title: Early identification of patients at risk for sinus node dysfunction after Mustard operation.
abstract: We studied 60 patients who had survived the Mustard procedure for transposition of the great arteries, performed between the ages of 2 days and 24 months (mean 4.51 +/- 3.79). All patients were given a postoperative 24-hour dynamic electrocardiogram at 15 days, 1 year and 3 years and then every 2 years. Those who were found to have sinus node dysfunction during follow-up, were given a dynamic electrocardiogram every 3-6 months. The average follow-up period was 38.7 +/- 19.8 months, median 36. Sinus node dysfunction was detected during follow-up in 20 patients (33.3% of the total), 8 of whom had had a pacemaker inserted. Risk factors for late development of sinus node dysfunction were found to include prolonged cross-clamping of the aorta during surgery (P = 0.003), especially over 50 minutes (relative risk 3.5:1), and the presence of even transient sinus node dysfunction after surgery (P = 0.006). These observations suggest, first, that sinus node dysfunction may develop after the Mustard operation as a combined effect of extensive atrial surgery and a long period of myocardial ischemia and, second, that the presence of the disease immediately after the operation sometimes indicates that it will recur or persist during follow-up.
authors.affiliation: Servizio di Medicina dello Sport, Ospedale Pediatrico Bambino Gesù, Rome, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Drago
authors.forename: A
authors.initials: A
authors.lastname: Turchetta
authors.forename: A
authors.initials: A
authors.lastname: Calzolari
authors.forename: S
authors.initials: S
authors.lastname: Giannico
authors.forename: S
authors.initials: S
authors.lastname: Marianeschi
authors.forename: R
authors.initials: R
authors.lastname: Di Donato
authors.forename: D
authors.initials: D
authors.lastname: Di Carlo
authors.forename: P
authors.initials: P
authors.lastname: Ragonese
authors.forename: C
authors.initials: C
authors.lastname: Marcelletti
mesh_terms: D001145:Arrhythmias, Cardiac / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D006348:Cardiac Surgical Procedures / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology*; D012307:Risk Factors; D012849:Sinoatrial Node / Q000503:physiopathology*; D013997:Time Factors; D014188:Transposition of Great Vessels / Q000503:physiopathology / Q000601:surgery*