Discussion

The patients who underwent physiologic correction of D-transposition of great arteries remain at increased risk of cardiovascular complications and have a markedly increased mortality risk compared to the general populations. Complications of this procedure include systemic ventricular dysfunction, tricuspid regurgitation, dysrhythmias, and venous baffles obstruction and/or leaks, which are generally occurred in adulthood.^{Reference Horer, Karl and Theodoratou4} The clinical consequences of baffle leaks in this population are poorly understood, and the indications for closure are incompletely defined. Baffle leak device closure procedures after atrial switch operations have been reported to succeed in correcting haemodynamic defects. Baffle leaks are reported in 5–10% of atrial switch-operated patients, these being generally resolved by surgical treatment.^{Reference Khairy, Landzberg, Lambert and O’Donnell5} One study reported baffle leaks in four patients from a cohort of 59 undergoing cardiac catheterisation for electrophysiological or haemodynamic study. One defect was managed with an occluder, and a second with stent. The other two defects were of no haemodynamic importance and were not closed.^{Reference Patel, Shah, Chintala and Karpawich6} Baffle leaks were detected in 11 patients (15 leaks) during outpatient follow-up of 126 patients following atrial redirection surgery in another study. The mean age of the 11 patients was 26 years, and 10 were cyanosed at rest or during a simple walk test. All underwent transcatheter closure using either an occluding device or a covered stent in the presence of concomitant baffle obstruction.^{Reference Bentham, English, Hares, Gibbs and Thomson7} Most defects can easily closed by simple closure devices. The use of endografts to exclude Mustard baffle leaks was also reported in a patient with obstructed systemic baffles. In that report, a baffle leak without obstruction was managed by endograft by generating a three-dimensional printed model of the complex anatomy.^{Reference Porras, Mitsouras and Steigner8} There have also been brief reports describing successful Amplatzer septal occluder use for this procedure in some adult patients, because the Amplatzer septal occluder is easy to deploy and recapture prior to release from the delivery system.^{Reference Schneider and Moore9,Reference Armstrong, Kwa, Bhat, Romick, Smith and Rogers10} Use of newer imaging methods, such as intra-cardiac echocardiography, may be useful for better visualisation during the procedure.^{Reference Armstrong, Kwa, Bhat, Romick, Smith and Rogers10}