Thanks to Mark for presenting an awesome cardiology case this morning! We discussed congenital heart disease, as well as some hemodynamic changes in pregnancy. Pearls below! Thanks to YY for always providing terrific food for thought!
Truncus arteriosus (AKA “common arterial trunk”):
- Cyanotic congenital heart defect (right to left shunt)
- Blood goes through single truncal valve (think combined aortic + pulmonic valves) into a single truncal artery (think aorta + pulmonary artery)
- Only 0.7% of all congenital heart disease (but of course 100% of Moffitt cases…lol)
- Associated findings: aortic arch anomalies, VSD
- Can be part of DiGeorge syndrome! Whoa, that’s a throwback! (22q11 deletion associated with hypocalcemia, hypoplastic thymus, cleft palate in addition to truncus)
- Most patients present in first weeks of life with cyanosis and resp distress
- Neonatal repair recommended for all patients, but 10% perioperative mortality!!
- YY’s pearls: Look out for a-fib/flutter, conduit issues, and valvulopathies!
- Harry’s pearl: Look out for endocarditis!
Hemodynamic changes in pregnancy:
- Increased cardiac output
- Decreased SVR
- Increased HR (by 10-15 bpm)
- Minimal change in BP
- Changes ramp up in 1st trimester and sustain through 2nd and 3rd