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1/6. Transcatheter occlusion of atrial baffle leak after mustard repair.

    We present a case of transcatheter closure of an atrial baffle leak with significant systemic to pulmonary atrium shunt in a patient late after Mustard operation and pulmonary valvotomy for transposition of the great arteries. This procedure alleviated the need for reoperation in a high-risk symptomatic patient. Cathet. Cardiovasc. Intervent. 51:305-307, 2000.
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2/6. Combined mustard and Rastelli operations. An alternative approach for repair of associated anomalies in congenitally corrected transposition in situs inversus [I,D,D]

    We report on two patients with congenitally corrected transposition of the great arteries in situs inversus who underwent successful anatomic repair of associated cardiac anomalies--ventricular septal defect and pulmonary outflow tract obstruction. Surgical intervention was influenced by the recently introduced technique of Ilbawi and colleagues in cases of congenitally corrected transposition in situs solitus. Principles of the correction are as follows: (1) patch redirection of venous flows at the atrial level through an incision in the left-sided right atrium; (2) patch closure of the ventricular septal defect through a right ventriculotomy, baffling the left ventricle to the aorta; and (3) valved conduit interposition between the right ventricle and the pulmonary artery. If the ventricular septal defect is restrictive, it can be safely enlarged by extensive resection of the anterosuperior border, because of the posteroinferior location of the bundle of his in this anomaly. With this technique, the left ventricle and the native mitral and aortic valves are recruited for systemic work, with intrinsic long-term advantages. It is, however, a complex procedure involving substantial use of prosthetic material. More experience is necessary to establish whether this approach is superior to currently available physiologic repairs.
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3/6. Balloon dilation of pulmonary venous pathway obstruction in an infant after the mustard procedure.

    Pulmonary venous pathway obstruction developed after a Mustard procedure in an infant with transposition of the great arteries. The stenosis was successfully dilated by the percutaneous balloon technique with immediate clinical, echocardiographic, and hemodynamic improvement, which has persisted for 8 months after dilation. This technique is a feasible alternative to reoperation in such an obstruction, even in infants.
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4/6. Communicating hydrocephalus secondary to venous complications following intraatrial baffle operation (mustard procedure) for d-transposition of the great arteries.

    A 39-month-old male had macrocephaly and communicating hydrocephalus secondary to superior vena cava (SVC) obstruction which was a postoperative complication of an intraatrial baffle operation (Mustard procedure) performed at age 10 months. Computerized tomography revealed progressive hydrocephalus. cardiac catheterization showed an SVC pressure of 24 mm Hg. IVC and systemic vein atrium pressures were 5 mm Hg. Cineangiograms showed huge azygos collaterals from SVC to IVC. The operation was revised using a Dacron baffle instead of the original pericardial baffle. Nine months postoperatively, the head circumference was 55.0 cm and there was no clinical evidence of SVC obstruction.
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5/6. Anatomic correction for post-mustard pulmonary venous obstruction.

    pulmonary artery banding and arterial switch operation as a two-stage approach have offered a surgical solution to the failing right ventricle after intraatrial repair of the transposition of the great arteries. Banding of the pulmonary artery increases the resistance to the left ventricular output and, therefore, "prepares" the left ventricle for supporting the systemic circulation and arterial switch operation. We report a case of anatomic correction for transposition of the great arteries after intraatrial repair (Mustard's operation) in which the left ventricle was retrained serendipitously as a consequence of pulmonary venous obstruction complicating Mustard's procedure.
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6/6. pregnancy after mustard repair for transposition of the great arteries.

    BACKGROUND: Since the introduction of surgical repair procedures, women with complete transposition of the great arteries are surviving into their reproductive years. Only three successful pregnancies in such women have been described previously. CASES: Three women with transposition of the great arteries repaired in childhood became pregnant in 1991. Two pregnancies were complicated by failure of the systemic ventricle and one by preterm labor. Labor was managed with antibiotic prophylaxis against endocarditis, clinical hemodynamic assessment, epidural anesthesia, avoidance of maternal expulsive efforts in the second stage, and low forceps delivery. Three healthy infants were delivered vaginally between 34-39 weeks' gestation. CONCLUSION: With close cooperation between the cardiologist and obstetrician, successful pregnancy is possible after surgical repair of transposition of the great arteries. However, failure of the systemic ventricle is common and should be diagnosed and treated promptly.
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