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)
Sources
Abstract
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.
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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...
83 Citations
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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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#1Seiji AsagaiH-Index: 3
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Last. Toshio NakanishiH-Index: 28
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Objectives This study aimed to analyze long-term survival and functional outcomes after truncus arteriosus repair in a single institution with more than 40 years of follow-up. Methods Medical records were analyzed retrospectively in 52 patients who underwent the Rastelli procedure for truncus arteriosus repair between 1974 and 2002. Thirty-five patients survived the initial repair. The median age at the initial operation was 2.8 months (range, 0.1–123 months) and the body weight was 3.9 kg (rang...
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Arrhythmias in patients with congenital heart disease present a challenge to the care of these patients and can result in significant morbidity and mortality. Transposition of the great arteries and common arterial trunk are no exceptions. It is important to identify risk factors for arrhythmia development in the peri-operative period. The peri-operative arrhythmia burden may relate to the underlying congenital heart disease, haemodynamic perturbations, operative events, and potential residual l...
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Most commonly encountered cyanotic cardiac lesions in children, namely, tetralogy of Fallot, transposition of the great arteries and tricuspid atresia are reviewed. Pathology, pathophysiology, clinical features, non-invasive and invasive laboratory studies and management are discussed. The clinical and non-invasive laboratory features are sufficiently characteristic for making the diagnosis and invasive cardiac catheterization and angiographic studies are not routinely required and are needed ei...
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