Mustard Procedure Heart: An Evidence-Based Patient Guide

The Mustard procedure is a historical type of congenital heart surgery used to treat transposition of the great arteries (TGA). It creates an internal pathway, called an atrial baffle, that redirects blood so oxygen-rich blood reaches the body; people who had this operation need lifelong specialist follow-up.

Overview: What Is the Mustard Procedure in Cardiology?

The Mustard procedure heart operation is a form of atrial switch surgery for d-transposition of the great arteries (d-TGA), a congenital heart condition present at birth. In d-TGA, the two main arteries leaving the heart are connected to the wrong pumping chambers. Without treatment, oxygen-poor blood may circulate back to the body rather than traveling to the lungs to receive oxygen.

During Mustard procedure heart surgery, a surgeon constructs a channel inside the upper chambers of the heart using the person’s own tissue or a patch material. This channel, called a baffle, redirects incoming blood to the appropriate ventricle. The operation does not move the great arteries themselves; instead, it changes the route blood takes through the heart.

The Mustard operation was an important advance in congenital heart care and was performed most often from the 1960s through the 1980s. Today, most newborns with suitable anatomy undergo an arterial switch operation instead. However, many adolescents and adults worldwide are living with a previous Mustard repair and benefit from care in an adult congenital heart disease program.

How the Repair Changes Blood Flow

In a typical heart, the right ventricle pumps oxygen-poor blood to the lungs, while the left ventricle pumps oxygen-rich blood to the body. In d-TGA, these connections are reversed. The result is two largely separate circulations, which is life-threatening unless blood can mix between them through natural openings or medical treatment.

A Mustard baffle routes oxygen-poor blood returning from the body across the atria toward the left ventricle and then to the lungs. It also routes oxygen-rich blood returning from the lungs toward the right ventricle and then to the aorta, allowing it to reach the body. This circulation can provide effective oxygen delivery.

A key long-term feature is that the right ventricle remains the main pumping chamber for the body, often called the systemic right ventricle. The right ventricle was not originally designed to work against the higher pressure of the body’s circulation throughout life. For this reason, specialists monitor its size and function carefully with imaging, including a Mustard procedure echocardiogram and, when needed, cardiac MRI.

Candidacy and Mustard Procedure Arterial Switch Choices

Historically, the Mustard procedure was used in babies with d-TGA when an atrial switch was the accepted treatment. It may also have been selected in particular anatomical or clinical circumstances. In modern practice, the arterial switch operation is generally the preferred early repair for most babies with d-TGA because it restores the left ventricle as the systemic pumping chamber and reconnects the arteries in their intended positions.

The choice between a historical Mustard procedure and a modern Mustard procedure arterial switch comparison is therefore mostly relevant to understanding past care, reviewing an adult patient’s anatomy, or considering complex reoperations. A multidisciplinary congenital heart team reviews heart anatomy, previous operations, heart function, coronary artery anatomy, lung pressures, rhythm history, and the person’s overall health.

For adults with a previous atrial switch, treatment decisions are individualized. Some need only routine monitoring, while others may need rhythm treatment, catheter procedures for baffle problems, medicines for heart failure symptoms, valve treatment, or selected surgical revision. A specialist assessment is the safest way to understand the options for an individual heart.

What Happens During Mustard Procedure Heart Surgery?

The original Mustard procedure is performed under general anesthesia through an incision in the chest. The surgical team uses a heart-lung machine to maintain circulation while the heart is opened. The surgeon then creates the baffle within the atria, carefully directing blood returning from the body and lungs into the correct pumping chambers.

After the baffle is positioned, the surgeon checks for unobstructed flow and closes the heart and chest. The patient is cared for in an intensive care setting after surgery, where breathing, circulation, oxygen levels, heart rhythm, bleeding, and fluid balance can be monitored closely.

Although the initial operation is rarely performed as a primary repair today, adults may undergo catheter-based or surgical procedures related to a prior baffle. These interventions may address narrowing, leaks, or other complications. The exact plan depends on detailed imaging and assessment by congenital cardiology, cardiac surgery, electrophysiology, and anesthesia teams.

Recovery Timeline, Benefits and Possible Risks

Recovery after the original operation generally began with several days of close hospital monitoring, followed by a longer hospital stay and gradual recovery at home. In contemporary care, recovery times vary according to age, the reason for intervention, the complexity of prior surgery, and whether a catheter procedure or open-heart operation is needed. The treating team provides individualized guidance about activity, wound care, medicines, and return to school or work.

The main benefit of the Mustard procedure was that it allowed oxygen-rich blood to circulate to the body and enabled many children with TGA to survive and grow into adulthood. Its long-term outcome is an important success of congenital heart surgery, but it also requires continued surveillance because the circulation is not anatomically normal.

Potential late risks include baffle obstruction or leakage, abnormal heart rhythms such as atrial flutter or atrial fibrillation, sinus node dysfunction, blood clots, systemic right-ventricle weakness, tricuspid valve leakage, and reduced exercise tolerance. Not everyone develops these problems. Regular review helps identify changes early, often before symptoms become severe.

