PERSISTENT TRUNCUS ARTERIOSUS OPERATED DURING INFANCY - LONG-TERM FOLLOW-UP

Between July 1974 and October 1988 19 consecutive infants (mean age 2. 7 months, range 5 days to 11.7 months) underwent surgical correction f or persistent truncus arteriosus by one surgeon (J.L.M.). Continuity b etween the right ventricle and pulmonary arteries was achieved with an antibiotic-sterilized aortic homograft (diameter 13-18 mm) together w ith patch closure of the ventricular septal defect. There were 3 early postoperative deaths (16%): 1 patient had severe aortic regurgitation , the other 2 had preoperative cardiac arrests. Of the latter, 1 had s uffered severe cerebral damage, and the other developed recurrent pulm onary hypertensive crises and low cardiac output. The 16 survivors hav e been followed for 3.1-17.3 years (mean 7.8 years). Four patients req uired subsequent replacement of the homograft for stenosis, aortic val ve replacement for regurgitation, or both (3.0, 4.0, 8.5, and 12.0 yea rs postoperatively). Of the 16 survivors, 15 are in NYHA class 1. Of t he 13 patients who have not had aortic valve surgery, 9 have no eviden ce of stenosis or regurgitation. In the 14 children with the original homograft the median of the residual peak gradient across the right ve ntricular outflow tract is 15 mmHg (range 10-40 mmHg), and no patient has severe homograft regurgitation at follow-up. Repair of persistent truncus arteriosus has been achieved with low early mortality and no l ate mortality, which reflects excellent long-term function of the homo graft. Furthermore, if truncal valve function is good at presentation, patients are unlikely to require aortic valve surgery.