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. 1996 Jan;75(1):72–77. doi: 10.1136/hrt.75.1.72

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

G Sagin-Saylam 1, J Somerville 1
PMCID: PMC484227  PMID: 8624877

Abstract

OBJECTIVE--To assess the clinical, functional state, and complications late (15-20 years) after palliative Mustard operation. DESIGN--Examination and evaluation of all patients presenting in adolescence and adult life after palliative Mustard operation for transposition of the great arteries and pulmonary vascular disease. SETTING--Grown-up Congenital Heart Unit specialised in the care of adolescents and adults with congenital heart disease, designated as having "quaternary" status within a tertiary referral centre for cardiac diseases. PATIENTS AND METHODS--Database searched for patients referred after palliative Mustard for classic transposition of the great arteries. Ten patients aged 18-31 (mean (SD) 25.9 (5.2)) years with a palliative Mustard operation performed at age 1.7-15 (mean (SD) 9 (4.6)) years were fully evaluated by echocardiography, exercise testing, Holter monitoring, and magnetic resonance imaging or radionuclide ventriculography, or both 15-20 years later. RESULTS--One patient died aged 25 years with biventricular failure (ability index 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.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bernhard W. F., Dick M., 2nd, Sloss L. J., Castaneda A. R., Nadas A. S. The palliative Mustard operation for double outlet right ventricle or transposition of the great arteries associated with ventricular septal defect, pulmonary arterial hypertension, and pulmonary vascular obstructive disease. A report of eight patients. Circulation. 1976 Nov;54(5):810–817. doi: 10.1161/01.cir.54.5.810. [DOI] [PubMed] [Google Scholar]
  2. Dhasmana J. P., Stark J., de Leval M., Macartney F. J., Rees P. G., Taylor J. F. Long-term results of the "palliative" Mustard operation. J Am Coll Cardiol. 1985 Nov;6(5):1138–1141. doi: 10.1016/s0735-1097(85)80321-1. [DOI] [PubMed] [Google Scholar]
  3. Dunn J. M., Donner R., Black I., Balsara R. K. Palliative repair of transposition of the great arteries with criss-cross heart: ventricular septal defect and hypoplastic right (systemic) ventricle. J Thorac Cardiovasc Surg. 1982 May;83(5):755–760. [PubMed] [Google Scholar]
  4. Gillette P. C., el-Said G. M., Sivarajan N., Mullins C. E., Williams R. L., McNamara D. G. Electrophysiological abnormalities after Mustard's operation for transposition of the great arteries. Br Heart J. 1974 Feb;36(2):186–191. doi: 10.1136/hrt.36.2.186. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Hagler D. J., Ritter D. G., Mair D. D., Tajik A. J., Seward J. B., Fulton R. E., Ritman E. L. Right and left ventricular function after the Mustard procedure in transposition of the great arteries. Am J Cardiol. 1979 Aug;44(2):276–283. doi: 10.1016/0002-9149(79)90317-5. [DOI] [PubMed] [Google Scholar]
  6. Haworth S. G., Radley-Smith R., Yacoub M. Lung biopsy findings in transposition of the great arteries with ventricular septal defect: potentially reversible pulmonary vascular disease is not always synonymous with operability. J Am Coll Cardiol. 1987 Feb;9(2):327–333. doi: 10.1016/s0735-1097(87)80384-4. [DOI] [PubMed] [Google Scholar]
  7. Hayes C. J., Gersony W. M. Arrhythmias after the Mustard operation for transposition of the great arteries: a long-term study. J Am Coll Cardiol. 1986 Jan;7(1):133–137. doi: 10.1016/s0735-1097(86)80270-4. [DOI] [PubMed] [Google Scholar]
