Mustard’s operation modified to avoid dysrhythmias and pulmonary and systemic venous obstruction

Abstract

Between, May of 1973 and May of 1978, 130 patients underwent correction of complete transposition of the great arteries by a modification of the Mustard operation specifically designed to avoid dysrhythmias and to minimize systemic and pulmonary venous obstruction. Of the 102 surviving patients who underwent this operation, 99 still exhibited sinus rhythm on the latest standard electrocardiographic (ECG) recording. On 24 hour ECG recording between 2 weeks and 4 years postoperatively, nine (15.5%) of 58 patients having the Mustard operation for simple and complex transposition showed dysrhythmias. There were no cases of pulmonary venous or inferior vena caval obstruction in this series. Six cases of superior vena caval obstruction were encountered. Our operative and autopsy findings point to the importance of avoiding the area of the sinus and atrioventricular nodes, since by doing so, we have reduced postoperative dysrhythmias. Operative technique, in particular, wide excision of the septum secundum and baffle design as suggested by Brom, have reduced the incidence of superior and inferior caval obstruction and pulmonary venous obstruction. The modifications we have applied in our series suggest that Mustard's operation should not be discarded prematurely.