Truncus

Arteriosus
Definition
• a rare type of
congenital heart disease
characterized by a single blood
vessel arising from the right
and left ventricles, instead of
the pulmonary artery and aorta.
• It occurs when the two large
arteries carrying blood away
from the heart don’t form
properly and one large artery is
present instead. This single
great vessel carries blood both
to the body and to the lungs.
• truncus sits over a large
opening or hole in the wall
between the two pumping
chambers (ventricular septal
defect).
Cause
• Some congenital heart defects may have a genetic
link, either occurring due to a defect in a gene, a
chromosome abnormality, or environmental
exposure, causing heart problems to occur more
often in certain families. Other times this heart
defect occurs sporadically (by chance), with no
clear reason for its development.
Risk Factors
• A mother who had rubella (German measles) or
another viral illness during early pregnancy
• A parent who had a congenital heart defect
• Excessive alcohol consumption during pregnancy
• A mother who has diabetes
• Taking some types of medications during
pregnancy
Symptoms

• Heart failure
• Lethargy
• Poor feeding
• Shortness of breath (dyspnea)
• Rapid breathing (tachypnea)
• Fatigue
• Cyanosis (blue discoloration of skin)
• Delayed growth or growth failure
• Broadening of the finger tips (clubbing)
Diagnostic Test
• Echocardiogram shows a ventricular septal defect
(VSD) and a single truncal artery -- definitive
diagnosis.

• a procedure that evaluates the structure and

function of the heart by using sound waves
recorded on an electronic sensor that produce a
moving picture of the heart and heart valves.
Diagnostic Test

• cardiac catheterization is an invasive

procedure that gives very detailed
information about the structures inside the
heart. Under sedation, a small, thin, flexible
tube (catheter) is inserted into a blood
vessel in the groin, and guided to the inside
of the heart.
Diagnostic Test

• X-ray of the chest shows heart enlargement

and fluid-filled lungs.

• a diagnostic test which uses invisible

electromagnetic energy beams to produce
images of internal tissues, bones, and
organs onto film.
Diagnostic Test

• ECG shows signs of enlargement of the heart

(ventricular hypertrophy).

• a test that records the electrical activity of the

heart, shows abnormal rhythms (arrhythmias or
dysrhythmias), and detects heart muscle stress.
Nursing responsibility
1.Check Patient name, details, date and time of ECG and the
indication
Knowing the indication will help you to focus in on the
problem.  However, it is also important to look at the
whole ECG.
2.  Rate
A tachycardia is a rate more than 100 bpm, bradycardia is
a rate of less than 60 bpm.
 
3.  Rhythm
Is the rhythm irregular or regular?  (regularly irregular or
irregularly irregular?)
Is it sinus rhythm?      
 
Management
• medical management
Generic Name: digoxin (oral) (di JOX in)

Brand names: Digitek, Lanoxicaps, Lanoxin, Cardoxin

Classification: Cardiac antidysrhytmic (treats rhythm problems of the heart)

Action: a medication that helps strengthen the heart muscle, enabling it to pump
more efficiently

Indication: Heart Failure

Medication

Generic Name: Thiazide diuretics

Brand Name: Clorpres, Tenoretic, Thalitone

Classification: diuretics

Action: the body's water balance can be affected when the heart is not
working as well as it could. These medications help the kidneys
remove excess fluid from the body

Indications: Hypertension
Medication

Generic Name: captopril

Brand Name: Capoten, Vasotec, Monoprilinhibitors

Claqssification: ACE (angiotensin-converting enzyme)

Action: dilates the blood vessels, making it easier for the heart to pump
blood forward into the body.

Indication: Hypertension
surgical repair
• The operation is performed under general anesthesia, and involves the
following:

• The pulmonary arteries are detached from the common

artery (truncus arteriosus) and connected to the right
ventricle using a homograft (a section of pulmonary artery
with its valves intact from a tissue donor). Occasionally, a
conduit (a small tube containing a valve) is used instead of
a homograft (human tissue valve).
• operation for Truncus involves separating the pulmonary
blood vessels from the truncal vessel. Then a synthetic
tube (conduit) containing a heart valve is connected to the
right-sided pumping chamber (right ventricle) at one end,
and to the pulmonary artery at the other end. The hole
between the two pumping chambers also must be closed
with a patch of synthetic material.
Nursing Diagnosis

Dx: ineffective tissue perfusion R/T inadequate cardiac output

Outcomes: client will be able to improve circulation after nursing intervention

Intervention:
• Determined factors related to individual situation (previous history)

• Observed for sings of pulmonary emboli: sudden onset of chest pain, cyanosis,
respiratory distress
Dx: Fatigue R/T poor physical condition

Outcomes: client will be able to demonstrate improved sense of energy

with in the day

Intervention:

• Noted daily energy patterns

• Interviewed parent regarding specific changes observed in child/infant

Dx: Imbalance nutrition ,less than body requirements R/T inability to
absorb nutrient because of insufficient oxygen

Outcomes: client will be able to maintain appropriate weight with in the

week

Intervention:

• Assisted in developing individual regimen (anorexia)

• Calculated basal energy expenditure using Harris Benedict formula

and estimate energy and protein requirements
Prognosis

• Complete repair usually provides good results. Re-

operation may be necessary as the patient grows.
Untreated cases have a poor outcome, usually
leading to death between during the first year of
life. Rarely, the diagnosis is missed until early
adulthood; these patients generally need a heart
and a lung transplant.
Current status of the surgical treatment of truncus arteriosus

RA Poirier, MA Berman and HC Stansel Jr

Persistent truncus asteriosus is now correctable surgically in patients
with favorable anatomy. Given pulmonary arteries of reasonable size
arising from any source, successful correction is possible so long as
irreversible pulmonary vascular disease has not occurred. Although
the majority of children with this defect demonstrate increased
pulmonary blood flow, systemic-pulmonary artery shunts can be used.
Also, banding of the pulmonary artery, followed subsequently by
successful total correction, has been described. Recent reports of a few
successful total corrections in infancy, performed with the aid of deep
hypothermia and circulatory arrest, may modify the current approach.
Although the majority of the reported corrections have involved aortic
homograft reconstruction of the pulmonary artery, we strongly favor a
synthetic prosthesis containing a heterograft valve. Based upon our
clinical experience and this review of the literature, a suggested
management protocol is presented.
References

• http://www.nlm.nih.gov/medlineplus/ency/article/001111.ht
m
,
• Zipes DP, Libby P, Bonow RO, Braunwald E, eds.
Braunwald's Heart Disease: A Textbook of Cardiovascular
Medicine, 8th ed. St. Louis, Mo; WB Saunders; 2007,
• http://jtcs.ctsnetjournals.org/cgi/content/abstract/69/2/16
9,
• http://www.americanheart.org/presenter.jhtml?
identifier=11073