TRANSESOPHAGEAL ECHOCARDIOGRAPHIC ASSESSMENT OF OBSTRUCTION TO THE PULMONARY VENOUS PATHWAY IN CHILDREN WITH MUSTARD OR SENNING REPAIR

The morphology and mechanism of obstruction to the pulmonary venous pa thway in patients following either Mustard or Senning repair of comple te transposition was assessed using transoesophageal echocardiography. Seven patients underwent catheterization and complete transoesophagea l study in both transverse and longitudinal planes, followed by balloo n dilation of the obstructed venous pathway in five of seven under tra nsoesophageal echocardiography guidance. A complete scan of both syste mic and venous pathway was obtained in all patients. Four patients wit h a Mustard repair were found to have a 'tubular' baffle, with stenosi s resulting from a discrete wedge of tissue arising from the atrial fr ee wall in association with fibrous adhesions to the baffle. In the th ree patients with a Senning repair the intra-atrial baffle showed a ch aracteristic 'peaked' appearance, with stenosis of the venous pathway stenosis related directly to contracture of the patch used to augment the atrial free wall. The mechanism of obstruction appears to be inher ent to the different surgical techniques. Indwelling transoesophageal echocardiography provided immediate haemodynamic and morphologic asses sment of the efficacy of dilation of the obstructed venous pathway.