Revival and modification of the Mustard operation

Abstract

Objective: The neonatal arterial switch operation is currently the procedure of choice for patients with transposition of the great arteries. However, a large number of patients present too late for the arterial switch operation and are best managed with the atrial switch operation. Methods:We have used the Mustard operation in its original form or following a new modification designed to enhance the atrial functions and filling of the left ventricle in an attempt to improve long-term results.From the

Pulmonary artery banding in a modified Mustard operation improves biventricular geometry and function

“…Trying to improve outcome, we have recently described a modification of the Mustard operation aiming to improve atrial functions and pattern of left ventricular filling. 1 Yet, the failing systemic RV and significant TR continue to be major problems . 9 , 10 , 11 In an attempt to solve these problems, we have used additional pulmonary artery banding in the patient described in this communication.…”

“…The patient had modified Mustard operation 1 and tricuspid valve annuloplasty. After discontinuing cardiopulmonary bypass, a moderately loose pulmonary artery banding was applied under trans-esophageal echo guidance.…”

Commentary: An important contribution to pediatric cardiac surgery in low- and middle-income countries

“…Most of them die early as the result of lack of diagnosis or access to pediatric heart surgery. Those who survive are the ''late presenters,'' and these form the basis for the study in this issue of the Journal by Hosny and colleagues 1 from the Aswan Heart Center in Upper Egypt.…”

Commentary: Worldwide, the management of transposition may be more baffling than we knew

“…I encourage readers to review the linked videos describing these technical advances, as eloquently narrated by Dr Yacoub. 1 Whereas previous reports have focused largely on tailoring the perfect Mustard pantaloon to prevent stenosis, the revisions described by Hosny and colleagues 1 seek to ''normalize'' the mitral inflow, which they demonstrate by magnetic resonance imaging and have previously also shown by 3-and 4-dimensional modeling. [2][3][4][5] In addition, these modest alterations of the baffle suture line are hoped to preserve sinus node function and ideally limit later issues of arrhythmia.…”

“…[9][10][11] Trainees today are taught reflexively to answer on board examinations that the atrial switch belongs in the graveyard of abandoned eponymous procedures-atriopulmonary Fontan, Baffes, Brock. The contribution of Hosny and colleagues, 1 however, reminds us that the Mustard procedure cannot become a lost art. Indeed, whereas implementation of obstetrical screening guidelines boast a prenatal diagnosis of transposition approaching 80% in North America, the findings worldwide are far more sobering.…”