Long-term results of atrial correction for transposition of the great arteries Comparison of Mustard and Senning operations Few data exists on the differences in long-term outcome between Mustard and Senning operations. We reviewed available data of all hospital survivors of these operations and assessed risk factors for late death and sinus node dysfunction. Of those patients undergoing the Mustard operation, 60 were hospital survivors (46 simple transposition, 14 complex); of those patients undergoing the Senning operation, 62 were hospital survivors (43 simple, 19 complex). Median duration of follow-up was 16 years (maximum 25 years) for Mustard operation, 11 years (maximum 20 years) for Senning operation. No reoperations were done, except for pacemaker implantation. No differences were found between the two groups with regard to baffle-associated problems, right ventricular failure, sudden death (6 %•in both groups), and functional status at final follow-up (New York Heart Association class I or II, except for four patients). For patients undergoing the Mustard operation, survival at 16-year follow-up was 91 % with simple transposition and 60% with complex transposition (p = 0.027); for both groups of patients undergoing the Senning operation, survival at 16-year follow-up was 78 %. Survival in the absence of rhythm disturbance at 16-year follow-up was 18 % for Mustard operation and 53% for Senning operation (p < 0.001). In multivariate analysis, significant independent risk factors for late death turned out to be complex transposition (versus simple) and active arrhythmias. The only .significant risk factor for the occurrence of sinus node dysfunction was the Mustard operation. We conclude that apart from the difference in the loss of sinus rhythm, no differences were found in the long-term clinical results of the two types of operations.
Quaegebeur, J. M., Rohmer, J., and Brom, A. G. (1977). Thorax, 32,[517][518][519][520][521][522][523][524] (1959) we were impressed by their good haemodynamic condition. There was no sign of venous stenosis either in the right or left half of the heart. One of us (AGB) has since tried to apply the principles of the Senning operation (trapeziform roof over the pulmonary veins and two channels for the venae cavae) to the Mustard procedure (Geldof and Aytug, 1975). In view of the fact that the original Senning operation involves the use of only a small amount of foreign material, the logical next step was to revert to this procedure. The following is a preliminary report on our recent experience in the revival of this operation.
Patients
Between 1953 and 1985, 109 consecutive patients (17 % with isolated coarctation) younger than 3 years of age underwent resection of aortic coarctation. These patients had nonelective operations because of congestive heart failure or severe systemic hypertension not responding to medical therapy. Special surgical techniques were used to lower the prevalence of restenosis. Hospital mortality was 32 % (35 patients). Logistic regression analysis proved that age at operation, pulmonary artery banding, and type of repair were independent predictors of hospital death. Late mortality occurred in 9 patients. Associated cardiac anomalies were an independent prognostic factor for late mortality. The operation rate for recoarctation was low (5.8 %). However, the follow-up study revealed that 30 patients (41%) had recoarctation. The Kaplan-Meier estimate of recoarctation is 86% after 30 years' follow-up in patients undergoing classic end-to-end anastomosis with silk sutures (n = 48). None in the group with an "extended" anastomosis and polypropylene sutures (n = 26) had recoarctation. The Cox analysis revealed age at operation under 6 months to be prognostic for recoarctation. Because of the shorter period of follow-up, the extended anastomosis with polypropylene sutures proved not to be a significant prognostic factor for recoarctation. In the late postoperative period (mean follow-up 16.7 years), blood pressure was elevated in 49% of the patients. At last follow-up 27 (36%) of the 74 survivors had aortic valve disease. Patients operated on for coarctation of the aorta under the age of 3 years need lifelong follow-up for detection of restenosis, hypertension, and valvular disease. Reoperation-free rate is not a good criterion to judge the outcome of operation for coarctation. Longer follow-up will be needed to investigate whether or not the use of the extended anastomosis technique with polypropylene sutures lowers the prevalence of recoarctation.
In 810 schoolchildren heart auscultation was performed by both a school medical officer (SMO) and a pediatric cardiologist (PC). The prevalence for a grade 1, 2, or 3 vibratory innocent heart murmur (VIHM), a grade 2 or 3 VIHM, and a grade 3 VIHM heard by the PC was 41%, 13%, and 1%, respectively. The SMO noted such murmurs in 26%, 9%, and 1%, respectively. In 30% of the cases in which the PC had noted a grade 2 or 3 VIHM, the SMO agreed; in 30% of such cases the SMO did not hear any heart murmur. If the PC heard a grade 2 or 3 VIHM phonocardiography was performed in a case-control study in which the controls did not have a heart murmur (94 pairs). In four children with a grade 2 or 3 VIHM no heart murmur could be registered and in three other children the murmur did not have the typical diamond shape. In contrast, in three children without a heart murmur at school a VIHM was seen on the phonocardiogram. In 26 children with a phonocardiographically proven grade 2 or 3 VIHM the SMO did not hear any heart murmur. One child with a grade 3 VIHM (both by the PC and SMO) had a minor subvalvular aortic stenosis. There is quite a difference in auscultatory detection of a venous hum: 9% (PC) and 2% (SMO). The prevalence of the pulmonary ejection murmur is identical at 4%. The carotid bruit is heard in 4% (PC) and 2% (SMO).(ABSTRACT TRUNCATED AT 250 WORDS)
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