HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Michael D. Black Vinayak Shukla Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Black, M. D. Articles by Freedom, R. M. Search for Related Content PubMed PubMed Citation Articles by Black, M. D. Articles by Freedom, R. M.

Ann Thorac Surg 1999;67:1137-1141
© 1999 The Society of Thoracic Surgeons

---

Original Articles

Direct neonatal ventriculo-arterial connections (REV): early results and future implications

^a Divisions of Division of Cardiovascular Surgery, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
^b Division of Cardiology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada

Accepted for publication September 30, 1998.

Address reprint requests to Dr Black, Cardiac Surgery, Lucile Packard Children’s Hospital, Stanford University School of Medicine, Stanford, CA 94305-5407

Background. Is the time-honored supposition correct that insertion of a competent prosthetic conduit or homograft is necessary to achieve right ventricular (RV) to pulmonary artery continuity in neonates? A direct ventriculo-arterial connection, or réparation à l’étage ventriculaire (REV), has been successfully used to achieve RV to pulmonary artery continuity in neonates without mortality or major morbidity. Acute RV function is preserved even in the face of free pulmonary insufficiency, but scrupulous preservation of pulmonary artery patency (unobstructed pathway) must be achieved.

Methods. We retrospectively reviewed the cases of 6 neonates who underwent direct ventriculo-arterial connection to achieve RV to pulmonary artery continuity during open heart procedures in the last 3 years.

Results. The 6 neonates had a mean age of 12.3 days (range, 2 days to 6 weeks) and a mean weight of 3.2 kg (range, 2.7 to 3.6 kg) at operation. Two of them had a diagnosis of aortic atresia + ventricular septal defect and successfully achieved an in-series circulation. Two had pulmonary atresia + ventricular septal defect and 2, double-outlet right ventricle + transposition of the great arteries + ventricular septal defect + pulmonary atresia. Follow-up is a mean of 16 months (range, 6 to 22 months). Surgical reintervention was required in 3 neonates and resulted in excellent hemodynamics in 2 of them. In the other patient, who had bilateral long-segment branch pulmonary artery hypoplasia, stents were placed without hemodynamic benefit. All children are currently alive with preserved RV function even in the presence of free pulmonary insufficiency.

Conclusions. Although the creation of a direct ventriculo-arterial connection has routinely been used for children older than 1 year with satisfactory initial results, its application in neonate is very limited. Why have neonates been denied this viable alternative? Perhaps the answer involves legitimate concerns about the consequent free pulmonary insufficiency and the presumed acute RV diastolic dysfunction.

This article has been cited by other articles:

				K. D. Bakshi, B. Vaidyanathan, K. R. Sundaram, S. J. Roth, K. Shivaprakasha, S. G. Rao, S. G. Nair, S. Chengode, and R. K. Kumar Determinants of early outcome after neonatal cardiac surgery in a developing country J. Thorac. Cardiovasc. Surg., September 1, 2007; 134(3): 765 - 771. [Abstract] [Full Text] [PDF]

				D. Di Carlo REV (Lecompte) procedure: how much better than the Rastelli operation? Eur. J. Cardiothorac. Surg., December 1, 2004; 26(6): 1226 - 1227. [Full Text] [PDF]