[Surgery of truncus arteriosus in the first 2 years of life. Analysis of a consecutive series of 22 patients].
At the Laennec Hospital in Paris, between 1976 and 1980 twenty-two children with Truncus Arteriosus Communis (TAC) underwent primary total repair during the first twenty-four months of life, according to the technique described by McGoon in 1968. All infants operated before the age of three months (group A: 7 patients) were in severe cardiac insufficiency with respiratory distress. Eleven patients (group B) were electively operated between four and nine months of age. Only four patients (group C) underwent surgical treatment after twelve months and before twenty-four months of age. The hospital mortality was very high in group A, because of the severity of the preoperative conditions. In three patients who underwent total repair at eight and eighteen months of age respectively, irreversible pulmonary hypertension (stage IV according to Edwards classification) was the cause of death. In our experience, severe postoperative myocardial ischemia was often associated with complete atrio-ventricular block (BAV): the possible causes are discussed. Furthermore, all patients, to a variable extent, had some manifestations of left ventricular (LV) insufficiency, which was always reversible after medical treatment. For several days, almost systematically, mechanical ventilation is necessary after a total repair of TAC. The result in the nine surviving patients is excellent: they had a strictly normal life, without any therapy. In conclusion, we believe that elective surgery for TAC can be performed more safely between six and nine months of age: if medical treatment cannot control heart failure, surgery must be performed urgently in order to avoid severe ventilatory disturbances. After twelve months of age, total repair is performed only if a pulmonary biopsy confirms the possibility of regression of the pulmonary vascular lesions.