D-TGA, atrial switch procedure and pacemaker

Case contributed by Dr Jayanth Keshavamurthy


Chest radiograph ordered for congestive heart failure and to assess pulmonary vascular status.

Patient Data

Age: 32
Gender: Male

DTGA, atrial switch procedure.


Where is the right atrial lead going?

The patient has a known history of congenital heart disease: D-TGA and corrective surgery.
Sternotomy wires are noted.

There is a left chest wall 2-lead ICD.

  • the atrial lead crosses to the left of midline and overlies posteriorly in the region of the functional right atrium or anatomical left atrium
  • the ventricular / ICD lead crosses to the left of the midline and is terminating posteriorly, likely in the functional posterior right ventricle which is anatomical left ventricle.

Lungs are clear. No pneumothorax or pleural effusion.

Case Discussion

In atrial baffle surgeries with D-TGA radiologists should recognize the aberrant course of the pacemaker/ICD leads.

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Case information

rID: 39434
Published: 14th Sep 2015
Last edited: 14th Aug 2019
System: Chest, Cardiac
Inclusion in quiz mode: Included

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