Schwagten B, Jordaens L, Jessurun E, Witsenburg M, Scheffer M, Szili-Torok T
Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.
Eur J Echocardiogr. 2009 Jan;10(1):144-7. doi: 10.1093/ejechocard/jen196. Epub 2008 Jul 16.
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.
房间隔穿刺是一项具有挑战性的操作，但通过直接可视化感兴趣区域可以安全地完成。然而，据我们所知，从未在右位心患者中进行过此项操作。我们报告一例62岁男性患者，患有右位心、右心异构、先天性矫正型大动脉转位、永存左上腔静脉和左下腔静脉、房间隔缺损以及肺动脉瓣狭窄。房间隔缺损通过聚四氟乙烯补片进行手术闭合，实施了改良Mustard手术，并植入了人工三尖瓣。患者多次发生房性心动过速，多次导致急性心力衰竭。为了创建双房电解剖图，进行了电生理研究。由于存在人工三尖瓣，采用股静脉入路，并在荧光透视和经食管超声心动图（TEE）的持续监测下进行房间隔穿刺。房间隔穿刺成功，房性心动过速在体静脉心房内被消融。据我们所知，我们展示了首例关于右位心和Mustard矫正患者房间隔穿刺成功的病例报告。使用TEE进行直接成像似乎是指导穿刺的非常有用的工具。
