Abstract
Transposition of the great arteries is functionally corrected by Mustard’s operation, an operation in which the atrial septum is removed and the resulting common atrial chamber repartitioned by a baffle to transpose venous return to the heart. To better understand the new physiology, a physically-based mathematical model of the infant circulation following Mustard’s operation was developed and studied with the aid of computer simulation. The model reproduces certain clinical observations, including the tendency for mean pressure in both atria to be equal early postoperatively and for the pressure waveform to exhibit a steep y-descent in the systemic venous atrium. Simulation studies suggest that the mechanism for the former is transbaffle pressure coupling resulting from dynamic motion of the baffle; the mechanism for the latter is limitation of the extent of such baffle excursions. Dynamic volume of the two atria is found in the model to change according to the relative performance of the two ventricles, and stiffening the baffle leads to pressure waveforms characteristic of a small, noncompliant atrium. Mechanisms for venous “obstruction” and decompression were also studied. The baffle and its movements, however, have little effect upon cardiac output in the model, leaving unexplained the clinical observation of low output early postoperatively.
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Abbreviations
- SVA:
-
Systemic venous atrium, that portion of the atrium partitioned so as to receive desaturated systemic venous blood; it empties through the mitral valve into the morphological left ventricle (which, due to the transposed great arteries, is the pulmonary ventricle)
- IVL:
-
Inferior portion (leg) of SVA, receiving blood from the inferior vena cava
- SVL:
-
Superior portion (leg) of SVA, receiving blood from the superior vena cava
- PVA:
-
Pulmonary venous atrium, that portion of the atrium partitioned so as to receive oxygenated pulmonary venous blood; it empties through the tricuspid valve into the right ventricle (which, due to the transposed great arteries, is the systemic ventricle)
- SVC:
-
Superior vena cava
- IVC:
-
Inferior vena cava
- SV:
-
Systemic ventricle, the morphological right ventricle into which the PVA empties oxygenated blood, and which faces systemic (aortic) pressures du to the transposed great arteries
- PV:
-
Pulmonary ventricle, the morphological left ventricle into which the SVA empties desaturated blood, and which faces pulmonic (pulmonary artery) pressures due to the tricuspid great arteries
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Supported in part by Program Project Grant HL-11310 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland, and Engineering Experiment Station, University of Wisconsin, Madison, Wisconsin.
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Blackstone, E.H., Rideout, V.C. & Beduhn, D.L. Simulation analysis of interatrial transposition of venous return (Mustard’s operation). Ann Biomed Eng 10, 193–218 (1982). https://doi.org/10.1007/BF02367393
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DOI: https://doi.org/10.1007/BF02367393