|
From Feburary 1988 to December 1990, 42 patients underwent so called REV operation for pulmonary stenosis or atresia with or without anomalies of ventricultnrterial connection and truncus arteriosus. The principles of operative technique are mobilization of pulmonary arterial tret beyond the pericardial reflection, transection of pulmonary trunk_ between the pulmonary v 3ntricle and pulmonary artery, suture of distal pulmonary arterial stump to the upper margin of Pulmonary ventriculotomy site with absorvable suture, and anterior patch with 0.625% gluteraldehyde fixed autologous pericardium with monocusp inside it. Age at operation ranged 3-156months (mean 41.8 month) with twelve of whom infants. Operative indications were pulmonary atresia, with ventricular septal defect (16), and pulmonary steosis with double outlet right ventricle(8), with ventricular septal defec:(1F;), with double outlet right ventricle(8), with complete transposition of the great arse ies(fs), with corrected transposition of the great arteries(6), with Fallot´s tetralogy(3). and truncus arteriosus (1). There were six hopital deaths (14%) and no late death. Tv,e- `_y-frs,3r of 36 survivals were followed up more than 12 months with good clinical results. p~,str,;frative angiocardiogram was performed in fifteen patients. Hemodynamically, twc patr__ is had residual pressure gradients along the pulmonary outflow tract, one patient shower,- severe pulmonary regurgitation ; morphologically, there were six significant ste:zt is of left pulmonary arterial tree, two of whom showed significant pressure gradients. (fi ;resent expeirence with REV operation suggests that this technique make it posst:L ?~ =rform anatomic repair in a wide variety of congenital anomalies of abnormal ver_:-iculr.-fterial connection associated with pulmonary outflow tract obstruction without prosthetic material, even in infants, with realtively low mortality and morbidity.
|