Dysrhythmias after mustard's operation for transposition of the great arteries

El-Said, Galal M.; Rosenberg, Harvey S.; Mullins, Charles E.; Hallman, Grady L.; Cooley, Denton A.; McNamara, Dan G.

doi:10.1016/0002-9149(72)90043-4

Cited by 174 publications

(34 citation statements)

References 17 publications

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“…These operations have given good early and moderately late results (Breckenbridge et al, 1972), but they are not corrective, as the right ventricle continues to serve the systemic circulation, and there is some concern about the incidence of late arrhythmias (El Said et al, 1972), tricuspid regurgitation (Tynan et al, 1972), and pulmonary or systemic venous obstruction . The ideal operation, in theory, should consist of transposing the aorta and pulmonary arteries to their appropriate ventricles and resiting the coronary arteries.…”

Section: Discussionmentioning

confidence: 99%

Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction.

Yacoub¹,

Radley-Smith²

1978

Thorax

285

153

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Yacoub, M I, and Radley-Smith, R (1978). Thorax, 33,[418][419][420][421][422][423][424] (Jatene et al, 1976;Ross et al, 1976; Yacoub et al, 1976 Material and methodsThe anatomy of the coronary arteries was examined during operation for TGA both before and, whenever possible, after transection of the aorta in 18 patients in an attempt to characterise:(1) The location of each coronary ostium and its relation to the sinuses and commissures of the aortic and pulmonary valves.(2) The course, direction, and length of the main coronary artery before branches are given off. (3) The mode of origin and course of the early branches.

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Section: Discussionmentioning

confidence: 99%

Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction.

Yacoub¹,

Radley-Smith²

1978

Thorax

285

153

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“…Both were asymptomatic and neither has required surgery. The pulmonary arterial pressure and pulmonary vascular resistance were normal in all 25 patients evaluated. One patient had pulmonary venous obstruction (mean pressure difference of 10 mm Hg between pulmonary vein and pulmonary venous atrium), but she is asymp- tients, more problems may become apparent as these children enter school.…”

Section: General Clinicalmentioning

confidence: 88%

Long-term results after atrial repair of transposition of the great arteries in early infancy.

Mahony¹,

Turley²,

Ebert³

et al. 1982

Circulation

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SUMMARY Fifty-two patients younger than age 100 days who had an intact interventricular septum or a small ventricular septal defect underwent atrial repair of d-transposition of the great arteries (d-TGA). No patient died. To assess long-term results, we evaluated all 36 patients who had been followed for at least 1.5 years (mean 2.7 years) after surgery. The physical findings, chest roentgenograms, ECGs and echocardiograms were reviewed. Catheterization was done 6-60 months (mean 15 months) after surgery in 28 patients. Growth was normal in all but three patients. Neurologic development was abnormal in six patients (delayed speech in one patient, learning disability in three patients and preoperative cerebral infarction in two patients). The ECG showed sinus rhythm in 24 patients, minor abnormalities in nine and major dysrhythmias in three. Catheterization showed a normal cardiac index in all 28 patients. No intracardiac shunt was detected in 19 of 24 patients in whom complete oximetry data were available. One patient required reoperation for persistent atrial shunt and subsequent pacemaker placement. Two patients required baffle revision for symptoms related to superior vena caval obstruction. Right ventricular end-diastolic pressure was less than 15 mm Hg in all of 18 patients evaluated. We conclude that atrial repair of d-TGA in early infancy can be performed with a low mortality rate and a low incidence of late complications.THE SURVIVAL rate of children with d-transposition of the great arteries (d-TGA) (concordant atrioventricular and discordant ventriculoarterial connections) and an intact interventricular septum or a small ventricular septal defect improved dramatically after balloon atrial septostomy and the atrial baffle operation were introduced. 1-5 Balloon atrial septostomy in the first days of life provides palliation until an atrial baffle operation can be performed.The optimal age for an atrial baffle operation is controversial. Early repair has been recommended for several reasons. First, although many infants are clinically stable after successful balloon atrial septostomy, before atrial repair they are at risk of death7 and complications including moderately severe hypoxemia, polycythemia, cerebrovascular accidents, 1 12 growth retardation,'3 and early onset of pulmonary vascular disease. '4 In addition, infants who do not improve after balloon atrial septostomy require urgent further inter-

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“…Many reports have described hemody namic and electrophysiological abnormali ties following the Mustard repair for TGA, including vena caval obstruction, sinus node dysfunction, tricuspid insufficiency, and pul monary venous obstruction [4][5][6][7][8][9][10][11], The Sen ning procedure offers at least theoretical ad vantages over the Mustard procedure for re directing venous return in patients with TGA. The Mustard intra-atrial baffle re quires use of a patch, usually of Dacron or pericardium which has no blood supply.…”

Section: Discussionmentioning

confidence: 99%

“…18 years of experience with the Mustard technique has now been accumulated. Follow-up studies demonstrate frequent long-term postopera tive complications including dysrhythmias [4][5][6][7][8], obstruction to pulmonary and sys temic venous return [9,10], tricuspid insuffi ciency [10,11] and right ventricular dysfunc tion [11]. The frequency of these complica tions prompted Quaegebeur et al [12] to revise and modify the original Senning proce dure, and a number of institutions have re cently reexamined the modified Senning as an alternative approach to surgical treatment of children with TGA.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Hemodynamic and Electrophysiological Evaluation of the Senning Procedure

Epstein¹,

Riemenschneider²,

Mathewson³

et al. 1983

Cardiology

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To determine efficacy of the Senning procedure for correction of transposition of the great arteries we performed detailed hemodynamic and electrophysiological studies in 6 consecutive children operated upon at 5–18 months of age. Cardiac catheterizations were performed 10–19 months following surgery. All patients were asymptomatic on no medication. Hemodynamic studies demonstrated no evidence of pulmonary venous obstruction, pulmonary hypertension, or left ventricular outflow tract obstruction. 1 patient had mild upper baffle limb obstruction. Angiography demonstrated tricuspid insufficiency in 2 patients and a small atrial level shunt in 1. Ambulatory electrocardiographic monitoring in 5 of 6 patients revealed multiple premature ventricular contractions in 1. Invasive electrophysiological studies for sinus node function were normal. Corrected sinus node recovery time was 36–348 ms while total sinoatrial conduction time, determined in 4 patients, ranged between 83 and 128 ms.At our institution the Senning procedure has a low incidence of residual hemodynamic or electrophysiological abnormalities. Detailed postoperative evaluation is necessary to determine extent of residual problems.

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Dysrhythmias after mustard's operation for transposition of the great arteries

Cited by 174 publications

References 17 publications

Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction.

Anatomy of the coronary arteries in transposition of the great arteries and methods for their transfer in anatomical correction.

Long-term results after atrial repair of transposition of the great arteries in early infancy.

Postoperative Hemodynamic and Electrophysiological Evaluation of the Senning Procedure

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