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Repair of persistent truncus arteriosus with interrupted aortic arch
Tomas Tlaskal1, Bohumil Hucin, Vladimir Kucera
1Kardiocentrum, University Hospital Motol, V Uvalu 84, 150 06 Prague 5, Czech Republic. tomas.tlaskal@lfmotol.cuni.cz
Insights
Surgical repair of persistent truncus arteriosus with interrupted aortic arch shows low mortality and good mid-term outcomes. Aortic arch reconstruction with selective perfusion benefits recovery, though conduit issues require attention.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Defects
- Aortic Arch Reconstruction
Background:
- Persistent truncus arteriosus with interrupted aortic arch is a complex congenital heart defect requiring surgical intervention.
- Early surgical repair is critical for improving survival rates in affected neonates and infants.
Purpose of the Study:
- To analyze the surgical experience and outcomes of repairing persistent truncus arteriosus with interrupted aortic arch.
- To evaluate the effectiveness of different surgical techniques, including aortic arch reconstruction methods.
Main Methods:
- Retrospective analysis of eight consecutive patients undergoing repair between 1993 and 2004.
- Surgical repair involved aortic arch reconstruction, ventricular septal defect closure, and right ventricular to pulmonary artery conduit placement.
- Patients underwent repair using deep hypothermia with circulatory arrest or isolated selective low-flow perfusion.
Main Results:
- One operative death (12.5%) due to sepsis and hepato-renal failure; seven patients survived with a median follow-up of 2.6 years.
- Reoperations were necessary in 4 patients for conduit obstruction, aortic regurgitation, pulmonary artery stenosis, or airway obstruction.
- Surviving patients demonstrated good functional status, with 5 in NYHA class I and 2 in NYHA class II.
Conclusions:
- Primary repair of persistent truncus arteriosus with interrupted aortic arch is associated with low mortality and favorable mid-term results.
- Aortic arch reconstruction using isolated low-flow perfusion positively impacts postoperative recovery.
- Conduit obstruction and aortic insufficiency are significant long-term challenges requiring vigilant management.
Objective:
The aim of our study was to analyse experience with repair of truncus arteriosus with interrupted aortic arch.
Methods:
Between 1993 and 2004, eight consecutive patients underwent repair of truncus arteriosus with interrupted aortic arch. The median age was 6.5 days (range 1-85 days) and median weight was 3.2 kg (range 2.6-4.8 kg). Five patients had type A and 3 patients had type B aortic arch interruption. The repair was performed in deep hypothermia with circulatory arrest in 4 patients and isolated selective low-flow perfusion of the head and the heart in the last 4 patients. The repair consisted in aortic arch reconstruction by direct anastomosis between descending and ascending aorta, closure of ventricular septal defect and reconstruction of the right ventricular to pulmonary artery continuity using a valved conduit.
Results:
One (12.5%) patient died from sepsis and hepato-renal failure 18 days after surgery. Seven (87.5%) patients were followed up for 2.0-11.7 years (median 2.6 years). No patient died after the discharge from hospital. In 4 patients 1-3 reinterventions were required 0.6-10.0 years after repair. Reoperations were performed for conduit obstruction in 2 patients, aortic regurgitation in 2 patients, right pulmonary artery stenosis in 2 patients and airway obstruction in 1 patient. In 2 patients concommitant aortic valve and conduit replacement was required. Balloon angioplasty for aortic arch obstruction was necessary in 1 patient, and for bilateral pulmonary branch stenosis in 1 patient. Five (28.6%) surviving patients are in NYHA class I and 2 (71.4%) patients are in NYHA class II.
Conclusions:
Primary repair of persistent truncus arteriosus with interrupted aortic arch can be done with low mortality and good mid-term results. Aortic arch reconstruction in isolated low-flow perfusion of the head and the heart influences favourably the postoperative recovery. The main postoperative problems are associated with conduit obstruction and aortic insufficiency.
