D-TGA, atrial switch (Senning) procedure and pacemaker

Case contributed by Dr Jayanth Keshavamurthy

Presentation

Congenital heart disease preoperative chest radiograph.

Patient Data

Age: 25 years old
Gender: Female

Name the congenital heart disease and surgery performed.

Modality: X-ray

FINDINGS:

As provided in history patient has history of congenital heart disease and sternotomy as a child with tiny sternotomy sutures for transposition of great vessels and has undergone Senning repair.

There is a left chest wall 2-lead pacemaker.

The right atrial lead is curved posteriorly and going to the right atrium which has been surgically switched to correct DTGA. Right ventricle lead is going through the Senning baffle repair to the left ventricle.

There is no pneumothorax or pleural effusion. Normal pulmonary vasculature. There is normal osseous structures.

1. What is the normal curve of right atrial lead on lateral chest radiograph?

Case Discussion

EKG: sinus rhythm and rate, RVH

Pacemaker Evaluation: Patient has has Mode: AAI-DDR. Atrial paced 7.6%, Ventricular paced 0.2%. No arrhythmia noted during exam. Decreased RV output to 3.0V to conserve battery, otherwise end of life approximately in 6 months-1 year.

Echocardiogram Today's echocardiogram demonstrates previously defined anatomy of D-TGA s/p Senning. There is no obstruction seen throughout the baffle. The right ventricular systolic function is fair. The pacemaker leads are seen in the LV. A stent is seen partially in the IVC baffle. See zoomed in image.

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Case Information

rID: 44354
Case created: 18th Apr 2016
Last edited: 20th Apr 2016
System: Cardiac
Inclusion in quiz mode: Included

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