A simple new technique for hemodynamic assessment of pulmonary venous baffles in adults post-atrial switch operation

Published on May 18, 2021
· DOI :10.1016/J.IJCCHD.2021.100155
William R. Miranda16
Estimated H-index: 16
(Mayo Clinic),
C. Charles Jain4
Estimated H-index: 4
(Mayo Clinic),
Donald J. Hagler89
Estimated H-index: 89
(Mayo Clinic)
Abstract Although the arterial switch operation has become the standard form of surgical repair for complete transposition of the great arteries, a large number of adults post-atrial switch are still followed in current practice. Pulmonary venous baffle obstruction is a well-known complication of the atrial switch operation, mimicking heart failure. Its recognition is important as it is a potentially treatable disease. In the past, retrograde pulmonary venous atrium (PVA)/pulmonary venous baffle catheterization was commonly performed in the invasive hemodynamic assessment of patients post-atrial switch, but fewer operators are facile with its use in modern practice. We present herein a series of 4 patients referred for catheterization between May 2020 and January 2021 in which retrograde PVA hemodynamic assessment was performed using a pressure-wire (St. Jude Medical, Minneapolis, MN). Our initial experience suggests this approach is safe, not adding any significant risks above systemic right ventricular catheterization, and also provides incremental diagnostic information in individuals with elevated pulmonary wedge pressure and/or pulmonary venous baffle obstruction.
#1William R. Miranda (Mayo Clinic)H-Index: 16
#2C. Charles Jain (Mayo Clinic)H-Index: 4
Last. Donald J. Hagler (Mayo Clinic)H-Index: 89
view all 7 authors...
Objective To assess the prevalence of elevated systemic right ventricular (sRV) end-diastolic pressure and pulmonary arterial hypertension in adults with transposition of the great arteries (TGA) who have undergone atrial switch operation. Methods Forty-two adults (aged ≥18 years) with complete TGA and atrial switch palliation undergoing cardiac catheterisation between 2004 and 2018 at Mayo Clinic, MN, were identified. Clinical, echocardiographic and invasive haemodynamic data were abstracted fr...
#1William R. Miranda (Mayo Clinic)H-Index: 16
#2Abdallah El Sabbagh (Mayo Clinic)H-Index: 11
Last. Charanjit S. Rihal (Mayo Clinic)H-Index: 96
view all 4 authors...
A 67-year-old woman with systemic hypertension and morbid obesity (50.6 kg/m2) was referred for invasive hemodynamic assessment of her mitral valve in the setting of exertional dyspnea. Transthoracic echocardiography previously showed normal left ventricular (LV) size and systolic function, severe
1 CitationsSource
#1Joseph T. Poterucha (UR: University of Rochester)H-Index: 1
#2Nathaniel W. Taggart (UR: University of Rochester)H-Index: 14
Last. Frank Cetta (UR: University of Rochester)H-Index: 46
view all 8 authors...
Objectives To report our experience with intravascular and hybrid intra-operative stent placement for baffle obstruction in patients with complete transposition of the great arteries (TGA) after the atrial switch (Mustard/Senning) operation. Background Venous baffle obstruction is a challenging complication after atrial switch operation in patients with TGA. Traditional treatment options include intravascular stenting or surgery. Methods A retrospective analysis of Mayo Clinic's electronic medic...
8 CitationsSource
#1Rick A. Nishimura (Mayo Clinic)H-Index: 128
#2Charanjit S. Rihal (Mayo Clinic)H-Index: 96
Last. David R. Holmes (Mayo Clinic)H-Index: 190
view all 4 authors...
Abstract Objectives . This study compared the accuracy of Doppler echocardiography with that of conventional cardiac catheterization in the measurement of transmitral gradients in patients with mitral stenosis. Background . Simultaneous measurement of left atrial and left ventricular pressures is the most accurate method for determination of the mean mitral valve gradient in patients with mitral stenosis. Because of the inherent risks of transseptal catheterization, pulmonary capillary wedge pre...
107 CitationsSource
#1Donald J. HaglerH-Index: 89
#2Donald G. RitterH-Index: 38
Last. Dwight C. McGoonH-Index: 71
view all 5 authors...
Since 1974, late results of the Mustard procedure for correcting complete transposition of the great arteries have been evaluated by cardiac catheterization, electrocardiography, roentgenography, history, and physical examination of 48 Mayo Clinic patients. Of these, 15 were studied 1 month to 2 years postoperatively because of clinical deterioration. The other 33 had been asymptomatic but were asked to return for hemodynamic reevaluation one-half to 11 years postoperatively. Of the asymptomatic...
62 CitationsSource
#1David J. DriscollH-Index: 71
#2Michael R. NihillH-Index: 31
Last. Dan G. McNamaraH-Index: 56
view all 5 authors...
Three patients developed late pulmonary vein obstruction (PVO) following Mustard's operation for transposition of the great arteries. In all three the absence of PVO had been documented by an earlier postoperative cardiac catheterization. At reoperation shrinkage and kinking of the dacron baffle was evident. After Mustard's operation, patients should be observed closely for symptoms and signs of PVO since it can occur insidiously despite previously proven absence of this complication.
24 CitationsSource
Cited By0