Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-23T16:03:23.440Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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 Eight children had to be withdrawn and 33 (80.5%) received operation – mean saturation 91%.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
Check for updates
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Thibert, M, Leca-Chetochine, F. Cardiologie pratique de l’enfant. Maloine s.a. éditeur Paris, Compiègne, 1976.Google Scholar
2. Van Praagh, R. Truncus arteriosus: what is it really and how should it be classified? Eur J Cardiothorac Surg 1987; 1: 65–70.Google Scholar
3. Dupuis, C, Kachaner, J, Pernot, C, Quero-Jimenez, M, Rey, C. Tronc Artériel Commun. Flammarion Médecine – Sciences, Paris, 1981, 304–310pp.Google Scholar
4. Chai, PJ, Jacobs, JP, Quitessenza, JA. Surgery for common arterial trunk. Cardiol Young 2012; 22: 691–695.Google Scholar
5. Mavroudis, C, Jonas, RA, Bove, EL. Personal glimpses into the evolution of truncus arteriosus repair. World J Pediatr Congenit Heart Surg 2015; 6: 226–238.Google Scholar
6. Kharwar, RB, Dwivedi, SK, Chandra, S, Saran, RK. Persistent truncus arteriosus: a rare survival beyond the first decade. J Am Coll Cardiol 2014; 63: 1807.CrossRefGoogle ScholarPubMed
7. Zampi, G, Celestini, A, Benvissuto, F, et al. An unrepaired persistent truncus arteriosus in a 62 year old adult. J Cardiovasc Med 2016; 17: e124–e125.Google Scholar
8. Association Mécénat-Chirurgie Cardiaque – Enfants du monde. Retrieved May 30, 2017, from http://www.mecenat-cardiaque.org/ Google Scholar
9. Selvan, JP, Uthaman, B, Abushaban, L, et al. Long term follow up of persistent truncus arteriosus: Kuwait experience. Med Princ Pract 2012; 21: 277–281.CrossRefGoogle ScholarPubMed
10. Zhang, Y, Li, SJ, Yan, J, Hu, SS, Shen, XD, Xu, JP. Mid-term results after correction of type 1 and type 2 persistent truncus arteriosus in older patients. J Card Surg 2012; 27: 228–230.CrossRefGoogle Scholar
11. O’Byrne, ML, Mercer-Rosa, L, Zhao, H, et al. Morbidity in children and adolescents after surgical correction of truncus arteriosus communis. Am Heart J 2013; 166: 512–518.Google Scholar
12. Van Praagh, R, Van Praagh, S. The anatomy of common aorticopulmonary trunk (truncus arteriosus communis) and its embryologic implications – a study of 57 necropsy cases. Am J Cardiol 1965; 16: 406–425.Google Scholar
13. Frank, L, Dillman, JR, Parish, V, et al. Cardiovascular MR imaging of conotruncal anomalies. Radiographics 2010; 30: 1069–1094.Google Scholar
14. Stapleton, GE, Wilmot, I, Suh, EJ. Cardiac catheterization of patients with common arterial trunk and transposition of the great arteries. Cardiol Young 2012; 22: 687–690.Google Scholar
15. Arslan, AH, Ugurlucan, M, Yildiz, Y, et al. Surgical treatment of common arterial trunk in patients beyond the first year of life. World J Pediatr Congenit Heart Surg 2014; 5: 211–215.Google Scholar
16. Naimo, PS, Fricke, TA, Yong, MS, et al. Outcomes of truncus arteriosus repair in children: 35 years of experience from a single institution. Semin Thorac Cardiovasc Surg 2016; 28: 500–511.Google Scholar
17. Chen, Q, Gao, H, Hua, Z, et al. Outcomes of surgical repair for persistent truncus arteriosus from neonates to adults: a single center’s experience. PLoS 2016; 11: e0146800.Google Scholar
18. Hosseinpour, AR, Shinebourne, EA. Assessment of operability for common arterial trunk without cardiac catheterisation. Cardiol Young 2005; 15: 241–244.Google Scholar
19. Russel, HM, Mavroudis, CD, Backer, CL, Mavroudis, C. Long-term follow up after truncal valve repair. Cardiol Young 2012; 22: 718–723.Google Scholar
20. Kaza, AK, Burch, PT, Pinto, N, Minich, LL, Tani, LY, Hawkins, JA. Durability of truncal valve repair. Ann Thorac Surg 2010; 90: 1307–1312.Google Scholar
21. Myers, PO, Bautista-Hernandez, V, del Nido, P, et al. Surgical repair of valve regurgitation. Eur J Cardiothorac Surg 2013; 44: 813–820.Google Scholar
22. Perri, G, Filippelli, S, Polito, A, Di Carlo, D, Albanese, SB, Carotti, A. Repair of incompetent truncal valves: early and mid-term results. Interact Cardiovasc Thorac Surg 2013; 16: 808–813.Google Scholar
23. Karl, TR. Safe surgical strategy for extracardiac conduit replacement in common arterial trunk. Cardiol Young 2012; 22: 708–717.Google Scholar