A simple new technique for hemodynamic assessment of pulmonary venous baffles in adults post-atrial switch operation

Although the arterial switch operation has become the standard form of surgical repair for complete transposition of the great arteries, a large number of adults post-atrial switch are still followed in current practice. Pulmonary venous baffle obstruction is a well-known complication of the atrial switch operation, mimicking heart failure. Its recognition is important as it is a potentially treatable disease. In the past, retrograde pulmonary venous atrium (PVA)/pulmonary venous baffle catheterization was commonly performed in the invasive hemodynamic assessment of patients post-atrial switch, but fewer operators are facile with its use in modern practice. We present herein a series of 4 patients referred for catheterization between May 2020 and January 2021 in which retrograde PVA hemodynamic assessment was performed using a pressure-wire (St. Jude Medical, Minneapolis, MN). Our initial experience suggests this approach is safe, not adding any significant risks above systemic right ventricular catheterization, and also provides incremental diagnostic information in individuals with elevated pulmonary artery wedge pressure and/or pulmonary venous baffle obstruction.