The Mustard and Senning Procedure for Transposition of the Great Arteries (TGA)
This page is dediated to all the children and adults with TGA.
The Mustard Procedure:
This is the open heart surgery that I had in 1973 when I was 2 years
and 2 weeks old. Thanks to the pioneering work of Dr Mustard and due to
the fact that I am such a fighter, which is why I am still here today
to tell my story. My story is now published under Personal Stories.
The
Mustard procedure – developed by Dr. William Mustard with support from
the Heart and Stroke Foundation – was the first operation to correct
the congenital abnormality that produced "blue babies"
"Blue
babies" are born with a defect called transposition of the great
vessels/arteries, in which blood from the lungs flows back to the lungs
and blood from the body flows back to the body. The two major arteries
coming out of the heart, the aorta and the pulmonary artery are
connected to the wrong chambers. Such babies look blue because
insufficient oxygen is circulating in their bodies.
What does the Mustard Procedure do?
The
Mustard procedure restores the circulation but reverses the direction
of the blood flow in the heart. In a normal heart, de-oxygenated, blue,
blood is pumped into the lungs via the right ventricle. Then it is
distributed throughout the body via the left ventricle. In the Mustard
procedure, blood is pumped to the lungs via the left ventricle and
disseminated throughout the body via the right ventricle.
But
the right ventricle is not the optimal shape to support the high
pressure work performed in a normal heart by the left ventricle. Over a
period of 20 or 30 years the right ventricle may begin to fail. The
research conducted by Dr. Liu and Dr. Gatzoulis confirms that this is
indeed the case.
When was it first performed and is there a different type of operation performed now?
The
first Mustard procedure was performed in 1963 and the operation was
superseded in 1987 when an arterial switch procedure was introduced
which normalizes left ventricular function. The Mustard procedure
reduced an 80% mortality in the first year of life to an 80% survival
at age 20.
Worldwide the total is approximately 46,000.
"The
Mustard procedure was the first to show that congenital heart defects
could be repaired. It transformed the whole field. There is a wide
spectrum of heart defects, over 700, and the majority can be operated
on with good results," says Dr. Gatzoulis.
I obtained this information and also amended it to fit from my point of view from http://ww2.heartandstroke.ca:
This
page is very fascinating - it contains a pic of the Mustard/Senning
procedure and all the outcomes and other types of operation that may be
required. PLEASE VISIT THIS PAGE: Yorkshire and Humberside Hearts NHS:
The Senning Procedure
Surgical intervention for TGA predates the invention of cardiopulmonary
bypass. In 1950, Blalock and Hanlon described the first palliative
procedure to surgically excise the atrial septum, thereby improving
mixing and arterial saturation. With early bypass techniques, Senning
performed the first 'complete' repair for TGA in 1957.4
In the Senning
repair, a baffle is created within the atria that redirects the
deoxygenated caval blood to the mitral valve and the oxygenated
pulmonary venous blood to the tricuspid valve. The anatomic
left ventricle continues to act as the pulmonary pump and the anatomic
right ventricle acts as the systemic pump.
In Senning's operation,
complicated 'origami-style' cutting and folding of the native atrial
tissue is required to achieve the venous baffle. Owing to its
complexity, the Senning technique was initially not widely embraced.
In
1964, Mustard described a simpler technique by which the atrial septum
is excised, and the atrial baffle is created by the placement of a
single pantaloon-shaped patch . This technique was quickly
adopted by surgeons and became the standard operation for TGA.
One
might wonder why the arterial switch procedure was not the technique
first employed for TGA? In fact, both Senning and Mustard tried this
approach in the early 1950s without success. The obstacles to
success in that era included the inability to transfer the coronary
arteries, and inadequate early techniques of cardiopulmonary bypass
that precluded surgery in early infancy.
Have a look at http://www.nature.com/ncpcardio/journal/v5/n8/full/ncpcardio1252.html
The differences between The Mustard procedure and Senning procedure are identical except that the baffle is contructed from atrial tissue in the Senning and from pericardium in the Mustard.
Disclaimer: The
facts and opinions shown on this blog are as accurate and up to date as
possible, but are provided as general "information resources", which
may not be relevant to individual persons. This blog is not a
substitute for individual assessment and always take advice from a
doctor who is familiar with the particular person..