A solitary arterial trunk exits the heart by a shared ventriculoatrial junction and serves the systemic, pulmonary, and coronary arterial pathways directly. However, the optimal way to subclassify those hearts that meet this description has yet to be discovered. The traditional classification is based on the anatomy of the pulmonary arteries, but a new method emphasizes the nature of the systemic routes. We analyzed our experiences to see if these disparate approaches might be reconciled.
We looked at 28 autopsied hearts with common arterial trunks that came from three different institutions’ archives. Based on our findings, we divided hearts into two categories: aortic and pulmonary dominance. We classified 42 patients who had received surgical correction using this method.
All autopsied hearts fell into one of two categories: aortic or pulmonary dominance of the common artery trunk, with 20 and 8 specimens fitting into each category, respectively. Only when the aortic component of the trunk was hypoplastic and an arterial duct supplied the majority of flow to the descending aorta was pulmonary dominance discovered. Only in this condition did we see pulmonary arteries sprouting from the sides of the primary channel, and only in this setting was the aortic component of the pericardial cavity separated from the pulmonary component.
This straightforward classification system unifies previously different classifications of patients with shared arterial trunks and emphasizes the most important morphologic predictor of surgical outcome.