Gillette P C, Wampler D G, Shannon C, Ott D
J Am Coll Cardiol. 1986 Jan;7(1):138-41. doi: 10.1016/s0735-1097(86)80271-6.
The most frequent complication of the venous redirection (Mustard or Senning) operation for transposition of the great arteries is cardiac arrhythmia. Drug treatment of tachyarrhythmia often worsens bradyarrhythmia. Pacemakers can now treat both arrhythmias. The technique for implantation of pacemakers after redirection for transposition has changed over time from thoracotomy to subxiphoid to transvenous. Atrial pacing is almost always the mode of choice since the electrophysiologic abnormality is sinus node dysfunction with intact atrioventricular conduction. Twenty-nine patients aged 3 to 19 years (mean 9.6) had implantation of a pacemaker a mean of 5.5 years (range 1 to 14) after undergoing the Mustard operation for transposition of the great arteries. Symptoms referable to bradycardia were eliminated in each case. Four patients who received an antitachycardia pacemaker no longer have symptomatic tachycardia. Four patients have required reoperation, three because of lead problems and one because of traumatic erosion of the pacemaker. Pacemakers provide excellent relief of symptoms after the Mustard or Senning operation. Transvenous atrial automatic antitachycardia pacemakers offer the best combination of ease of implantation and symptomatic relief.
大动脉转位行静脉改道术（Mustard术或Senning术）最常见的并发症是心律失常。快速性心律失常的药物治疗常常会使缓慢性心律失常恶化。现在起搏器能够治疗这两种心律失常。随着时间推移，大动脉转位改道术后起搏器植入技术已从开胸手术发展为剑突下手术，再到经静脉手术。由于电生理异常为窦房结功能障碍且房室传导完整，心房起搏几乎总是首选模式。29例年龄在3至19岁（平均9.6岁）的患者在接受大动脉转位Mustard手术后平均5.5年（范围1至14年）植入了起搏器。每例患者心动过缓相关症状均得以消除。4例接受抗快速性心律失常起搏器治疗的患者不再有症状性快速性心律失常。4例患者需要再次手术，3例是由于导线问题，1例是由于起搏器的创伤性侵蚀。起搏器能很好地缓解Mustard或Senning术后的症状。经静脉心房自动抗快速性心律失常起搏器在植入便利性和症状缓解方面提供了最佳组合。
