From the Research
Potential residual lesions after truncal atresia repair include pulmonary stenosis, truncal valve regurgitation or stenosis, right ventricular outflow tract obstruction, branch pulmonary artery stenosis, ventricular septal defect patch leaks, and arrhythmias. These complications can arise due to various factors such as conduit dysfunction, patient growth, or surgical technique. Some key points to consider include:
- Pulmonary stenosis commonly occurs at the conduit site connecting the right ventricle to the pulmonary arteries, as these conduits do not grow with the patient and eventually require replacement 1.
- Truncal valve dysfunction may persist or worsen over time, potentially requiring valve repair or replacement.
- Right ventricular outflow tract obstruction can develop due to conduit calcification or patient growth.
- Branch pulmonary artery stenosis may occur at anastomotic sites or due to distortion during repair.
- Small residual ventricular septal defects might remain if closure was challenging during the initial repair.
- Arrhythmias can develop from surgical scarring near the conduction system. These residual lesions necessitate lifelong cardiology follow-up with regular echocardiography, and sometimes cardiac MRI or catheterization, to monitor for progression and determine timing of reinterventions 2. Most patients will require multiple procedures throughout their lifetime, particularly conduit replacements as they outgrow their initial repairs. A modified repair technique, where the branch pulmonary arteries are left in situ, may reduce the rate of branch pulmonary artery stenosis and the need for surgical reintervention 1. Overall, the management of residual lesions after truncal atresia repair requires a comprehensive and long-term approach to ensure optimal patient outcomes.