Long-term follow-up of surgically corrected patients with common arterial trunk

Published on Jun 1, 2002in Progress in Pediatric Cardiology
· DOI :10.1016/S1058-9813(02)00010-3
Douglas D. Mair53
Estimated H-index: 53
(Mayo Clinic),
Eugene K Sim1
Estimated H-index: 1
(Mayo Clinic)
+ 1 AuthorsFrancisco J. Puga73
Estimated H-index: 73
(Mayo Clinic)
Abstract The first successful surgical correction of truncus arteriosus (common arterial trunk) was performed in 1967 and long-term follow-up is now available on 137 operative survivors. Actuarial survival was 46.4% at 24 years. Late survival was statistically significantly improved in patients having correction during the first 2 years of life when compared to those corrected after the age of 2. Late mortality was secondary to reoperation, most commonly for truncal valve replacement, progressive pulmonary vascular obstructive disease and right ventricular failure, or progressive left ventricular deterioration and failure. Reoperation for isolated conduit replacement was associated with low mortality (one death in 54 reoperations) and morbidity. Reoperation for truncal valve replacement was frequently necessary in patients showing significant truncal incompetence immediately after operative correction, but had not been observed in any patients showing no or minimal incompetence at the time of initial hospital discharge. Of the 86 presently surviving patients, many of whom are now adults, 78 (91%) were NYHA Class I or II, capable of full-time school or employment, at the time of most recent follow-up. Operative correction of truncus arteriosus is now possible at low mortality during the first few months of life, and this is the approach now utilized in all centers to relieve the large left ventricular volume load and its detrimental effects on left ventricular function as soon as possible, as well as to minimize the risk of irreversible pulmonary vascular obstructive disease. With this present approach, late mortality and morbidity could be expected to be significantly less in infants operated today than the late results seen in our unique group of patients corrected, for the most part, at older ages, many even as adolescents or young adults. An infant born with truncus arteriosus today has an excellent chance of survival with good quality of life well into adulthood years.
#1Robert J. Cerfolio (Mayo Clinic)H-Index: 10
#1Robert J. Cerfolio (UR: University of Rochester)H-Index: 1
Last. Duane M. Ilstrup (UR: University of Rochester)H-Index: 159
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Abstract Between May 1983 and March 1, 1995, 50 patients had replacement of an obstructed pulmonary ventricle–pulmonary artery conduit with an autologous tissue reconstruction in which a prosthetic roof was placed over the fibrous tissue bed of the explanted conduit. The roof was constructed with xenograft pericardium (most recently) ( n = 42), homograft dura mater ( n = 5), or Dacron fabric ( n = 3). Patient ages ranged from 5 to 34 years (median 16 years). The explanted conduits were Hancock c...
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Abstract Improvements in myocardial protection, surgical technique, and postoperative care have decreased operative mortality for neonatal repair of truncus arteriosus. Primary repair of truncus arteriosus in infancy without prior pulmonary artery banding is currently the preferred approach. During the period from 1982 to December 1990, 32 patients under the age of 12 months underwent surgical correction of truncus arteriosus at UCLA. The average age was 3.5 months (range, 12 days to 12 months)....
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A new corrective operation for truncus arteriosus without the use of an extracardiac conduit was performed in seven patients with truncus type I or type II aged from 2 to 9 months. The common truncus arteriosus was septated with a patch into aortic and pulmonary segments and the ventricular septal defect was closed through a ventriculotomy. A direct anastomosis between the pulmonary arteries and the right ventricle was performed, the anterior wall being constructed with a patch with a monocusp v...
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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 pat...
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A study of 26 patients with truncus arteriosus showed a high prevalence of facial dysmorphism, aortic arch abnormalities, extracardiac malformations, and significant prenatal risk factors. There was little evidence of parathyroid or thymic abnormalities. However, there was laboratory evidence of immune deficiency, especially T-helper lymphocytes, and clinical evidence of predilection to infection. These findings suggest that patients with truncus arteriosus belong to the spectrum of the Di Georg...
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