Efficient approach to superior vena cava baffle stenosis following the Mustard procedure: Expanding the role of a mechanical rotating dilator sheath for lead extraction.
Arterial Switch Operation
/ adverse effects
Constriction, Pathologic
/ etiology
Device Removal
/ instrumentation
Female
Humans
Middle Aged
Pacemaker, Artificial
/ adverse effects
Postoperative Complications
/ etiology
Self Expandable Metallic Stents
Transposition of Great Vessels
/ surgery
Treatment Outcome
Vena Cava, Superior
/ pathology
Mustard procedure
baffle stenosis
cardiovascular pathology
congenital heart disease
lead extraction
surgical history
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
pubmed:
10
5
2020
medline:
23
10
2020
entrez:
9
5
2020
Statut:
ppublish
Résumé
In adult congenital patients with transposition of the great arteries originally treated with the Mustard (atrial switch) procedure, the most common reason for re-intervention is baffle stenosis. This may be exacerbated by permanent transvenous pacemaker lead placement across the baffle. A 47-year-old female status post Mustard procedure performed at 15 months old presented with a high-grade stenosis of the superior vena cava (SVC) baffle from the SVC to the left atrium, with a nonfunctional permanent pacemaker lead passing through the baffle. A mechanical rotating dilator sheath was used for attempted lead extraction, relieving the baffle stenosis almost completely as a secondary effect, before the placement of a 10 × 27 mm Visipro balloon-expandable stent in the SVC baffle. Use of the mechanical rotating dilator sheath is an evolving treatment strategy in adult congenital heart disease to minimize the risk of bleeding, trauma to surrounding structures, and death. Its ability to fully alleviate baffle stenosis even when full lead extraction is not feasible or is associated with significant procedural risk, further demonstrates its expanded role in this patient population. A multidisciplinary approach and great diligence must be employed to avoid potential complications.
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
1664-1668Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
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