Cardiac magnetic resonance imaging-derived 3-D printed model for pre-procedural planning in a patient with pulmonary venous baffle obstruction following senning palliation: Case report

Pulmonary venous baffle obstruction (PVBO) is a clinically significant complication following atrial switch palliation for D-transposition of the great arteries. 3-dimensional printed models have become a valuable tool in pre-procedural planning for cardiac interventions. We report successful PVBO stenting using a cardiac magnetic resonance imaging (MRI)-derived three-dimensional (3-D) printed model. A 20-year-old male with a history of D-transposition of the great arteries s/p Senning procedure was twice hospitalized for respiratory failure. Transthoracic echocardiogram (TTE) and cardiac MRI demonstrated severe PVBO. MRI images were utilized to create a 3-D printed cardiac model that was used to guide the approach for trans-baffle puncture. During cardiac catheterization, there was a mean gradient of 15 mmHg across the pulmonary venous baffle by Gorlin equation and transesophageal echocardiogram (TEE) continuous Doppler. A trans-baffle approach was utilized under fluoroscopic and TEE guidance. The tiny pulmonary vein confluence was crossed with a Judkins Right (JR) 3.5 catheter and a 0.035“ Glidewire, and a 10 mm x 17 mm Valeo stent was deployed in the pulmonary venous baffle over a 0.035” Rosen wire. The stent was post-dilated with a 12 mm × 2 cm Atlas Gold balloon, and pressure pullback demonstrated resolution of the gradient. The trans-baffle puncture site was then closed with a 4 mm Amplatzer septal occluder device. The patient's respiratory symptoms resolved, and his baseline saturations increased. This case demonstrates the utility of MRI-derived 3-D printing in pre-procedural planning for pulmonary venous baffle intervention.