• Chi Chi Do-Nguyen, Alexander Ochman, Maxwell F Kilcoyne, Richard Kovach, Boban P Abraham, Pedram Kazemian, Lynn McGrath, and Randy M Stevens.
• Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania.
• J Card Surg. 2020 Jul 1; 35 (7): 1664-1668.

IntroductionIn adult congenital patients with transposition of the great arteries originally treated with the Mustard (atrial switch) procedure, the most common reason for re-intervention is baffle stenosis. This may be exacerbated by permanent transvenous pacemaker lead placement across the baffle.Case ReportA 47-year-old female status post Mustard procedure performed at 15 months old presented with a high-grade stenosis of the superior vena cava (SVC) baffle from the SVC to the left atrium, with a nonfunctional permanent pacemaker lead passing through the baffle. A mechanical rotating dilator sheath was used for attempted lead extraction, relieving the baffle stenosis almost completely as a secondary effect, before the placement of a 10 × 27 mm Visipro balloon-expandable stent in the SVC baffle.ConclusionsUse of the mechanical rotating dilator sheath is an evolving treatment strategy in adult congenital heart disease to minimize the risk of bleeding, trauma to surrounding structures, and death. Its ability to fully alleviate baffle stenosis even when full lead extraction is not feasible or is associated with significant procedural risk, further demonstrates its expanded role in this patient population. A multidisciplinary approach and great diligence must be employed to avoid potential complications.© 2020 Wiley Periodicals LLC.

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