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Sandhya R, Nazia H, Angira P, Andrada P, Joseph C, Paul T. 3D Echocardiographic and Computed Tomographic Angiography Guidance for Percutaneous Closure of a Type II (Intermediate) Aortopulmonary Window. Pediatr Cardiol 2024; 45:934-938. [PMID: 37823902 DOI: 10.1007/s00246-023-03293-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 08/29/2023] [Indexed: 10/13/2023]
Abstract
A 4-year-old female was diagnosed with Type II Aortopulmonary window after being seen for a murmur. By utilizing multimodality advanced imaging, including 2D and 3D echo, computed tomography (CTA) with semi-transparent overlay as a road map, we were able to preoperatively plan camera angles and device selection as well as close the defect percutaneously under echocardiography guidance. This report highlights the importance of a multimodality imaging approach to interventional procedures.
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Affiliation(s)
- Ramlogan Sandhya
- Ann and Robert H. Lurie Children's Hospital, 225 E Chicago Av, Chicago, IL, 60611, USA.
| | - Husain Nazia
- Ann and Robert H. Lurie Children's Hospital, 225 E Chicago Av, Chicago, IL, 60611, USA
| | - Patel Angira
- Ann and Robert H. Lurie Children's Hospital, 225 E Chicago Av, Chicago, IL, 60611, USA
| | - Popescu Andrada
- Ann and Robert H. Lurie Children's Hospital, 225 E Chicago Av, Chicago, IL, 60611, USA
| | - Camarda Joseph
- Ann and Robert H. Lurie Children's Hospital, 225 E Chicago Av, Chicago, IL, 60611, USA
| | - Tannous Paul
- Ann and Robert H. Lurie Children's Hospital, 225 E Chicago Av, Chicago, IL, 60611, USA
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Transcatheter closure of a large aortopulmonary window with the novel device Multifunctional occluder (Konar) under TEE guidance (A case report). J Cardiol Cases 2022; 25:370-372. [DOI: 10.1016/j.jccase.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/04/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
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Campos-Quintero A, García-Montes JA, Zabal-Cerdeira C, Cervantes-Salazar JL, Calderón-Colmenero J, Sandoval JP. Cierre transcatéter de la ventana aortopulmonar. ¿Vale la pena un método de cierre alternativo a la cirugía? Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Campos-Quintero A, García-Montes JA, Zabal-Cerdeira C, Cervantes-Salazar JL, Calderón-Colmenero J, Sandoval JP. Transcatheter Device Closure of Aortopulmonary Window. Is There a Need for an Alternative Strategy to Surgery? ACTA ACUST UNITED AC 2018; 72:349-351. [PMID: 29844004 DOI: 10.1016/j.rec.2018.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/16/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Aldo Campos-Quintero
- Departamento de Cardiología Intervencionista en Cardiopatías Congénitas, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - José Antonio García-Montes
- Departamento de Cardiología Intervencionista en Cardiopatías Congénitas, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Carlos Zabal-Cerdeira
- Departamento de Cardiología Intervencionista en Cardiopatías Congénitas, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Jorge Luis Cervantes-Salazar
- Departamento de Cirugía Cardiovascular en Cardiopatías Congénitas, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Juan Calderón-Colmenero
- Departamento de Cardiología Intervencionista en Cardiopatías Congénitas, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Juan Pablo Sandoval
- Departamento de Cardiología Intervencionista en Cardiopatías Congénitas, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
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Diagnosis and surgical treatment of aortopulmonary window: Our single-center experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:30-37. [PMID: 32082708 DOI: 10.5606/tgkdc.dergisi.2018.14772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 10/02/2017] [Indexed: 11/21/2022]
Abstract
Background In this study, we aimed to report our single-center experience in aortopulmonary window and review clinical signs, symptoms, surgical correction techniques, and long-term outcomes. Methods We retrospectively reviewed the medical records of a total of 30 patients who were followed with the diagnosis of aortopulmonary window in our hospital between May 1998 and June 2016. The clinical characteristics of the patients, echocardiographic and angiographic findings, surgical treatment outcomes, and medical problems during follow-up were reviewed. Results The most common signs and symptoms were murmur, dyspnea, tachypnea, growth retardation, and signs of congestive heart failure. The mean age at the time of surgery was 8.2±14.4 months (7 days to 60 months). Eighteen patients (60%) had additional congenital cardiac anomalies. Eleven patients had simple congenital heart diseases, and seven patients had complex congenital heart diseases. Four patients were unable to be operated due to Eisenmenger syndrome (n=3) and complex congenital heart disease (n=1). No early or late postoperative death was observed. The mean follow-up was 6.4±4.8 years (range, 5 months to 16 years). In addition to aortopulmonary window repair, an additional cardiac anomaly modifying surgical intervention was corrected in nine patients (34.6%). One patient was reoperated for residual aortopulmonary window and another patient for pulmonary stenosis (valvular, supravalvar) after three years. One of these patients underwent pulmonary balloon valvuloplasty after two years. The reoperation rate was 7.7% (n=2) during follow-up. Conclusion Aortopulmonary window is a rare cardiac anomaly which may be overlooked by echocardiographic study, and which is amenable for repair with low-surgical risk. It is, therefore, imperative to diagnose and treat this condition, before pulmonary vascular disease develops.
