A Unique Combination of Criss-Cross-Heart and Common Arterial Trunk: Case Report of Successful Management

We present the unique combination of a criss-cross heart and common arterial trunk, our management strategy, and challenges of the treatment course. The child was born weighing 2.4 kg as one of twins at the 36th week of gestation. Bilateral pulmonary artery (PA) banding was performed initially as symptoms of congestive heart failure manifested. The decision to proceed with a 2-stage approach was made due to the low body weight (<2.5 kg) and distorted anatomy, suspected to affect the position of a right ventricle to pulmonary artery (RV-PA) conduit. During the interstage period, the patient developed moderate to severe truncal valve insufficiency. At the age of 8 months, complete repair was performed that included truncal valve repair. The ventricular septal defect was closed, and a 14 mm RV-PA conduit was implanted. Pericardial patch augmentation of the right ventricular outflow tract and both PA branches was performed in order to insure unobstructed pulmonary blood flow. The patient developed severe truncal valve regurgitation on postoperative day 3. A 21 mm mechanical valve was implanted utilizing several maneuvers to fit the over sized valve with the intention of decreasing the reoperation burden. To the best of our knowledge, only one published case report of this rare combination of congenital heart defects could be identified in the literature, and we believe this is the first case that was surgically repaired.