pediatrics
Persistent Truncus Arteriosus
Treatment of Persistent Truncus Arteriosus
Medical treatment of heart failure (eg, diuretics,digoxin, angiotensin-converting enzyme inhibitors) before surgery Surgical repair Heart failure in older infants and children is treated vigorously with diuretics, Surgical management consists of repair during the neonatal period. The ventricular septal defect is closed so that the left ventricle ejects into the truncal root. Usually, continuity between the right ventricle and the confluence of the pulmonary arteries is achieved using a conduit with or without a valve. Some centers have reported good success using a non conduit approach, in which the left atrial appendage is used as the posterior wall of the pulmonary outflow and a patch is used as the anterior wall, with or without the insertion of a monocusp valve. When a conduit is placed during early infancy, its size becomes inadequate as children grow, and the conduit must be revised during childhood. When the patient's own tissue is used for part of this outflow tract, there is the potential for growth of the conduit as the child grows. Branch pulmonary artery stenosis is a common sequela and is often effectively treated with transcatheter balloon dilation with or without stent placement. Surgical mortality rates are as low as 10%. Prevention is recommended preoperatively but is required only for the first 6 months after repair unless there is a residual defect adjacent to a surgical patch or prosthetic material. 