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The Journal of Thoracic and Cardiovascular Surgery, Vol 96, 569-576, Copyright © 1988 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
J Deanfield, J Camm, F Macartney, T Cartwright, J Douglas, J Drew, M de Leval and J Stark
Arrhythmia and late sudden death are recognized complications of
intraatrial repair of transposition of the great arteries. We performed a
prospective study over 8 years in 100 consecutive hospital survivors who
underwent Mustard (46 patients) or Senning (54 patients) operations between
1978 and 1982. Arrhythmia was analyzed by preoperative, postoperative, and
serial follow-up Holter monitoring and standard electrocardiograms and was
related to clinical outcome. Before repair, all patients were in sinus
rhythm with a low incidence of arrhythmia. After repair, there was a
gradual decrease in stable sinus rhythm during follow-up so that at a mean
of 7 years after operation only 56% of patients having the Senning
operation and 66% having the Mustard, with simple transposition, were in
stable sinus rhythm on Holter monitoring. There was no significant
difference between the two operations. Eleven patients (five after Senning
[two simple, three complex], six after Mustard [five simple, one complex])
died during follow-up, four suddenly (two after Senning, two after
Mustard). However, loss of sinus rhythm or the presence of arrhythmia on
standard electrocardiograms or Holter recordings did not identify patients
at risk for increased morbidity or mortality. Thus, even with current
surgical techniques, gradual loss of sinus rhythm occurred after both
Mustard and Senning operations. Because late death could not be predicted
by electrocardiographic analysis, an alternative approach involving
detailed hemodynamic and electrophysiologic measurements may be required to
identify high-risk patients.
ARTICLES
Arrhythmia and late mortality after Mustard and Senning operation for transposition of the great arteries. An eight-year prospective study
Thoracic Unit, Hospital for Sick Children, London, England.
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