Transplantation after Mustard operation for transposition of the great arteries

Area of Science:

• Cardiology
• Adult Congenital Heart Disease
• Cardiac Surgery

Background:

• Improved long-term outcomes for congenital heart disease (CHD) lead to increased adult cases requiring heart transplantation.
• Systemic right ventricular (RV) failure is a significant long-term complication in adults with dextro-transposition of the great arteries (d-TGA) initially treated with palliative procedures.

Observation:

• This report details a rare case of a patient with d-TGA who underwent heart transplantation.
• The patient had previously undergone a Mustard procedure 36 years prior, representing their third major cardiac operation.

Findings:

• The patient presented with progressive late failure of the systemic RV, a known but challenging long-term complication.
• Heart transplantation was deemed the necessary intervention for end-stage RV failure in this complex CHD case.

Implications:

• This case underscores the critical need for lifelong monitoring of adult CHD patients, particularly those with d-TGA treated with older palliative techniques.
• It highlights heart transplantation as a viable, albeit complex, option for managing end-stage RV failure in this population.
• Further research into the long-term RV performance after palliative CHD surgeries is warranted to optimize management strategies.