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Transoesophageal echocardiographic assessment of obstruction to the pulmonary venous pathway in children with Mustard or Senning repair

Published online by Cambridge University Press:  19 August 2008

Aijaz Hashmi ,
Martin Hosking ,
Otto Teixeira ,
Gary Cornel  and
Walter Duncan
Aijaz Hashmi
Affiliation:
Division of CardiologyChildren's Hospital of Eastern Ontario, Canada
Martin Hosking*
Affiliation:
Division of CardiologyChildren's Hospital of Eastern Ontario, Canada
Otto Teixeira
Affiliation:
Division of CardiologyChildren's Hospital of Eastern Ontario, Canada
Gary Cornel
Affiliation:
Division of Cardiovascular Surgery, Children's Hospital of Eastern Ontario, Canada
Walter Duncan
Affiliation:
Division of CardiologyChildren's Hospital of Eastern Ontario, Canada
*
Dr Martin Hosking Division of Cardiology, Children's Hospital of Eastern Ontario, 401 Smythe Road, Ottawa, Ontario Canada K1H 8L1 Tel: (613)-737-2390, Fax:(613)-598-4835
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Abstract

The morphology and mechanism of obstruction to the pulmonary venous pathway in patients following either Mustard or Senning repair of complete transposition was assessed using transoesophageal echocardiography. Seven patients underwent catheterization and complete transoesophageal study in both transverse and longitudinal planes, followed by balloon dilation of the obstructed venous pathway in five of seven under transoesophageal echocardiography guidance. A complete scan of both systemic and venous pathway was obtained in all patients. Four patients with a Mustard repair were found to have a ‘tubular’ baffle, with stenosis resulting from a discrete wedge of tissue arising from the atrial free wall in association with fibrous adhesions to the baffle. In the three patients with a Senning repair the intra-atrial baffle showed a characteristic ‘peaked’ appearance, with stenosis of the venous pathway stenosis related directly to con tracture of the patch used to augment the atrial free wall. The mechanism of obstruction appears to be inherent to the different surgical techniques. Indwelling transoesophageal echocardiography provided immediate haemodynamic and morphologic assessment of the efficacy of dilation of the obstructed venous pathway.

Keywords

Transoesophageal echocardiographyobstructionMustardSenning
Type
Original Articles
Information
Cardiology in the Young , Volume 8 , Issue 1 , January 1998 , pp. 79 - 85
Copyright
Copyright © Cambridge University Press 1998

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