[Surgical treatment of truncus arteriosus in children]

Abstract

Objective: To summarize the surgical results of truncus arteriosus in children.

Methods: Five patients with persistent truncus arteriosus underwent complete repair of truncus arteriosus. Type I was found in 2 patients, type II in 2 and type IV in 1 according to Collett and Edwards. Their ages ranged from 3 to 12 years (mean 6.3 years). The time of pulmonary circulation and evacuation of the pulmonary artery was not significantly prolonged. Complete repair was via a median sternotomy utilizing hypothemia with cardiopulmonary bypass, entailing separation of the pulmonary arteries from the truncus, repair of the resultant defect in the aorta, ventricular septal defect (VSD) closure with a patch in which the interrupted pledget-supported suture was placed in the truncal valve annulus of the superior border of VSD, and restoration of right ventricular outflow tract (RVOT) continuity utilizing extra cardiac conduits, of which autologous pericardial valved dacron conduit was used in 4 patients and homograft conduit in 1.

Results: Postoperative mean pulmonary pressure decreased significantly in all patients (P < 0.01) and the pressure gradient across conduit was 7 - 35 mm Hg. Two patients died immediately after the operation, which was not associated with pulmonary vascular lesion. Among 3 survivors, I had low cardiac output and respiratory dysfunction after operation and the others recuperated uneventfully. Survivors were followed up for a period of 114, 96 and 34 months respectively, and were all in NYHA functional class I. One died of occlusion of conduit 8 years after operation.

Conclusions: Children with truncus arteriosus are still indicated for complete correction. Autologous pericardial valved dacron conduit has excellent long-term outcomes. Correcting truncal valve insufficiency, repairing VSD, avoiding large pressure gradient across conduit and shortening CPB time are keys to improve the survival rate of patients and achieve excellent long-term outcome.