Objective To investigate clinical outcomes of one-stage repair for patients with persistent truncus arter-iosus who missed optimal timing of surgery. Methods We retrospectively analyzed clinical data of 12 patients with persistent truncus arteriosus who had missed optimal timing of surgery and were admitted to Wuhan Asia Heart Hospital between June 2003 and August 2011. There were 7 male patients and 5 female patients with their median age of 4.5 （0.6-14.0）years and median body weight of 23 （6-36）kg. All the patients underwent one-stage surgical repair. There were 9 patients with Van Praagh type A1，2 patients with type A2，and 1 patient with type A4 persistent truncus arteriosus. There were 2 patients with anomalous origin of coronary artery，2 patients with moderate truncal valve insufficiency，and 3 patients with moderate tricuspid valve insufficiency which required concomitant surgical repair. All the patients received preoperative right heart catheterization which showed severe pulmonary hypertension. The median pulmonary-systemic blood flow ratio （Qp/Qs ratio） was 2.42 （1.50-5.26），and median pulmonary vascular resistance was 8.1 （4-12） Wood units. All the patients showed a positive pulmonary vasodilator response to oxygen. Right ventricular outflow tract （RVOT） reconstruction was achieved using a valved conduit in 7 patients and a valved patch in 5 patients. Results There was no in-hospital death in this group. Three patients had transient pulmonary hypertensive crisis during postoperative intensive care and were healed after proper treatment. Early postoperative pulmonary artery pressure monitoring in all the patients showed that main pulm-onary artery systolic pressure/radial artery systolic pressure was 0.48±0.12. All the 12 patients were followed up for 48（12-91）months. There were 10 patients with New York Heart Association （NYHA） classⅠand 2 patients with NYHA classⅡ during follow-up. One patient received reoperation for residual ventricular septal defect and right ventricular failure.Two patients required long-term medication treatment for high pulmonary vascular resistance and right ventricular failure. The latest echocardiography during follow-up showed that average pressure gradient across RVOT was 21 （16-42） mm Hg in patients with valved conduit for RVOT reconstruction and 18 （10-28） mm Hg in patients with valved patch for RVOT reconstruction. None of the patients required reoperation for RVOT obstruction. Pulmonary regurgitation was less than moderate degree in all the patients. Two patients with anomalous origin of coronary artery didn’t have symptoms or electrocardiogram changes of myocardial ischemia during follow-up. Conclusion For patients with persistent truncus arteriosus who missed optimal timing of surgery， one-stage repair can achieve good early and intermediate clinical outcomes，but long-term follow-up is needed to observe truncal valve regurgitation and right ventricular function.
Citation：
WANG Xiao,JIN Jing,TAO Liang,ZHOU Hong,ZENG Xiangjun,ZHOU Dan.. Surgical Treatment for Patients with Persistent Truncus Arteriosus Who Missed Optimal Timing of Surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2013, 20(3): 269-272. doi: 10.7507/1007-4848.20130085
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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Thompson LD， Mcelhinney DB， Reddy M， et al. Neonatal repair of truncus arteriosus：continuing improvement in outcomes. Ann Thorac Surg， 2001， 72 （2）：391-395.
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Bove EL， Lupinetti FM， Pridjian AK， et al. Results of a policy of primary repair of truncus arteriosus in the neonate. J Thorac Cardiovasc Surg， 1993， 105 （6）：1057-1065.
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Corno AF， Chief Editor. Congenital heart defects. Decision Making for Surgery. Vol 2. Darmstadt. Germany：Steinkopf Verlag， 2004.71-81.
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曹鼎方， 仇黎生， 苏肇伉， 等. 小儿永存动脉干外科诊治19例. 中华胸心血管外科杂志， 2003， 19 （3）：131-133.
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Schreiber C， Eicken A， Balling G. Single centre experience on primary correction of common arterial trunk：overall survival and freedom from reoperation after more than 15 years. Eur J Cardiothorac Surg， 2000， 18 （1）：68-73.
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Hanley FL， Heinemann MK， Jonas RA， et al. Repair of truncus arteriosus in the neonate. J Thorac Cardiovasc Surg， 1993， 105 （6）：1047-1056.
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Mcgoon DC， Rastelli GC， Ongley PA. An operation for the correction of truncus arteriosus. J Am Med Assoc， 1968， 205 （2）：69-73.
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Di Donato RM， Fyfe DA， Puga FJ， et al. Fifteen-year experience with surgical repair of truncus arteriosus. J Thorac Cardiovasc Surg， 1985， 89 （3）：414-422.
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Ebert PA， Turley K， Stanger P， et al. Surgical treatment of truncus arteriosus in the first 6 months of life. Ann Surg， 1984， 200 （4）：451-456.
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Lacour-Gayet F， Serraf A， Komiya T， et al. Truncus arteriosus repair：influence of techniques of right ventricular outflow tract reconstruction. J Thorac Cardiovasc Surg， 1996， 111 （4）：849-856.
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黎涛， 马春山， 周其文. 先天性心脏病合并重度肺动脉高压的手术适应证. 实用医药杂志， 2008， 25 （1）：10-12.
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沈佳， 徐志伟. 永存动脉干纠治术中右心室流出道重建方式的选择. 中国胸心血管外科临床杂志， 2008， 15 （2）：83-86.
