Hosny Hatem, Sedky Yasser, Romeih Soha, Simry Walid, Afifi Ahmed, Elsawy Amr, Khalek Mohamed Abdul, Doss Ramy, Elguindy Ahmed, Aguib Heba, Yacoub Magdi
Department of Cardiac Surgery, Aswan Heart Centre, Aswan, Egypt.
Department of Pediatrics, Cairo University, Cairo, Egypt; Department of Pediatric Cardiology, Aswan Heart Centre, Aswan, Egypt.
J Thorac Cardiovasc Surg. 2020 Jan;159(1):241-249. doi: 10.1016/j.jtcvs.2019.03.027. Epub 2019 Mar 22.
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.
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.
Between July 2013 and November 2018, a total of 101 patients underwent the Mustard operation, 86 with the new modification. The median age at operation was 16 months (6 months to 27 years). A total of 75 patients (74.3%) were male. Median preoperative oxygen saturation was 71%. There were no early deaths and there were 3 late deaths during a median follow-up period of 24.2 months (all in patients with large ventricular septal defect and established pulmonary vascular disease). At the latest follow-up, all patients were in stable sinus rhythm. There were no baffle leaks. Seven patients had asymptomatic narrowing of the superior baffle, and 1 patient required balloon dilatation. Follow-up is 100% complete and includes computed tomography and magnetic resonance imaging at regular intervals (75 patients to date). Computerized analysis of representative subsets showed enhanced rate and pattern of filling of the left ventricle in the modified operation compared with the classic operation.
The use of the Mustard operation, particularly the modified technique should play an important role in treating late-presenting patients with transposition of the great arteries. Improving the pattern of filling of the left ventricle could enhance the long-term results of the Mustard operation.
新生儿动脉调转术目前是大动脉转位患者的首选术式。然而，大量患者就诊时已错过动脉调转术的时机，最佳治疗方案是采用心房调转术。
我们采用了原始形式的Mustard手术或一种旨在增强心房功能及左心室充盈的新改良术式，以期改善长期疗效。
2013年7月至2018年11月期间，共有101例患者接受了Mustard手术，其中86例采用新改良术式。手术时的中位年龄为16个月（6个月至27岁）。共有75例患者（74.3%）为男性。术前中位血氧饱和度为71%。无早期死亡病例，在中位随访期24.2个月期间有3例晚期死亡（均为大型室间隔缺损且已出现肺血管疾病的患者）。在最近一次随访时，所有患者均处于稳定的窦性心律。无挡板渗漏。7例患者出现上腔挡板无症状性狭窄，1例患者需要球囊扩张。随访完成率为100%，定期进行计算机断层扫描和磁共振成像检查（截至目前有75例患者）。对代表性亚组的计算机分析显示，与经典手术相比，改良手术后左心室的充盈率和充盈模式有所增强。
Mustard手术，尤其是改良技术，在治疗就诊较晚的大动脉转位患者中应发挥重要作用。改善左心室的充盈模式可提高Mustard手术的长期疗效。
