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Late management of truncus arteriosus: 20 years of humanitarian experience

Published online by Cambridge University Press:  26 October 2017

Marielle Gouton ,
Vincent Lucet ,
Olivier Bical  and
Francine Leca
Marielle Gouton*
Affiliation:
Mécénat Chirurgie Cardiaque, Enfants du Monde, Paris, France Cardiologie Congénitale Montsouris, Institut Mutualiste Montsouris, Paris, France
Vincent Lucet
Affiliation:
Mécénat Chirurgie Cardiaque, Enfants du Monde, Paris, France Centre de Cardiologie Infantile, Le Château des Côtes, Les Loges en Josas, France
Olivier Bical
Affiliation:
Mécénat Chirurgie Cardiaque, Enfants du Monde, Paris, France
Francine Leca
Affiliation:
Mécénat Chirurgie Cardiaque, Enfants du Monde, Paris, France
*
Correspondence to: M. Gouton, Mécénat Chirurgie Cardiaque, Enfants du Monde, 33 rue Saint-Augustin, 75002 Paris, France. Tel: +33 6 17 27 16 19; E-mail: m.gouton@cardiocongenitale.fr
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Abstract

Objectives

Early surgical management of common arterial trunk is well established and has good prognosis. Late diagnosis is less common. We reviewed late-diagnosed common arterial trunk management and prognosis for children in developing countries. We also discuss the need for prior catheterisation.

Material and methods

We reviewed all common arterial trunk patients managed by our humanitarian organization since 1996.

Results

A total of 41 children with common arterial trunk were managed at a mean age of 3 years old. The lack of adequate facilities in developing countries explains the late management. The decision to proceed with surgery was based on clinical and radiological symptoms of persistent shunt, particularly a high cutaneous saturation level, regardless of catheterization – not carried out systematically. Eight children had to be withdrawn and 33 (80.5%) received operation – mean saturation 91%. The postoperative course was marked by pulmonary arterial hypertension requiring specific treatment in 30% of cases. The operative mortality was 1/33. The 32 children returned home without treatment after a mean post operative stay of 49 days and were followed up (mean FU 3.4 years, none lost to follow-up). At last contact, 1 child died six months after surgery, 1 child had a massive truncal valve insufficiency, 5 had a significant stenosis of the RV-PA tube, and 2 have had further surgery for tube replacement.

Conclusions

Late management and surgery of common arterial trunk is possible with good long-term results without prior hemodynamic examination up to an advanced childhood when signs of left-to-right shunt persist. A high saturation level (above 88%) seems to be a good operability criterion.

Keywords

Truncus arteriosuslate surgeryhumanitarian
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 2 , February 2018 , pp. 302 - 308
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Copyright
© Cambridge University Press 2017 

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