Alanís-Naranjo José Martín, Guerrero-Villalpando Alejandra Margarita, De la Cruz-Pelayo Javier, Basso-Barba Gennaro, De Ávila-Gómez María Mónica, Rosas-Vázquez Ana María, Jiménez-Santos Moisés, Lara-Ameca Víctor Jesús, García-Montes José Antonio, de la Mora-Cervantes Regina
Cardiovascular Imaging Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
Interventional Cardiology for Congenital Heart Disease Department, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
JACC Case Rep. 2025 Sep 17;30(28):105413. doi: 10.1016/j.jaccas.2025.105413.
Baffle stenosis and thrombus formation are recognized complications of atrial switch operation (ASO), with no concurrent cases documented. A 23-year-old man with dextro-transposition of the great arteries who had previously undergone Mustard ASO presented with progressive dyspnea, peripheral edema, and abdominal distension. Cardiac computed tomography (CT) showed severe bicaval baffle stenosis and 2 superior vena cava baffle thrombi, one occluding the stenosed segment. Mechanical thrombus fragmentation, systemic thrombolysis, and sequential stent implantation in both baffles achieved complete recovery. Follow-up cardiac CT confirmed patency of the stent and the absence of thrombi. The patient was discharged symptom free and on a daily regimen of acenocoumarin, with close follow-up. This case report emphasizes the value of cardiac CT in assessing baffle-related complications and guiding precise interventional strategies. In patients with a history of ASO and baffle complications, percutaneous stenting provides an effective alternative to surgical intervention.
双腔静脉挡板狭窄和血栓形成是心房调转术（ASO）公认的并发症，但尚无并发病例的记录。一名曾接受Mustard心房调转术的23岁大动脉右旋转位男性患者，出现进行性呼吸困难、外周水肿和腹胀。心脏计算机断层扫描（CT）显示严重的双腔静脉挡板狭窄和2个上腔静脉挡板血栓，其中1个阻塞了狭窄段。通过机械性血栓破碎、全身溶栓以及在两个挡板中序贯植入支架，患者实现了完全康复。随访心脏CT证实支架通畅且无血栓形成。患者症状消失后出院，每日服用醋硝香豆素，并接受密切随访。本病例报告强调了心脏CT在评估与挡板相关并发症及指导精确介入策略方面的价值。对于有ASO病史及挡板并发症的患者，经皮支架置入术为手术干预提供了一种有效的替代方法。
