Truncus Arteriosus共同动脉干

What is truncus arteriosus?什么是共同动脉干？

Truncus arteriosus is a congenital (present at birth) defect that occurs due to abnormal development of the fetal heart during the first 8 weeks of pregnancy. The heart begins as a hollow tube, and the chambers, valves, and great arteries develop throughout the first 8 weeks of pregnancy. The aorta and pulmonary artery start as a single blood vessel, which eventually divides and becomes two separate arteries. Truncus arteriosus occurs when the single great vessel fails to separate completely, leaving a connection between the aorta and pulmonary artery.共同动脉干是一种先天性心脏病(出生时即有的)是由于在妊娠的头8周里胎儿心脏发育异常造成的。心脏开始是一个中空管，并且心腔、瓣膜、和大血管的发育贯穿这妊娠的头8周。主动脉和肺动脉在开始时是一个血管，以后分隔成两个动脉。当这个大血管没有完全分开时，在主动脉和肺动脉之间留下连接处。

Truncus arteriosis is a complex defect where there is a single (normally there are two separate arteries) vessel arising from the heart that forms the aorta and pulmonary artery. Another congenital heart defect that occurs with truncus arteriosus is a ventricular septal defect (ventricular septum, or dividing wall between the two lower chambers of the heart known as the right and left ventricles).共同动脉干是一种复杂的缺陷，一个单一的血管从心脏发出，（正常时是两个互相分开的动脉）。与共同动脉干相伴的另外的心脏缺损是心室间隔缺损。

Normally, there are two separate arteries (the aorta and the pulmonary artery. Oxygen-poor (blue) blood returns to the right atrium from the body, travels to the right ventricle, then is pumped through the pulmonary artery into the lungs where it receives oxygen. Oxygen-rich (red) blood returns to the left atrium from the lungs, passes into the left ventricle, and then is pumped through the aorta out to the body.正常时，这儿是两个互相分开的动脉（主动脉和肺动脉。静脉血（兰）从全身回到右心房，进入右心室，然后泵出经肺动脉进入肺，在这里吸收氧。动脉血（红）从肺里回到左心房，进入左心室，然后泵出经主动脉到达全身）。

In truncus arteriosus, oxygen-poor (blue) and oxygen-rich (red) blood mix back and forth through the ventricular septal defect. This mixed blood then flows through the common truncal vessel. Some of it will flow through the branch that becomes the pulmonary artery and on to the lungs, and some of the mixed blood will go into the aortic branch and continue to the body. The mixed blood that goes to the body does not have as much oxygen as normal, and will cause varying degrees of cyanosis (blue color of the skin, lips, and nailbeds).在共同动脉干的病例，贫氧血（兰）和富氧血（红）经过室间隔缺损来回的混合，然后这混合的血液经过这共同的血管，一部分进入成为肺动脉的分支到达肺里，而另一部分则进入主动脉的分支继续流到全身。混合的血没有带上正常的那么多的氧到达全身，就会引起不同程度的紫绀。（皮肤、口唇、和甲床呈蓝色）

Truncus arteriosus occurs in less than one out of every 10,000 live births. It makes up 1 percent of all cases of congenital heart disease.共同动脉干的发生在每一万新生儿中少于一个。在所有的先天性心脏病中达1％。

What causes truncus arteriosus?什么引起共同动脉干？

Some congenital heart defects may have a genetic link, either occurring due to a defect in a gene, a chromosome abnormality, or environmental exposure, causing heart problems to occur more often in certain families. Other times this heart defect occurs sporadically (by chance), with no clear reason for its development.某些先天性心脏病可能带有遗传链接，由于基因缺陷，染色体异常，或环境暴露，任何一项引起心脏问题较常发生在某些家庭。其他情况下，心脏病的发生是偶然的，对于它的发展没有明确的原因。

