SHM Converge Scientific Abstract ePoster Gallery-Stroke After Baffle Leak in Transposition of the Great Arteries

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A 41-year-old man with a history of dextro-transposition of the great arteries (D-TGA) repaired in infancy with a Mustard procedure presented with a 30-minute episode of global aphasia that resolved before arrival. He had experienced a similar episode twice in the prior three months. Brain MRI showed a small acute cortical infarct in the left posterior parietal lobe, consistent with ischemic stroke. Transthoracic echocardiography demonstrated venous and systemic baffles with a baffle leak, with contrast bubbles crossing into the systemic right ventricle, which was also severely dilated and had moderately to severely reduced systolic function.<br /><br />D-TGA is a congenital condition in which the great arteries are switched. Before the arterial switch became standard, Mustard and Senning repairs were commonly used; these operations create baffles to reroute blood flow. Adults who had these older repairs are now increasingly encountered in hospitals and may develop complications such as right heart failure, arrhythmias, baffle stenosis, and baffle leak. Presentations can be nonspecific, including dyspnea, fatigue, and palpitations.<br /><br />This case highlights a rare neurologic complication of a Mustard repair: suspected cardioembolic stroke due to baffle leak. Transthoracic echocardiography was key to diagnosis. Definitive management may include percutaneous closure with a covered stent, and care requires coordination between hospitalists, cardiology, and congenital heart specialists.

Asset Subtitle

William A. Bath

Meta Tag

Author List Frederick R. Helmcke, Sireesha Upadhrasta, William A. Bath

Category Clinical Vignettes

Concept Dextro-Transposition of the Great Arteries

Concept Baffle Leak

Concept Mustard Repair

Concept Baffle Stenosis

Concept Right Heart Failure

Distinguished Non-Finalist

Presenter Organization Tulane University

Presenting Author William A. Bath

Track Adult

Keywords

dextro-transposition of the great arteries

Mustard procedure

baffle leak

ischemic stroke

cardioembolic stroke

global aphasia

transthoracic echocardiography

congenital heart disease

systemic right ventricle

covered stent closure

Dextro-Transposition of the Great Arteries

Baffle Leak

Mustard Repair

Baffle Stenosis

Right Heart Failure