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Clinical, angiographic, and hemodynamic assessment of late results after Mustard operation
Insights
Late results of the Mustard procedure for complete transposition of the great arteries show significant cardiovascular issues in many patients, even those without symptoms. These findings highlight the need for improved surgical techniques.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
Background:
- The Mustard procedure has been used since 1974 to correct complete transposition of the great arteries (TGA).
- Long-term outcomes require ongoing evaluation to identify potential complications and guide future treatment strategies.
Purpose of the Study:
- To evaluate the late clinical and hemodynamic results of the Mustard procedure in patients with complete TGA.
- To assess the effectiveness of various diagnostic methods in identifying postoperative complications.
Main Methods:
- Retrospective analysis of 48 patients who underwent the Mustard procedure for complete TGA.
- Utilized cardiac catheterization, electrocardiography, roentgenography, history, and physical examination for patient evaluation.
- Distinguished between symptomatic patients requiring reevaluation and asymptomatic patients undergoing routine hemodynamic assessment.
Main Results:
- Significant cardiovascular abnormalities were detected in 35 of 47 patients (74%), including 20 of 33 asymptomatic individuals.
- Common abnormalities included caval obstruction and residual pulmonary stenosis.
- Cardiac catheterization was the most effective diagnostic modality for identifying these issues.
Conclusions:
- The Mustard procedure is associated with a high rate of late cardiovascular complications, even in asymptomatic patients.
- These findings underscore the urgent need for the development of superior surgical interventions for complete TGA.
- Further research into improved palliative and corrective strategies for TGA is warranted.
Abstract:
Since 1974, late results of the Mustard procedure for correcting complete transposition of the great arteries have been evaluated by cardiac catheterization, electrocardiography, roentgenography, history, and physical examination of 48 Mayo Clinic patients. Of these, 15 were studied 1 month to 2 years postoperatively because of clinical deterioration. The other 33 had been asymptomatic but were asked to return for hemodynamic reevaluation one-half to 11 years postoperatively. Of the asymptomatic group, 19 underwent exercise electrocardiography prior to catheterization and eight performed supine exercise during catheterization. Cardiac catheterization proved the most effective mode of study. Significant cardiovascular abnormalities (caval obstruction, residual pulmonary stenosis, etc.) were found in 35 of the 47 patients--including 20 of the 33 who were asymptomatic. Eight of the symptomatic group and three of the others have died since this restudy. These poor results warrant renewed effort to devise better methods for correcting complete transposition,