Surgical experience with left ventricular outflow tract obstruction in patients with complete transposition of the great arteries and essentially intact ventricular septum undergoing the Mustard operation

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Abstract
During a 24-year period (1963-1987), 46 infants and children withcomplete transposition of the great arteries (CTGA) and an essentiallyintact ventricular septum (IVS) have undergone surgical relief of leftventricular outflow tract obstruction (LVOTO) concurrently with the Mustardoperation (MO). The obstruction was valvar in 2 patients, subvalvar in 43and combined valvar and subvalvar in 1; the ventricular septum was intactin 42, and 4 patients had a small VSD at the time of repair. Neonatal andpre-Mustard cardiac catheterization (CC) data were analyzed to obtain LV toright ventricular peak systolic pressure ratio (LV/RVPSP) and LVOT peaksystolic gradient (PSG). The mean neonatal LV/RVPSP (n = 31) was 0.79 +/-0.04; pre-Mustard LV/RVPSP (n = 44) was 0.75 +/- 0.05; pre-Mustard LVOT PSG(n = 34) was 46.5 +/- 3.5 mmHg. Neonatal (n = 29) and pre-Mustard (n = 30)cardiac angiograms were retrospectively reviewed to analyse morphologicsubstrates of LVOTO. In the neonatal period, LVOTO was present in 7patients (anatomic, n = 4; dynamic, n = 2; combined, n = 1). Immediatelyprior to the MO, LVOTO was present in 29 (anatomic, n = 20; dynamic n = 2;combined, n = 7). Techniques to correct LVOTO at the initial MO includedpulmonary valvotomy (n = 3), ventriculomyectomy (n = 41), resection of anwindsock aneurysm (n = 1), LV to pulmonary artery valved conduit (VC) (n =1). Two patients underwent VC early postoperatively (PO) for severeresidual LVOTO (both died).(ABSTRACT TRUNCATED AT 250 WORDS)

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