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Danton MH， Barron DJ， Stumper O， et al. Repair of truncus arteriosus：a considered approach to right ventricular outflow tract Reconstruction. Eur J Cardiothorac Surg， 2001， 20 （1）：95-103.
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| 21. |
Honjo O， Kotani Y， Akagi T， et al. Right ventricular outflow tract reconstruction in patients with persistent truncus arteriosus：a 15-year experience in a single Japanese center. Circ J， 2007， 71 （11）：1776-1780.
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| 22. |
Rajasinghe HA， Mcelhinney DB， Reddy VM， et al. Long-term follow-up of truncus arteriosus repaired in infancy：a twenty-year experience. J Thorac Cardiovasc Surg， 1997， 113 （5）：869-878.
|
- 1. Anderson RH， Thiene G. Categorization and description of hearts with a common arterial trunk.Eur J Cardiothorac Surg， 1989， 3 （6）：481-487.
- 2. Keith JD， Rowe RD， Vlad P， Chief Editor. Heart Disease in Infancy and Childhood. 3rd ed. New York：Macmillan， 1978. 457-469.
- 3. Thompson LD， Mcelhinney DB， Reddy M， et al. Neonatal repair of truncus arteriosus：continuing improvement in outcomes. Ann Thorac Surg， 2001， 72 （2）：391-395.
- 4. Bove EL， Lupinetti FM， Pridjian AK， et al. Results of a policy of primary repair of truncus arteriosus in the neonate. J Thorac Cardiovasc Surg， 1993， 105 （6）：1057-1065.
- 5. 张岩， 李守军， 闫军， 等. Ⅰ型和Ⅱ型永存动脉干的外科治疗结果及随访分析. 中国胸心血管外科临床杂志， 2012， 19 （1）：19-21.
- 6. Jahangiri M， Zurakowski D， Mayer JE， et al. Repair of the truncal valve and associated interrupted arch in neonates with truncus arteriosus. J Thorac Cardiovasc Surg， 2000， 119 （3）：508-514.
- 7. Marcelletti C， Mcgoon DC， Mair DD. The natural history of truncus arteriosus. Circulation， 1976， 54 （1）：108-111.
- 8. Moller JH. Prevalence and Incidence of Cardiac Malformations. In：Moller JH， Chief Editor. Surgery of Congenital Heart Disease. Pediatric Cardiac Care Consortium 1984～1995. Philadelphia：Futura， 1998.19-26.
- 9. Corno AF， Chief Editor. Congenital heart defects. Decision Making for Surgery. Vol 2. Darmstadt. Germany：Steinkopf Verlag， 2004.71-81.
- 10. Mavroudis C， Backer CL. Truncus Arteriosus. In：Mavroudis C， Backer CL， Chief Editor. Pediatric Cardiac Surgery. 3rd ed. St Louis：CV Mosby， 2003.339-352.
- 11. 曹鼎方， 仇黎生， 苏肇伉， 等. 小儿永存动脉干外科诊治19例. 中华胸心血管外科杂志， 2003， 19 （3）：131-133.
- 12. Schreiber C， Eicken A， Balling G. Single centre experience on primary correction of common arterial trunk：overall survival and freedom from reoperation after more than 15 years. Eur J Cardiothorac Surg， 2000， 18 （1）：68-73.
- 13. Hanley FL， Heinemann MK， Jonas RA， et al. Repair of truncus arteriosus in the neonate. J Thorac Cardiovasc Surg， 1993， 105 （6）：1047-1056.
- 14. Mcgoon DC， Rastelli GC， Ongley PA. An operation for the correction of truncus arteriosus. J Am Med Assoc， 1968， 205 （2）：69-73.
- 15. Di Donato RM， Fyfe DA， Puga FJ， et al. Fifteen-year experience with surgical repair of truncus arteriosus. J Thorac Cardiovasc Surg， 1985， 89 （3）：414-422.
- 16. Ebert PA， Turley K， Stanger P， et al. Surgical treatment of truncus arteriosus in the first 6 months of life. Ann Surg， 1984， 200 （4）：451-456.
- 17. Lacour-Gayet F， Serraf A， Komiya T， et al. Truncus arteriosus repair：influence of techniques of right ventricular outflow tract reconstruction. J Thorac Cardiovasc Surg， 1996， 111 （4）：849-856.
- 18. 黎涛， 马春山， 周其文. 先天性心脏病合并重度肺动脉高压的手术适应证. 实用医药杂志， 2008， 25 （1）：10-12.
- 19. 沈佳， 徐志伟. 永存动脉干纠治术中右心室流出道重建方式的选择. 中国胸心血管外科临床杂志， 2008， 15 （2）：83-86.
- 20. Danton MH， Barron DJ， Stumper O， et al. Repair of truncus arteriosus：a considered approach to right ventricular outflow tract Reconstruction. Eur J Cardiothorac Surg， 2001， 20 （1）：95-103.
- 21. Honjo O， Kotani Y， Akagi T， et al. Right ventricular outflow tract reconstruction in patients with persistent truncus arteriosus：a 15-year experience in a single Japanese center. Circ J， 2007， 71 （11）：1776-1780.
- 22. Rajasinghe HA， Mcelhinney DB， Reddy VM， et al. Long-term follow-up of truncus arteriosus repaired in infancy：a twenty-year experience. J Thorac Cardiovasc Surg， 1997， 113 （5）：869-878.
