Serial coagulation studies in patients undergoing Mustard procedure

Following the Mustard procedure for operative correction of transposition of the great arteries, the incidence of serious hemorrhage in our original series was nearly 40%. Coagulation studies were performed serially in the next 4 patients undergoing the operation in an attempt to elucidate the etiology. Preexisting coagulation defects were present in all, but none had evidence of intravascular coagulation. Multiple clotting factors and platelets were decreased in the immediate postoperative period with gradual improvement in two weeks.In a patient with thrombocytopenia or deficient coagulation factors, preoperative phlebotomies may elevate these values to normal levels. When complete correction of the coagulation system has been achieved by this maneuver, a normal amount of postoperative bleeding has occurred in our patients.