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Baffle puncture guided by transoesophageal echocardiography in a patient with dextrocardia and Mustard correction
B Schwagten1, L Jordaens, E Jessurun
1Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
Insights
This study reports the first successful baffle puncture in a patient with dextrocardia and a Mustard correction to treat atrial tachycardia. Transesophageal echocardiography (TEE) guided the procedure, enabling ablation in the systemic venous atrium.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Dextrocardia presents unique challenges for cardiac procedures.
- Mustard correction for complex congenital heart disease can lead to arrhythmias like atrial tachycardia.
- Baffle puncture is a critical but difficult intervention for tachycardia ablation.
Observation:
- A 62-year-old male with dextrocardia and a history of Mustard correction experienced recurrent atrial tachycardia and heart failure.
- An electrophysiological study was performed to map the atria.
- A prosthetic tricuspid valve necessitated a modified venous access approach.
Findings:
- A baffle puncture was successfully performed using femoral venous access under fluoroscopy and transesophageal echocardiography (TEE) guidance.
- The atrial tachycardia was effectively ablated in the systemic venous atrium.
- This represents the first documented successful baffle puncture in a dextrocardia patient with Mustard correction.
Implications:
- Direct imaging, particularly TEE, is crucial for guiding baffle puncture in complex cardiac anatomy.
- This technique offers a viable treatment option for arrhythmias in patients with dextrocardia and previous Mustard procedures.
- Successful baffle puncture can improve outcomes and quality of life for patients with challenging congenital heart disease.
Abstract:
A baffle puncture is a challenging procedure but can be safely done using direct visualization of the region of interest. To our knowledge, however, it has never been performed in a patient with dextrocardia. We present a 62-year-old male with dextrocardia, right isomerism, congenitally corrected transposition of the great arteries, persistent left-sided superior and inferior caval veins, atrial septum defect, and pulmonary valve stenosis. The atrial septum defect was surgically closed with a Teflon patch, a variant Mustard operation was performed, and also a prosthetic tricuspid valve was implanted. The patient developed multiple episodes of atrial tachycardia leading to acute heart failure on many occasions. An electrophysiological study was undertaken in order to create a bi-atrial electro-anatomical map. Owing to the presence of a prosthetic tricuspid valve, the femoral venous access was used and a baffle puncture was performed using continuous monitoring with fluoroscopy and transoesophageal echocardiography (TEE). The baffle puncture was successful and the tachycardia was ablated in the systemic venous atrium. To our knowledge, we present the very first case report demonstrating a successful baffle puncture in a patient with dextrocardia and Mustard correction. Direct imaging using TEE seems to be a very useful tool for guiding the puncture.
