Truncus Arteriosus: Possible Causes and Treatment Options

Overview

Truncus arteriosus is a rare congenital (present by birth) heart condition in which only one blood vessel (artery), known as the truncus arteriosus, comes out from the heart. However, in a normal heart, two separate blood vessels, namely, the pulmonary artery and the aorta, arise from the heart .

About Truncus Arteriosus 

At the time when the fetal heart formed, all babies have truncus arteriosus (a single large vessel) exiting the heart. Overtime,  this large single vessel divides into two parts. However, in babies with truncus arteriosus at birth, the single large vessel would not have divided into two different vessels and the wall separating the two ventricles does not closes completely. This results in a single blood vessel arising from the heart, and a big hole between the two chambers called ventricular septal defect.

Depending on how the blood vessels remain united, there are different types of truncus arteriosus. 

Truncus arteriosus is a Critical Congenital Heart Defect (CCHD) because a baby with this condition is likely to need medical or surgical intervention right after birth. 

The right side pumps deoxygenated (low oxygen) blood via the pulmonary blood vessel to the lungs in a healthy heart. Further, the left side of the heart carries the oxygenated (oxygen-rich) blood via the aorta to the different parts of the body. In truncus arteriosus, deoxygenated and oxygenated blood mix.

Signs and Symptoms of Truncus Arteriosus

The common signs and symptoms of truncus arteriosus include the following.

• Shortness of breath
• Bluish tinge in skin color (cyanosis)
• Pulsating heart
• Fast breathing
• Poor feeding and growth
• Excessive sleepiness
• Delayed growth
• Clubbing of fingers

Causes of Truncus Arteriosus

The underlying causes of congenital heart conditions, including truncus arteriosus, are not yet known. However, some of the possible reasons could be the following.

• Some babies develop truncus arteriosus due to changes in their chromosomal or genetic makeup. 
• In some cases, the combination of various genes and other risk factors may be responsible. The other risk factors are usually related to the mother. They include the food or medications the mother takes and the environment she is exposed to.

When Should You Seek Medical Help?

See a doctor if you notice any of the following signs and symptoms of truncus arteriosus in your baby.

• Poor feeding
• Bluish skin
• Excessive sleepiness

The symptoms of truncus arteriosus that need immediate medical attention include,

• Shallow, fast, or strained breathing
• Loss of consciousness 
• Increasing or worsening blue coloration of the skin

Please consult a specialist if you observe any of these symptoms in your newborn or infant. 

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Ways to Prevent Truncus Arteriosus

As truncus arteriosus is a congenital condition, in most cases, you cannot prevent it. However, you can consider the following tips.

• If anyone in your family has a heart condition or one of your children already has a heart defect, ensure to contact a cardiologist and genetic counselor before planning another pregnancy.
• Some viruses, including the rubella virus (German measles), can affect your pregnancy. So, ensure to get all the relevant vaccinations before becoming pregnant.
• Certain medications can be harmful to you, especially during pregnancy. Therefore, before you take any medication, ensure to discuss the same with your doctor.
• Talk to your doctor about taking folic acid. This supplement can help prevent many birth-related health conditions, including heart, brain, and spinal cord disorders. 
• If you have diabetes, ensure to discuss the risks that could occur during your pregnancy and how you can manage them. 

Treatment Options for Truncus Arteriosus

Surgery is one of the best treatments for infants who have truncus arteriosus. Your child is more likely to need more surgical procedures and medications as they grow. The doctor may also prescribe medications to promote heart health before the surgery. Most importantly, going for regular follow-ups with your doctor is crucial. 

Here are some treatment options for truncus arteriosus.

• Medications: Your doctor would prescribe the following medications.
• Inotropic agents: These drugs help strengthen the contractions of the heart.
• Diuretics (water pills): This medication helps prevent fluid accumulation in the body by increasing the volume and frequency of urination.
• Surgery: Most children need surgery after birth. Your doctor may perform the surgery within the first few weeks after the child is born. The most common steps that your doctor performs during the surgery include,
• Closing the hole in your baby’s heart with a patch
• Separating upper part of the pulmonary artery from large blood vessel
• Implanting a valve and a tube for connecting the right ventricle with the upper part of the pulmonary artery and creating a whole artery
• Reconstructing the single, large blood vessel for creating a complete new aorta
• Cardiac catheterization: This is a minimally invasive procedure in which the doctor inserts a cardiac catheter. This procedure may help avoid conventional heart surgery as your child gets older or when the already-installed artificial tube wears off. In this procedure, your doctor inserts a catheter into a blood vessel in your baby’s leg and directs it to the heart to replace the old tube or valve.

After the corrective surgical procedure for truncus arteriosus, your child will require regular follow-ups with the doctor for a lifetime. In most of the cases, children with this condition are likely to require more surgeries as they become older. The reason is, as they grow, the size of their organs changes. However, the dimensions of the artificial tube remain the same, requiring surgery for replacement.

Conclusion

Truncus arteriosus is a rare heart disease that is present in a child since their birth. Therefore, it is a congenital condition. If your child has this condition, your doctor is likely to perform surgery to fix the problem. Your child may need more surgery as they grow older. If left untreated, truncus arteriosus can lead to severe health complications, including heart attack, pulmonary hypertension (high blood pressure in the lungs), and even death. Therefore, seeking medical help is crucial. 

Frequently Asked Questions (FAQs)

Is there a cure for truncus arteriosus?

Truncus arteriosus is a severe heart condition. If it is not treated on time, it is likely to cause many life-threatening complications, including death. Doctors recommend surgery, which is the best treatment before a child turns two months old. Most infants survive the surgery. However, they have to commit to lifelong visits to the doctor’s clinic for follow-up care. 

What tests are crucial for diagnosing truncus arteriosus?

Your doctor will observe a murmuring sound while examining the heart using a stethoscope. Other tests include the following.

• Echocardiogram (ECG) 
• Cardiac catheterization
• Chest X-ray
• Magnetic resonance imaging (MRI)
• Computerized tomography (CT) scan of the heart

By which week does the heart of your baby fully develop?

The heart of the fetus develops by the 10th week of pregnancy. You can ask your doctor if you want to hear the heartbeat of your child when it is still inside your womb.

If a child has Down syndrome, what are the chances of developing heart defects?

Cardiovascular problems are common in children with Down syndrome. As many as 50% of all children with Down syndrome also develop heart defect(s). 

How many kinds of truncus arteriosus are found?

There are four different types of truncus arteriosus: Type I, Type II, Type III, and Type IV.