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(Circulation. 1995;91:2679-2680.)
© 1995 American Heart Association, Inc.

Articles

Transesophageal Ultrasound Imaging During Stent Implantation to Relieve Superior Vena Cava–to–Intra-atrial Baffle Obstruction After Mustard Repair of Transposition of the Great Arteries

Shuping Ge, MD; Takahiro Shiota, MD, PhD; Mary J. Rice, MD; William M. Hellenbrand, MD; David J. Sahn, MD

From the Clinical Care Center for Congenital Heart Disease, Oregon Health Sciences University, Portland, Ore.

Correspondence to David J. Sahn, MD, The Clinical Care Center for Congenital Heart Disease, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, UHN60, Portland, OR 97201.

Key Words: cardiovascular images • transposition of great vessels • imaging

	Introduction

Top Introduction

 
A 13-year-old girl who had complete transposition of the great arteries after Mustard repair at 2 months of age developed superior baffle obstruction. During cardiac catheterization and as a guide for balloon dilation, the obstruction was imaged by transesophageal ultrasound and angiography (Fig 1). Before dilation, the mean pressure gradient was 8 mm Hg, and a small right-to-left intra-atrial baffle leak was also found. After the implantation of a Palmaz stent (model P308 with an initial diameter of 3.4 mm and a length of 30 mm; Johnson and Johnson Interventional Systems Co) dilated to 20 mm in diameter, there was no pressure gradient and the left-to-right shunt was reduced (Fig 2). The patient has been doing well in the 6 months of follow-up. (Figures on following page.)

View larger version (113K): [in this window] [in a new window]   Figure 1. Transesophageal ultrasound (total depth, 4 cm) and angiographic images of the superior vena cava (SVC) to the systemic venous atrium (SVA) obstruction. Although the obstructive flow was well delineated by two-dimensional and Doppler color flow imaging (A), the segment was nearly obliterated by a 6F catheter positioned retrograde from the SVA to the SVC, as seen in the anteroposterior projection of the SVC angiogram (B). (The ultrasound color images have been deliberately inverted to match the angiograms. Flow from SVC to SVA is going downward and is shown in red.) B A

View larger version (143K): [in this window] [in a new window]   Figure 2. After implantation of the Palmaz stent, the previously obstructed area was wide open with nonturbulent flow on transesophageal ultrasound (total image depth is now 6 cm) (A) and an improved appearance on angiography (B). See Fig 1 for abbreviations. (The ultrasound color images have been deliberately inverted to match the angiograms. Flow from SVC to SVA is going downward and is shown in red.) B A

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