Permanent transvenous pacing after a Mustard procedure

Transposition complexes in the adult: a changing perspective

This study has shown the heterogeneous group of patients with discordant ventricular arterial relations, their management and problems encountered during follow up. Patients after surgery for transposition are still relatively young by cardiology standards and their problems continue to evolve; nevertheless the future is becoming clearer. However there are still important lessons to be learnt by continued and diligent observation and systematic, multicenter research. It is important to maintain a low threshold for thorough re-evaluation of patients whenever new symptoms are discovered. Indeed, patients should undergo regular detailed investigations at timely intervals. It is vital that this evolving group of adult patients, as with most patients emerging from a childhood with other congenital heart malformations, is managed by cardiologists fully trained in congenital heart disease.

Left ventricular transvenous electrode dislodgement after Mustard repair for transposition of the great arteries

An 11-year-old girl who underwent Mustard's operation for complete transposition of the great arteries in infancy, developed Mobitz type II second-degree AV block 8 1/2 years later. A transvenous, active fixation left ventricular lead was inserted and connected to a rate responsive pacemaker. Two years later the lead dislodged due to the child's growth. A new active fixation electrode was positioned in the left ventricle below the pulmonary valve, leaving an electrode loop in the ventricle. Such an approach may prevent lead dislodgement due to growth after intraatrial repair for transposition of the great arteries, but regular radiological or echocardiographic follow-up of lead position is recommended in these patients.