Why is truncus arteriosus a concern?为什么关注共同动脉干？

The blood that passes through the common truncal vessel has a lower oxygen content than normal. Oxygen-poor (blue) blood from the right ventricle and oxygen-rich (red) blood from the left ventricle mix together before entering the common vessel. Some of this mixed blood will go into the aorta and on to the body, producing cyanosis (blue color of the skin, lips, and nailbeds).通过共同动脉的血流的含氧量较正常的低。在进入共同血管之前，来自右心室的贫氧血（兰）和来自左心室的富氧血（红）混合在一起。这混合血的一部分进入主动脉供应全身，产生紫绀（皮肤、口唇、和甲床呈蓝色）。

The pulmonary artery section of the common vessel gets more blood flow than the aorta does, because the pressure is lower in the lungs than the body and it is easier for blood to travel in that direction. If not repaired, the blood vessels in the lungs become damaged by the extra blood flow. As the pressure in the blood vessels in the lungs becomes higher, less blood goes to the lungs and more goes to the body. Cyanosis becomes worse as blood with lower amounts of oxygen travels to the body.这共同血管的肺动脉部分得到比主动脉多的血液，因为肺的压力比全身的压力低，所以血液容易流入。如果不矫治，肺内的血管就会被过多的血流损伤。随着肺内血管的压力增高，到肺的血减少而到全身的血增加。随着到全身的血液携带的氧量的减少，紫绀变得更严重。

What are the symptoms of truncus arteriosus?TA有什么症侯群？

The following are the most common symptoms of truncus arteriosus. However, each child may experience symptoms differently. Symptoms may include:以下是TA最常见的症侯群。然而，每一个患儿可能经历的症侯群有所不同。症候群可能包括：

• cyanosis紫绀
• fatigue疲劳
• sweating多汗
• pale skin
• cool skin皮肤凉
• rapid breathing呼吸急促
• heavy breathing呼吸沉重
• rapid heart rate快心律
• congested breathing
• disinterest in feeding, or tiring while feeding食欲差，或喂食的时候易疲劳
• poor weight gain体重增加缓慢

The symptoms of truncus arteriosus may resemble other medical conditions or heart problems. Always consult your child's physician for a diagnosis.共同动脉干的症候群可能与其它疾病或心脏问题相似。为了诊断总要请教你孩子的医生。

How is truncus arteriosus diagnosed?怎样诊断共同动脉干？

Your child's physician may have heard a heart murmur during a physical examination, and referred your child to a pediatric cardiologist for a diagnosis. A heart murmur is simply a noise caused by the turbulence of blood flowing through the heart defects. Symptoms your child exhibits will also help with the diagnosis.在查体时你孩子的医生可能听到心脏杂音，并把你孩子交付给一位小儿心脏病专家以明确诊断。心脏杂音是血流从左心室到升主动脉通过狭窄的主动脉瓣口时产生的湍流引起的噪音。你孩子表现出来的症状对于诊断也有帮助。

A pediatric cardiologist specializes in the diagnosis and medical management of congenital heart defects, as well as heart problems that may develop later in childhood. The cardiologist will perform a physical examination, listening to the heart and lungs, and make other observations that help in the diagnosis. The location within the chest that the murmur is heard best, as well as the loudness and quality of the murmur (harsh, blowing, etc.) will give the cardiologist an initial idea of which heart problem your child may have. However, other tests are needed to help with the diagnosis, and may include the following:一位儿童心脏病专家专门研究先天性心脏病的诊断和医疗方法，和随后心脏问题在儿童期可能的发展。心脏专家将进行体检，听诊你的孩子的心和肺，作一些有助于诊断的观测。在胸部杂音听得最清楚的位置，以及杂音的响度和性质（粗糙的，吹风样的，等等）对于你的孩子可能患有什么样的心脏问题，将给心脏专家一个初步的意向。然而，有助于诊断的其他的一些检查也是需要的，可能包括以下的检查：

• chest x-ray - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.胸部X线检查：用一种看不见的电磁波投射在胶片上产生内部组织，骨骼，和脏器的影像的诊断性的检查。
  