• Follow-up may include an ECG, Holter or event monitoring, echocardiography, exercise testing, and cardiac MRI.
• Some people require a pacemaker, catheter ablation, baffle stenting, or other targeted treatment.
• Pregnancy and major non-cardiac surgery should be planned with an adult congenital heart specialist when possible.

What Is the Life Expectancy After the Mustard Procedure?

Life expectancy after the Mustard procedure varies widely. Many people who had the operation in childhood reach adulthood and can participate in work, education, relationships, and many everyday activities. However, life expectancy may be affected by the condition of the systemic right ventricle, heart rhythm disorders, baffle complications, valve function, lung pressures, and other individual factors.

It is not possible to give one reliable life-expectancy figure for every person with a Mustard repair. Long-term outcomes have improved with specialist follow-up, imaging, rhythm monitoring, medicines, catheter techniques, and surgery when appropriate. A congenital cardiologist can provide the most meaningful outlook after reviewing an individual’s anatomy, tests, symptoms, and medical history.

People who feel well should still continue scheduled review throughout life. Important changes, including a decline in exercise capacity or new palpitations, may be subtle at first. Ongoing surveillance is a practical way to protect heart health and guide decisions early.

What Is the Success Rate of the Mustard Procedure?

The success rate of the Mustard procedure depends on what “success” means: survival through the original operation, oxygen levels after repair, freedom from later procedures, heart function, and quality of life are all different measures. The operation was historically effective at establishing a circulation that delivered oxygenated blood to the body, and it made long-term survival possible for many children with TGA.

At the same time, it is not considered the usual first-line repair for newborn TGA today because long-term complications can occur and the systemic right ventricle may become strained over time. The arterial switch operation is generally favored when feasible. For people already living with a Mustard repair, the focus is not on comparing historical success rates but on monitoring their current heart health and treating any identified concerns.

A person’s own outcome may be more usefully assessed through current symptoms, exercise tolerance, oxygen levels, heart rhythm testing, baffle assessment, and ventricular function. A congenital heart team can explain what these findings mean and whether any intervention is advisable.

Can You Live With TGA Without Surgery? When to Seek Medical Care

Untreated d-TGA is usually not compatible with long-term survival because oxygen-poor and oxygen-rich blood circulate in separate loops. Some newborns survive briefly when there is mixing between the circulations through an opening such as an atrial septal defect, ventricular septal defect, or patent ductus arteriosus, but this does not replace definitive specialist treatment. Urgent neonatal care and congenital heart surgery are generally needed.

People with a repaired TGA, including those with mustard procedure heart disease, should seek urgent medical care for severe or persistent chest pain, severe shortness of breath, fainting, blue or gray lips, sudden weakness, or a sustained rapid or irregular heartbeat. New swelling of the legs or abdomen, unexplained weight gain, worsening fatigue, or a noticeable fall in exercise ability should also be discussed promptly with a clinician.

Routine care should be led or coordinated by a cardiologist experienced in adult congenital heart disease. Acibadem International’s multidisciplinary specialists and JCI-accredited hospitals provide assessment and treatment for international patients with complex congenital heart conditions, including those with previous atrial switch repairs.

Frequently asked questions

Is the Mustard procedure still performed today?

The Mustard procedure is rarely used as the primary repair for newborns with d-TGA today. For most suitable infants, the arterial switch operation is preferred. Specialists may still evaluate Mustard-type anatomy when caring for adults who had the procedure in childhood or when treating a complication of a prior repair.

What is a Mustard procedure echocardiogram?

This usually means an echocardiogram performed to assess a heart after a Mustard repair. It can help evaluate baffle flow, valve function, the systemic right ventricle, and other aspects of circulation. Cardiac MRI or other tests may be used when echocardiography cannot provide all necessary detail.

Can a Mustard baffle leak or become narrowed?

Yes. A baffle can develop a leak or narrowing years after surgery, although not every patient experiences these issues. The concern may be found during routine imaging or because of symptoms such as reduced exercise tolerance, low oxygen levels, or fluid retention; treatment may include catheter-based or surgical approaches.

Can people exercise after a Mustard procedure?

Many people can remain physically active, but the appropriate level and type of exercise should be individualized. Exercise testing can help a congenital cardiologist give safe, practical guidance. New breathlessness, dizziness, palpitations, or chest discomfort during activity should be reported.

Does a person with a Mustard repair need lifelong follow-up?

Yes. Lifelong follow-up with a congenital heart disease specialist is recommended, even when the person feels well. Monitoring helps detect rhythm disorders, baffle concerns, valve problems, and changes in systemic right-ventricle function early.

Can someone with a Mustard procedure have a pregnancy?

Pregnancy may be possible for some people with a Mustard repair, but it requires pre-pregnancy assessment because the circulation can place additional demands on the heart. A cardiologist experienced in adult congenital heart disease and a high-risk obstetric team can help assess individual risks and plan care.

References

• American Heart Association
• Adult Congenital Heart Association
• European Society of Cardiology
• Centers for Disease Control and Prevention
• National Heart, Lung, and Blood Institute

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.