保留肺动脉瓣的改良REV手术治疗复杂型大动脉转位——附3例报道及文献综述

目的 介绍一种改良REV手术治疗合并室间隔缺损（VSD）、肺动脉瓣狭窄（PS）的复杂型大动脉转位或右心室双出口（DORV）。方法 2005年9月～2006年2月我院收治3例复杂型先天性心脏病患者，在经典REV手术的基础上，我们改良了REV手术，保留了肺动脉瓣和瓣环进行手术治疗。结果 2例痊愈，1例同时用体外膜式氧合器（ECMO）进行抢救后死亡。痊愈患者分别随访4个月和1个月，超声心动图检查提示肺动脉瓣跨瓣压差分别为15mmHg和5mmHg，结果满意。结论 保留肺动脉瓣的改良REV手术对治疗合并VSD、PS的复杂大动脉转位是一种较为理想的手术方法。

Surgical Treatment of Complicated Transposition of the Great Arteries by a Modified REV Procedure with Preservation of Native Pulmonary Valve——3 Cases Report and Literature Review

Objective To introduce a modified REV procedure of complicated transposition of the great arteries(TGA) or double outlet right ventricle(DORV) which was combined with ventricular septal defect(VSD) and pulmonary valve stenosis(PS).Methods From Sep.2005 to Feb.2006, 3 children with complicated transposition of the great arteries underwent a modified REV operation.This modified REV operation was designed on the basis of classical REV procedure to preserve the native pulmonary artery valve and its function. Results Two patients recovered uneventfully but one died after extracorporeal membrane oxygenator(ECMO) treatment.After 4 and 1 months follow-up respectively,the discharged 2 patients were asymptomatic and the echocardiography revealed that the pressure gradient between left ventricular-main pulmonary were estimated to be 15 and 5mmHg.Conclusion This modified REV operation for preservation of pulmonary artery valve is an ideal procedure to complicated transposition of the great arteries.Advantages and disadvantages of this modified REV procedure were discussed.