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[Total repair for truncus arteriosus]
H Yaku1, T Yagihara, H Kishimoto
1Department of Cardiovascular Surgery, National Cardiovascular Center, Osaka, Japan.
Insights
Total repair for truncus arteriosus using external conduits showed satisfactory results, with improved pulmonary/systemic pressure ratios in survivors. Management of severe truncal valve regurgitation remains a challenge.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Defects
Context:
- Truncus arteriosus is a complex congenital heart defect requiring surgical intervention.
- External conduits have been utilized for total repair, with varying graft materials.
- Early surgical repair aims to improve hemodynamics and long-term outcomes.
Purpose:
- To evaluate the outcomes of total repair for truncus arteriosus using external conduits.
- To assess the efficacy of different conduit types and their long-term durability.
- To identify challenges and areas for improvement in surgical management.
Summary:
- This study reviewed 12 patients undergoing total repair for truncus arteriosus with external conduits between 1978 and 1989.
- Both valved and non-valved conduits were used, with composite valved conduits and pericardial rolls being most common.
- Postoperative cardiac catheterization demonstrated a significant decrease in the pulmonary/systemic pressure ratio, indicating improved hemodynamics. Conduit stenosis and aortic regurgitation necessitated reoperations in some survivors.
Impact:
- Satisfactory surgical outcomes were achieved for truncus arteriosus repair using external conduits.
- The study highlights the need for further research into managing truncus arteriosus associated with severe truncal valve regurgitation.
- Long-term surveillance is crucial for detecting and managing conduit-related complications such as stenosis.
Abstract:
Total repair for truncus arteriosus using an external conduit was performed in 12 patients from 1978 through 1989. Six cases were infants (mean age: 3.4 months) and 6 were children (mean age; 1 years 9 months). Two cases had Collet-Edwards type II truncus and the other 10 cases had type I truncus. One of the infants was associated with an interruption of the aorta and another had a severe regurgitation of the truncal valve (TrV). For external conduits, we used a non-valved conduit in one infant, a composite valved conduit of Dacron containing a heterograft valve in 4 children and a valved pericardial roll made of an autologous or porcine pericardium in 5 infants and 2 children. One infant with a severe regurgitation of the TrV needed valve replacement along with enlargement of the annulus of the TrV. One infant who had replacement of the TrV died early postoperatively. Another infant died 10 months after total repair due to an infection of an external conduit. Cardiac catheterization was performed in all 10 survivors. The mean value for the systolic pulmonary/systemic pressure ratio decreased from 0.98 +/- 0.09 preoperatively to 0.36 +/- 0.09 postoperatively. Replacement of an external conduit was performed due to a conduit stenosis in 2 children and 1 infant, 10 years and 2 months, 7 years and 9 months, and 1 year and 8 months after the total repair, respectively. In one of these 2 children, replacement of the aortic valve was performed due to a severe aortic regurgitation. We conclude that our results of total repair for truncus arteriosus were satisfactory. However, it remains to be solved how to manage an infant with truncus arteriosus associated with a severe regurgitation of the TrV.