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Right ventricular function 10 years after the Mustard operation for transposition of the great arteries: analysis of
A N Redington1, M L Rigby, P Oldershaw
1Department of Paediatric Cardiology, Brompton Hospital, London.
Insights
Mustard repair for transposition of the great arteries can impair right ventricular function, leading to reduced ejection fraction and filling rates. Preoperative wall motion abnormalities may predict long-term outcomes after this surgery.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiac Surgery
Background:
- The Mustard procedure is a palliative surgery for transposition of the great arteries.
- Long-term ventricular function after Mustard repair requires further investigation.
Purpose of the Study:
- To assess right ventricular function in asymptomatic patients post-Mustard repair.
- To correlate ventricular function with preoperative findings and long-term outcomes.
Main Methods:
- Biplane right ventriculograms were performed on 18 asymptomatic patients.
- Ventricular size, shape, and wall motion were analyzed from angiograms.
- Data were compared with controls and patients before tetralogy of Fallot repair.
Main Results:
- Global right ventricular function indices were depressed post-Mustard repair.
- Wall motion abnormalities were prevalent and associated with reduced ejection fraction and filling rates.
- Preoperative wall motion abnormalities were observed in 4 out of 5 patients, suggesting a potential link to outcomes.
Conclusions:
- Mustard repair can lead to impaired right ventricular function.
- Preoperative ventricular status may significantly influence long-term outcomes after Mustard repair.
- Further research is needed to understand the long-term implications of these findings.
Abstract:
Biplane right ventriculograms were obtained in 18 symptom free patients 109 (26) months (mean (SD)) after Mustard repair of transposition of the great arteries. Ventricular size, shape, and wall motion were measured from the digitised angiograms and compared with previously published data on left ventricular function after anatomical correction of transposition of the great arteries, with right ventricular function in controls, and with patients before repair of tetralogy of Fallot. Global indices of ventricular function were depressed after Mustard repair and wall motion abnormalities were common. The presence of wall motion abnormalities in this group was associated with a reduction in ejection fraction and ventricular filling rates. In four of five patients in whom an appropriate preoperative angiogram was available a similar pattern of wall motion was seen before the Mustard operation, suggesting that preoperative events may be important in determining eventual outcome.