The management of truncus arteriosus has evolved, and results are now more consistent [1Henaine R. Azarnoush K. Belli E. et al.Fate of the truncal valve in truncus arteriosus.Ann Thorac Surg. 2008; 85: 172-178Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar]. As has been well described, however, the primary approach to truncus arteriosus and to significant associated lesions, such as interrupted aortic arch and truncal valve insufficiency, remain the major risk factors for reoperation and mid to late survival rates. The initial management of truncal valve is a good example of the problems that arise when pediatric cardiac surgeons try to standardize therapy. The lack of consensus on timing and surgical techniques for treatment of moderate or severe truncal valve insufficiency impacts mid- and long-term outcomes. Nowadays, rational analysis of specific lesions and possible solutions is recommended. The following are influential lesions that may impact results:1Truncal valve morphology that includes dysplastic, dysfunctional, and an abnormal number of leaflets; conal septal hypoplasia; and valve prolapse due to the ventricle septal defect (VSD) should be considered.2Aortic arch obstruction and anomalous coronary anatomy are important associated lesions.3Morphology of the pulmonary arteries and their relationship to the aorta should be inspected. The following are some influential solutions that have contributed to improved results:1Use of direct anastomosis, patch interposition, or conduit to produce truncal valve/aorta continuity.2Improve truncal valve function by truncal valve replacement, commissuroplasty, external or internal annuloplasty, truncal valve reduction, creating a functional tricuspid semilunar valve, or attachment of edges of prolapsed leaflets.3VSD closure using appropriate right ventriculotomy and patch size. I have found the following procedures and guidelines to be helpful:1For moderate to severe truncal valve insufficiency, truncal valve repair is the most desirable and first choice.2Multiple leaflets (more than three) require careful attention.3Carefully consider the efficacy of different valvuloplasty alternatives.4Avoid valve replacement as a first option.5Prevent injury to truncal valve commissures during dissection of pulmonary arteries.6Try to construct an ascending aorta of uniform diameter, usually by using a direct anastomosis to reestablish truncal valve–aortic continuity.7Limit the incision distance of your right ventriculotomy through the truncal valve orifice.8Close the VSD with a large patch that is a larger size than the truncal valve orifice.9Assess the function of the truncal valve using an infusion of cardioplegia through the ascending aorta; view the valve from the right ventricle before finishing the VSD closure.10Take advantage of a perioperative transesophageal echocardiographic evaluation, and remember that truncus arteriosus is a challenging disease so repair. Fate of the Truncal Valve in Truncus ArteriosusThe Annals of Thoracic SurgeryVol. 85Issue 1PreviewThe fate of the truncal valve (TV) after truncus arteriosus repair remains poorly defined. The purpose of this report was to analyze how the TV influences outcome of truncus arteriosus repair. Full-Text PDF