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The implications of common brachiocephalic trunk on associated congenital cardiovascular defects and their management

Published online by Cambridge University Press:  24 May 2005

William B. Moskowitz  and
On Topaz
William B. Moskowitz
Affiliation:
Medical College of Virginia Hospitals, Virginia Commonwealth University Health System, Richmond, Virginia, USA
On Topaz
Affiliation:
Medical College of Virginia Hospitals, Virginia Commonwealth University Health System, Richmond, Virginia, USA
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Abstract

A common brachiocephalic trunk is an anatomic variant in which both common carotid arteries and the right subclavian artery arise from the aortic arch via a single trunk. The impact of this condition on associated congenital cardiac malformations is presently unknown. Out of a total of 1480 cardiac catheterizations performed in children over a period of 10 years, we discovered 48 patients (3.2%) to have a common brachiocephalic trunk, of whom 98% had associated congenital cardiac malformations. A spectrum of associated lesions was identified, including left-to-right shunts in 19 patients, right-sided anomalies in 18 patients, left-sided obstructive lesions in 12 patients, and coronary arterial abnormalities in 10 patients, eight of whom had other cardiac defects. Genetic syndromes were present in one-fifth of the cases. When found with left-sided malformations, the common trunk was associated with persistent hypoplasia of the aortic arch, likely related to diminished flow through the arch during development. In each of four patients in whom the brachiocephalic trunk had been used during construction of a palliative shunt, we observed inadequate growth and deformation of the pulmonary arteries. Thus, angiographic identification of a common brachiocephalic trunk may be a marker for the presence of accompanying congenital cardiac defects and coronary arterial abnormalities. Understanding the pathophysiologic effects of the common trunk is important when planning the palliative or corrective procedures, and when assessing the potential benefit of the surgical repair over the long term.

Keywords

Common innominate arteryanomalous coronary arterycongenital heart defectsangiographyembryology
Type
Original Article
Information
Cardiology in the Young , Volume 13 , Issue 6 , December 2003 , pp. 537 - 543
Copyright
© 2003 Cambridge University Press

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References

Edwards JE. An Atlas of Acquired Diseases of the Heart and Great Vessels. W.B. Saunders Co, Philadelphia, 1961.
Bosniak MA. An analysis of some anatomic-roentgenologic aspects of the brachiocephalic vessels. Am J Roentgenol Rad Ther Nucl Med 1964; 91: 1222–1226.Google Scholar
Fouron JC. Fetal cardiovascular physiology. In: Allan, Hornberger, Sharland (eds). Textbook of Fetal Cardiology. Greenwich Medical Media Ltd, London, 2000, pp 29–45.
Becker AE, Becker MJ, Edwards JE. Anomalies associated with coarctation of aorta. Particular reference to infancy. Circulation 1970; 41: 1067–1075.Google Scholar
Matsuoka R, Yamamoto Y, Kuroki Y, Matsui I. Phenotypic expression of the tiromic segments in partial Trisomy 18. In: Van Praagh, Takao (eds). Etiology And Morphogenesis of Congenital Heart Disease. Futura Publishing Company, Inc., New York, 1980, pp 41–50.
Bogers AJ, Gittenberger-de Groot AC, Poelmann RE, Peault BM, Huysmans HA. Development of the origin of the coronary arteries, a matter of ingrowth or outgrowth? Anat Embryol (Berl) 1989; 180: 437–441.Google Scholar
Rudolph AM, Heymann MA. Cardiac output in the fetal lamb: the effects of spontaneous and induced changes of heart rate on right and left ventricular output. Am J Obstet Gynecol 1976; 124: 183–192.Google Scholar
Meng L, Ecknar FAO, Lev M. Coronary artery distribution in tetralogy of Fallot. Arch Surg 1965; 90: 363–370.Google Scholar
Topaz O, DeMarchena EJ, Perin E, Sommer L, Mallon SM, Chahine RA. Anomalous coronary arteries: angiographic findings in 80 patients. Int J Cardiol 1992; 34: 129–138.Google Scholar
Martin MM, Lemmer JH, Shaffer E, Dick II M, Bove EL. Obstruction to left coronary artery blood flow secondary to obliteration of the coronary ostium in supravalvar aortic stenosis. Ann Thorac Surg 1988; 45: 16–20.Google Scholar
Kimbris D, Iskandrian AS, Segal BL, Bemis CE. Anomalous aortic origin of coronary arteries. Circulation 1978; 58: 606–615.Google Scholar
Mikawa T, Gourdie RG. Pericardial mesoderm generates a population of coronary smooth muscle cells migrating into the heart along with ingrowth of the epicardial organ. Dev Biol 1996; 174: 221–232.Google Scholar
Hudlicka O, Brown MD. Physical forces and angiogenesis. In: Rubanyi GM (ed.). Mechanoreception by the Vascular Wall. Futura Publishing Co., Inc., Mount Kisko, NY, 1993, pp 197–241.
Zheng W, Seftor EA, Meininger CJ, Hendrix MJ, Tomanek RJ. Mechanisms of coronary angiogenesis in response to stretch: role of VEGF and TGF-beta [published erratum appears in Am J Physiol Heart Circ Physiol 2001; 280: section H, following table of contents]. Am J Physiol 2001; 280: H909–H917.Google Scholar