Diagnosis and Management of Common Arterial Trunk and Tetralogy of Fallot with Pulmonary Atresia

Characterization of Common Arterial Trunk

The American College of Cardiology notes that Common Arterial Trunk is characterized by a single arterial trunk arising from the heart, giving rise to the coronary arteries, one or more pulmonary arteries, and the systemic arterial circulation 1, 2
The condition is marked by a single trunk valve that accommodates flow from both ventricles, and is always associated with a ventricular septal defect (VSD) 2
The pulmonary artery typically originates directly from the arterial trunk, and pulmonary blood flow originates directly from the trunk 2
The Genetics in Medicine journal recommends genetic screening for 22q11.2 deletion syndrome, which is often associated with Common Arterial Trunk 2, 3

Tetralogy of Fallot with Pulmonary Atresia is characterized by four main components: VSD malalignment, right ventricular outflow obstruction, overriding aorta, and right ventricular hypertrophy 4, 5
The European Heart Journal notes that in the variant with pulmonary atresia, there is atresia of the pulmonary valve, rather than just stenosis 4, 6
There is no direct flow from the right ventricle to the pulmonary artery, and pulmonary blood flow may originate from a patent ductus arteriosus (PDA) or major aortopulmonary collateral arteries (MAPCAs) 6

The American College of Cardiology recommends careful evaluation of the arterial trunk and pulmonary artery anatomy to distinguish between Common Arterial Trunk and Tetralogy of Fallot with Pulmonary Atresia 1, 2
The Circulation journal notes that both conditions require close monitoring during pregnancy with fetal echocardiography every 2-4 weeks, and genetic screening for 22q11.2 deletion syndrome 3, 5
Delivery should be planned at a tertiary care center with expertise in neonatal cardiac care, and both conditions require surgical intervention with different strategies depending on the specific anatomy 3, 5, 6