Key result
Balanced aortic and pulmonary flow enables prolonged survival and successful delivery in persistent truncus arteriosus.
Why the study?
Persistent truncus arteriosus is a rare congenital heart condition with most patients dying within the first month after birth without surgery, and prolonged survival cases are uncommon.
Case Report (n=1)
Highlights a rare case of prolonged survival and successful parturition in an unoperated patient with persistent truncus arteriosus, with CMR 4D flow revealing a balanced aortic and pulmonary flow ratio as a potential mechanism.
Answers are grounded in this paper and cite their sources.
May inform CMR evaluation in complex adult congenital heart disease; leaves open whether balanced flow ratios predict survival in unoperated truncus arteriosus.
A 50-year-old woman was admitted to the coronary care unit due to recurrent chest distress for 30 years. She successfully gave birth to a healthy boy at the age of 24. Physical examination showed a pan systolic multifocal murmur, severe acropachia, and cyanosis (Panel A). Her oxygen saturation was 76% at room air. Both transthoracic echocardiography and computed tomographic angiography suggested a truncus arteriosus (Panels B and C). Cardiovascular magnetic resonance illustrated a large, persistent truncus arteriosus (PTA) arising from the base of the heart, overriding a non-restrictive outlet ventricular septal defect. A single left pulmonary artery originated from the basal of the trunk, where the right pulmonary artery was missing (Panel D). Cardiovascular magnetic resonance 4D flow, a non-contrast, blood flow quantifiable technique, was performed. Streamline flow visualization demonstrated a balanced aortic and pulmonary flow ratio (Panel D; see Supplementary data online, Movie S1), which might be the underlying reason for her unique long survival. PTA is a rare congenital heart condition and most patients died within the first month after birth without surgical procedures. Although a few cases of prolonged survival have been described, our case presented unique features: successful parturition and unique long survival without surgical procedure. The patient refused heart transplantation and was discharged after symptomatic treatment. Supplementary data is available at European Heart Journal online. The data underlying this article are available in the article. All authors declare no conflict of interest for this contribution. Yao Xie, MD, PhD, MPH (Conceptualization: Equal; Data curation: Equal; Project administration: Equal; Writing—review & editing: Lead), Chengchen Zhao, MD, PhD (Data curation: Lead; Writing—original draft: Equal), and Meixiang Xiang, MD, PhD (Conceptualization: Equal; Data curation: Supporting; Supervision: Lead; Writing—review & editing: Equal).
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Xie et al. (2023) conducted a case report in Persistent truncus arteriosus (n=1). Persistent truncus arteriosus was evaluated. A 50-year-old woman with persistent truncus arteriosus achieved unique prolonged survival and successful parturition, potentially due to a balanced aortic and pulmonary flow ratio.
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