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Circulation, Vol 52, 678-684, Copyright © 1975 by American Heart Association

ARTICLES

Abnormalities of right ventricular function following Mustard's operation for transposition of the great arteries

TP Graham Jr, GF Atwood, RJ Boucek Jr, RC Boerth and HW Bender Jr

Postoperative data were obtained at cardiac catheterization in twelve patients studied 6-29 months following Mustard's operation for transposition of the great arteries (TGA) to assess the incidence and severity of abnormalities of right ventricular (RV) function. Age at operation was 5-13 months in seven patients (infant group) and 19-25 months in the remaining five patients. RV end-diastolic volume (EDV) decreased in all patients following surgery and averaged 123% of normal in the postoperative group (NS). RV ejection fraction (EF) was depressed postoperatively averaging 0.45 (69% of normal (P less than 0.001) as was RV systolic output (78% of normal, P less than 0.01). LVEDV averaged 65% of normal (P less than 0.001), LVEF 0.67 (103% of normal, NS), and LV systolic output 67% of normal (P less than 0.001) following operation. Left atrial (systemic venous) volume was decreased in all postoperative patients averaging only 39% of normal (P less than 0.001). A high incidence (greater than 50%) of partial baffle obstruction was found and LV systolic output showed a significant negative correlation with baffle gradients. The low output postoperatively may be related to decreased LV filling pressure, a small LV reservoir, and thus a small atrial "booster pump." Pressure- velocity indices of RV contractile function in four patients showed a poor correlation with pump function. Long-term follow-up will be required to determine the clinical significance of the abnormalities of venous return and ventricular function.

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