Truncal Valve Repair in Neonates and Infants

Truncal valve insufficiency is one of the most important factors influencing the outcomes of truncus arteriosus repair. Approximately one-quarter of patients with truncus arteriosus have truncal valve insufficiency. Children with a quadricuspid truncal valve are more likely to have moderate or greater truncal valve insufficiency. Furthermore, most children with moderate or greater insufficiency will likely require truncal valve surgery at some stage during their lifetime. However, truncal valve repair is often not durable and likely requires reoperation. Quadricuspid truncal valve repair utilizing leaflet resection and annular reduction appears to give the best durability. Herein, we describe the surgical techniques for addressing truncal valve insufficiency in neonates and infants. We place particular emphasis on annular reduction, and in the case of the quadricuspid truncal valve, the combination of leaflet resection and annular reduction. The technique described should avoid some surgical pitfalls in these challenging patients and provide a more durable repair.