  
• electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle stress.心电图（ECG或EKG)：一种记录心脏电活动的测试，可以显示不正常的心律（arrhythmias或dysrhythmias),还可以发现心肌损害。
• echocardiogram (echo) - a procedure that evaluates the structure and function of the heart by using sound waves recorded on an electronic sensor that produce a moving picture of the heart and heart valves. 超声心动图（echo)：一种通过把超声波记录在电子传感器上再转换成心脏和心脏瓣膜的活动影像来评价心脏的结构和功能的方法。
• cardiac catheterization - a cardiac catheterization is an invasive procedure that gives very detailed information about the structures inside the heart. Under sedation, a small, thin, flexible tube (catheter) is inserted into a blood vessel in the groin, and guided to the inside of the heart. Blood pressure and oxygen measurements are taken in the four chambers of the heart, as well as the pulmonary artery and aorta. Contrast dye is also injected to more clearly visualize the structures inside the heart.心导管检查：心导管检查是一种侵入性的检查，它能够提供关于心内结构的很详细的信息。在镇静状态下，一条细小，壁薄，柔软的管子（心导管）在腹股沟部位插入血管，并且引导进入心内。在心脏的四个腔里以及肺动脉和主动脉里分别测量血压和血氧。也可以注入造影剂以便于更清楚的观察心内的结构。

Treatment for truncus arteriosus:共同动脉干的治疗：

Specific treatment for truncus arteriosus will be determined by your child's physician based on:共同动脉干的特殊治疗将由你孩子的医生根据以下几点作出决定：

• your child's age, overall health, and medical history
• extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference
• 你孩子的年龄，全面的健康情况，和病史。
• 病的程度。
• 你的孩子对于特殊的药物，手术，或其他治疗的耐受性。
• 疾病过程的预后。
• 你的意见或选择。

Truncus arteriosus must be treated by surgical repair of the defects. However, medical support may be necessary until the best time for the operation to take place. Treatment may include:共同动脉干只有进行外科手术治疗.然而,药物支持治疗直到施行手术的最佳时机以前都是必要的,

• medical management医疗管理
  Many children will eventually need to take medications to help the heart and lungs work better. Medication that may be prescribed includes the following:多数患儿最终需要服用药物来帮助他们的心和肺工作的好一些.处方的药物可能包括以下:
• digoxin - a medication that helps strengthen the heart muscle, enabling it to pump more efficiently.地高辛:一种增加心肌收缩力的药物,能使心脏的泵血更有效.
• diuretics - the body's water balance can be affected when the heart is not working as well as it could. These medications help the kidneys remove excess fluid from the body.利尿药:在心脏不能正常工作时影响到身体的水平衡.这类药物帮助肾脏从身体里排除过多的液体.
• ACE (angiotensin-converting enzyme) inhibitors - dilates the blood vessels, making it easier for the heart to pump blood forward into the body.ACE(血管紧张素转换酶)抑制剂:扩张血管,使心脏向前泵血到全身容易一些.
• adequate nutrition
  Infants may become tired when feeding, and may not be able to eat enough calories to gain weight. Options that can be used to ensure your baby will have adequate nutrition include:适当的营养：患婴在喂奶时可能会很疲劳，不能够吃惊足够的热量以增长体重。以下的选项可以用来保证你的宝贝将能够获得足够的营养。
• high-calorie formula or breast milk
  Special nutritional supplements may be added to formula or pumped breast milk that increase the number of calories in each ounce, thereby allowing your baby to drink less and still consume enough calories to grow.高热量配方或母乳：特殊的营养补充加入配方或抽取的母乳中，增加每一盎司中的卡路里的量。因此使你的宝贝虽然喝得少一点，依然能够获得正常生长所需要的足够的卡路里。
• supplemental tube feedings
  Feedings given through a small, flexible tube that passes through the nose, down the esophagus, and into the stomach, can either supplement or take the place of bottle feedings. Infants who can drink part of their bottle, but not all, may be fed the remainder through the feeding tube. Infants who are too tired to bottle feed may receive their formula or breast milk through the feeding tube alone.鼻饲管喂养：通过一条细小的、柔软的经鼻插入沿食管下去进入到胃的管子注入营养物质，可以补充或代替奶瓶喂养。婴儿可以用奶瓶喂一部分，但不是全部，剩下的部分经鼻饲管喂入。婴儿如果太虚弱了尚不能使用奶瓶，可以把配方奶或母乳都只通过鼻饲管喂入。
• surgical repair手术矫治
  Surgery is usually performed after the infant is 2 weeks old, but before the blood vessels in the lungs are overwhelmed by extra blood flow and become diseased.通常在患婴2周大时施行手术，但是要在肺内血管被过多的血量损伤和出现病变以前。

