Abstract 13637: Advanced Multimodality Imaging of Atrial Baffle Leak After the Senning Operation

Abstract

Description of Clinical Presentation We present a 40-year-old male with dextro-transposition of the great vessels and history of a Senning repair as an infant and a transvenous dual-chamber pacemaker at 7 years of age for sinus node dysfunction. Advanced imaging, including cardiac computed tomography (CT) and cardiac magnetic resonance (CMR), were performed as routine testing to evaluate the baffle and ventricular function. Diagnostic Testing and Their Most Important Findings: An ECG-gated cardiac CT demonstrated multiple defects between the systemic and pulmonary venous baffle (1A). CMR demonstrated a severely dilated right ventricle with moderately depressed systolic function, mild tricuspid valve insufficiency, and a moderately dilated, hyperdynamic left ventricle (LV). Advanced 4D flow confirmed a pulmonary to systemic blood flow ratio of 2.8:1, with large left-to-right shunt corresponding to the defects noted on CT (1B). There was no evidence of systemic or pulmonary venous baffle obstruction. 3D transesophageal echocardiography (echo) demonstrated multiple deficiencies in the septal/posterior atrial flap (1C). A stenotic, bicommissural pulmonary valve with moderate flow acceleration was also noted. 3D modelling from the CT/CMR data further clarified the location of the baffle leaks relative to pacemaker leads (1D). Cardiac catheterization confirmed these findings of large left-to-right shunt. Learning Points from this case: Atrial switch patients have a significant risk for baffle leaks, which can be challenging to identify. Advanced imaging including CT, CMR, 3D modeling, 3D echo, and cardiac catheterization are complimentary in the diagnosis of baffle leaks and can guide therapeutic options.