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Gužvinec P, Muscogiuri G, Hrabak-Paar M. CT Assessment of Aortopulmonary Septal Defect: How to Approach It? J Clin Med 2024; 13:3513. [PMID: 38930042 PMCID: PMC11204932 DOI: 10.3390/jcm13123513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
An aortopulmonary septal defect or aortopulmonary window (APW) is a rare cardiovascular anomaly with direct communication between the ascending aorta and the main pulmonary artery leading to a left-to-right shunt. It is accompanied by other cardiovascular anomalies in approximately half of patients. In order to avoid irreversible sequelae, interventional or surgical treatment should be performed as soon as possible. Cardiovascular CT, as a fast, non-invasive technique with excellent spatial resolution, has an increasing role in the evaluation of patients with APW, enabling precise and detailed planning of surgical treatment of APW and associated anomalies if present. This article aims to review the anatomical and clinical features of aortopulmonary septal defect with special emphasis on its detection and characterization by a CT examination.
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Affiliation(s)
| | | | - Maja Hrabak-Paar
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- University Hospital Center Zagreb, 10000 Zagreb, Croatia
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Ji Y, Kang J, Heo S, Lee K, Yoon H. Case report: Echocardiographic and computed tomographic features of congenital bronchoesophageal artery hypertrophy and fistula in a dog. Front Vet Sci 2024; 11:1400076. [PMID: 38840636 PMCID: PMC11150795 DOI: 10.3389/fvets.2024.1400076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/30/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Studies on aberrant bronchoesophageal arteries are limited. Herein, we report a case of a multi-origin systemic-to-pulmonary shunt with suspected bronchoesophageal artery hypertrophy and fistula in a dog. Case report A 4-year-old castrated male beagle weighing 11 kg underwent routine medical screening. Physical examination revealed a right-sided continuous murmur of grades 1-2. Thoracic radiography revealed a mild cardiomegaly. Echocardiography revealed a continuous turbulent shunt flow distal to the right pulmonary artery (RPA) branch from the right parasternal short axis pulmonary artery view. Computed tomography demonstrated systemic-to-pulmonary shunts originating from the descending aorta at the level of T7-8, the right 5th and 6th dorsal intercostal arteries, and the right brachiocephalic trunk, which formed anomalous networks around the trachea and esophagus that anastomosed into a large tortuous vessel at the level of T6-7 and entered the RPA. Surgical ligation of multiple shunting vessels was performed. Postoperative echocardiography and computed tomography showed decreased left ventricular volume overload and markedly decreased size of the varices. Additionally, most of the shunting vessels were without residual shunt flow. Conclusion The present study provides information regarding imaging features and the successful surgical management of multiple systemic-to-pulmonary shunts originating from the descending aorta, right brachiocephalic trunk, and intercostal arteries and terminating at the RPA. Multimodal imaging features after surgical ligation have also been described.
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Affiliation(s)
- Yewon Ji
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Jinsu Kang
- Department of Veterinary Surgery, College of Veterinary Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Suyoung Heo
- Department of Surgery, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Kichang Lee
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
| | - Hakyoung Yoon
- Department of Veterinary Medical Imaging, College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
- Biosafety Research Institute and College of Veterinary Medicine, Jeonbuk National University, Iksan, Republic of Korea
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Kalustian AB, Tang RC, Imamura M. Operative Repair of Aortopulmonary Window: A 25-Year Experience. World J Pediatr Congenit Heart Surg 2024:21501351241235959. [PMID: 38646828 DOI: 10.1177/21501351241235959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background: Aortopulmonary window (APW) is a rare anomaly with variable morphology and associated cardiac anomalies. We evaluated impact of patient and operative factors on mid-term outcomes following APW repair. Methods: Twenty-nine patients underwent surgical APW repair at our institution from 1996 to 2022. Eight (28%) had simple APW, accompanied by only atrial septal defect or patent ductus arteriosus; 21 (72%) had complex APW with additional cardiovascular lesions, including nine with interrupted aortic arch. Median operative age was 19 days (range 2 days-1.5 years) via single-patch (n = 12, 41%), double-patch (n = 15, 52%), or ligation and division (n = 2, 7%). Results: The only mortality occurred in-hospital 1.4 years postoperatively following remote myocardial infarction. Factors associated with longer postoperative length of stay were complex APW (P = .003), genetic syndrome (P = .003), noncardiovascular comorbidities (P = .002), lower birth weight (P = .03), and lower operative weight (P = .03). Six patients (21%) with complex APW underwent unplanned cardiothoracic reintervention(s), including two with arch reintervention following arch advancement for interruption. Reintervention-free survival was similar for simple versus complex APW, operative age categories, and repair techniques. At median follow-up 5.5 years postoperatively, no patients had residual APW or persistent pulmonary hypertension, 1 (3%) had greater than mild ventricular dysfunction, and 25 (89% survivors) had NYHA class I functional status. Conclusions: Operative APW repair has excellent mid-term survival, durability, and functional status, regardless of operative age, cardiovascular comorbidities, or repair technique. Cardiac and noncardiac comorbidities may be associated with prolonged length of stay.
