A neonate with ‘amphibian heart’: A rare combination of comp
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Persistent truncus arteriosus is a rare congenital malformation of the heart. It arises from the ventricular cavity through a common ventriculo-arterial junction and is usually associated with doubly committed ventricular septal defect. Common arterial trunk arising from single ventricle is very rare.

A 4 days old female child was referred for evaluation from peripheral health centre. She was the first-born child after 15 years of marriage and maternal age was 38 years. The baby weighed 2.5 kg and had mild central cyanosis and heart failure. Initial working diagnosis of a cyanotic congenital heart disease with an admixture physiology and increased pulmonary blood flow was considered.

Echocardiogram revealed viscero-atrial situs solitus, levocardia. Left and right atria were well formed with normal corresponding venous connections. There was ostium primum atrial septal defect (ASD) and vestigial remnants of AV septum in the form of diaphanous strands of tissue (Common atrium). There was single AV valve of which two leaflets seen attached directly to ventricular apex. Mild common AV valve regurgitation was present. Both atria were draining into a common ventricle which was had smooth surface possibly morphological LV.

Rudimentary outlet chamber was not visualized. Common arterial trunk was seen arising from the single ventricle which was slightly anteriorly placed. It was trileaflet with mild valvular regurgitation. It had left sided arch. Origin of right and left pulmonary arteries were seen close to each other from posterior aspect of common trunk like Collett and Edward type II of persistent truncus arteriosus. There was no stenosis in visualized parts of pulmonary arteries confirmed on Doppler examination.

Patient was admitted in neonatal intensive care unit and heart failure management was initiated. Cadiac CT and CT angiography was not possible because of heart failure. Cardiothoracic surgical unit was called for pulmonary artery (PA) banding as temporary palliation and plan was staged univentricular repair. Unfortunately, patient succumbed on the same day because of heart failure.

This is the description of a rare case where common arterial trunk arising from single ventricle of LV morphology having common AV connection via single AV valve.

Source: https://www.sciencedirect.com/science/article/pii/S2468600X2030058X?dgcid=rss_sd_all