INTRODUCTION
In adult congenital patients with transposition of the great arteries (TGA) originally treated with the Mustard (atrial switch) procedure, long term complications include baffle stenosis, arrhythmias, and sudden death.1 The re-intervention rate for these patients is as high as 9.7%, with the most common reason being baffle stenosis.2 Permanent pacemakers are required in this patient population for management of symptomatic sinus node or AV node dysfunction and the presence of transvenous leads across the baffle can increase stenosis rates up to 58%.1,3 This report describes a case of multidisciplinary lead extraction and recanalization of an occluded superior vena cava (SVC) baffle using a mechanical rotating dilator sheath in a patient with a prior Mustard procedure and retained left atrium (LA) pacemaker lead.