REV手术在复杂先天性心脏病中的应用

REV procedure for complex congenital heart diseases

目的:介绍REV手术在治疗合并室间隔缺损(ventricular septal defect,VSD),或同时合并肺动脉狭窄(pulmonary stenosis,PS)的复杂型大动脉转位(transposition of the great arteries,TGA)和矫正型大动脉转位中的经验。方法:2012年5—7月中南大学湘雅医院心胸外科收治了4例TGA患者。2例单纯合并VSD的患者(年龄分别为1个月和3个月)采用动脉调转术治疗。1例同时合并VSD及PS的患者(年龄6个月)采用REV手术,另1例同时合并VSD及PS的矫正型大动脉转位患者(年龄7岁)采用Senning术+REV术进行矫正。结果:4例患者痊愈出院,单纯REV手术治疗的患者体外循环时间及主动脉阻断时间最短。分别随访1个月和3个月,超声心动图检查提示心脏畸形矫治满意,心脏功能恢复良好。结论:REV手术对治疗合并VSD,PS的TGA是一种较为简便的手术方法。

Objective： To introduce REV procedure in patients with transposition of the great arteries （TGA） with a ventricular septal defect （VSD） and pulmonary stenosis （PS）. Methods： From May 2012 to June 2012, 4 patients with TGA were admitted for surgery. Two patients with VSD underwent SWITCH operation. REV procedure was used for the other two patients with PS. The Senning procedure was also used for the patient with atrioventricular discordance. Results： There was no in-hospital mortality. Shortest cardiopulmonary bypass time and aortic crossclamp time were found in simple REV procedure patient. Postoperative echocardiography demonstrated physiologic hemodynamics in the left ventricular outflow tract and normal heart function. All the patients were in excellent clinical condition during follow-up. Conclnsion： REV procedure is a good choice for transposition of great arteries associated with ventricular septal defect and obstruction of the pulmonary outflow tract.