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Occurrence After Mustard's Operation for Transposition of the Great Arteries

Richard I. Markowitz, MD; Charles S. Kleinman, MD; William E. Hellenbrand, MD; Gary Kopf, MD; Laura R. Ment, MD

Am J Dis Child. 1984;138(7):638-641.

Abstract
• Communicating hydrocephalus was observed on computed tomographic (CT) scans in two infants who had previously undergone Mustard's operation for transposition of the great arteries. Obstruction of the superior limb of the intracardiac baffle developed in these children, resulting in venous obstruction to the head and upper extremities that resulted in cranial enlargement. Radiologic clues included a bulging superior vena cava and a prominent azygous system on chest roentgenogram, split cranial sutures on skull films, and enlarged subarachnoid spaces and dilated ventricles on CT scans. Two-dimensional echocardiography showed the obstructed baffle, as well as signs of redirected blood flow. Angiography and measurement of venous pressures confirmed the obstruction, and surgical correction was successful. Follow-up CT scans showed resolution of the hydrocephalus. Increased venous pressure, leading to decreased CSF absorption and increased intraventricular and subarachnoid CSF accumulation in an infant with an expandable cranium, is a possible explanation for the development of cranial enlargement and hydrocephalus under these circumstances.

(AJDC 1984;138:638-641)

Author Affiliations
From the Departments of Diagnostic Radiology (Drs Markowitz and Kleinman), Pediatrics (Drs Markowitz, Kleinman, Hellenbrand, and Ment), and Surgery (Dr Kopf), Yale University School of Medicine and Yale-New Haven (Conn) Hospital.

Footnotes
Read before the meeting of the Society for Pediatric Radiology, Atlanta, April 17, 1983.

Reprint requests to Department of Diagnostic Radiology, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06510 (Dr Markowitz).

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