Transcatheter Mustard Revision Using Endovascular Graft Prostheses

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Transcatheter Mustard Revision Using Endovascular Graft Prostheses Diego Porras, MD, Dimitrios Mitsouras, PhD, Michael Steigner, MD, Andreas A. Giannopoulos, MD, Tatiana Kelil, MD, Audrey C. Marshall, MD, Matthew T. Menard, MD The Annals of Thoracic Surgery Volume 103, Issue 6, Pages e509-e512 (June 2017) DOI: 10.1016/j.athoracsur.2016.11.046 Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Pre-catheterization non-invasive imaging. A and B: MRI of the (A) inferior and (B) superior baffle leaks (white arrows); systemic venous pathway (*); pulmonary venous pathway (**). C–F: Three-dimensional printout model. (C) Posterior view shows the anatomy of the systemic venous and pulmonary venous pathways. (D) Posterior wall of the pulmonary venous pathway has been removed to show two baffle leaks. (E) Anterior view. (F) The anterior wall has been removed to show the large defect in the superior venous baffle at the base of the right atrial appendage. (IVC = inferior vena cava; LV = left ventricle; PV = pulmonary venous pathway; RA = right atrium; RAA = right atrial appendage; RV = right ventricle; SVC = superior vena cava.) The Annals of Thoracic Surgery 2017 103, e509-e512DOI: (10.1016/j.athoracsur.2016.11.046) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Angiograms of Mustard baffles (A, B) before and (C, D, F) after device deployment. (E) Sizing balloon in the leak that communicated with the base of the left atrial appendage (LAA). (PV = pulmonary venous pathway; SMC = supramitral chamber.) The Annals of Thoracic Surgery 2017 103, e509-e512DOI: (10.1016/j.athoracsur.2016.11.046) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Follow-up CTA. (A) Formatted image showing position of the inferior and superior baffle devices; systemic venous pathway (∗); pulmonary venous pathway (∗∗). (B) Three-dimensional reconstruction showing the endovascular graft prostheses in the intra-atrial baffles directing systemic venous blood (blue) towards the left ventricle (LV). The Annals of Thoracic Surgery 2017 103, e509-e512DOI: (10.1016/j.athoracsur.2016.11.046) Copyright © 2017 The Society of Thoracic Surgeons Terms and Conditions