Inadvertent complication of the Senning procedure

A 34-year-old man with complete transposition of the great arteries (D-TGA) presented for the first time to our clinic. He previously underwent balloon atrial septostomy (Rashkind procedure) early after birth followed by a Senning procedure at the age of 2 months together with ligation of a patent ductus arteriosus. He has been asymptomatic since his surgery. Transthoracic echocardiogram was technically challenging yet revealed a mildly dilated, hypertrophied systemic right ventricle with mild systolic dysfunction, normal subpulmonary left ventricular size and systolic function with no baffle leak or stenosis. No significant valvulopathy was noted (Movie). Cardiovascular magnetic resonance (CMR) and cardiac computed tomography (CCT) showed a moderately hypertrophied systemic right ventricle with normal systolic function (right ventricular ejection fraction 48%). The sub-pulmonic left ventricle was dilated with normal systolic function. Systemic venous baffles were patent. The pulmonary venous portion of the baffle was patent.