Modified Barbero-Marcial repair for type I truncus arteriosus in a 2.7-kg neonate


The basics of truncus arteriosus (TA) repair include separating the pulmonary and systemic circulations with closure of the ventricular septal defect (VSD) via a right ventriculotomy and establishing right ventricular (RV)-to-pulmonary artery (PA) continuity . The standard technique in type I involves excision of the pulmonary trunk (PT) from the TA with patch repair of the TA wall defect, closure of the VSD, followed by establishing RV-to-PA continuity with or without a valved conduit . One of the downsides of this technique is the possibility of distortion or obstruction of either branch pulmonary artery. Other alternate techniques use autologous tissues rather than homografts/heterografts for right ventricular outflow tract reconstruction . Barbero-Marcial described an alternate technique that does not require separation of the PT and the TA . In this technique, an incision is made over the PT with an extension into the left main branch, and the aortopulmonary communication is closed with a patch followed by establishing the RV-to-PA continuity. In the original description of the technique, the right ventricular outflow tract is reconstructed using autologous pericardium or left atrial appendage for the back wall and a patch with or without a monocusp for the front wall. We present a variant of this technique.

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