BACKGROUND: Patients with atrioventricular concordance and ventriculoarterial discordance (DTGA) and a Mustard procedure may develop stenosis of the superior limb of the systemic venous baffle (SLSVB). The frequency of this complication in an adult cohort was evaluated. METHODS: Patients >18 years with DTGA and a Mustard procedure with and without a pacemaker (PM)/implantable cardioverter defibrillator (ICD) were identified through an institutional database. Subjects were included following a cardiac imaging study (computed tomography, magnetic resonance imaging, venography or cardiac catheterization) and follow-up in the PM/ICD or congenital cardiac clinics from 2001 to 2007. The primary end-point was narrowing of the SLSVB (<10mm) on cardiac imaging. Hemodynamically significant narrowing was defined by: azygous vein dilatation with retrograde flow or superior vena cava syndrome or the need for dilatation ± stenting of the SLSVB. RESULTS: Narrowing of the SLSVB was observed in 49/112 patients (70 males) age 31 ± 6 years (range 18-49) and was hemodynamically significant in 15/49. Of 29 patients with a PM (23) or ICD (6) and cardiac imaging, 17 had narrowing of the SLSVB which was hemodynamically significant in 8. Non-echocardiographic imaging had a sensitivity of 88% at detecting narrowing of the SLSVB in contrast to pulse-wave Doppler, which yielded a sensitivity of 16% (61% negative predictive value, 88% positive predictive value). CONCLUSIONS: In our adult cohort of Mustard patients, narrowing of the SLSVB had a prevalence of 44% and was more likely to be detected by non-echocardiographic imaging. Baffle patency should be evaluated before transvenous device implantation.
BACKGROUND:Patients with atrioventricular concordance and ventriculoarterial discordance (DTGA) and a Mustard procedure may develop stenosis of the superior limb of the systemic venous baffle (SLSVB). The frequency of this complication in an adult cohort was evaluated. METHODS:Patients >18 years with DTGA and a Mustard procedure with and without a pacemaker (PM)/implantable cardioverter defibrillator (ICD) were identified through an institutional database. Subjects were included following a cardiac imaging study (computed tomography, magnetic resonance imaging, venography or cardiac catheterization) and follow-up in the PM/ICD or congenital cardiac clinics from 2001 to 2007. The primary end-point was narrowing of the SLSVB (<10mm) on cardiac imaging. Hemodynamically significant narrowing was defined by: azygous vein dilatation with retrograde flow or superior vena cava syndrome or the need for dilatation ± stenting of the SLSVB. RESULTS: Narrowing of the SLSVB was observed in 49/112 patients (70 males) age 31 ± 6 years (range 18-49) and was hemodynamically significant in 15/49. Of 29 patients with a PM (23) or ICD (6) and cardiac imaging, 17 had narrowing of the SLSVB which was hemodynamically significant in 8. Non-echocardiographic imaging had a sensitivity of 88% at detecting narrowing of the SLSVB in contrast to pulse-wave Doppler, which yielded a sensitivity of 16% (61% negative predictive value, 88% positive predictive value). CONCLUSIONS: In our adult cohort of Mustard patients, narrowing of the SLSVB had a prevalence of 44% and was more likely to be detected by non-echocardiographic imaging. Baffle patency should be evaluated before transvenous device implantation.
Authors: Lindsay Arthur; Laura Schoeneberg; Michael Angtuaco; S Bruce Greenberg; Markus S Renno; Srikant Das Journal: Int J Cardiovasc Imaging Date: 2021-04-17 Impact factor: 2.357