What options are available to the patient with right ventricular failure after a Mustard Operation ?
When RV failure is severe, and not well controlled medically, two main options are available: Heart Transplantation (or Heart-Lung Transplantation, if pulmonary vascular disease is advanced) Conversion to an Arterial Switch Transplantation is an entirely different issue which I will discuss in future articles. Since transplantation is a major, expensive and uncertain option in children, alternative approaches to avoid it are attractive. Dr.Roger Mee first conceived the idea of converting a failing Mustard to an Arterial Switch Operation (ASO). As we discussed earlier, RV failure is rather common after correction for TGA with VSD, but it also occurs in 10% of TGA without VSD. The course of RV failure is unpredictable. While in some patients, dysfunction appears relatively stable or very slowly progressive, in others it may worsen rapidly. Tricuspid valve replacement alone in this group of patients does not have very promising results. The only feasible option is to convert the repair to
