# Transcatheter management of obstructed baffle repairs of partial anomalous pulmonary veins: a case series

## TL;DR

This case series explores using drug-coated balloons and stents to treat blocked heart baffles in patients with a specific heart defect, aiming to prevent serious complications.

## Contribution

The study presents a novel interventional approach using drug-coated balloons for managing obstructed PAPVR baffles.

## Key findings

- Drug-coated balloon angioplasty and stenting improved baffle flow in three patients with obstructed PAPVR baffles.
- Post-intervention, lung perfusion improved as shown by nuclear medicine scintigraphy.
- Early detection and intervention can prevent right heart dysfunction and pulmonary hypertension.

## Abstract

Partial anomalous pulmonary venous return (PAPVR) can be surgically corrected using a pericardial baffle. This baffle can become obstructed post-surgery, leading to pulmonary hypertension and right heart dysfunction if not detected and corrected.

We describe three patients with occluded PAPVR baffles who underwent drug-coated balloon angioplasty and stenting of the obstructed baffle. In each case, baffle obstruction was detected post-operatively on surveillance cross-sectional imaging, and an invasively measured pulmonary capillary wedge-to-left atrium gradient was noted to be elevated. Post-intervention, each patient had an improvement in baffle flow by angiography as well as lung perfusion as assessed by nuclear medicine scintigraphy.

Given the subtle symptomatology of obstructed PAPVR pericardial baffle repairs, surveillance imaging is necessary to detect occluded baffles and intervene before downstream right heart disease and pulmonary hypertension develops. Given the high rates of re-stenosis in pulmonary vein stenting, pre-treatment of occluded PAPVR baffles with drug-coated balloons may help reduce re-intervention rates.