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Ann Thorac Surg 2007;83:2262-2263
© 2007 The Society of Thoracic Surgeons

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Correspondence

Reply

Department of Surgery, Oregon Health & Science University, Mail Code L223, 3181 Sam Jackson Park Rd, Portland, OR 97201

(Email: karamlou{at}ohsu.edu).

To the Editor:

The recent letter by Carotti and colleagues [1] addresses the association between a rare variant of truncus arteriosus and ductal origin of the distal pulmonary artery, which was not mentioned in our recent review [2]. The modified Van Praagh classification [3] describes a single origin of the pulmonary artery from the common arterial trunk (usually the right pulmonary artery), with either the ductus or collateral vessels supplying the contralateral side, classified as type A3. Others have described this morphologic type as hemitruncus [4, 5] to emphasize the discontinuity of the pulmonary arteries.

Although we are aware of this variant of truncus arteriosus, it is worth mentioning that overall, Van Praagh types A1 and A2 represent the majority of the morphologic spectrum of truncus arteriosus, comprising 86% of patients with truncus arteriosus in the GLH autopsy series and 89% in the Toronto series [6, 7]. Those patients with a true ductal origin of the distal pulmonary artery, as opposed to those with multiple collateral supply, represent an even more discrete subgroup, with only 2% of all patients with type A3 truncus arteriosus. Accordingly, we had no patients with hemitruncus in our series. This rarity notwithstanding, the morphology of hemitruncus is highly variable, and thus experience with each type is limited, making useful inferences problematic.

We chose instead to concentrate on the morphologic spectrum present in our series of patients, although certainly the association mentioned by Carotti and colleagues [1] is relevant. Regarding surgical management, it is pragmatic to consider general principles used in the management of patients with ductal origin of the distal pulmonary artery that are described in our report. Specifically, those with pulmonary atresia and bilateral ducti in which unifocalization to create an intrapericardial pulmonary confluence followed by right ventricular outflow tract reconstruction was required. Or, our description of the importance of pulmonary overcirculation as a presenting sign in patients with type A3 truncus arteriosus. The association with deletion of chromosome 22q11 with truncus arteriosus (ie, roughly 33%) is an important point [8, 9]. However this genetic abnormality is not specific to ductal origin of the distal pulmonary artery, and therefore it was not mentioned in our report.

	References

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1. Carotti A, Piacentini G, Marino B. Ductal origin of the distal pulmonary artery in truncus arteriosus Ann Thorac Surg 2007;83:2262(letter).[Free Full Text]
2. 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]
3. Van Praagh R, Van Praagh S. The anatomy of common aorticopumonary trunk (truncus arteriosus communis) and its embryonic implicationsA study of 57 necrospsy cases. Am J Cardiol 1965;16:406.[Medline]
4. Mee RB. Surgical repair of hemitruncus: principles and techniques J Card Surg 1987;2:247.[Medline]
5. Van der Horst RL, Gotsman MS. Type 3c truncus arteriosusCase report with clinical and surgical implications. B heart J 1974;36:1046.
6. 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]
7. Williams JM, de Leeuw M, Blalck, MD, Freedom RM, Williams WG, McCrindle BW. Factors associated with outcomes of persistent truncus arteriosus J Am Coll Cardiol 1999;34:545.[Abstract/Free Full Text]
8. Goldmuntz E, Clark BJ, Mitchell LE, Jawad AF, et al. Frequency of 22q11 deletions in patients with conotruncal defects J Am Coll Cardiol 1998;32:492.[Abstract/Free Full Text]
9. Momma K, Ando M, Matsuoka R. Truncus arteriosus communis associated with chromosome 22q11 deletion J Am Coll Cardiol 1997;30:1067.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Karamlou, T. Search for Related Content PubMed Articles by Karamlou, T. Related Collections Congenital - acyanotic Related Article