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Xu HX, Zheng DD, Pan M, Li XF. Transcatheter Treatment of Aortopulmonary Window with a Symmetrical Membranous Ventricular Septal Occluder. Cardiology 2017; 138:76-79. [PMID: 28609765 DOI: 10.1159/000475706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 11/19/2022]
Abstract
Aortopulmonary window (APW), the presence of a communication between aorta and pulmonary artery, is a rare congenital heart disease, and surgical intervention is the standard for closure. Recently, several cases have been treated with transcatheter device occluders. Here, we report an APW patient treated successfully using a transcatheter closure with a symmetrical membranous ventricular septal occluder. We are the first to report on a case treated with this type of occluder for APW.
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Affiliation(s)
- Hai-Xia Xu
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, China
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El-Saiedi SA, Attia WA, Sobhy R. Transcatheter Repair of Congenital Heart Defects in the Young. EUROPEAN MEDICAL JOURNAL 2017. [DOI: 10.33590/emj/10313512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
In recent decades, tremendous medical advances have been made. Therapeutic cardiac catheterisation for repair of congenital heart defects has become the standard mode of therapy. Catheter techniques have progressed. They now provide temporary palliation, prepare the patient for surgical reconstruction, or offer a definitive repair. The main advantages of non-surgical procedures are avoidance of thoracotomy and cardiopulmonary bypass, together with a shorter hospitalisation period and speedier convalescence.
Paediatric interventions include: transcatheter device closure of congenital cardiac defects, balloon angioplasty and valvuloplasty, atrial septostomy, patent ductus arteriosus stenting in the neonatal period, vessel embolisation, and many others. Topping those interventions is the introduction of transcatheter valve replacement. The aim of this article is to review these interventions and present them in a simplified, vibrant, and up-to-date fashion.
In conclusion, paediatric cardiac interventions have established their reliability and ever-expanding scope in the setting of congenital heart disease management. Nevertheless, success is dependent on selecting the proper procedure for each condition, which may also vary with each patient. Thus, it is highly dependent on the experience and expertise of the operator. With the current rate of technological innovation, more and more surgical procedures will eventually be replaced by catheter-based interventions with a great degree of safety and efficacy.
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Affiliation(s)
- Sonia A. El-Saiedi
- Division of Pediatric Cardiology, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Wael A. Attia
- Division of Pediatric Cardiology, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Rodina Sobhy
- Division of Pediatric Cardiology, Department of Pediatrics, Cairo University, Cairo, Egypt
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Chellappan S, Katewa A, Sathe YC. Transesophageal Echocardiography in a Distal Aortopulmonary Window. J Cardiovasc Echogr 2016; 26:131-134. [PMID: 28465980 PMCID: PMC5224664 DOI: 10.4103/2211-4122.192182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aortopulmonary window (APW) is a relatively rare cardiac lesion representing approximately 0.2%–0.4% of all cardiac malformation. It is a cardiac abnormality that results from abnormal communication between the proximal aorta and the main pulmonary artery in the presence of two normally separated aortic and pulmonary valves. In the past, the diagnostic and surgical approach to APW was almost always preceded by cardiac catheterization. With recent advances in noninvasive approach and techniques of two-dimensional echocardiography diagnosis of the defect and associated anomalies are facilitated without a cath study. We report a 4-month-old infant with a distal APW who was referred to our center for surgical repair. We emphasize the usage of transesophageal echocardiography as a valuable intraoperative tool which not only confirms the preoperative diagnosis but also helps in assessing the surgical repair of an APW.