The operation is performed under general anesthesia, and involves the following:手术在全身麻醉下进行，包括以下的步骤：

• The pulmonary arteries are detached from the common artery (truncus arteriosus) and connected to the right ventricle using a homograft (a section of pulmonary artery with its valves intact from a tissue donor).把肺动脉从共同动脉干上分离下来，然后用同种移植物（从一个组织供体上取下来的带有完整瓣膜的一段肺动脉）连接到右心室上，
• The ventricular septal defect is closed with a patch.用一个补片把室间隔缺损补上。

Postoperative care for your child:为你孩子的手术后护理：

Children will spend time in the intensive care unit (ICU) after a truncus repair.在共同动脉干矫治术后患儿将在监护室里待上一段时间。

While your child is in the ICU, special equipment will be used to help him/her recover, and may include the following:当你的小孩在监护室时，以下的特殊的设备将可能用来帮助他／她康复。

• ventilator - a machine that helps your child breathe while he/she is under anesthesia during the operation. A small, plastic tube is guided into the windpipe and attached to the ventilator, which breathes for your child while he/she is too sleepy to breathe effectively on his/her own. After a truncus repair, children will benefit from remaining on the ventilator overnight or even longer so they can rest.呼吸机：一个当你孩子在麻醉下手术时帮助他／她呼吸的机器。一个细小的塑料管插入气管并与呼吸机连接，当你的孩子沉睡不能自己有效地呼吸时，它给你的小孩通气。共同动脉干矫治术后患儿持续使用呼吸机过夜或者甚至更长一点将是有益的，因此他们可以得到休息。
• intravenous (IV) catheters - small, plastic tubes inserted through the skin into blood vessels to provide IV fluids and important medicines that help your child recover from the operation.静脉内（IV）导管：一条细小的塑料管经过皮肤插入血管，输注需要的静脉液体和重要的药物，以帮助你的孩子手术后康复。
• arterial line - a specialized IV placed in the wrist or other area of the body where a pulse can be felt, that measures blood pressure continuously during surgery and while your child is in the ICU.动脉管：一个专门的动脉内小插管，安置在腕部或身体其他可以触到脉搏的地方，当你的小孩在手术期间或在ICU里时用来连续测量血压。
  
  
• nasogastric (NG) tube - a small, flexible tube that keeps the stomach drained of acid and gas bubbles that may build up during surgery.鼻胃（NG)管：一个细小的，柔软的管子，用来持续排空胃内在手术期间可能聚集的胃酸和气体。
• urinary catheter - a small, flexible tube that allows urine to drain out of the bladder and accurately measures how much urine the body makes, which helps determine how well the heart is functioning. After surgery, the heart will be a little weaker than it was before, and, therefore, the body may start to hold onto fluid, causing swelling and puffiness. Diuretics may be given to help the kidneys to remove excess fluid from the body.导尿管：一个细小的，柔软的管子从膀胱引流尿液并且精确的测量机体产生了多少尿液，这对于判断心功能如何有帮助。在手术后，心脏比以前会有一点虚弱，并且，因此，机体可能开始保持液体，引起水肿和虚胖。可能会给与利尿药以帮助肾脏从身体里排出过多的液体。
• chest tube - a drainage tube may be inserted to keep the chest free of blood that would otherwise accumulate after the incision is closed. Bleeding may occur for several hours, or even a few days after surgery.胸管：一根胸腔引流管保持切口缝合以后胸腔里没有积血。出血可能发生在术后数小时或甚至几天。
• heart monitor - a machine that constantly displays a picture of your child's heart rhythm, and monitors heart rate, arterial blood pressure, and other values.心脏监视器：一个机器持续的显示你孩子的心律的图形，并且监视心率，动脉血压，和其它的数值。

