1. Direct neonatal ventriculo-arterial connections (REV): early results and future implications 
Michael D. Black, MD, Vinayak Shukla, Robert M. Freedom, MD 
The Annals of Thoracic Surgery 
Volume 67, Issue 4, Pages (April 1999)
DOI: /S (99)

2. Fig 1
(A) Anatomy in patient with aortic atresia + ventricular septal defect (VSD) prior to surgical intervention. (B) The ascending aorta (Asc. Ao) is transected, beveled, and anastomosed in end-to-side fashion to the neo-aortic root (neo-Ao). A Lecompte maneuver is performed in addition to reconstruction of the transverse aortic arch. A rotational flap of descending aorta to the transverse arch is believed to lessen the occurrence of recoarctation of the aorta. (C) Repair of aortic atresia + VSD. Through a right ventriculotomy made to assist with VSD closure, additional muscle bundles are excised or transected. The ventriculotomy is extended as cephalad as possible to assist in creation of the direct ventriculo-arterial connection (réparation à l’étage ventriculaire [REV]). (D) The right ventricular outflow tract is completed by attaching the posterior wall of the pulmonary artery confluence to the most superior aspect of the right ventriculotomy. A hood of homograft or autologous pericardium treated in glutaraldehyde completes the repair. (Reprinted from Black MD, Smallhorn JF, Freedom RM. Aortic atresia with ventricular septal defect: modified single-stage neonatal biventricular repair. Ann Thorac Surg 1999;67:751–5.)
The Annals of Thoracic Surgery  , DOI: ( /S (99) )

3. Fig 2
(Patients.) Angiogram demonstrating patent direct ventriculo-arterial connection (réparation à l’étage ventriculaire [REV]). Although there is no discrete stenosis, stretching of the branch pulmonary arteries (PA) is demonstrated. Distal peripheral arborization abnormalities (peripheral pulmonary artery branch stenosis) are indicated (x). (RV = right ventricle.)
The Annals of Thoracic Surgery  , DOI: ( /S (99) )