The mustard operation 50 years on: When surgical success is not enough.

The success of congenital heart surgery and care has created a rapidly expanding population of adults with congenital heart disease. Many individuals who underwent atrial switch procedures for transposition of the great arteries in infancy have now reached middle adulthood, where excellent early surgical outcomes contrast with the long-term vulnerability of a systemic right ventricle. This article draws on a unique longitudinal narrative centred on an individual first documented as a newborn with transposition of the great arteries in a remarkable 1976 medical documentary. Now followed in adulthood at the same tertiary ACHD centre, his life course illustrates the evolving clinical challenges faced by this generation of patients, including arrhythmia, systemic right ventricular dysfunction, and heart failure. Using this rare historical perspective, we highlight how modifiable lifestyle and psychosocial factors interact with congenital physiology to influence long-term outcomes, and argue for a model of lifelong ACHD care that extends beyond anatomical repair to sustained lifestyle support and prevention.