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Treatments and drugs
By Mayo Clinic staffThe main treatment for an infant with truncus arteriosus is surgery. Multiple procedures or surgeries may be necessary, especially as your child grows. Medications may be given before surgery to help improve the health of the heart.
Medications
Medications that may be prescribed prior to surgery may include:
- Digoxin (Lanoxin). This drug, also referred to as digitalis, increases the strength of heart muscle contractions.
- Diuretics. Often called water pills, diuretics increase the frequency and volume of urination, preventing fluid from collecting in the body, which is a common effect of heart failure.
Surgical procedures
Most infants with truncus arteriosus have surgery before they're three months old. The exact procedure will depend on your baby's condition. Most commonly your baby's surgeon will:
- Close the hole between the two ventricles, often with a patch
- Separate the upper portion of the pulmonary artery from the single large vessel
- Implant a tube (conduit) and valve to connect the right ventricle with the upper portion of the pulmonary artery — creating a new, complete pulmonary artery
- Reconstruct the single large vessel and aorta to create a new, complete aorta
- Implant a new valve separating the left ventricle and aorta if needed
After corrective surgery, your child will need lifelong follow-up care with a cardiologist to monitor his or her heart health. The cardiologist may recommend that your child limit physical activity, particularly intense competitive sports. Your child may need to take antibiotics before dental procedures and other surgical procedures to prevent infections. In general, preventive antibiotics are recommended for six months following surgery to repair the truncus arteriosis. Ask your cardiologist what he or she advises for your child.
Because the artificial conduit does not grow with your child, one or more follow-up surgeries to replace the conduit are usually necessary as he or she gets older. Newer surgical procedures that use a cardiac catheter inserted into a blood vessel in the leg that are then threaded slowly up to the heart are being developed to replace the conduit without the need for traditional heart surgery. In addition, cardiac catheterization with an inflatable balloon tip can be used to open up an obstructed or narrowed artery, which may delay the need for follow-up surgery.
Pregnancy
Women who've had surgery to repair truncus arteriosus in infancy need to be evaluated by a cardiologist with expertise in adult congenital heart defects and an obstetrician specializing in high-risk pregnancies before attempting to become pregnant. Depending on the level of lung damage that occurred before surgery, pregnancy may or may not be recommended. In addition, some drugs taken for heart problems can be harmful to a fetus.
- Maldonado JA, et al. Congenital thoracic vascular anomalies. Radiologic Clinics of North America. 2010;48:85.
- Persistent truncus arteriosus. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/pediatrics/congenital_cardiovascular_anomalies/persistent_truncus_arteriosus.html#v1096866. Accessed Sept. 5, 2012.
- Doherty GM, ed. Current Diagnosis & Treatment: Surgery. 13th ed. New York, N.Y.: The McGraw-Hill Companies; 2010. http://www.accessmedicine.com/content.aspx?aID=5215009. Accessed Sept. 5, 2012.
- What are congenital heart defects? National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/chd/printall-index.html. Accessed Sept. 5, 2012.
- Truncus arteriosus. American Heart Association. http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/AboutCongenitalHeartDefects/Truncus-Arteriosus_UCM_307040_Article.jsp. Accessed Sept. 5. 2012.
- Congenital heart defects. March of Dimes. http://www.marchofdimes.com/baby/birthdefects_congenitalheart.html. Accessed Sept. 9, 2012.
- Infective endocarditis. The American Heart Associaton. http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/TheImpactofCongenitalHeartDefects/Infective-Endocarditis_UCM_307108_Article.jsp. Accessed Sept. 9, 2012.
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