Flow visualization of a unique case of persistent truncus arteriosus with prolonged survival

Abstract

A 50-year-old woman was admitted to the coronary care unit due to recurrent chest distress for 30 years. She successfully gave birth to a healthy boy at the age of 24. Physical examination showed a pan systolic multifocal murmur, severe acropachia, and cyanosis (Panel A). Her oxygen saturation was 76% at room air. Both transthoracic echocardiography and computed tomographic angiography suggested a truncus arteriosus (Panels B and C). Cardiovascular magnetic resonance illustrated a large, persistent truncus arteriosus (PTA) arising from the base of the heart, overriding a non-restrictive outlet ventricular septal defect. A single left pulmonary artery originated from the basal of the trunk, where the right pulmonary artery was missing (Panel D). Cardiovascular magnetic resonance 4D flow, a non-contrast, blood flow quantifiable technique, was performed. Streamline flow visualization demonstrated a balanced aortic and pulmonary flow ratio (Panel D; see Supplementary data online, Movie S1), which might be the underlying reason for her unique long survival.