Journal article
Efficient approach to superior vena cava baffle stenosis following the Mustard procedure: Expanding the role of a mechanical rotating dilator sheath for lead extraction
Journal of cardiac surgery, v 35(7), pp 1664-1668
Jul 2020
PMID: 32383229
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
Introduction 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.
Case report 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 x 27 mm Visipro balloon-expandable stent in the SVC baffle.
Conclusions 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.
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Details
- Title
- Efficient approach to superior vena cava baffle stenosis following the Mustard procedure: Expanding the role of a mechanical rotating dilator sheath for lead extraction
- Creators
- Chi Chi Do-Nguyen - College Station Medical CenterAlexander Ochman - Deborah Heart and Lung CenterMaxwell F. Kilcoyne - Philadelphia College of Osteopathic MedicineRichard Kovach - Deborah Heart and Lung CenterBoban P. Abraham - Deborah Heart and Lung CenterPedram Kazemian - Deborah Heart and Lung CenterLynn McGrath - Deborah Heart and Lung CenterRandy M. Stevens - St. Christopher's Hospital for Children
- Publication Details
- Journal of cardiac surgery, v 35(7), pp 1664-1668
- Publisher
- Wiley
- Number of pages
- 5
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Pediatrics
- Web of Science ID
- WOS:000530747000001
- Scopus ID
- 2-s2.0-85085152342
- Other Identifier
- 991021448049304721
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InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Surgery