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Affiliation(s)
- Subramanian Chellappan
- Department of Pediatric Cardiac Anaesthesia, Sri Sathya Sai Sanjeevani Hospital, Naya Raipur, Chhattisgarh, India
| | - Ashish Katewa
- Department of Pediatric Cardiac Anaesthesia, Sri Sathya Sai Sanjeevani Hospital, Naya Raipur, Chhattisgarh, India
| | - Yogesh C Sathe
- Department of Pediatric Cardiology, Sri Sathya Sai Sanjeevani Hospital, Naya Raipur, Chhattisgarh, India
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Demir IH, Erdem A, Sarıtaş T, Demir F, Erol N, Yücel IK, Aydemir NA, Celebi A. Diagnosis, treatment and outcomes of patients with aortopulmonary window. Balkan Med J 2013; 30:191-6. [PMID: 25207099 DOI: 10.5152/balkanmedj.2013.6995] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 12/27/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Aortopulmonary window (APW) is a communication between the ascending aorta and the pulmonary artery in the presence of two separate semilunar valves and is the rarest of septal defects. AIMS To present our experience with the diagnosis and outcome of APW cases. STUDY DESIGN Retrospective cohort study. METHODS Between June 2003 and October 2011, thirteen patients were diagnosed with APW. Clinical features of patients, findings of echocardiographic and angiographic examination, results of surgical intervention and follow-up were reviewed retrospectively. RESULTS Eleven children (10 days to 16 years), underwent surgical correction of APW. In a 12-month-old boy, the defect was repaired by the transcatheter approach. In addition to APW repair, closure of VSD was performed in 2 patients. APW were associated with interruption in two patients; one also had a complex pathology. None of the patients died due to complications of surgical or transcatheter procedures. After a median follow-up period of 40 months, the patients were asymptomatic and none of them required additional medication, except for the patient with complex pathology including an interrupted aortic arch, who underwent balloon angioplasty for recoarctation. CONCLUSION In any infant with the findings of congestive heart failure and failure to thrive, APW must be kept in mind as a differential diagnosis. In isolated APW cases before 6 months of age, echocardiography is often sufficient for diagnosis. In complex cases, cardiac catheterisation is performed for the comprehensive evaluation of associated defects. After 6 months, cardiac catheterisation could be utilised to perform vasoreactivity testing and, if possible, to close the defect.
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Affiliation(s)
- Ibrahim Halil Demir
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Abdullah Erdem
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Türkay Sarıtaş
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Fadli Demir
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Nurdan Erol
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ilker Kemal Yücel
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Numan Ali Aydemir
- Department of Pediatric Cardiac Surgery, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Ahmet Celebi
- Department of Pediatric Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
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Abstract
One of the rarest congenital heart diseases that results from a defect between the main pulmonary artery and the proximal aorta is named aortopulmonary window (APW). Such abnormality could be isolated, but in fifty percent of patients may be associated with other cardiac abnormalities, including arch abnormalities, specifically coarctation of the aorta, interrupted aortic arch, tetralogy of fallot, and atrial septal defect (ASD). Surgical closure or catheter-delivered devices is recommended in all patients with APW and should be performed after diagnosis as soon as possible to prevent irreversible pulmonary vascular disease. In the current era, early mortality following repair of simple APW is low and depends on the presence of associated lesions, especially interrupted aortic arch. We report an 8-month-old boy with APW who was referred to our center by respiratory symptoms and heart murmurs.
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Affiliation(s)
- Mehdi Ghaderian
- Department of Paediatric Cardiology, Golestan Medical, Educational and Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Prem Sekar R, Bhima Shankar PR, Cherian KM. Transcatheter closure of a residual aortopulmonary window through internal jugular vein access. Indian Heart J 2012; 64:521-3. [PMID: 23102395 DOI: 10.1016/j.ihj.2012.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/09/2012] [Accepted: 07/17/2012] [Indexed: 11/15/2022] Open
Abstract
The use of Amplatzer septal occluder for closing a residual aortopulmonary defect has been described. This is usually performed by femoral access. We report closure of a residual aortopulmonary defect using right internal jugular vein access in a patient who had no femoral access as a result of previous cannulation for surgical repair. The 1 cm defect was closed successfully using a 10 mm Amplatzer septal occluder. Technical difficulty anticipated was unfounded although it was more cumbersome than femoral access. Left to right cardiac defects including PDA and AP window are amenable to transcatheter closure through internal jugular vein access.
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Affiliation(s)
- R Prem Sekar
- Frontier Lifeline & Dr K M Cherian Heart Foundation, Mogappair, Tamilnadu, India
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Abstract
We present two procedures of transcatheter closure: that of an aorto-pulmonary window in a 12-month-old infant with a body weight of 7 kilograms, and that of ruptured sinus of Valsalva aneurysm into the right atrium in an adult patient. In the first case, we applied the muscular ventricular septal defect Cardio-O-Fix, while in the other we applied the patent ductus arteriosus Cardio-O-Fix occluder. The procedures were successful in both patients, and we achieved complete closure of the unwanted shunts.
