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Surgical repair of persistent truncus arteriosus in infancy
Insights
Primary repair for persistent truncus arteriosus in infants is feasible, offering better outcomes than staged repair. Early surgical intervention before age two is recommended for improved results.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Neonatal Medicine
Background:
- Persistent truncus arteriosus (PTA) is a complex congenital heart defect.
- Infants with PTA often present with intractable heart failure or pulmonary hypertension.
- Previous management strategies included pulmonary artery banding followed by later repair.
Purpose of the Study:
- To evaluate the feasibility and outcomes of primary surgical repair in infants with persistent truncus arteriosus.
- To compare primary repair with staged surgical approaches for PTA.
- To identify optimal timing for surgical intervention in infants with PTA.
Main Methods:
- Retrospective review of 14 infants younger than two years undergoing primary repair for PTA.
- Analysis of surgical indications, including intractable heart failure and pulmonary vascular resistance.
- Assessment of hospital and late mortality, and long-term functional status of survivors.
Main Results:
- Overall mortality was 5 hospital deaths and 2 late deaths (35.7% mortality rate).
- Six of seven survivors (85.7%) were symptom-free at a median follow-up of 29 months.
- Infants with truncal valve regurgitation also showed favorable outcomes post-repair.
Conclusions:
- Primary repair for persistent truncus arteriosus in infants is a viable option with encouraging results.
- This approach appears superior to staged pulmonary artery banding and later intracardiac repair.
- Primary repair is recommended for infants with intractable heart failure or pulmonary hypertension, ideally before age two.
Abstract:
Fourteen patients younger than two years of age with persistent truncus arteriosus underwent primary repair. Twelve of them were less than 1 year and 4 less than 3 months of age. Intractable heart failure was the indication for surgery in all patients but one who had increased pulmonary vascular resistance. There were 5 hospital and 2 late deaths. Six out of the 7 survivors (median follow-up: 29 months) were symptom-free. The remaining infant who preoperatively had significant truncal valve regurgitation was doing fairly well 2 1/2 years after repair. Our experience suggests that, although the mortality remains high, primary repair for infants with persistent truncus arteriosus is feasible and offers better overall results than does pulmonary artery banding followed by later intracardiac repair. We advise primary repair for all infants with intractable heart failure or increasing pulmonary vascular resistance with or without truncal valve regurgitation. Elective repair is recommended before the age of 2 years to minimize the risk of pulmonary vascular disease.