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What are the complications of the Mustard and Senning procedures?

These two older procedures arose about 50 years ago to treat transposition of the great arteries - in which the vessels that supply the lung and the rest of the body are switched. Both were successful at the time; however, newer techniques have evolved that are preferred and have fewer long-term complications.

Most of the problems related to the Mustard and Senning procedures result because the right lower pumping chamber of the heart is not designed to pump blood to the whole body - yet these procedures force it to do just that. Patients who have undergone the procedures often develop signs of heart failure or reduced function of the heart’s right pumping chamber. Reduced function, as well as leakiness of the tricuspid valve between the heart’s upper and lower right chambers, often causes the heart’s upper right chamber (the atrium) to become enlarged. Furthermore, because of the rerouting of blood in the upper chambers during surgery, these pathways can become narrow over time, causing obstruction of blood flow as it enters the heart.

Enlargement of the upper chamber as well as the complex stitching to reroute blood in the upper heart chambers can lead to a variety of electrical rhythm problems, such as the heart intermittently beating much too fast or much too slowly, or a combination of both. A patient whose heart develops electrical problems often requires a pacemaker and sometimes an electrical defibrillator. The risk of sudden cardiac death in patients who have undergone the Mustard or Senning procedure is about 100 times that of the general population.

 

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