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Affiliation(s)
- Alyssa B Kalustian
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Richard C Tang
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Michiaki Imamura
- Division of Congenital Heart Surgery, Department of Surgery, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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Nagashima T, Taira M, Hasegawa M, Kugo Y, Watanabe T, Yoshioka D, Shimamura K, Ueno T, Miyagawa S. Pseudoaneurysm after aortopulmonary window repair and bilateral lung transplantation for eisenmenger syndrome: a case report. J Cardiothorac Surg 2023; 18:201. [PMID: 37393254 DOI: 10.1186/s13019-023-02305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 06/10/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Aortopulmonary window (APW) is a rare congenital cardiac anomaly characterized by communication between the main pulmonary artery and ascending aorta. There are various surgical techniques, and the short- and long-term results are excellent if the surgical repair is performed early in life. To our knowledge, there have been no reports of pseudoaneurysm after APW repair. Herein, we present a case of a 30-year-old woman with an ascending aortic pseudoaneurysm found at the site of APW repair nine months after the APW repair and bilateral lung transplantation. CASE PRESENTATIONS A 30-year-old woman presented with APW and Eisenmenger syndrome. The patient underwent APW repair and bilateral lung transplantation. We transected the communication between the aorta and pulmonary artery and closed the aortic side directly with strips of felts. Nine months after the surgery, the patient complained of chest pain. Cardiac computed tomography revealed an ascending aortic pseudoaneurysm at the anastomotic site. Emergent graft replacement of the ascending aorta was performed and the postoperative course was uneventful. CONCLUSIONS We have presented a case of a pseudoaneurysm at the anastomotic site after APW repair and bilateral lung transplantation. The choice of surgical technique should be based on the patient's background requiring lung transplantation, and in these cases close postoperative follow-up is required.
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Affiliation(s)
- Toshiaki Nagashima
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, 565-0871, Osaka, Japan
| | - Masaki Taira
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, 565-0871, Osaka, Japan.
| | - Moyu Hasegawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, 565-0871, Osaka, Japan
| | - Yosuke Kugo
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, 565-0871, Osaka, Japan
| | - Takuji Watanabe
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, 565-0871, Osaka, Japan
| | - Daisuke Yoshioka
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, 565-0871, Osaka, Japan
| | - Kazuo Shimamura
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, 565-0871, Osaka, Japan
| | - Takayoshi Ueno
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, 565-0871, Osaka, Japan
| | - Shigeru Miyagawa
- Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-Oka, Suita, 565-0871, Osaka, Japan
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Verma M, Pandey NN, Ramakrishnan S, Jagia P. Evaluation of aortopulmonary window using virtual dissection of multidetector computed tomography angiography data sets. J Card Surg 2022; 37:4475-4484. [PMID: 36321703 DOI: 10.1111/jocs.17075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/14/2022] [Accepted: 09/10/2022] [Indexed: 11/06/2022]
Abstract
AIM The present study sought to evaluate the morphology and associated cardiovascular anomalies in patients with aortopulmonary window on virtual dissection of multidetector computed tomography (CT) angiography data sets. MATERIAL AND METHODS We conducted a retrospective search of our departmental database from January 2014 to September 2021 to identify patients with aortopulmonary window and relevant information was extracted from the electronic case records and from routine examination as well as virtual dissection of CT data sets. RESULTS An aortopulmonary window was observed in 26 patients (20 males; 6 females). Based on location of the defect, a distal aortopulmonary window was the most common subtype, seen in 13/26 (50%) patients followed by a proximal, complete and intermediate subtypes seen in 7/26 (27%), 5/26 (19%) and 1/26 (4%) patients respectively. Associated ventricular septal defect was observed in 9/26 (34.6%) patients while an interrupted aortic arch was present in 5/26 (19.2%) patients. Tetralogy of Fallot was seen in 5/26 (19.2%) patients. Anomalous origin of right pulmonary artery from ascending aorta and crossed pulmonary arteries were seen in 2/26 (7.6%) patients each. An isolated aortopulmonary window without any simple/complex congenital anomaly was seen in 10/26 (38.5%) patients. CONCLUSION Aortopulmonary window is associated with a wide gamut of cardiovascular lesions, with ventricular septal defect being the commonest associated anomaly followed by tetralogy of Fallot and interrupted aortic arch respectively. Virtual dissection of multidetector CT angiography allows detailed anatomical evaluation of aortopulmonary window, allowing a clear visualization of the defect and associated cardiovascular anomalies.
