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Arrhythmias after the Mustard operation for transposition of the great arteries: a long-term study
Insights
Long-term follow-up of Mustard operation patients reveals significant atrial arrhythmias develop over time. While slow rhythms are common, they rarely become life-threatening in youth, but adult prognosis is unknown.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Transposition of the great arteries (TGA) is a critical congenital heart defect.
- The Mustard operation, an intraatrial baffle repair, was a common surgical approach for TGA.
Purpose of the Study:
- To evaluate the long-term cardiac rhythm outcomes in patients who underwent the Mustard operation for TGA.
- To assess the incidence and progression of arrhythmias post-surgery.
Main Methods:
- Serial follow-up of 95 patients with TGA post-Mustard operation.
- Utilized scalar electrocardiograms and 24-hour Holter monitoring for rhythm assessment.
Main Results:
- Atrial arrhythmias were present in 20% at discharge, rising to 75% by year six.
- Slow junctional rhythm was most common; complete heart block did not occur.
- Supraventricular tachycardia and 3% sudden death incidence were noted, often linked to prior tachyarrhythmias.
Conclusions:
- Mustard operation leads to progressive atrial rhythm disturbances, with uncertain adult prognosis.
- While severe arrhythmias are rare in youth, caution is advised for long-term outcomes.
- The arterial switch operation may offer an advantage in preventing surgical-induced arrhythmias.
Abstract:
This study presents follow-up data on 95 patients with transposition of the great arteries who underwent a Mustard intraatrial baffle operation. The patients were followed up serially by means of scalar electrocardiograms and 24 hour Holter monitoring studies. The latter study was effective in documenting abnormal rhythm patterns when the standard electrocardiogram was within normal limits. Twenty percent of the patients had atrial arrhythmias at the time of hospital discharge. new rhythm disturbances were recognized during each year of follow-up; 75% of the patients had atrial rhythm disorders by the sixth year. Slow junctional rhythm was the most common rhythm disturbance found. Complete heart block did not occur. Supraventricular tachycardia occurred within the context of the tachycardia/bradycardia syndrome in 8 of 10 patients, and in all it was documented after hospital discharge. The incidence of sudden death in this series was 3%. Six of the patients have had pacemaker insertions and there have been no deaths among these individuals. It was observed that the slow atrial or junctional rhythms that appeared after intraatrial correction of transposition of the great arteries rarely progressed to life-threatening rhythm disorders in childhood or adolescence, but the prognosis in adult life remains unknown. The three deaths in the series occurred in patients with a history of supraventricular tachyarrhythmias. Elimination of arrhythmias caused by extensive intraatrial surgery is one of the potential advantages of the arterial switch operation for correction of transposition of the great arteries.