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Patrick WL, Mainwaring RD, Carrillo SA, Ma M, Reinhartz O, Petrossian E, Selamet Tierney ES, Reddy VM, Hanley FL. Anatomic Factors Associated With Truncal Valve Insufficiency and the Need for Truncal Valve Repair. World J Pediatr Congenit Heart Surg 2015; 7:9-15. [DOI: 10.1177/2150135115608093] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: Truncus arteriosus is a complex and heterogeneous form of congenital heart defect. Many of the risk factors from several decades ago, including late repair and interrupted aortic arch, have been mitigated through better understanding of the entity and improved surgical techniques. However, truncal valve dysfunction remains an important cause of morbidity and mortality. The purpose of this study was to evaluate the anatomic factors associated with truncal valve dysfunction and the need for truncal valve surgery. Methods: This was a retrospective review of 72 infants who underwent repair of truncus arteriosus at our institution. The median age at surgery was nine days, and the median weight was 3.1 kg. Preoperative assessment of truncal valve insufficiency by echocardiography revealed no or trace insufficiency in 30, mild in 25, moderate in 10, and severe in 7. The need for truncal valve surgery was dictated by the severity of truncal valve insufficiency. Results: Sixteen (22%) of the 72 patients undergoing truncus arteriosus repair had concomitant truncal valve surgery. Anatomic factors associated with the need for truncal valve surgery included an abnormal number of truncal valve cusps ( P < .005), presence of valve dysplasia ( P < .005), and the presence of an anomalous coronary artery pattern ( P < .005). Fifteen (94%) of the sixteen patients who underwent concomitant surgery had two or all three of these anatomic factors (sensitivity = 94%, specificity = 85%). Conclusion: This study demonstrates that the presence of specific anatomic factors was closely associated with the presence of truncal valve insufficiency and the need for concomitant truncal valve surgery. Preoperative evaluation of these anatomic factors may provide a useful tool in determining who should undergo concomitant truncal valve surgery.
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Affiliation(s)
- William L. Patrick
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
| | - Richard D. Mainwaring
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
| | - Sergio A. Carrillo
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
| | - Michael Ma
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
| | - Olaf Reinhartz
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
- Division of Pediatric Cardiac Surgery, Oakland Children’s Hospital, Oakland, CA, USA
| | - Edwin Petrossian
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
- Division of Pediatric Cardiac Surgery, Central Valley Children’s Hospital, Madera, CA, USA
| | - Elif Seda Selamet Tierney
- Division of Pediatric Cardiology, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
| | - V. Mohan Reddy
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
| | - Frank L. Hanley
- Division of Pediatric Cardiac Surgery, Lucile Packard Children’s Hospital/Stanford University, Stanford, CA, USA
- Division of Pediatric Cardiac Surgery, Oakland Children’s Hospital, Oakland, CA, USA
- Division of Pediatric Cardiac Surgery, Central Valley Children’s Hospital, Madera, CA, USA
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de Siena P, Ghorbel M, Chen Q, Yim D, Caputo M. Common arterial trunk: review of surgical strategies and future research. Expert Rev Cardiovasc Ther 2014; 9:1527-38. [DOI: 10.1586/erc.11.170] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fujiwara K, Imai K, Yoshizawa K, Ohno N, Sakazaki H, Tukuda K. Truncal valve repair using autologous pericardial patch augmentation. Asian Cardiovasc Thorac Ann 2013; 21:352-4. [DOI: 10.1177/0218492312454729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 35-month-old boy with severe truncal valve regurgitation underwent successful repair by tricuspidization using raphe slicing and an extension technique with glutaraldehyde-treated autologous pericardium. His truncal valve regurgitation improved from severe to mild 5 years postoperatively. Tricuspidization using raphe slicing and valve extension with autologous pericardium might be one of the alternatives for truncal valve regurgitation with a quadricuspid valve.
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Affiliation(s)
- Keiichi Fujiwara
- Department of Cardiovascular Surgery and Pediatric Cardiology, Heart Center, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan
| | - Kenta Imai
- Department of Cardiovascular Surgery and Pediatric Cardiology, Heart Center, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan
| | - Kohsuke Yoshizawa
- Department of Cardiovascular Surgery and Pediatric Cardiology, Heart Center, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan
| | - Nobuhisa Ohno
- Department of Cardiovascular Surgery and Pediatric Cardiology, Heart Center, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan
| | - Hisanori Sakazaki
- Department of Cardiovascular Surgery and Pediatric Cardiology, Heart Center, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan
| | - Kazuya Tukuda
- Department of Cardiovascular Surgery and Pediatric Cardiology, Heart Center, Hyogo Prefectural Amagasaki Hospital, Hyogo, Japan
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Kaza AK, Burch PT, Pinto N, Minich LL, Tani LY, Hawkins JA. Durability of Truncal Valve Repair. Ann Thorac Surg 2010; 90:1307-12; discussion 1312. [DOI: 10.1016/j.athoracsur.2010.06.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Revised: 05/29/2010] [Accepted: 06/04/2010] [Indexed: 11/28/2022]
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