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The Journal of Thoracic and Cardiovascular Surgery, Vol 104, 1218-1224, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
J Alonso de Begona, M Kawauchi, D Fullerton, AJ Razzouk, SR Gundry and LL Bailey
Since April 1976, 34 infants (25 male and 9 female) less than 1 month of
age underwent a Mustard intraatrial baffle procedure for repair of simple
transposition of the great arteries. Thirty patients were less than 2 weeks
old and 19 patients less than 1 week (mean 7.8 +/- 6 days). The weights
ranged from 2.6 to 4.4 kg (mean 3.4 +/- 0.4 kg). Rashkind balloon atrial
septostomy was performed in the first hours or days of life in 29 patients.
The average interval from balloon atrial septostomy to baffle repair was
3.9 days (range 2 hours to 14 days). Mechanical ventilation was required in
eight patients preoperatively and prostaglandin E1 was infused in 17
patients to maintain ductal patency. In all patients, the Mustard procedure
was performed with the use of deep hypothermic circulatory arrest,
averaging 53 minutes (range 37 to 82 minutes). The duration of
postoperative intubation and ventilatory support averaged 1.7 +/- 1.0 days
(range 1 to 5 days). Inotropic drugs were used in 24 patients during a
period of 1.4 +/- 1.3 days (range 1 to 6 days) postoperatively. There were
no hospital deaths. Follow-up evaluation has extended from 1 month to 14
years (mean 3 +/- 3 years). One infant died 2 months postoperatively as a
result of milk aspiration; no cardiac defects were found at the autopsy. A
second infant died at 1 year with right ventricular and tricuspid valve
dysfunction. Baffle complications occurred in 6 of the 32 survivors,
including superior vena caval stenosis in 4, inferior vena caval stenosis
in 1, and pulmonary venous obstruction in 3. Reoperations for baffle
obstructions were performed in three patients (8.8%) and balloon
angioplasties in two. One patient required permanent pacemaker
implantation. Results with the Mustard procedure before 1 month of age show
that it can be performed with negligible mortality and a low incidence of
late complications at an age comparable to when arterial switching would be
performed. Until long-term studies demonstrate superiority of arterial
operations, the low operative mortality favors continued evaluation of the
neonatal Mustard repair as a valid alternative to the arterial switch.
ARTICLES
The Mustard procedure for correction of simple transposition of the great arteries before 1 month of age
Department of Surgery, Loma Linda University Medical Center, CA 92354.
This article has been cited by other articles:
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  J. Soongswang, I. Adatia, C. Newman, J. F. Smallhorn, W. G. Williams, and R. M. Freedom Mortality in potential arterial switch candidates with transposition of the great arteries J. Am. Coll. Cardiol., September 1, 1998; 32(3): 753 - 757. [Abstract] [Full Text] [PDF]
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 J. L. Myers Transposition of the Great Arteries Ann. Thorac. Surg., March 1, 1997; 63(3): 895 - 898. [Full Text]
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 F. Meijboom, A. Szatmari, J. W. Deckers, E. M. W. J. Utens, J. R. T. C. Roelandt, E. Bos, and J. Hess LONG-TERM FOLLOW-UP (10 TO 17 YEARS) AFTER MUSTARD REPAIR FOR TRANSPOSITION OF THE GREAT ARTERIES J. Thorac. Cardiovasc. Surg., June 1, 1996; 111(6): 1158 - 1168. [Abstract] [Full Text]
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L. A. Rhodes, G. Wernovsky, J. F. Keane, J. E. Mayer Jr., A. Shuren, C. Dindy, S. D. Colan, and E. P. Walsh Arrhythmias and intracardiac conduction after the arterial switch operation J. Thorac. Cardiovasc. Surg., February 1, 1995; 109(2): 303 - 310. [Abstract] [Full Text]
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