Division of Neurology, Department of Medicine, Jichi Medical University, Shimotsuke, Japan.
J Int Med Res. 2024 Oct;52(10):3000605241291753. doi: 10.1177/03000605241291753.
Atrial switch procedures such as the Mustard operation were previously popular for the complete transposition of the great arteries (i.e. dextro-transposition of the great arteries [d-TGA]). Patients with d-TGA who underwent atrial switch procedures approximately three decades ago have now entered adulthood. A female patient in her 30s with d-TGA had a paradoxical embolic stroke following the initiation of a low-dose oestrogen plus progesterone oral pill for dysmenorrhoea. She underwent Mustard surgery when she was 2 years old. Following a series of procedures including implantation of a permanent pacemaker that was required because of sinus node dysfunction, she had reached adulthood, was living by herself and working independently. One month after taking the low-dose oestrogen plus progesterone oral pill, venous thrombosis occurred in the left soleus and left peroneal veins; and she experienced an acute ischaemic stroke in the right middle cerebral artery area. Transoesophageal echocardiography revealed that the shunt was present only during the Valsalva manoeuvre. Based on the examinations, the patient was diagnosed with juvenile ischaemic stroke as a result of a paradoxical embolism. These findings suggest that paradoxical cerebral embolism can occur as a late complication in patients with d-TGA who underwent the Mustard operation as children.
房间隔转换手术，如 Mustard 手术，曾广泛用于完全性大动脉转位（即右旋型大动脉转位，d-TGA）的治疗。大约三十年前接受房间隔转换手术的 d-TGA 患者现已成年。一位 30 多岁的女性 d-TGA 患者因痛经开始服用低剂量雌激素加孕激素口服避孕药后发生反常栓塞性卒中。她在 2 岁时接受了 Mustard 手术。由于窦性心动过缓，她接受了一系列的手术，包括植入永久性起搏器，现在已经成年，独自生活并独立工作。在服用低剂量雌激素加孕激素口服避孕药一个月后，她的左比目鱼肌和左腓肠静脉发生静脉血栓形成；并在右侧大脑中动脉区域发生急性缺血性卒中。经食管超声心动图显示，分流仅在瓦氏动作时出现。根据检查结果，该患者被诊断为青少年缺血性卒中，为反常栓塞所致。这些发现提示，儿童期接受 Mustard 手术的 d-TGA 患者可能会发生反常性脑栓塞作为晚期并发症。
