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Right and left ventricular function after the Mustard procedure in transposition of the great arteries
Insights
The Mustard operation for complete transposition of the great arteries significantly impairs right ventricular function, with preserved left ventricular function. This finding supports using the left ventricle as the systemic ventricle in surgical repairs.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Cardiovascular Physiology
Background:
- The Mustard operation is a palliative surgical procedure for complete transposition of the great arteries (TGA).
- Long-term outcomes and ventricular function after the Mustard operation require continued investigation.
Purpose of the Study:
- To assess right and left ventricular function in asymptomatic patients following the Mustard operation.
- To evaluate the long-term impact of the Mustard operation on cardiac hemodynamics.
Main Methods:
- Cardiac catheterization was performed in 33 asymptomatic patients (0.5-11 years post-operation).
- Right ventricular function was assessed using videodensitometry and computerized video analysis (Simpson's rule) for ejection fraction and volumes.
- Left ventricular function was evaluated through end-diastolic volume measurements.
Main Results:
- Right ventricular ejection fraction was significantly reduced (37-42% vs. normal, P < 0.001).
- Right ventricular end-diastolic volume was significantly increased (202% of normal, P < 0.001).
- Left ventricular end-diastolic volume was only mildly increased (125% of normal).
Conclusions:
- The Mustard operation leads to seriously decreased right ventricular function with relatively preserved left ventricular function.
- These findings support surgical strategies that utilize the left ventricle as the systemic ventricle for TGA repair.
Abstract:
Right and left ventricular function was assessed at cardiac catheterization in 33 asymptomatic patients 0.5 to 11 years (mean 4.6) after the Mustard operation for complete transposition of the great arteries. Ages at operation had ranged from 0.5 to 16 years (mean 4.2 years). Right ventricular function was assessed using videodensitometric determination of ejection fraction and ventricular volume data. Ventricular volumes were obtained by computerized video analysis utilizing Simpson's rule. The right ventricular ejection fraction was 37 +/- 11 percent (standard deviation), as assessed with videodensitometry and 42 +/- 10 percent as assessed with ventricular volume--both values less than normal (P less than 0.001). Right ventricular end-diastolic volume was significantly greater than normal (P less than 0.001) and averaged 202 +/- 70 percent, but left ventricular end-diastolic volume averaged only 125 +/- 53 percent. These observations after the Mustard operation indicate that right ventricular function is seriously decreased with relatively preserved left ventricular function. They support efforts for surgical correction utilizing the left ventricle as the systemic ventricle.