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Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | | | - Priya Jagia
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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Özdemir Şahan Y, Ecevit AN, Gürsu HA, Aydın NH, Çetin İİ. Tetralogy of Fallot with double aortic arch and aortopulmonary window: a very rare trifecta. Cardiol Young 2022; 33:1-3. [PMID: 36348619 DOI: 10.1017/s1047951122003328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Tetralogy of Fallot with an aortopulmonary window and double aortic arch is very rare. This complex coexistence may be over a wide clinical spectrum. Herein, we present an asymptomatic 8-day-old infant who was diagnosed as having tetralogy of Fallot, double aortic arch, and an aortopulmonary window using transthoracic echocardiography while being examined for microcephaly.
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Affiliation(s)
- Yasemin Özdemir Şahan
- Department of Pediatric Cardiology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ata Niyazi Ecevit
- Department of Pediatric Cardiovascular Surgery, Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Hazım Alper Gürsu
- Department of Pediatric Cardiology, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - Nuri Hakan Aydın
- Department of Pediatric Cardiovascular Surgery, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
| | - İbrahim İlker Çetin
- Department of Pediatric Cardiology, Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
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Chowdhury UK, George N, B. S, Chandhirasekar B, Goja S, Manjusha N, Pandey NN, Kapoor PM. Technical Details of Transwindow Fenestrated, Unidirectional, Valved, Aorticopulmonary Fabric Patch Closure of Aortopulmonary Window (UKC's Modification): A Video Presentation. JOURNAL OF CARDIAC CRITICAL CARE TSS 2022. [DOI: 10.1055/s-0042-1759805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
AbstractA 10-year-old female patient diagnosed with isolated type I aortopulmonary window and severe pulmonary arterial hypertension who underwent repair of the aortopulmonary window via Johansson's transwindow approach using a unidirectional, fenestrated, valved, aorticopulmonary patch. The preoperative pulmonary vascular resistance was 9.0 Woods units/m2 that reduced to 4.0 Woods units/m2 after oxygen (100%) and nitric oxide (80 ppm) administration. The postoperative recovery was uneventful.
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Affiliation(s)
- Ujjwal K. Chowdhury
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niwin George
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sushamagayatri B.
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Balaji Chandhirasekar
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shikha Goja
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Nagasai Manjusha
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiac Radiology, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Poonam Malhotra Kapoor
- Department of Cardiac Anaesthesia, Cardiothoracic Sciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Cui H, Yang Y, Qiu H, Cen J, Wen S, Zhuang J, Chen J. Pulmonary artery reconstruction and correction of tetralogy of Fallot combined with the absence of the mediastinal left pulmonary artery. J Card Surg 2022; 37:2285-2291. [PMID: 35526149 DOI: 10.1111/jocs.16588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/22/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Tetralogy of Fallot (TOF) is the most common deformity combined with the unilateral absence of the mediastinal pulmonary artery (UAMPA), and its treatment strategy remains controversial. In this study, we analyzed the effect of bilateral pulmonary reconstruction in patients with TOF combined with UAMPA. METHODS This was a single-center, retrospective review of 1713 patients with TOF between January 2009 and November 2021. Overall, eight patients were diagnosed with TOF combined with UAMPA. Among them, seven underwent surgery: three underwent one-stage TOF correction with bilateral pulmonary artery reconstruction; three patients underwent bilateral pulmonary artery reconstruction, followed by two-stage TOF correction after several months; and one patient underwent two procedures of left pulmonary artery reconstruction, and the ventral septal defect remained open. The left pulmonary arteries were reconstructed with a Goretex conduit in three cases, direct anastomosis in two cases, and the modified autologous tissue extension technique in two cases. RESULTS All seven patients survived during the postoperative follow-up and showed good cardiac function and normal oxygen saturation of >97%. During follow-up echocardiography, we noted that the left pulmonary arteries reconstructed with a Goretex conduit or direct anastomosis had thrombosis or stenosis. However, those reconstructed using the modified autologous tissue extension technique was unobstructed. CONCLUSIONS In patients with TOF and UAMPA, if there is a pulmonary artery confluence in the affected hilum, it is feasible to implement bilateral pulmonary artery reconstruction for one-stage TOF correction. The use of the pulmonary artery extension technique and autologous tissue for bilateral pulmonary reconstruction could reduce the incidence of anastomotic stenosis.
