Zavanella C, Subramanian S
Ann Surg. 1978 Feb;187(2):143-50. doi: 10.1097/00000658-197802000-00008.
Elective intracardiac repair by the Mustard operation is recommented in patients with transposition of the great arteries and intact ventricular septum in the first year of life (Fig. 1). In patients with associated ventricular septal defect in the first three months of life, early banding followed by early debanding before the first year of life is recommended. When the left ventricular outflow tract obstruction is discrete at valvular or subvalvular level, Mustard operation, closure of the ventricular septal defect and direct relief of out-flow obstruction is acceptable, but in patients with an unfavorable left ventricular outflow tract anatomy, a preliminary shunt followed by a Rastelli operation after the age of four years will probably result in a greater salvage. The utilization of surface induced profound hypothermia and circulatory arrest allows for more precise and rapid surgery and is shown to be a definite advantage in the very young infant.
对于出生后第一年患有大动脉转位且室间隔完整的患者，建议采用Mustard手术进行选择性心内修复（图1）。对于出生后前三个月伴有室间隔缺损的患者，建议早期进行束带术，然后在一岁前尽早解除束带。当左心室流出道梗阻位于瓣膜或瓣膜下水平且为局限性时，可接受Mustard手术、室间隔缺损修补及流出道梗阻直接解除，但对于左心室流出道解剖结构不利的患者，四岁后先行分流术再行Rastelli手术可能会挽救更多生命。采用体表诱导深度低温和循环停止可使手术更精确、快速，对于非常小的婴儿而言，这已被证明是一个明确的优势。
