Truncal Valve Repair, VSD Repair, And Aortic Arch Reconstruction
M Mujeeb Zubair, MD, Mariana Chávez, MD, MPH, Christopher W. Baird, MD.
Boston Children's Hospital, Boston, MA, USA.
Objective(s): We present a case of a 6-day-old boy with truncus arteriosus, interrupted aortic arch, ventricular septal defect (VSD), PDA, and PFO. Pre-operative echocardiogram showed moderate truncal valve regurgitation and a large conoventricular septal defect.
Methods: The truncal root was opened, and a complete transverse ascending aortotomy. Inspecting a quadricuspid valve, taking down the raphe of the two small vestigial leaflets. The left-coronary button was harvested to allow for future root reduction. Central approximation of the vestigial leaflets created a tricuspid valve, further reconstruction of the posterior sinus with the left coronary button reimplantation. Several figure of 8 sutures were used to reduce the anterior leaflet prolapse. An annuloplasty was performed with subannular suture. At inspection excellent coaptation, with no prolapse, was noticed. Closure of the VSD via ventriculotomy with a 0.6% glutaraldehyde treated autologous pericardium patch. We then went on regional bypass and placed a C-clamp on the descending aorta, and Yasargils on the left subclavian and carotid. Bringing the left subclavian and left carotid together. The ductus was resected, including a posterior shelf and 2 V-shaped incisions in the descending aorta. The near transverse arch was taken down to the descending aorta. The arch reconstruction was completed with a pulmonary homograft patch and a running 7-0 Prolene suture.
Results: Post-operative echocardiogram showed trivial truncal regurgitation with good ventricular function, good coronary flow, no significant tricuspid or mitral regurgitation, no residual VSD.
Conclusions: Truncal valve tricuspidization is possible in neonates and provides other excellent surgical option for this pathology.
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