Palliative Mustard operation for transposition of the great arteries: late results after 15-20 years.

Abstract

3/4), haemoptysis, and atrial flutter, eight were well (ability index 2), and one disabled (ability index 3). Arterial oxygen saturation at rest was 85-98% (mean (SD) 93'8 (4)%) decreasing to 59-87% (mean 77 (9.5)%) after limited exercise. Symptomatic arrhythmias occurred in four patients, atrial flutter being the most common, and two had sinus node dysfunction. Significant tricuspid regurgitation occurred in four patients. Conclusion-Patients with palliative Mustard operation have a low incidence of symptomatic ventricular dysfunction and despite exercise limitation by hypoxia, continue to live active, near normal lives until their thirties.

Damus-Kaye-Stansel Biventricular Repair for Transposition of the Great Arteries with Pulmonary Hypertension

“…PHT may be irreversible and potentially progressive in older children or adolescents with TGA, which may preclude standard surgical correction including anatomic and physiological repair. Palliative arterial switch or palliative Mustard operation, in which the VSD was repaired with a fenestrated patch or not closed at all to allow right‐to‐left decompression, has been reported with acceptable late outcome in patients with TGA and elevated pulmonary resistance 1,2 . However, left‐to‐right shunt coexisting with right‐to‐left decompression in palliative procedures will inevitably increase right ventricular preload.…”

Echocardiography in adult congenital heart disease

“…Until 10–20 years ago surgery took the form of redirection of venous flow by the Mustard or Senning procedure (fig 31). The right ventricle remains the systemic one and functional deterioration and tricuspid (systemic atrioventricular) valve regurgitation77 78 are key determinants of prognosis. It is also appropriate to check for baffle obstruction or leak, left ventricular outflow obstruction, or pulmonary hypertension although they are not likely to progress much after full growth has been attained (table 14).…”

“…An attempt to assess function from “eyeballing” contraction is very subjective but allows the extremes to be recognised. Tricuspid regurgitation is present in up to 70% of subjects77; although echocardiographic assessment of its severity is important the situation is not analogous to a normal heart.…”

“…Raised pulmonary pressure is common after the Mustard operation77 and should be assessed from the velocity of mitral regurgitation. Left ventricular outflow tract obstruction may develop secondary to the reversed roles of the two ventricles, with systolic bowing of the ventricular septum into the left ventricular outflow tract.…”

Mustard procedure for late natural survival with complete transposition of the great arteries and atrial septal defect

“…A late dpalliativeT Mustard procedure has also been employed for patients with TGA and a large VSD and pulmonary hypertension with good long-term results. The VSD in these patients is left open but the atrial switch procedure has a streaming effect, leading to significant improvement in oxygen saturations [6]. Right ventricular hypertrophy, which can be extreme in some patients, is a clear remodelling response of the right ventricle in the systemic circulation [7].…”