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European Journal of Echocardiography Advance Access published online on January 23, 2009
European Journal of Echocardiography, doi:10.1093/ejechocard/jen335
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

The missing leak: a case report of a baffle-leak closure using real-time 3D transoesophageal guidance

Andrew J. Klein, Michael S. Kim, Ernesto Salcedo, Thomas Fagan and Joseph Kay*

University of Colorado at Denver, 12401 E. 17th Avenue, Leprino Building, 5th Floor, #524, Anschutz Medical Campus, B-132, PO Box 6511, Aurora, CO 80045, USA

Received 15 July 2008; accepted after revision 22 December 2008.

* Correspondence to: Tel: +1 720 848 6564; Fax: +1 720 848 7314. E-mail address: joseph.kay{at}uchsc.edu


  Abstract

Brady-arrhythmias in patients undergone atrial switch procedures (Mustard or Senning procedure) for complete transposition of the great arteries (TGA) are common and often require implantation of permanent pacemakers. It has been shown that in patients with palliated congenital cardiac defects with residual intra-cardiac shunts, permanent pacemaker implantation is associated with an increased risk of thrombo-embolism. Patients with TGA and concomitant baffle leaks may have an even further increased thrombo-embolic risk, given that the leaks can provide the conduit for venous to systemic thrombo-embolism. In order to decrease this risk, all TGA patients who require pacemaker implantation typically undergo a thorough pre-procedural evaluation to assess for the presence of a baffle leak. Traditional imaging modalities, however, are often limited in their ability to detect and/or properly locate small baffle leaks. We report a case of a patient with TGA and a baffle leak that was both identified and percutaneously closed with the assistance of real-time 3D transoesophageal echocardiography.

Keywords: Transposition of the great arteries; Baffle complications; Baffle leak; Real-time 3D transoesophageal echocardiography


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