Pulmonary artery banding in a modified Mustard operation improves biventricular geometry and function

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology
• Congenital Heart Disease

Background:

• Transposition of great arteries with intact interventricular septum (TGA-IVS) poses challenges, especially with a deconditioned left ventricle.
• The modified Mustard operation improves atrial function and left ventricular filling but can lead to systemic right ventricular dysfunction and tricuspid regurgitation.
• Interventricular septum deviation in TGA-IVS can cause impaired ventriculo-ventricular interaction and dynamic left ventricular outflow tract obstruction (LVOTO).

Observation:

• A case of TGA-IVS with a deconditioned left ventricle was treated with a modified Mustard operation.
• Pulmonary artery banding was added to the modified Mustard operation to address specific hemodynamic issues.
• The surgical intervention aimed to improve biventricular geometry, valve function, and alleviate LVOTO.

Findings:

• The addition of moderately loose pulmonary artery banding to the modified Mustard operation resulted in improved biventricular geometry and function.
• Significant improvements were observed in both tricuspid and mitral valve functions post-operatively.
• Dynamic left ventricular outflow tract obstruction (LVOTO) resolved completely after the combined surgical approach.

Implications:

• This combined surgical strategy offers a potential solution for managing complex TGA-IVS cases, particularly in resource-limited settings.
• Addressing systemic right ventricular dysfunction and LVOTO concurrently can lead to better long-term outcomes for these patients.
• Further research is warranted to validate the efficacy and long-term benefits of this combined approach in a larger patient cohort.