Quadricuspid truncal valve repair in a 6-year-old with severe annular dilatation

Reintervention after truncus arteriosus repair is frequently driven by progressive neoaortic (truncal) valve regurgitation. In many patients, valve dysfunction is primarily associated with annular and root dilatation rather than intrinsic leaflet pathology. We present a 6-year-old child with prior neonatal repair of truncus arteriosus who developed severe truncal valve regurgitation in the setting of marked annular dilatation and quadricuspid truncal valve. The patient underwent truncal valve repair by tricuspidization, annular reduction and root stabilization. Replacement of the right pulmonary valve was performed. Postoperative echocardiography demonstrated excellent truncal valve function with only a trace of regurgitation. At 2-month follow-up, valve function remained stable. This case highlights the importance of annular reduction and valve-preserving strategies in truncal valve surgery.