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Ann Thorac Surg 1990;50:728-733
© 1990 The Society of Thoracic Surgeons

Articles

Correction of truncus arteriosus with truncal valvar stenosis or insufficiency using two homografts

Ronald C. Elkins, MD*, John B. Steinberg, MD, Jerry D. Razook, MD, Kent E. Ward, MD, Edward D. Overholt, MD, Webb M. Thompson, Jr, MD

Section of Thoracic Surgery, Department of Surgery, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA

Accepted for publication June 18, 1990.

* Address reprint requests to Dr Elkins, University of Oklahoma Health Sciences Center, PO Box 26901, Oklahoma City, OK 73190.

Surgical correction of truncus arteriosus requires the creation of right ventricular to pulmonary artery continuity and closure of the ventricular septal defect. A variety of conduits have been used including valved and non-valved. Despite a significant incidence of truncal valvar stenosis and insufficiency, this valve has seldom been replaced. We present 4 cases of truncus arteriosus with truncal valvar stenosis or insufficiency that were repaired using two valved homografts: one to create the pulmonary outflow tract and the other to replace the abnormal truncal valve. Two of these patients are doing well after 4 months. Another child survived the operation and did well for 2 months when she died suddenly. The last child died 14 hours postoperatively from low cardiac output syndrome secondary to diabetic hypertrophie cardiomyopathy. When truncal valvar abnormalities are present, the primary repair of truncus arteriosus in an infant should include replacement of the truncal valve. Total correction can be successfully achieved using two valved homografts, resulting in long-term palliation and freedom from thromboembolic events and the use of anticoagulants.




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