The echocardiographic profile of patients after Mustard's operation

In order to establish an echocardiographic profile of patients with simple transposition after Mustard's operation, we examined the M-mode records of 10 patients who were found to be free of significant abnormalities at follow-up cardiac catheterization. When compared with established normals, right ventricular wall thicknesses and cavity dimensions were increased, while left ventricular wall thicknesses and cavity dimensions fell below the mean. The wall thicknesses, cavity dimensions and ratios of right ventricular preejection period/ejection time and left ventricular preejection period/ejection time were appropriate for the physiologic role of the ventricles rather than their morphologic identity. In each patient, a portion of the intra-atrial baffle was identified behind the pulmonary root. There was variation in baffle position and baffle mobility within the group, as well as in individual echograms. A variety of valve motion abnormalities were noted; these included diastolic flutter of the atrioventricular valves in all 10 patients and systolic anterior motion of the mitral valve in six patients. Paradoxical septal motion was found in nine patients. Although only minimal or no left ventricular outflow gradients were found at catheterization, nine patients had narrowing of the left ventricular outflow tract, 10 had systolic flutter of the pulmonary valve and eight had early partial closure of the pulmonary valve. The finding of a large number of echocardiographic abnormalities in a group of patients with good hemodynamic results suggests that these echocardiographic features are to be expected after Mustard's opration. Furthermore, the reversal of the physiologic role of the ventricles must be considered when interpreting the echocardiographic dimensions and systolic time intervals.