Percutaneous Management of Right Ventricular Outflow Tract Obstruction in an Adult Patient After Atrial Switch - A Case for Targeted Infundibular Ablation

Sep 30, 2026

Uploaded by Oliver

Alcohol septal ablation is an established option for symptomatic hypertrophic cardiomyopathy. The report describes an adult patient with transposition of the great arteries after a Mustard atrial switch, who developed a significant right ventricular outflow tract obstruction resembling subaortic stenosis. Because repeat surgery carried high risk, interventional alcohol ablation of the conus branch of the right coronary artery was performed, producing a significant reduction in the pressure gradient.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages4

Reading Time10 min

AccessFree to download

Case Report

Introduction

Case Report

Intervention

Catheterization and Cardiovascular Interventions CASE REPORT Percutaneous Management of Right Ventricular Outflow Tract Obstruction in an Adult Patient After Atrial Switch: A Case for Targeted Infundibular Ablation Vera Osberghaus | Kerstin Wustmann | Pinar Bambul Heck | Stanimir Georgiev | Andreas Eicken | Peter Ewert | Katarzyna Gendera Department of Congenital Heart Defects and Paediatric Cardiology, TUM University Hospital German Heart Center, Technical University of Munich, Munich, Germany Correspondence: Katarzyna Gendera (gendera@dhm.mhn.de) Received: 5 September 2025 | Revised: 28 October 2025 | Accepted: 4 November 2025 | ABSTRACT
Alcohol septal ablation is a well‐established treatment method for patients with hypertrophic cardiomyopathy. We present a case report of a patient with transposition of the great arteries (TGA) after a Mustard procedure, who developed significant right ventricular outflow tract obstruction (RVOTO), functionally resembling subaortic stenosis. Given the high surgical risk, interventional alcohol ablation of the conus branch of the right coronary artery (RCA) was successfully performed, resulting ina significant decrease in the pressure gradient. | | | --- | --- | | 1 | Introduction | 2 | Case Report | | Surgical reinterventions in adult patients with congenital | A 42‐year‐old woman (height 157 cm, weight 66 kg) with com- | | heart disease are often associated with increased procedural | plete transposition of the great arteries (TGA), initially palliated | | risks. This is particularly true for patients with a systemic | with a central aortopulmonary shunt, repaired in childhood by | | right ventricle, who represent a challenging group as | atrial switch (Mustard procedure), and later reoperated for left | | they reach the age of 30 or 40, when right ventricular | ventricle–pulmonary artery (LV–PA) allograft implantation | | function may begin to deteriorate and lead to clinical | followed by revision of a stenotic pulmonary venous baffle | | symptoms [1] . | 20 years ago, presented with heart failure symptoms, including bilateral lower‐limb edema, exertional dyspnea, and nocturia. | | For this reason, repeated cardiac surgical procedures should be avoided in this patient population whenever | She also reported intermittent episodes of resting tachycardia. | | possible. | Transthoracic echocardiography at presentation demonstrated subaortic stenosis with a peak Doppler velocity of 4.8 m/s and a | | On the one hand, successful surgical repair of subaortic | corresponding maximal pressure gradient of 93 mmHg. The | | stenosis does not always provide long‐lasting relief from | subaortic right ventricle (systemic ventricle) was markedly hy- | | obstruction, and restenosis may occur during follow‐up. On | pertrophied and showed mildly impaired systolic function. | | the other hand, for nearly three decades, alcohol septal | Tricuspid regurgitation was mild. Cardiac magnetic resonance | | ablation has served as a less invasive alternative to surgical | imaging confirmed these findings (Figure 1A−C) . Electro- | | myectomy in the treatment of symptomatic obstructive | cardiography showed a sinus rhythm. Given the hemodynamic | | hypertrophic cardiomyopathy [2, 3] . | significance of the obstruction and the higher surgical risk, an | | This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
© 2025 The Author(s) . Catheterization and Cardiovascular Interventions published by Wiley Periodicals LLC. | | Catheterization and Cardiovascular Interventions, 2026; 107:357–360 357 [https://doi.org/10.1002/ccd.70328](https://doi.org/10.1002/ccd.70328) FIGURE 1 | Cardiac magnetic resonance imaging demonstrating relevant right ventricular outflow tract obstruction before the procedure (A–C) . Infundibular hypertrophy causing the obstruct

FAQs

Why was repeat surgical reintervention avoided in this patient population?

Repeated cardiac surgical procedures should be avoided when possible due to increased procedural risks in adult congenital heart disease, especially in patients with a systemic right ventricle who may develop worsening symptoms with age.

What clinical problem was treated in the case report?

The patient developed a significant right ventricular outflow tract obstruction (RVOTO) that functionally resembled subaortic stenosis, leading to symptomatic heart failure findings.

What interventional strategy was used and what was the outcome?

Interventional alcohol ablation of the right coronary artery conus branch was performed under sedation, resulting in a significant decrease in the transobstructive pressure gradient.

Sep 30, 2026

Uploaded by Oliver