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Fischer G, Smevik B, Novoa JCR, Suáres FJO, Kramer HH, Bjørnstad PG. Catheter-based treatment with the Amplatzer® devices in alien positions. Catheter Cardiovasc Interv 2009; 73:669-75. [DOI: 10.1002/ccd.21899] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Trehan V, Nigam A, Tyagi S. Percutaneous closure of nonrestrictive aortopulmonary window in three infants. Catheter Cardiovasc Interv 2008; 71:405-11. [DOI: 10.1002/ccd.21366] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Hernández-García JM, Alonso-Briales JH, Jiménez-Navarro MF, Cabrera-Bueno F, González-Cocina E, Such-Martínez M. Cierre percutáneo de una fístula entre aorta y aurícula izquierda mediante dispositivo Amplatzer. Rev Esp Cardiol 2005. [DOI: 10.1157/13078559] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Cabalka AK, Hagler DJ, Mookadam F, Chandrasekaran K, Wright RS. Percutaneous closure of left ventricular-to-right atrial fistula after prosthetic mitral valve rereplacement using the Amplatzer duct occluder. Catheter Cardiovasc Interv 2005; 64:522-7. [PMID: 15789381 DOI: 10.1002/ccd.20310] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A 70-year-old female with a history of rheumatic heart disease underwent rereplacement of mitral valve mechanical prosthesis in May 2003. Seven months later, she presented with progressive exertional dyspnea, exercise intolerance, and a new holosystolic/diastolic murmur. Echocardiography confirmed a large shunt through a fistula in the inferior limbus of the atrial septum with left ventricular-to-right atrial communication. We report the novel use of the Amplatzer duct occluder for closure of the fistulous tract.
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Affiliation(s)
- Allison K Cabalka
- Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN 55905, USA.
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Abstract
The Cardioseal/Starflex septal occluder is usually deployed through a long transvenous sheath for closure of atrial septal defects, persistent foramen ovale, and, less commonly, ventricular septal defects. We describe two patients with residual left-to-right shunting after surgical palliation of congenital heart defects and illustrate the successful use of the double-umbrella device in these situations using a retrograde transarterial approach. This is exemplified by two previously not described interventions: retrograde closure of a large muscular ventricular septal defect in a patient after a palliative Mustard operation and a transcatheter closure of a Waterston-Cooley anastomosis. Effective and safe closure of left-to-right shunting can be achieved by retrograde use of the Cardioseal/Starflex device in selected adolescents and grown-ups with congenital heart disease.
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Affiliation(s)
- Christian Jux
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Georg-August University Goettingen, Germany.
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Bagtharia R, Trivedi KR, Burkhart HM, Williams WG, Freedom RM, Van Arsdell GS, McCrindle BW. Outcomes for patients with an aortopulmonary window, and the impact of associated cardiovascular lesions. Cardiol Young 2004; 14:473-80. [PMID: 15680067 DOI: 10.1017/s1047951104005025] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An aortopulmonary window is a communication between the ascending aorta and pulmonary trunk in the presence of two separate arterial valves, and is often complicated by other associated defects. We sought to determine management and related outcomes in patients with this malformation. We identified those patients presenting between 1969 and 1999 from the databases held in our Departments of Cardiology, Pathology and Cardiovascular Surgery. We obtained data relating to issues concerning demography, clinical findings, imaging, management and outcome. The median age at presentation for the 42 patients identified, of whom 23 were female, was 62 days, with a range from birth to 6 years. Associated cardiac defects were present in 34 patients, including interruption of the aortic arch in 6 patients. The correct diagnosis was initially missed in 13 patients. Of the patients, six died without surgical repair, and 1 patient was lost-to-follow-up. Repair was performed in 35 patients, subsequent to repair of other defects in 4, in association with repair of other defects in 17, of whom 3 died, and as an isolated procedure in 14 patients, one of the latter being treated by transcatheter closure. Overall, there were 9 deaths, all in patients with complex associated defects, except 1 patient with a missed aortopulmonary window after repair of aortic coarctation. Kaplan-Meier estimates of survival were 81% at 3 months until 11.5 years, and 69% up to 21 years. Only the presence of interrupted aortic arch was independently associated with increased time-related mortality, the hazard ratio being 5.87 (p = 0.009). The outcome for an isolated lesion is excellent. Mortality occurs mainly before repair, mostly with complex associated lesions, particularly interruption of the aortic arch.
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Affiliation(s)
- Rajesh Bagtharia
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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