Surgery for malposition of the great arteries: the REV procedure

Abstract

The REV procedure was introduced in 1980 to treat transposition of the great arteries with ventricular septal defect (VSD) and pulmonary stenosis and malpositions similar to transposition of the great arteries (TGA). It aims at overcoming the drawbacks and limitations of the classic Rastelli operation, such as subaortic stenosis, late ventricular deterioration, arrhythmias and sudden death. In particular, the resection of the infundibular septum allows for the placement of a straighter, smaller ventricular patch, bulging much less in the right ventricular cavity. The extensive mobilization of the main pulmonary branches permits a direct connection with the right ventricular incision, thus avoiding the need for an extracardiac conduit. The procedure was performed in 205 patients as of December 2003 with 12% hospital mortality. Patients for whom the Rastelli operation would have been contraindicated, were accepted for REV repair. Late results show a clear improvement over those reported with the Rastelli operation in terms of overall survival (85% at 25-year follow-up interval) and prevalence of reoperation for right ventricular obstruction. Obstruction of the left ventricle-to-aorta tunnel is exceedingly rare. This operation should be considered the gold standard when new surgical options are considered for this complex form of transpositions/malpositions of the great arteries.

Percutaneous closure of multiple ventricular septal defects: simultaneous use of muscular ventricular septal defect device and Multi-Fenestrated Septal Occluder – “Cribriform” to close residual ventricular septal defects after complex cardiac surgery in a child

“…The incidence of residual ventricular septal defects around the accessible areas such as the upper muscular septum and in inaccessible portions of the apical interventricular septum that require re-intervention after réparation à l'étageventriculaire procedure with closure of ventricular septal defects has been reported to the tune of 6%. 1 These residual ventricular septal defects, pulmonary regurgitation, and right pulmonary artery stenosis made the child symptomatic, thus necessitating intervention. Device closure of the upper muscular ventricular septal defect with a single muscular septal defect occluder device was a straightforward procedure; however, closing the multiple, closely placed apical muscular ventricular septal defects was technically difficult and was carried out with a cribriform septal occluder device.…”

“…Our case was unique on two counts: first, a cardiac anomaly that was most likely to go the univentricular pathway due to borderline anatomy; however, owing to the surgical expertise, an intraoperative decision for a biventricular repair was taken and executed remarkably; and, second, the use of cribriform septal occluder device for multiple apical ventricular septal defects makes it the only case reported in the paediatric age group. The incidence of residual ventricular septal defects around the accessible areas such as the upper muscular septum and in inaccessible portions of the apical interventricular septum that require re-intervention after réparation à l’étageventriculaire procedure with closure of ventricular septal defects has been reported to the tune of 6% 1 . These residual ventricular septal defects, pulmonary regurgitation, and right pulmonary artery stenosis made the child symptomatic, thus necessitating intervention.…”