The Mustard and Senning Procedure for Transposition of the Great Arteries (TGA)

This page is dediated to all the children and adults with TGA.
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The Mustard Procedure:

This is the open heart surgery that I had in 1973 when I was 2 years and 2 weeks old. Thanks to the pioneering work of Dr Mustard and due to the fact that I am such a fighter, which is why I am still here today to tell my story. My story is now published under Personal Stories.

The Mustard procedure – developed by Dr. William Mustard with support from the Heart and Stroke Foundation – was the first operation to correct the congenital abnormality that produced “blue babies

Blue babies” are born with a defect called transposition of the great vessels/arteries, in which blood from the lungs flows back to the lungs and blood from the body flows back to the body. The two major arteries coming out of the heart, the aorta and the pulmonary artery are connected to the wrong chambers. Such babies look blue because insufficient oxygen is circulating in their bodies.

What does the Mustard Procedure do?

The Mustard procedure restores the circulation but reverses the direction of the blood flow in the heart. In a normal heart, de-oxygenated, blue, blood is pumped into the lungs via the right ventricle. Then it is distributed throughout the body via the left ventricle. In the Mustard procedure, blood is pumped to the lungs via the left ventricle and disseminated throughout the body via the right ventricle.

But the right ventricle is not the optimal shape to support the high pressure work performed in a normal heart by the left ventricle. Over a period of 20 or 30 years the right ventricle may begin to fail. The research conducted by Dr. Liu and Dr. Gatzoulis confirms that this is indeed the case.

When was it first performed and is there a different type of operation performed now?

The first Mustard procedure was performed in 1963 and the operation was superseded in 1987 when an arterial switch procedure was introduced which normalizes left ventricular function. The Mustard procedure reduced an 80% mortality in the first year of life to an 80% survival at age 20.

Worldwide the total is approximately 46,000.

“The Mustard procedure was the first to show that congenital heart defects could be repaired. It transformed the whole field. There is a wide spectrum of heart defects, over 700, and the majority can be operated on with good results,” says Dr. Gatzoulis.

I obtained this information and also amended it to fit from my point of view from http://ww2.heartandstroke.ca:

This page is very fascinating – it contains a pic of the Mustard/Senning procedure and all the outcomes and other types of operation that may be required. PLEASE VISIT THIS PAGE: Yorkshire and Humberside Hearts NHS:

The Senning Procedure

Surgical intervention for TGA predates the invention of cardiopulmonary bypass. In 1950, Blalock and Hanlon described the first palliative procedure to surgically excise the atrial septum, thereby improving mixing and arterial saturation. With early bypass techniques, Senning performed the first ‘complete’ repair for TGA in 1957.4

In the Senning repair, a baffle is created within the atria that redirects the deoxygenated caval blood to the mitral valve and the oxygenated pulmonary venous blood to the tricuspid valve. The anatomic left ventricle continues to act as the pulmonary pump and the anatomic right ventricle acts as the systemic pump.

In Senning’s operation, complicated ‘origami-style’ cutting and folding of the native atrial tissue is required to achieve the venous baffle. Owing to its complexity, the Senning technique was initially not widely embraced.

In 1964, Mustard described a simpler technique by which the atrial septum is excised, and the atrial baffle is created by the placement of a single pantaloon-shaped patch . This technique was quickly adopted by surgeons and became the standard operation for TGA.

One might wonder why the arterial switch procedure was not the technique first employed for TGA? In fact, both Senning and Mustard tried this approach in the early 1950s without success. The obstacles to success in that era included the inability to transfer the coronary arteries, and inadequate early techniques of cardiopulmonary bypass that precluded surgery in early infancy.

Have a look at http://www.nature.com/ncpcardio/journal/v5/n8/full/ncpcardio1252.html

The differences between The Mustard procedure and Senning procedure are identical except that the baffle is contructed from atrial tissue in the Senning and from pericardium in the Mustard.

Disclaimer: The facts and opinions shown in this article are as accurate and up to date as possible, but are provided as general “information resources”, which may not be relevant to individual persons. This article is not a substitute for individual assessment and always take advice from a doctor who is familiar with the particular person.

Consult you or your child’s physician regard the specific outlook for you or your child.