Surgery for common arterial trunk

Truncus arteriosus (common arterial trunk) is a devastating congenital anomaly which left untreated in some cases can cause death within hours. It has remained a challenge even in recent years. Children may present with heart failure, myocardial ischemia, cardiovascular collapse, or may be only mildly cyanotic and nearly asymptomatic. Repair consists of closure of the ventricular septal defect, separation of the pulmonary arteries from the arterial trunk, and insertion of a valved homograft between the right ventricle and pulmonary artery. The truncal valve is repaired if there is significant regurgitation. Concomitant arch reconstruction is performed in those with an interrupted aortic arch. Repair early in infancy has led to 95% survival and nearly eliminated the perioperative risk of pulmonary hypertensive crisis. Reintervention for right ventricular outflow obstruction is usually necessary and occurs between 4 and 7 years of age. Up to 40% of the truncal valves are at risk for late deterioration. Clinical outcomes are favorable in the present era; however, reintervention is a mandatory part of patient management.