Surgical Treatment of Common Arterial Trunk in Patients Beyond the First Year of Life

Abstract

Common arterial trunk (persistent truncus arteriosus) is a rare cardiac defect requiring surgical repair early in life because of the fast development of pulmonary vascular obstructive disease. We present our institutional experience with patients having common arterial trunk who are diagnosed after one year of age. Between August 2010 and May 2013, a total of 1,436 patients were treated for congenital cardiac defects at our institution. Common arterial trunk was treated surgically in seven patients older than one year of age (three males, four females; age: 13 months to 5 years, mean: 2.8 ± 2.04 years). All patients underwent cardiac catheterization in order to determine operability. All patients had the aortic dominant type of common arterial trunk. The pulmonary vascular resistance and Qp/Qs ratio before and after oxygen inhalation were mean 9.04 + 4.2 (range: 3.8 and 10.7) wood units and 4.67 ± 2.3 (range: 3 and 6.5) wood units and 3.3 + 1.8 (range: 1.42 and 5.3) and 4.98 + 2.2 (range: 4 and 6.2), respectively. All patients underwent elective primary repair. The ventricular septal defect was closed in all patients, five with a nonvalved patch and two with a unidirectional check-valved patch. Early postoperatively, patients were sedated, hyperventilated, and received nitric oxide for a minimum of 24 hours. There was no early or late mortality. The mean length of hospital stay was 9.3 ± 5.7 days, and mean duration of follow-up was 214 ± 59 days. Complete repair of common arterial trunk in patients older than one year of age is feasible in appropriately selected cases. Preoperative cardiac catheterization to assess reactivity of the pulmonary vascular bed is important as are appropriate strategies for postoperative management. Together, these elements make it possible to achieve primary repair with excellent outcomes despite late presentation.