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Advanced imaging improves detection of baffle leaks and stenoses after atrial switch compared with transthoracic echocardiography

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Abstract

Current guidelines for adults with atrial switch repair recommend baseline cardiovascular magnetic resonance (CMR) for assessment of ventricular size and function, systemic and venous baffle obstruction and leaks, and valvular function. It also recommends transthoracic echocardiography (TTE) for outpatient follow up. Many such patients with implanted cardiac devices may need cardiac computed tomography (CCT) when CMR is not feasible. This study reviews and compares CMR, transesophageal echocardiography (TEE), CCT, cardiac catheterization with angiography and TTE in detection of baffle problems in patients after atrial switch operation. The medical records of patients who had at least one imaging study performed after atrial switch operation at our center from 2010 to 2020 were retrospectively reviewed. Results are reported as descriptive statistics for demographics and imaging findings. The principal outcome measure was detection of baffle leak and/or baffle stenosis. Fifty-seven patients had at least one cardiac imaging study after atrial switch operation (36 Senning and 21 Mustard operations) during the study period. Nearly 33% (19/57) had baffle complications of stenosis and/or baffle leaks identified. All 57 patients had TTE performed but baffle problems were noted by TTE in only 8 (14%) patients (7 baffle stenosis and 1 baffle leak). Of the 49 patients without known baffle problems by TTE, 24 had advanced imaging (TEE/CCT/CMR/angiography). Advanced imaging identified baffle problems in nearly half (11/24, 46%) of them (7 baffle leaks and 4 baffle stenosis). Baffle problems were present in (8/23) patients with transvenous cardiac devices. Baffle complications are common after atrial switch operations and in our study occur in 1/3rd of the patients. However, TTE is not sensitive enough to recognize these complications. Advanced imaging for detection of baffle complications should be considered in all patients after atrial switch operation

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Deidentified raw data is available upon request.

References

  1. Senning A (1959) Surgical correction of transposition of the great vessels. Surgery 45:966–980

    CAS  PubMed  Google Scholar 

  2. Mustard WT, Keith JD, Trusler GA, Fowler R, Kidd L (1964) The surgical management of transposition of the great vessels. J Thorac Cardiovasc Surg 48:953–958

    Article  CAS  Google Scholar 

  3. Ilbawi MN, DeLeon SY, Backer CL, Duffy CE, Muster AJ, Zales VR, Paul MH, Idriss FS (1990) An alternative approach to the surgical management of physiologically corrected transposition with ventricular septal defect and pulmonary stenosis or atresia. J Thorac Cardiovasc Surg 100(3):410–415

    Article  CAS  Google Scholar 

  4. Imamura M, Drummond-Webb JJ, Murphy DJ Jr, Prieto LR, Latson LA, Flamm SD, Mee RB (2000) Results of the double switch operation in the current era. Ann Thorac Surg 70(1):100–105. https://doi.org/10.1016/s0003-4975(00)01416-8

    Article  CAS  PubMed  Google Scholar 

  5. Greutmann M, Tobler D, Kovacs AH, Greutmann-Yantiri M, Haile SR, Held L et al (2015) Increasing mortality burden among adults with complex congenital heart disease. Congenit Heart Dis 10(2):117–127

    Article  Google Scholar 

  6. Schwerzmann M, Salehian O, Harris L, Siu SC, Williams WG, Webb GD et al (2009) Ventricular arrhythmias and sudden death in adults after a Mustard operation for transposition of the great arteries. Eur Heart J 30:1873–1879

    Article  Google Scholar 

  7. Stout KK, Daniels CJ, Aboulhosn JA, Bozkurt B, Broberg CS, Colman JM, Crumb SR, Dearani JA, Fuller S, Gurvitz M, Khairy P, Landzberg MJ, Saidi A, Valente AM, Van Hare GF (2019) 2018 AHA/ACC guideline for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 73(12):e81–e192

    Article  Google Scholar 

  8. Fogel MA, Hubbard A, Weinberg PM (2001) A simplified approach for assessment of intracardiac baffles and extracardiac conduits in congenital heart surgery with two- and three-dimensional magnetic resonance imaging. Am Heart J 142:1028–1036

