Abstract
The precordial views in children with truncus arteriosus show a biventricular heart, usually associated with a large perimembranous VSD. The truncus arteriosus, representing the single arterial outlet, originates from both ventricles, overriding the VSD. Colour Doppler in the parasternal long axis and in the apical five-chamber view is essential to assess the function of the truncal valve, which is frequently both regurgitant and stenotic. Colour Doppler helps to identify the origin and course of the pulmonary arteries. PW Doppler interrogation of diastolic flow in the descending aorta and in systemic arteries provides the possibility to assess diastolic run-off from the systemic circulation. CW Doppler interrogation helps to quantify obstruction of the truncal valve and of the central pulmonary arteries.
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13.1 Electronic Supplementary Material
Video 13.1
Parasternal long-axis view in a newborn shows the large perimembranous malalignment VSD and overriding of the truncus arteriosus. The truncal valve is slightly dysplastic. Cranial to the truncal valve, the pulmonary artery originates from the posterior truncal wall (AVI 21441 kb)
Video 13.2
(AVI 4049 kb)
Video 13.3
The large perimembranous VSD and overriding of the truncal valve are displayed in the apical five-chamber view of a newborn with truncus arteriosus (AVI 9127 kb)
Video 13.4
The apical four-chamber view in the plane of the atrioventricular valves shows a seemingly intact ventricular septum in a young infant with truncus arteriosus. Note the enlarged left atrium and left ventricle which is due to increased pulmonary blood flow (AVI 14007 kb)
Video 13.5
In a newborn with truncus arteriosus, the parasternal short-axis sweep starting at the level of the papillary muscles reveals the large perimembranous malalignment VSD, which is located underneath the truncal valve(AVI 68502 kb)
Video 13.6
The parasternal short-axis sweep starting at the level of the truncal valve (same patient as in Video 13.5) displays a tricuspid truncal valve. Both pulmonary arteries originate very close from the posterior wall of the truncus arteriosus (truncus arteriosus type A2)(AVI 46969 kb)
Video 13.7
Colour Doppler in the parasternal short-axis view (same patient as in Video 13.7) confirms unobstructed origin of the pulmonary arteries from the truncus arteriosus (AVI 2635 kb)
Video 13.8
Colour Doppler in the parasternal short-axis view of a newborn with truncus arteriosus type A3 reveals origin of the right pulmonary artery from the posterior truncal wall. The left pulmonary artery is displayed by colour Doppler but does not connect to the main pulmonary artery (see also Videos 13.9 and 13.10) (AVI 952 kb)
Video 13.9
Colour Doppler in the high left parasternal short-axis view reveals a left innominate artery dividing into left common carotid and left subclavian artery suggesting a right aortic arch (same patient as in Videos 13.8 and 13.10). From the base of the innominate artery originates a left ductus arteriosus, which supplies the left pulmonary artery (see Video 13.8) (AVI 19904 kb)
Video 13.10
Colour Doppler in the suprasternal long-axis view (same patient as in Videos 13.8 and 13.9) confirms a right aortic arch (AVI 1024 kb)
Video 13.11
The high right parasternal long-axis view of the aortic arch in a patient with truncus arteriosus type A2 displays posterior origin of the right pulmonary artery from the arterial trunk(WMV 1892 kb)
Video 13.12
The colour Doppler sweep in a patient with truncus arteriosus type A4 starts in a high parasternal sagittal plane. Leftward orientation of the transducer displays origin of both pulmonary arteries from the posterior wall of the truncus arteriosus; the large cranial structure is a huge patent ductus arteriosus. Rightward orientation of the transducer displays the ascending aorta originating from the truncus arteriosus. At the end of the sweep, the transducer is tilted again towards the left, displaying the ductus and the origin of the pulmonary arteries (AVI 16882 kb)
Video 13.13
The high parasternal short-axis view in a patient with truncus arteriosus type A4 shows separation of the common trunk into a small ascending aorta, which is located slightly anterior, and a large pulmonary artery. The innominate vein is visualized anterior the truncus arteriosus (AVI 24263 kb)
Video 13.14
Colour Doppler in a slightly more cranial view (same patient as in Video 13.13) displays origin of the right and left pulmonary artery from the posterior aspect of the truncus arteriosus (AVI 20827 kb)
Video 13.15
Colour Doppler in the oblique high parasternal short-axis view in a patient with TAC type A4 and interrupted aortic arch shows continuation of the large ductus arteriosus into the descending aorta (AVI 1352 kb)
Video 13.16
The subcostal coronal view in this neonate with TAC type A1 shows the truncus arteriosus overriding both ventricles and the large VSD (AVI 8477 kb)
Video 13.17
Colour Doppler in the subcostal coronal view (same patient as in Video 13.16) reveals systolic acceleration of flow across the truncal valve, while there is only minor regurgitation displayed in diastole (AVI 3196 kb)
Video 13.18
The sweep in the subcostal coronal view of a newborn with TAC type A2 displays origin of the right pulmonary artery from the posterior aspect of the truncus arteriosus, while the left pulmonary artery takes its origin from the more leftward aspect of the truncus arteriosus (AVI 6101 kb)
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Hofbeck, M., Deeg, KH., Rupprecht, T. (2017). Truncus Arteriosus. In: Doppler Echocardiography in Infancy and Childhood. Springer, Cham. https://doi.org/10.1007/978-3-319-42919-9_13
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DOI: https://doi.org/10.1007/978-3-319-42919-9_13
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