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Thirulogachandar S — Understanding the Atrial Switch Operation: Senning and Mustard Procedures Explained
Thirulogachandar S/LinkedIn
Oct 18, 2025, 05:17

Thirulogachandar S — Understanding the Atrial Switch Operation: Senning and Mustard Procedures Explained

Thirulogachandar S, Intensive Care Nurse at Narayana Institute of Cardiac Sciences, shared a post on LinkedIn:

“51/100

The Atrial Switch Operation (ASO) — also known as the Senning or Mustard procedure — is a cardiac surgery primarily used to treat TGA.

Transposition of the Great Arteries (TGA), a congenital heart defect in which the two main arteries leaving the heart (the aorta and the pulmonary artery) are switched (transpose).

Purpose
The procedure is designed to redirect blood flow at the atrial level so that oxygenated and deoxygenated blood go to the correct circulations, even though the arteries are still transposed.

Problem in TGA
In TGA:

  • The aorta arises from the right ventricle (instead of the left), sending deoxygenated blood to the body.
  • The pulmonary artery arises from the left ventricle (instead of the right), sending oxygenated blood back to the lungs.
  • This creates parallel circulation, which is incompatible with life unless there’s mixing of blood.

Surgical Techniques
There are two main types of atrial switch operations:

1. Senning Procedure (1959)

  • Uses the patient’s own atrial tissue to create a baffle inside the atria to reroute blood.
  • More technically complex due to working with native tissue.

2. Mustard Procedure (1964)

  • Uses a synthetic material (e.g., pericardium, Dacron) to create the baffle.
  • Technically easier, but long-term complications may include baffle obstruction or arrhythmias.

How the ASO Works (Blood Flow Rerouting)

Circulation

Normal TGA
After Atrial Switch

  • Body → RA → RV → Aorta → Body (deoxygenated)
    YES
  • Redirected to lungs
    Lungs → LA → LV → Pulmonary artery → Lungs (oxygenated)
    YES
  • Redirected to body
    • Atrial switch reroutes blood inside the atria so that:
    • Systemic venous blood (from body) goes to the left ventricle, which pumps it to the lungs.
    • Pulmonary venous blood (from lungs) goes to the right ventricle, which pumps it to the body.

Common Indications
Complete TGA in infants when arterial switch (Jatene procedure) is not feasible (usually in late presenters or in some complex cases).
Historically used more frequently before the development of the arterial switch procedure (which anatomically corrects the arteries).

Long-Term Complications

While ASO can be lifesaving, it’s associated with long-term risks:

  • Right ventricular failure (since RV becomes systemic ventricle)
  • Atrial arrhythmias
  • Baffle obstruction or leaks
  • Sudden cardiac death (rare but serious)

Indication
Transposition of the Great Arteries (TGA)

Types

  • Senning (autologous tissue)
  • Mustard (synthetic material)

Goal
Redirect blood flow at atrial level to allow proper oxygenation

Replaced By
Arterial Switch Operation (Jatene) in most cases today

Risks

  • RV failure
  • Arrhythmias
  • Baffle issues”

Thirulogachandar S — Understanding the Atrial Switch Operation: Senning and Mustard Procedures Explained

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Atrial Switch Operation (ASO) Blood Flow Rerouting deoxygenated blood Health Hematology Hemostasis Hemostasis Today Medicine Mustard Procedure Narayana Institute of Cardiac Sciences Senning Procedure Thirulogachandar S Transposition of the Great Arteries (TGA)
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