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Repair of truncus arteriosus in the neonate and young infant
E L Bove1, R H Beekman, A R Snider
1Division of Thoracic Surgery, C.S. Mott Children's Hospital, University of Michigan Medical Center, Ann Arbor, Michigan 48109.
Insights
Early surgical repair of truncus arteriosus in neonates is feasible and safe. This study shows low operative mortality for truncus arteriosus repair in infants younger than six months.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Neonatal Medicine
Background:
- Truncus arteriosus presents significant management challenges in infants.
- Delayed surgical repair due to high operative mortality is common.
- Early repair may prevent critical heart failure and pulmonary vascular disease.
Purpose of the Study:
- To evaluate the safety and efficacy of early surgical repair for truncus arteriosus in neonates and young infants.
- To assess the outcomes of truncus arteriosus repair performed within the first month of life.
Main Methods:
- Retrospective review of 11 neonates and young infants undergoing truncus arteriosus repair.
- Surgical techniques included porcine valved conduits and homografts for RV-PA continuity.
- Echocardiography and Doppler assessment were used for follow-up evaluation.
Main Results:
- One operative death (9%) occurred in the study group.
- Eight of nine late survivors are growing normally with preserved ventricular function.
- Trivial valve regurgitation or mild to moderate obstruction was noted in some patients post-repair.
Conclusions:
- Surgical repair of truncus arteriosus in neonates carries a low operative risk.
- Early repair in the first month of life is recommended to improve outcomes.
- Timely intervention can prevent irreversible complications associated with truncus arteriosus.
Abstract:
Infants with truncus arteriosus present a difficult management issue. Because of the high operative mortality, repair is often delayed beyond the first 3 to 6 months of age. We reviewed our experience with 11 neonates and young infants with truncus arteriosus undergoing repair (median age, 21 days). Five patients also had major truncal valve insufficiency, and 2 required valve replacement. Right ventricle-pulmonary artery continuity was established with a porcine valved conduit in 3 patients and an aortic or pulmonary homograft in 8. There was 1 operative death (9%; 70% confidence limits, 3%-22%) and 1 late death over a mean follow-up of 21 months (range, 4 to 32 months). Eight of the 9 late survivors are growing normally. Echocardiographic examination revealed normal ventricular function in all patients (mean shortening fraction, 39%). Doppler assessment demonstrated trivial prosthetic or homograft valve regurgitation in 7 patients and mild to moderate obstruction in 5 patients. This recent experience with repair of truncus arteriosus indicates that the operative risk is low even in the neonate. Repair in the first month of life should be recommended before the development of critical congestive heart failure or irreversible pulmonary vascular disease.