  8. Humes R. A., Driscoll D. J., Mair D. D., Danielson G. K., McGoon D. C. Palliative transposition of venous return. Long-term follow-up. J Thorac Cardiovasc Surg. 1988 Sep;96(3):364–367. [PubMed] [Google Scholar]
  9. Lindesmith G. G., Stanton R. E., Lurie P. R., Takahashi M., Tucker B. L., Stiles Q. R., Meyer B. W. An assessment of Mustard's operation as a palliative procedure for transposition of the great vessels. Ann Thorac Surg. 1975 May;19(5):514–520. doi: 10.1016/s0003-4975(10)64425-6. [DOI] [PubMed] [Google Scholar]
  10. Lindesmith G. G., Stiles Q. R., Tucker B. L., Gallaher M. E., Stanton R. E., Meyer B. W. The Mustard operation as a palliative procedure. J Thorac Cardiovasc Surg. 1972 Jan;63(1):75–80. [PubMed] [Google Scholar]
  11. Mair D. D., Ritter D. G., Danielson G. K., Wallace R. B., McGoon D. C. The palliative Mustard operation: rationale and results. Am J Cardiol. 1976 Apr;37(5):762–768. doi: 10.1016/0002-9149(76)90372-6. [DOI] [PubMed] [Google Scholar]
  12. Martin R. P., Qureshi S. A., Ettedgui J. A., Baker E. J., O'Brien B. J., Deverall P. B., Yates A. K., Maisey M. N., Radley-Smith R., Tynan M. An evaluation of right and left ventricular function after anatomical correction and intra-atrial repair operations for complete transposition of the great arteries. Circulation. 1990 Sep;82(3):808–816. doi: 10.1161/01.cir.82.3.808. [DOI] [PubMed] [Google Scholar]
  13. Newfeld E. A., Paul M. M., Muster A. J., Idriss F. S. Pulmonary vascular disease in complete transposition of the great arteries: a study of 200 patients. Am J Cardiol. 1974 Jul;34(1):75–82. doi: 10.1016/0002-9149(74)90096-4. [DOI] [PubMed] [Google Scholar]
  14. Redington A. N., Rigby M. L., Oldershaw P., Gibson D. G., Shinebourne E. A. Right ventricular function 10 years after the Mustard operation for transposition of the great arteries: analysis of size, shape, and wall motion. Br Heart J. 1989 Dec;62(6):455–461. doi: 10.1136/hrt.62.6.455. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Rees S., Somerville J., Warnes C., Underwood R., Firmin D., Klipstein R., Longmore D. Comparison of magnetic resonance imaging with echocardiography and radionuclide angiography in assessing cardiac function and anatomy following Mustard's operation for transposition of the great arteries. Am J Cardiol. 1988 Jun 1;61(15):1316–1322. doi: 10.1016/0002-9149(88)91176-9. [DOI] [PubMed] [Google Scholar]
  16. Saalouke M. G., Rios J., Perry L. W., Shapiro S. R., Scott L. P. Electrophysiologic studies after mustard's operation for d-transposition of the great vessels. Am J Cardiol. 1978 May 22;41(6):1104–1109. doi: 10.1016/0002-9149(78)90864-0. [DOI] [PubMed] [Google Scholar]
  17. Stark J., de Leval M. R., Taylor J. F. Mustard operation and creation of ventricular septal defect in two patients with transposition of the great arteries, intact ventricular septum and pulmonary vascular disease. Am J Cardiol. 1976 Oct;38(4):524–527. doi: 10.1016/0002-9149(76)90472-0. [DOI] [PubMed] [Google Scholar]
  18. WOOD P. The Eisenmenger syndrome or pulmonary hypertension with reversed central shunt. I. Br Med J. 1958 Sep 20;2(5098):701–709. doi: 10.1136/bmj.2.5098.701. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Warnes C. A., Somerville J. Transposition of the great arteries: late results in adolescents and adults after the Mustard procedure. Br Heart J. 1987 Aug;58(2):148–155. doi: 10.1136/hrt.58.2.148. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Warnes C. A., Somerville J. Tricuspid atresia in adolescents and adults: current state and late complications. Br Heart J. 1986 Dec;56(6):535–543. doi: 10.1136/hrt.56.6.535. [DOI] [PMC free article] [PubMed] [Google Scholar]

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