Surgical treatment of persistent truncus arteriosus in infancy
Yokota, M.; Muraoka, R.; Aoshima, M.; Kyoku, I.; Nomoto, S.; Kobayashi, A.; Nakano, H.; Ueda, K.; Saito, A.
Nihon Kyobu Geka Gakkai 30(3): 453-460
1982
ISSN/ISBN: 0369-4739 PMID: 7108305 Document Number: 195121
Although the corrective operation of persistent truncus arteriosus for older children was performed with a relatively low mortality rate, the result was not very satisfactory for the correction in infancy, particularly under the age of 12 mo. Since 80% of the patients died within 12 mo. of age, the surgical management should be indicated within this period in the majority of the patients. There are only a few cases of primary correction under 12 mo. of age reported so far in Japan, and in this paper, a case of 9-mo.-old child was reported. At the age of 9 mo. (5.3 kg of body weight), surgical intervention was indicated due to unresponsiveness to the anticongestive therapy and poor weight gain. Rastelli procedure was performed with the aid of surface cooled deep hypothermia combined with limited use of cardiopulmonary bypass. An atrial septal defect and a ventricular septal defect were closed and a Hancock valved conduit 12 mm in diameter was placed between the right ventricle and the pulmonary artery. The distal anastomosis was complicated by the unexpected division of bilateral pulmonary arteries in a double barrel fashion due to the short main pulmonary artery, which required a plasty of the divided pulmonary arteries forming into a common large vessel. Circulatory arrest time was 67 min and total duration of cardiopulmonary bypass was 101 min. Intraoperative measurements of the right ventricular and systemic arterial pressures were 85 and 126 mm Hg, respectively. The lung specimen obtained at operation showed the pulmonary vascular changes of Heath-Edwards III. Postoperative course was essentially uneventful and the child is enjoying a normal active life without any medication 16 mo. postoperatively. Review of the literature revealed a tendency toward early primary correction of this lesion even in infancy because of the unsatisfactory results of pulmonary artery banding. Although the conduits will have to be replaced in several years, overall results of the primary correction in infancy are better than that of the pulmonary artery banding followed by later correction or that of primary correction at 5 yr of age in selected patients.