Summary
The Mustard operation for transposition of the great arteries is associated with good long-term survival. Typical complications at follow-up include progressive loss of sinus node function requiring permanent pacemaker implantation, and systemic venous pathway obstruction often precluding a transvenous approach to pacing. We report on 7 patients (median age 14.1; range 5–19) with bradyarrhythmia requiring permanent pacemaker implantation with associated stenosis (n = 6) or occlusion (n = 1) of the superior vena cava, in whom stent implantation relieved the obstruction and facilitated subsequent transvenous permanent pacing. In five of them stenting and pacemaker implantation were performed during a single procedure; two patients underwent elective pacemaker implantation 6 weeks later. In one patient the pacemaker had to be explanted due to pacemaker pocket infection. In the others the follow-up has been uneventful, with excellent chronic pacing thresholds and appropriate sensing. Two patients have had their generator replaced electively.
We conclude that stenting of the SVC stenosis allows implantation of transvenous pacemaker leads with good intermediate term results in patients with a Mustard operation for transposition of the great arteries.
Similar content being viewed by others
References
Chintala K, Forbes TJ, Karpavich P (2005) Effectiveness of transvenous pacemaker leads placed through intravascular stents in patients with congenital heart disease. Am J Cardiol 95:424–427
Dähnert I, Hennig B, Wiener M, Rotsch C (2005) Interventions in leaks and obstructions of the interatrial baffle late after Mustard and Senning correction for transposition of the great arteries. Catheterization and Cardiovascular Interventions 66:400–407
Gewillig M, Cullen S, Mertens B, Lesaffre E, Deanfield J (1991) Risk factors for arrhythmia and death after Mustard operation for simple transposition of the great arteries. Circulation 84(Suppl III):III-187–III-192
Gillette PC, Wampler DG, Shannon C, Ott D (1986) Use of cardiac pacing after the Mustard operation for transposition of the great arteries. J Am Coll Cardiol 7:138–141
Ing FF, Mullins CE, Grifka RG, Nihill MR, Fenrich AL, Collins EL, Friedman RA (1998) Stent dilation of superior vena cava and innominate vein obstructions permits transvenous pacing lead implantation. Pacing Clin Electrophysiol 21:1517–1530
Kammeraad JA, van Deuzern CH, Sreeram N, Bink Boelkens MT, Ottenkamp J, Helbing WA, Lam J Sobotka- Plojhar MA, Daniels O, Balaji S (2004) Predictors of sudden cardiac death after Mustard or Senning repair for transposition of the great arteries. J Am Coll Cardiol 44:1095–1102
Khairy P, Landzberg MJ, Lambert J, O’Donnell CP (2004) Long-term outcomes after the atrial switch for surgical correction of transposition: a meta-analysis comparing the Mustard and Senning procedures. Cardiol Young 14:284–292
Michel-Behnke I, Hagel KJ, Bauer J, Schranz D (1998) Superior caval venous syndrome after atrial switch operation: relief of complete venous obstruction by gradual angioplasty and placement of stents. Cardiol Young 8:443–448
Mohsen AE, Rosenthal E, Qureshi SA, Tynan M (2001) Stent implantation for superior vena cava occlusion after the Mustard operation. Catheter Cardiovasc Interv 52:351–354
Moons P, Gewillig M, Sluysmans T, Verhaaren H, Viart P, Massin M, Suys B, Budts W, Pasquet A, De Wolf D, Vliers A (2004) Long term outcome up to 30 years after the Mustard or Senning operation: a nationwide multicentre study in Belgium. Heart 90:307–313
Puley G, Siu S, Conelly M, Harrisson D, Webb G Williams WG, Harris L (1999) Arrhythmia and survival in patients >18 years of age after the Mustard procedure for complete transposition of the great arteries. Am J Cardiol 83:1080–1084
Rhodes LA, Wernowski G, Keane JF, Mayer JE Jr, Shuren A, Dindy C, Colan SD, Walsh EP (1995) Arrhythmias and intracardiac conduction after the arterial switch operation. J Thorac Cardiovasc Surg 109:303–310
Sreeram N, Dikkala V, Arnold R (1995) Balloon dilation of stenosed systemic venous pathways following the Mustard operation. Cardiol Young 5:238–242
Udink ten Cate F, Breur J, Boramanand N, Crosson J, Friedman A, Brenner J, Meijboom E, Sreeram N (2002) Endocardial and epicardial steroid lead pacing in the neonatal and paediatric age group. Heart 88:392–396
Wells WJ, Blackstone E (2000) Intermediate outcome after Mustard and Senning procedures: a study by the Congenital Heart Surgeons Society. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 3:186–197
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Emmel, M., Sreeram, N., Brockmeier, K. et al. Superior vena cava stenting and transvenous pacemaker implantation (stent and pace) after the Mustard operation. Clin Res Cardiol 96, 17–22 (2007). https://doi.org/10.1007/s00392-006-0451-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00392-006-0451-2