    Article  CAS  Google Scholar 

  9. Ho JG, Cohen MD, Ebenroth ES et al (2012) Comparison between transthoracic echocardiography and cardiac magnetic resonance imaging in patient’s status post atrial switch procedure. Congenit Heart Dis 7:122–130

    Article  Google Scholar 

  10. Wilhelm CM, Sisk TL, Roble SL, Chisolm JL, Janevski I, Cheatham JP, Cua CL (2016) Accuracy of imaging modalities in detection of baffle leaks in patients following atrial switch operation. Echocardiography 33(3):437–442

    Article  Google Scholar 

  11. De Pasquale G, Bonassin Tempesta F, Lopes BS, Babic D, Oxenius A, Seeliger T, Gruner C, Tanner FC, Biaggi P, Attenhofer Jost C, Greutmann M (2017) High prevalence of baffle leaks in adults after atrial switch operations for transposition of the great arteries. Eur Heart J Cardiovasc Imaging 18(5):531–535. https://doi.org/10.1093/ehjci/jew276

    Article  PubMed  Google Scholar 

  12. Patel S, Shah D, Chintala K et al (2011) Atrial baffle problems following the mustard operation in children and young adults with dextro-transposition of the great arteries: the need for improved clinical detection in the current era. Congenit Heart Dis 6:466–474

    Article  Google Scholar 

  13. Bottega NA, Silversides CK, Oechslin EN, Dissanayake K, Harrison JL, Provost Y, Harris L (2012) Stenosis of the superior limb of the systemic venous baffle following a Mustard procedure: an under-recognized problem. Int J Cardiol 154(1):32–37. https://doi.org/10.1016/j.ijcard.2010.08.064

    Article  PubMed  Google Scholar 

  14. Arciniegas E, Farooki ZQ, Hakimi M, Perry BL, Green EW (1981) Results of the Mustard operation for dextro-transposition of the great arteries. J Thorac Cardiovasc Surg 81(4):580–587

    Article  CAS  Google Scholar 

  15. Bradley EA, Cai A, Cheatham SL, Chisolm J, Sisk T, Daniels CJ, Cheatham JP (2015) Mustard baffle obstruction and leak—how successful are percutaneous interventions in adults? Prog Pediatr Cardiol 39(2 Pt B):157–163. https://doi.org/10.1016/j.ppedcard.2015.10.018

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Arkansas Children’s Hospital, Little Rock, AR, USA

    Lindsay Arthur, Laura Schoeneberg, Michael Angtuaco, S. Bruce Greenberg, Markus S. Renno & Srikant Das

  2. Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    Lindsay Arthur, Laura Schoeneberg, Michael Angtuaco, S. Bruce Greenberg, Markus S. Renno & Srikant Das

  3. Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR, USA

    S. Bruce Greenberg & Markus S. Renno

Authors
  1. Lindsay Arthur
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  2. Laura Schoeneberg
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  3. Michael Angtuaco
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  4. S. Bruce Greenberg
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  5. Markus S. Renno
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  6. Srikant Das
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by LA. The first draft of the manuscript was written by LA and MSR, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Srikant Das.

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The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the Institutional Review Board (IRB) of the University of Arkansas for Medical Sciences (UAMS).

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The study was approved by the UAMS IRB with a waiver of informed consent.

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The study was approved by the UAMS IRB for publication of deidentified, aggregated patient data.

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Supplementary Information

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Supplementary file1 (AVI 8949 kb)

Online Resource 1: Two atrial baffle leaks (arrows) demonstrated by transesophagealechocardiography during cardiac catheterization communicating between the superior vena cavabaffle and the common pulmonary vein.

Supplementary file2 (AVI 7082 kb)

Online Resource 2: Near total occlusion of the superior limb venous baffle with contrastinjection demonstrating rerouting of contrast and decompression via the azygos vein duringcardiac catheterization.

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Arthur, L., Schoeneberg, L., Angtuaco, M. et al. Advanced imaging improves detection of baffle leaks and stenoses after atrial switch compared with transthoracic echocardiography. Int J Cardiovasc Imaging 37, 2767–2772 (2021). https://doi.org/10.1007/s10554-021-02236-w

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  • DOI: https://doi.org/10.1007/s10554-021-02236-w

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