported in only one case until now. We have recently performed surgical treatment for TA with CAT on a 6-year-old boy using the staged Fontan procedure.

Margot M Bartelings - One of the best experts on this subject based on the ideXlab platform.

  • common Arterial Trunk with atrioventricular septal defect new observations pertinent to repair
    The Annals of Thoracic Surgery, 2009
    Co-Authors: Iki Adachi, Margot M Bartelings, Karen P. Mccarthy, Anna N. Seale, Hideki Uemura
    Abstract:

    Background. The coexistence of abnormalities in both atrioventricular and ventriculoArterial junctions occasionally represents a formidable challenge to the surgeon. The association of common Arterial Trunk with atrioventricular septal defect is such an example. To date, only two reports have described successful operative outcome. This paucity of success might reflect the anatomical complexity that could prevent favorable results. Methods. We reviewed six specimens with common Arterial Trunk and atrioventricular septal defect, focusing on how to establish a nonobstructed connection between the left ventricle and the truncal valve. Results. In all cases, the common Trunk arose exclusively from the right ventricle, and the only exit from the left ventricle was the ventricular component of the septal deficiency. In particular, the preferential route was limited to a space below the superior bridging leaflet that did not have any tendinous cords inserting onto the ventricular crest, in contrast to the inferior bridging leaflets that were always tethered to the crest with many short cords. Accordingly, the size of potential left ventricular outflow depended on the shape of the anterosuperior margin of the ventricular crest below the superior bridging leaflet. The potential outflow was narrower than the truncal valvar area in all hearts but one having extensive anterosuperior excavation of the ventricular crest, suggesting the necessity of septal enlargement had anatomical repair been attempted during life. Conclusions. Owing to the unique ventriculoArterial connection, the surgeon, considering anatomical repair, needs to pay attention to the anterosuperior margin of the ventricular scoop, which determines the adequacy of left ventricular outflow size.

  • Common Arterial Trunk with atrioventricular septal defect: new observations pertinent to repair.
    The Annals of thoracic surgery, 2009
    Co-Authors: Iki Adachi, Margot M Bartelings, Karen P. Mccarthy, Anna N. Seale, Hideki Uemura
    Abstract:

    The coexistence of abnormalities in both atrioventricular and ventriculoArterial junctions occasionally represents a formidable challenge to the surgeon. The association of common Arterial Trunk with atrioventricular septal defect is such an example. To date, only two reports have described successful operative outcome. This paucity of success might reflect the anatomical complexity that could prevent favorable results. We reviewed six specimens with common Arterial Trunk and atrioventricular septal defect, focusing on how to establish a nonobstructed connection between the left ventricle and the truncal valve. In all cases, the common Trunk arose exclusively from the right ventricle, and the only exit from the left ventricle was the ventricular component of the septal deficiency. In particular, the preferential route was limited to a space below the superior bridging leaflet that did not have any tendinous cords inserting onto the ventricular crest, in contrast to the inferior bridging leaflets that were always tethered to the crest with many short cords. Accordingly, the size of potential left ventricular outflow depended on the shape of the anterosuperior margin of the ventricular crest below the superior bridging leaflet. The potential outflow was narrower than the truncal valvar area in all hearts but one having extensive anterosuperior excavation of the ventricular crest, suggesting the necessity of septal enlargement had anatomical repair been attempted during life. Owing to the unique ventriculoArterial connection, the surgeon, considering anatomical repair, needs to pay attention to the anterosuperior margin of the ventricular scoop, which determines the adequacy of left ventricular outflow size.

  • the embryology of the common Arterial Trunk
    Progress in Pediatric Cardiology, 2002
    Co-Authors: Adriana Gittenbergerde C Groot, Margot M Bartelings, Ad J J C Bogers, Marit J Boot, Robert E Poelmann
    Abstract:

    Abstract The developmental background of common Arterial Trunk still remains to be elucidated. In this anomaly both the coronary, systemic and pulmonary circulation arise from a common Arterial stem with a common orifice. The contribution of the embryonic ectomesenchymal neural crest seems to be essential for a normal separation of the aorta, pulmonary Trunk and the adjoining myocardium lined outflow tract. Experimental neural crest ablation studies in chicken have proved that there is a role for neural crest cells. Several molecular biological studies, however, have shown that we are not solely dealing with the influence of neural crest. Many genes and gene cascades have been manipulated in mice and have shown that e.g. the endothelin cascade, Foxc1 and Foxc2, and more recently Sema3C and neuropilin-1 are factors, that if disturbed, can lead to common Arterial Trunk often in combination with aortic arch anomalies such as interruption type B. In humans common Arterial Trunk is one of the characteristics of the 22q11 deletion syndrome. In the mouse several of these genes, located on the syntenic chromosome 16 have been studied for this effect, but most result in an embryolethal phenotype. Neural crest tracing studies in both chicken–quail chimeras and transgenic neural crest reporter mice have revealed that there is a difference in neural crest contribution to the aortic and pulmonary truncal wall. The orifice of the common Arterial Trunk reflects this finding in that the often abnormally high positioned coronary orifices reside in the aortic part of the orifice. Combining current data the common denominator for common Arterial Trunk seems to be a defective interaction of neural crest, endothelial cells and the surrounding mesenchyme. Disturbances of genes in any of the three cell types can lead to the malformation.

  • common Arterial Trunk uncommon coronary Arterial anatomy
    The Journal of Thoracic and Cardiovascular Surgery, 1993
    Co-Authors: Ad J J C Bogers, Margot M Bartelings, Robert E Poelmann, Regina Bökenkamp, Theo Stijnen, R.j. Van Suylen, A Gittenbergerde C Groot
    Abstract:

    Macroscopic investigation was done in 44 postmortem specimens of hearts with common Arterial Trunk. In 38 hearts, the normal distribution in left and right coronary arteries was found. Of the coronary orifices, five were pinpoint and three showed a double orifice. The left coronary orifice was positioned in the posterior part of the truncus (p J Thorac Cardiovasc Surg 1993;106:1133-7)

  • Common Arterial Trunk, uncommon coronary Arterial anatomy.
    The Journal of thoracic and cardiovascular surgery, 1993
    Co-Authors: Ad J J C Bogers, Margot M Bartelings, Robert E Poelmann, Regina Bökenkamp, Theo Stijnen, R.j. Van Suylen, A. C. Gittenberger-de Groot
    Abstract:

    Macroscopic investigation was done in 44 postmortem specimens of hearts with common Arterial Trunk. In 38 hearts, the normal distribution in left and right coronary arteries was found. Of the coronary orifices, five were pinpoint and three showed a double orifice. The left coronary orifice was positioned in the posterior part of the truncus (p < 0.0001); the right coronary orifice was positioned in the right anterior and lateral part (p < 0.0001). In 19 hearts, coronary orifices were found above sinus level, left coronary orifices more often than right coronary orifices (p < 0.001). In seven hearts, type I truncus was found, in seven type II truncus was found, in 17 the truncus was intermediate between types I and II, in two type III truncus was found. In 11 hearts, the pulmonary artery distribution could no longer be identified. The truncal valve was bicuspid in 11 hearts, tricuspid in 25 hearts, and quadricuspid in eight hearts. The truncal valve showed overriding of 5% to 100%. Malformations of the coronary arteries were found in 28 hearts (64%). In 27 hearts (61%), the coronary Arterial anatomy might have had clinical consequences. In nine hearts, coronary Arterial orifices were at risk in excision of the pulmonary arteries from the common Arterial Trunk. The role of the neural crest as an etiologic factor of coronary Arterial malformations in common Arterial Trunk should be taken into account.