title: Anatomic Factors Associated With Truncal Valve Insufficiency and the Need for Truncal Valve Repair.
abstract: OBJECTIVE
  Truncus arteriosus is a complex and heterogeneous form of congenital heart defect. Many of the risk factors from several decades ago, including late repair and interrupted aortic arch, have been mitigated through better understanding of the entity and improved surgical techniques. However, truncal valve dysfunction remains an important cause of morbidity and mortality. The purpose of this study was to evaluate the anatomic factors associated with truncal valve dysfunction and the need for truncal valve surgery.
  
  
  METHODS
  This was a retrospective review of 72 infants who underwent repair of truncus arteriosus at our institution. The median age at surgery was nine days, and the median weight was 3.1 kg. Preoperative assessment of truncal valve insufficiency by echocardiography revealed no or trace insufficiency in 30, mild in 25, moderate in 10, and severe in 7. The need for truncal valve surgery was dictated by the severity of truncal valve insufficiency.
  
  
  RESULTS
  Sixteen (22%) of the 72 patients undergoing truncus arteriosus repair had concomitant truncal valve surgery. Anatomic factors associated with the need for truncal valve surgery included an abnormal number of truncal valve cusps (P < .005), presence of valve dysplasia (P < .005), and the presence of an anomalous coronary artery pattern (P < .005). Fifteen (94%) of the sixteen patients who underwent concomitant surgery had two or all three of these anatomic factors (sensitivity = 94%, specificity = 85%).
  
  
  CONCLUSIONS
  This study demonstrates that the presence of specific anatomic factors was closely associated with the presence of truncal valve insufficiency and the need for concomitant truncal valve surgery. Preoperative evaluation of these anatomic factors may provide a useful tool in determining who should undergo concomitant truncal valve surgery.
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA.
authors.forename: William L
authors.initials: WL
authors.lastname: Patrick
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA mainwaring@stanford.edu.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Mainwaring
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA.
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Carrillo
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Ma
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA Division of Pediatric Cardiac Surgery, Oakland Children's Hospital, Oakland, CA, USA.
authors.forename: Olaf
authors.initials: O
authors.lastname: Reinhartz
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA Division of Pediatric Cardiac Surgery, Central Valley Children's Hospital, Madera, CA, USA.
authors.forename: Edwin
authors.initials: E
authors.lastname: Petrossian
authors.affiliation: Division of Pediatric Cardiology, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA.
authors.forename: Elif Seda
authors.initials: ES
authors.lastname: Selamet Tierney
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA.
authors.forename: V Mohan
authors.initials: VM
authors.lastname: Reddy
authors.affiliation: Division of Pediatric Cardiac Surgery, Lucile Packard Children's Hospital/Stanford University, Stanford, CA, USA Division of Pediatric Cardiac Surgery, Oakland Children's Hospital, Oakland, CA, USA Division of Pediatric Cardiac Surgery, Central Valley Children's Hospital, Madera, CA, USA.
authors.forename: Frank L
authors.initials: FL
authors.lastname: Hanley
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014339:Truncus Arteriosus, Persistent / Q000175:diagnosis / Q000601:surgery*
keywords: congenital heart surgery; morbidity); outcomes (includes mortality; statistics; truncus arteriosus communis (common arterial trunk)