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Early identification of patients at risk for sinus node dysfunction after Mustard operation
F Drago1, A Turchetta, A Calzolari
1Servizio di Medicina dello Sport, Ospedale Pediatrico Bambino Gesù, Rome, Italy.
International Journal of Cardiology
|April 1, 1992
Summary
Sinus node dysfunction affects one-third of Mustard procedure survivors, often linked to prolonged aortic cross-clamping and early post-operative issues. This cardiac condition may develop late after surgery.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Electrophysiology
Background:
- The Mustard procedure is a palliative surgery for transposition of the great arteries.
- Sinus node dysfunction (SND) is a potential long-term complication following complex congenital heart surgeries.
Purpose of the Study:
- To investigate the incidence and risk factors for late-onset sinus node dysfunction in patients who underwent the Mustard procedure.
- To identify predictors of persistent or recurrent sinus node dysfunction after the Mustard operation.
Main Methods:
- Retrospective analysis of 60 patients who survived the Mustard procedure.
- Serial 24-hour dynamic electrocardiogram monitoring at various intervals post-surgery.
- Statistical analysis to identify risk factors associated with sinus node dysfunction development.
Main Results:
- Sinus node dysfunction was detected in 33.3% of patients during follow-up.
- Prolonged aortic cross-clamping (especially >50 minutes) was a significant risk factor (P=0.003).
- Transient post-operative sinus node dysfunction predicted later development (P=0.006).
Conclusions:
- Late sinus node dysfunction after the Mustard operation likely results from combined atrial surgery effects and myocardial ischemia.
- Early post-operative sinus node dysfunction can indicate a higher likelihood of recurrence or persistence.
- Risk stratification and vigilant monitoring are crucial for these patients.