Surgical treatment of persistent truncus arteriosus in the first year of life.

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Abstract
Between Oct. 1974 and Dec. 1977, 17 infants with persistent truncus arteriosus were treated; 4 had gross heart failure and severe metabolic acidosis. Of these 2 had an interrupted aortic arch. All 4 died without operation. An urgent or semi-urgent correction was performed in 12 infants. Operations were done on cardiopulmonary bypass with deep hypothermia and circulatory arrest or periods of reduced flow. Continuity between the right ventricle and the pulmonary artery was established with a valved conduit (either fresh aortic homograft or porcine xenograft). Infants (7) (aged 28 days to 8 mo., wt 2.4 to 5.7 kg) survived the operation and are progressing satisfactorily. The causes of death in 5 infants are analyzed. An 11 mo. old infant with raised pulmonary arteriolar resistance died after operation. The lung histology showed grade III pulmonary vascular obstructive disease. The policies of medical treatment alone, palliation followed by correction, and early primary repair, are analyzed on the basis of published data and our own results. The chances of a child surviving with a normal or near normal pressure in the pulmonary artery apparently are best when the policy of early primary repair is followed.