Survival Into the Seventh Decade of Life Following Mustard Repair

Abstract

Atrial switch procedures (Senning and Mustard) for transposition of the great arteries have largely been abandoned for arterial switch procedures. The number of surviving patients who have undergone atrial switch procedures is declining. We present a case of the oldest known survivor (aged 67 years) of the Mustard procedure. (Level of Difficulty: Beginner.).

Keywords: Mustard procedure; cardiac CT; congenital; echocardiography; right ventricle; transposition of the great arteries.

Graphical abstract

Figure 1

Imaging Follow-Up 54 Years After Mustard Procedure With Echocardiography and Cardiac Computed Tomography Angiography (A) Echocardiographic parasternal long-axis view demonstrating an enlarged subpulmonic morphologic left ventricle (LV) with an implantable cardioverter-defibrillator lead (arrowheads) entering through the mitral valve into the left ventricle. (B) Apical 4-chamber view showing an intact surgical conduit directing pulmonary venous flow to the dilated systemic morphologic right ventricle (RV). (C) Cardiac computed tomography angiographic coronal view of the subpulmonic morphologic left ventricle connected to a dilated main pulmonary artery (MPA). (D) Coronal view of the dilated, hypertrophic, and hypertrabeculated systemic morphologic right ventricle connected to the ascending aorta (Ao). (E) Sagittal view demonstrating a dilated systemic morphologic right ventricle with the septum bowing into the subpulmonic morphologic left ventricle. A dilated main pulmonary artery is also noted. (F) Axial view of the aortic root and left main coronary artery (LM) (arrow) demonstrating an anomalous origin of the right coronary artery (RCA) from the left main coronary artery and calcified coronary artery plaques. LA = left atrium; LAD = left anterior descending coronary artery; LCx = left circumflex artery; RA = right atrium.