Venous congestion in a d-TGA patient after Mustard procedure
A 45-year-old patient with dextro-transposition of the great arteries (d-TGA) repaired via Mustard procedure at the age of 5 years presented with lower limb venous congestion. Transthoracic echocardiography revealed turbulent flow at the systemic-venous-return baffle (video 1 of the supplementary da...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Permanyer
2025-08-01
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| Series: | REC: Interventional Cardiology (English Ed.) |
| Online Access: | https://recintervcardiol.org/en/index.php?option=com_content&view=article&id=2645 |
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| Summary: | A 45-year-old patient with dextro-transposition of the great arteries (d-TGA) repaired via Mustard procedure at the age of 5 years presented with lower limb venous congestion. Transthoracic echocardiography revealed turbulent flow at the systemic-venous-return baffle (video 1 of the supplementary data). Spiroergometry showed reduced peak VO2 and an O2-pulse curve with an early plateau and decline towards the end of exertion (figure 1A), both signs of reduced cardiac output at exertion. Cardiac magnetic resonance and fluoroscopy revealed heavily calcified and stenotic baffles (figure 1B; video 2 of the supplementary data). A 3 mmHg gradient between the superior (SVC) and inferior (IVC) vena cavae and the baffle chamber was present. The patient underwent baffle dilation with a covered stent at both SVC and IVC levels (figure 1C; videos 3 and 4 of the supplementary data). Follow-up echocardiography demonstrated restored laminar flow through the systemic-venous-return baffle with peak velocity of 0.8 cm/s (video 5 of the supplementary data). Self-limiting atrial arrhythmias occurred shortly after the procedure, highlighting the importance of follow-up and a low threshold for aggressive management of atrial arrhythmias given their association with sudden cardiac death in these patients. Mustard procedure—introduced with the Senning procedure for the management of d-TGA—uses... |
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| ISSN: | 2604-7322 |