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Affiliation(s)
- Hujun Cui
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yongchao Yang
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hailong Qiu
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jianzheng Cen
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shusheng Wen
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jian Zhuang
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jimei Chen
- Department of Cardiac Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Reddy C, Kaskar A, Karthick E, Siddaiah S, Kiran VS, Suresh P. Surgical Management of Aortopulmonary Window and its Associated Cardiac Lesions. World J Pediatr Congenit Heart Surg 2022; 13:334-340. [PMID: 35446205 DOI: 10.1177/21501351221077888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The aim of this study was to review our institutional experience with patients who underwent surgical repair of aortopulmonary window, either as an isolated lesion or in association with other cardiac anomalies. Methods: Between January 2006 and December 2020, 183 patients underwent surgical repair of aortopulmonary window at our institute. Sixty-three patients had associated lesions (Group 1); 120 patients had isolated aortopulmonary window (Group 2). Median age was 7 months. Results: The early mortality in Group 1 was significantly higher (12.7%) compared to Group 2 (0.8%) (P = .001). The most common associated anomaly was ventricular septal defect (29 patients). On univariable analysis, cardiopulmonary bypass time (P < .001), aortic cross-clamp time (P < .001), delayed chest closure (P = .02), sepsis (P = .006), tracheostomy (P = .002), extracorporeal membrane oxygenation (P < .001), associated lesions (P = .001), pulmonary artery hypertensive crisis (P < .001) were predictors for early mortality. On multivariable analysis only pulmonary artery hypertensive crisis was identified as predictor for early mortality (P = .03; odds ratio = 24). Survival at both 5 years and 8 years was 77% ± 6.5 in Group 1 and 98.8% ± 1.2 in Group 2 (P≤.001). Freedom from reintervention at both 5 years and 8 years was 92.4% ± 5.2 in Group 1 and 100% in Group 2 (P = .055). Conclusion: Early outcomes of aortopulmonary window repair are excellent among patients in which this is an isolated lesion, as compared to those with associated lesions. Long-term outcomes in terms of freedom from reoperation are excellent in both the groups.