Your child may need other equipment not mentioned here to provide support while in the ICU, or afterwards. The hospital staff will explain all of the necessary equipment to you.当你的小孩在ICU里时或者随后可能需要这里没有提到的设备提供支持。医院的职员将向你说明所有的这些必需的设备。

Your child will be kept as comfortable as possible with several different medications; some which relieve pain, and some which relieve anxiety. The staff will also be asking for your input as to how best to soothe and comfort your child.使用几种不同的药物治疗，将使你的孩子尽可能的保持舒适；有的止痛，有的解除焦虑。职员将会告诉你怎样最好的使你的孩子安静和舒适。

After discharged from the ICU, your child will recuperate on another hospital unit for a few days before going home. You will learn how to care for your child at home before your child is discharged. Your child may need to take medications for a while at home, and these will be explained to you. The staff will give you instructions regarding medications, activity limitations, and follow-up appointments before your child is discharged.从ICU转出之后，在回家之前你的孩子要在医院的另一个单元里恢复几天。在你的孩子出院之前，你将要学习在家里怎样照顾你的孩子。你的孩子在家期间可能需要服药，我们将把这些向你解释。在你的孩子出院之前，职员将给你关于药物治疗，活动限制，和随访约定的指导。

Caring for your child at home following truncus arteriosus repair:你孩子在共同动脉干矫治手术后的家庭护理：

Pain medications, such as acetaminophen or ibuprofen, may be recommended to keep your child comfortable at home. Your child's physician will discuss pain control before your child is discharged from the hospital.止痛药，比如醋氨酚或布洛芬，可以保持你的孩子比较舒服的待在家里。在出院之前你孩子的医生将会讲述疼痛的控制。

Often, infants who fed poorly prior to surgery have more energy after the recuperation period, and begin to eat better and gain weight faster. However, high-calorie formulas may be needed for several weeks or months after surgery to help your child catch up growth-wise. Tube feedings may also be helpful until your child is able to feed better.经常的，一些在手术前喂养困难的婴儿，在恢复期后有了较多的活力，开始吃得好一些和较快的增加体重。然而，在手术后高卡路里配方可能需要数周或数月以帮助你的孩子赶上正常的生长发育。直到你的孩子能够喂得比较好以前，鼻饲管喂养可能也有帮助。

After surgery, older children usually have a fair tolerance for activity. Your child may become tired easily, and sleep more right after surgery, but, within a few weeks, your child should be fully recovered.手术后，较大的儿童对于活动通常有较好的耐受力。你的孩子在手术后可能比较容易疲劳，睡眠多一些，但是在数周内，你的孩子应当完全的痊愈了。

You may receive additional instructions from your child's physicians and the hospital staff.你可能从你孩子的医生和医院的职员那里得到进一步的指示。

Long-term outlook after truncus arteriosus surgical repair:共同动脉干外科手术以后的长期前景：

Many children who have had truncus arteriosus surgical repair can live healthy lives. Activity levels, appetite, and growth will eventually return to normal in most children.多数孩子在共同动脉干的矫治手术后能够过上健康的生活。绝大多数孩子的活动水平、食欲、和生长发育最终将恢复正常。

Future intervention may be necessary if the pulmonary artery branches were small and do not grow well after surgery. The homograft connecting the right ventricle to the pulmonary artery may also need to be replaced in the future as your child grows.假如，在手术后肺动脉的分支较小和没有发育好，将来干预性治疗可能是必要的。随着你孩子的生长，，连接肺动脉和右心室之间的同种移植物可能也需要更换。

Your child's cardiologist may recommend that antibiotics be given to prevent bacterial endocarditis after discharge from the hospital.在出院以后，你孩子的心脏专家可能建议给于抗生素以预防细菌性心内膜炎。

Consult your child's physician regarding the specific outlook for your child.请教你孩子的医生关于你孩子的前景

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