Paradoxical cerebral embolism three decades after mustard surgery in a patient with complete transposition of the great arteries: a case report

Paradoxical cerebral embolism three decades after mustard surgery in a patient with complete transposition of the great arteries: a case report

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Atrial switch procedures such as the Mustard operation were previously popular for the complete transposition of the great arteries (i.e.dextro-transposition of the great arteries [d-TGA]).

Patients with d-TGA who underwent atrial switch procedures approximately three decades ago have now entered adulthood.A female patient in her 30s with d-TGA had a paradoxical embolic stroke following the initiation of a low-dose oestrogen plus progesterone oral pill for dysmenorrhoea.She underwent Mustard surgery when she was 2 years old.

Following a series of procedures including implantation of a permanent pacemaker that was required because of sinus node dysfunction, she had Toilet Brushes reached adulthood, was living by herself and working independently.One month after taking the low-dose oestrogen plus progesterone oral pill, venous thrombosis occurred in the left soleus and left peroneal veins; and she experienced an acute ischaemic stroke in the right middle cerebral artery area.Transoesophageal echocardiography revealed that the shunt was present 6 only during the Valsalva manoeuvre.

Based on the examinations, the patient was diagnosed with juvenile ischaemic stroke as a result of a paradoxical embolism.These findings suggest that paradoxical cerebral embolism can occur as a late complication in patients with d-TGA who underwent the Mustard operation as children.