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Affiliation(s)
- Chinnaswamy Reddy
- Department of Cardiothoracic Surgery, 501944Narayana Institute of Cardiac Sciences, Narayana Health, Bangalore, Karnataka, India
| | - Ameya Kaskar
- Department of Cardiothoracic Surgery, 501944Narayana Institute of Cardiac Sciences, Narayana Health, Bangalore, Karnataka, India
| | - Eswara Karthick
- Department of Cardiothoracic Surgery, 501944Narayana Institute of Cardiac Sciences, Narayana Health, Bangalore, Karnataka, India
| | - Satheesh Siddaiah
- Department of Pediatric Cardiology, 501944Narayana Institute of Cardiac Sciences, Narayana Health, Bangalore, Karnataka, India
| | - Viralam S Kiran
- Department of Pediatric Cardiology, 501944Narayana Institute of Cardiac Sciences, Narayana Health, Bangalore, Karnataka, India
| | - PujarVenkateshauarya Suresh
- Department of Pediatric Cardiology, 501944Narayana Institute of Cardiac Sciences, Narayana Health, Bangalore, Karnataka, India
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A Rare Case Report: Tetralogy of Fallot, Right Aortic Arch, Isolated Left Subclavian from Patent Ductus Arteriosus, Neonatal Aortopulmonary Window, and Hypoplastic Right Pulmonary Artery. JTCVS Tech 2022; 14:191-194. [PMID: 35967219 PMCID: PMC9366297 DOI: 10.1016/j.xjtc.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 03/30/2022] [Indexed: 11/23/2022] Open
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Martens T, Vandekerckhove K, Decaluwe W, François K, Bové T. Clipping of an Aortopulmonary Window in a Small Neonate With Bronchial Bleeding: A Simple Solution for a Complex Condition. World J Pediatr Congenit Heart Surg 2022; 13:791-793. [PMID: 35289208 DOI: 10.1177/21501351221083988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although the conventional treatment of aortopulmonary (AP) window consists of reconstructive surgery with the use of cardiopulmonary bypass (CPB), some conditions like low birth weight or active respiratory tract bleeding may lead to diverting therapeutic options. We present a case of a premature 1.9 kg neonate with severe pulmonary arterial hypertension based on the association of an AP window and large patent ductus arteriosus. Because of intrabronchial hemorrhage, a conservative strategy was chosen excluding the need for heparinization and CPB. Through median sternotomy, the ductus arteriosus and AP window were clipped, effectively occluding both shunts. The postoperative course was uneventful with a rapid decrease of pulmonary artery pressure. Although classical surgical reconstruction is still advocated as primary therapy, this case illustrates the suitability of an alternative approach without the need for CPB and full heparinization in a patient with an increased risk of bleeding complications.
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Affiliation(s)
- Thomas Martens
- 60200Department of Cardiac Surgery, Ghent University Hospital, Gent, Belgium
| | | | - Wim Decaluwe
- Department of Pediatric Cardiology, AZ Sint-Jan Brugge-Oostende AV, Brugge, Belgium
| | - Katrien François
- 60200Department of Cardiac Surgery, Ghent University Hospital, Gent, Belgium
| | - Thierry Bové
- 60200Department of Cardiac Surgery, Ghent University Hospital, Gent, Belgium
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Abstract
Tetralogy of Fallot with pulmonary atresia is a group of congenital cardiac malformations, which is defined by the absence of luminal continuity between both ventricles and the pulmonary artery, and an interventricular communication. Pulmonary arterial supply in patients with tetralogy of Fallot with pulmonary atresia can be via the arterial duct or from collateral arteries arising directly or indirectly from the aorta (systemic-to-pulmonary artery collaterals), or rarely both. The rarest sources of pulmonary blood flow are aortopulmonary window and fistulous communication with the coronary artery.Herein, we describe an outflow tract malformation, tetralogy of Fallot with pulmonary atresia and aortopulmonary window, which was misdiagnosed as common arterial trunk. We emphasise the morphological differences.
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13
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Kasielska-Trojan A, Święchowicz B, Antoszewski B. Coexistence of Thumb Aplasia and Cleft Lip and Alveolus with Aortopulmonary Window—A Tip for Prenatal Diagnostics for Rare Heart Anomalies. Diagnostics (Basel) 2022; 12:diagnostics12030569. [PMID: 35328123 PMCID: PMC8947534 DOI: 10.3390/diagnostics12030569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 11/16/2022] Open
Abstract
Multiple congenital anomaly syndromes pose a challenge to neonatologists, as many anomalies may indicate cryptogenic malformations or disorders. Aortopulmonary window (APW) is a very rare congenital heart disease (CHD) and causes many difficulties in prenatal diagnostics. In this report, we describe a case of a female patient with multiple rare congenital malformations: aortopulmonary window, right thumb aplasia, facial nerve palsy and cleft lip and alveolus. None of the malformations were diagnosed prenatally. A long-term follow-up (40 years) is presented. The presence of certain defects (thumb aplasia) may indicate the need for a careful fetal examination extended by a fetal ECHO performed in a reference center of prenatal cardiology. The coexistence or syndromic character of the presented malformations should be verified in future if more such cases are described.
