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Ann Thorac Surg 2007;83:2262
© 2007 The Society of Thoracic Surgeons

Correspondence

Ductal Origin of the Distal Pulmonary Artery in Truncus Arteriosus

Adriano Carotti, MDa, Gerardo Piacentini, MDb, Bruno Marino, MDb

a Pediatric Cardiac Surgery, Ospedale del Bambino Gesù, Piazza S. Onofrio, 4, Rome, 00165 Italy
b Pediatric Cardiology, Department of Pediatrics, University of Rome "La Sapienza", Viale Regina Elena, 324, Rome, 00161 Italy

(Email: carotti{at}opbg.net; bruno.marino{at}uniroma1.it).

To the Editor:

We read with interest the article by Trivedi and colleagues [1] on ductal origin of the distal pulmonary artery. Authors report on a series of patients with discontinuous pulmonary arteries and ductal origin of one of them not only as an isolated lesion, but also in association with tetralogy of Fallot, pulmonary atresia with ventricular septal defect, and heterotaxy. However there is no mention in their article about the possible association of ductal origin of distal pulmonary artery with truncus arteriosus.

Such association represents a subgroup of truncus arteriosus with discontinuity of the pulmonary arteries classified by Van Praagh as truncus arteriosus type A3 [2]. In children with truncus arteriosus and left aortic arch the "duct dependent" pulmonary artery is usually the left one.

It is important to outline that the discontinuity of pulmonary arteries may complicate surgical treatment [3, 4] and follow-up [5] of patients undergoing truncus repair. Finally, in our own experience, its occurrence was mainly associated with DiGeorge-Velocardiofacial syndrome and del22q11 [6].

We believe that this association of cardiac defects deserve particular attention. Specific anatomic cardiac patterns should lead to an accurate genetic assessment of patients. On the other hand, genetic syndromes should alert clinicians on the possible presence of specific additional cardiac malformations [7] that may affect the outcome of surgical treatment.


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 References
 

  1. Trivedi KR, Karamlou T, Yoo SJ, Williams WG, Freedom RM, McCrindle BW. Outcomes in 45 children with ductal origin of the distal pulmonary artery Ann Thorac Surg 2006;81:950-957.[Abstract/Free Full Text]
  2. Calder L, Van Praagh R, Van Praagh S, et al. Truncus arteriosus communisClinical, angiocardiographic, and pathologic findings in 100 patients. Am Heart J 1976;92:23-38.[Medline]
  3. Bove EL, Lupinetti FM, Pridjian AK, et al. Results of a policy of primary repair of truncus arteriosus in the neonate J Thorac Cardiovasc Surg 1993;105:1057-1066.[Abstract]
  4. Brizard CP, Cochrane A, Austin C, Nomura F, Karl TR. Management strategy and long term outcome for truncus arteriosus Eur J Cardiothorac Surg 1997;11:687-696.[Abstract/Free Full Text]
  5. Hanley FL, Heinemann MK, Jonas RA, et al. Repair of truncus arteriosus in the neonate J Thorac Cardiovasc Surg 1993;105:1047-1056.[Abstract]
  6. Marino B, Digilio MC, Toscano A. Common arterial trunk, DiGeorge syndrome and microdeletion 22q11 Prog Ped Cardiol 2002;15:9-17.
  7. Marino B, Digilio MC. Congenital heart disease and genetic syndromes: specific correlation between cardiac phenotype and genotype Cardiovasc Pathol 2000;9:303-315.[Medline]

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Tara Karamlou
Ann. Thorac. Surg. 2007 83: 2262-2263. [Extract] [Full Text] [PDF]



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Ann. Thorac. Surg., June 1, 2007; 83(6): 2262 - 2263.
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