Transposition of the Great Arteries

Mustard Baffle: Superior Baffle Obstruction

Fig 1: A 35 year old lady with symptoms of fainting on exersion and elevated SVC pressure. Above is the 3D TOE showing the obstructed superior venous baffle as it passes through the roof of the right atrium. Note the proximity of the obstructed baffle to the native atrial communication. Any expansion of the baffle would at the expense of reducing the atrial communication. At operation there was severe calcification of the baffle and the native atrial communication needed to be enlarged. Compare the size of the baffle space with the size of the pacing lead going through it.

Figure 2: Same patient as above with another angle of the anatomy. CS= coronary Sinus.

Figure 3: 3D TOE image demonstrating the obstructed superior baffle. Observe the bulge of the baffle at the superior caval end with early filling phase from the turbulant inflow through the obstructed inflow.