Truncal valve repair in common arterial trunk

Abstract

Truncus arteriosus communis (common arterial trunk) remains a rare congenital heart defect occurring in approximately 0.04 of 1000 live births (Neonatal Heart Dis. (1992) 428). The initial presentation remains variable but mild cyanosis and tachypnea remain common signs and symptoms due to the obligate pulmonary blood flow via the common arterial trunk and the ventricular septal defect. Severe congestive heart failure develops in time simultaneous with the characteristic decrease in pulmonary vascular resistance. Primary repair of truncus arteriosus during the neonatal period has become the established practice. Neonatal repair minimizes both the possibilities of pulmonary hypertension and the occurrence of late ventricular dysfunction. The presence of moderate to severe truncal valve insufficiency continues to be associated with an increased morbidity and mortality. Traditional strategies for the operative management of these children with neonatal valve replacement either mechanical or homograft has proved to be less than ideal. Truncal valvuloplasty, a natural corollary to semilunar valve repair in the adult population, may hold some promise in the restoration of early, valve competence and/or the delay or avoidance of truncal valve replacement.