INTRODUCTION
In adult congenital patients with transposition of the great arteries
(TGA) originally treated with the Mustard (atrial switch) procedure,
long term complications include baffle stenosis, arrhythmias, and sudden
death.1 The re-intervention rate for these patients is
as high as 9.7%, with the most common reason being baffle
stenosis.2 Permanent pacemakers are required in this
patient population for management of symptomatic sinus node or AV node
dysfunction and the presence of transvenous leads across the baffle can
increase stenosis rates up to 58%.1,3 This report
describes a case of multidisciplinary lead extraction and recanalization
of an occluded superior vena cava (SVC) baffle using a mechanical
rotating dilator sheath in a patient with a prior Mustard procedure and
retained left atrium (LA) pacemaker lead.