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Kaushik PK, Dhabe V, Majhi L, Kaskar A, Paanwala H. Anomalous right coronary artery from pulmonary artery in aortopulmonary window. Indian J Thorac Cardiovasc Surg 2022; 38:415-417. [DOI: 10.1007/s12055-022-01334-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 11/29/2022] Open
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15
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Nyamande D, Mazibuko SM. Traumatic Aortopulmonary Fistula: An Acquired Type 1 Aortopulmonary Window. Ann Thorac Surg 2021; 114:e35-e37. [PMID: 34637766 DOI: 10.1016/j.athoracsur.2021.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Accepted: 09/02/2021] [Indexed: 11/01/2022]
Abstract
An acquired traumatic aortopulmonary window has not been previously reported. We report a case of an aortopulmonary fistula between the proximal ascending aorta and pulmonary trunk, which was missed on the initial hospital admission. The 26year old patient presented with high output cardiac failure and examination features of a diastolic runoff. Patch closure of the defect using a sandwich technique was undertaken, with resolution of symptoms.
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Affiliation(s)
- Dambuza Nyamande
- Department of Cardiothoracic Surgery, Sefako Makgatho Health Sciences University, South Africa.
| | - Siphosenkosi M Mazibuko
- Department of Cardiothoracic Surgery, Sefako Makgatho Health Sciences University, South Africa
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16
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Jacobs JP, Franklin RCG, Béland MJ, Spicer DE, Colan SD, Walters HL, Bailliard F, Houyel L, St Louis JD, Lopez L, Aiello VD, Gaynor JW, Krogmann ON, Kurosawa H, Maruszewski BJ, Stellin G, Weinberg PM, Jacobs ML, Boris JR, Cohen MS, Everett AD, Giroud JM, Guleserian KJ, Hughes ML, Juraszek AL, Seslar SP, Shepard CW, Srivastava S, Cook AC, Crucean A, Hernandez LE, Loomba RS, Rogers LS, Sanders SP, Savla JJ, Tierney ESS, Tretter JT, Wang L, Elliott MJ, Mavroudis C, Tchervenkov CI. Nomenclature for Pediatric and Congenital Cardiac Care: Unification of Clinical and Administrative Nomenclature - The 2021 International Paediatric and Congenital Cardiac Code (IPCCC) and the Eleventh Revision of the International Classification of Diseases (ICD-11). World J Pediatr Congenit Heart Surg 2021; 12:E1-E18. [PMID: 34304616 DOI: 10.1177/21501351211032919] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Substantial progress has been made in the standardization of nomenclature for paediatric and congenital cardiac care. In 1936, Maude Abbott published her Atlas of Congenital Cardiac Disease, which was the first formal attempt to classify congenital heart disease. The International Paediatric and Congenital Cardiac Code (IPCCC) is now utilized worldwide and has most recently become the paediatric and congenital cardiac component of the Eleventh Revision of the International Classification of Diseases (ICD-11). The most recent publication of the IPCCC was in 2017. This manuscript provides an updated 2021 version of the IPCCC. The International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD), in collaboration with the World Health Organization (WHO), developed the paediatric and congenital cardiac nomenclature that is now within the eleventh version of the International Classification of Diseases (ICD-11). This unification of IPCCC and ICD-11 is the IPCCC ICD-11 Nomenclature and is the first time that the clinical nomenclature for paediatric and congenital cardiac care and the administrative nomenclature for paediatric and congenital cardiac care are harmonized. The resultant congenital cardiac component of ICD-11 was increased from 29 congenital cardiac codes in ICD-9 and 73 congenital cardiac codes in ICD-10 to 318 codes submitted by ISNPCHD through 2018 for incorporation into ICD-11. After these 318 terms were incorporated into ICD-11 in 2018, the WHO ICD-11 team added an additional 49 terms, some of which are acceptable legacy terms from ICD-10, while others provide greater granularity than the ISNPCHD thought was originally acceptable. Thus, the total number of paediatric and congenital cardiac terms in ICD-11 is 367. In this manuscript, we describe and review the terminology, hierarchy, and definitions of the IPCCC ICD-11 Nomenclature. This article, therefore, presents a global system of nomenclature for paediatric and congenital cardiac care that unifies clinical and administrative nomenclature.The members of ISNPCHD realize that the nomenclature published in this manuscript will continue to evolve. The version of the IPCCC that was published in 2017 has evolved and changed, and it is now replaced by this 2021 version. In the future, ISNPCHD will again publish updated versions of IPCCC, as IPCCC continues to evolve.
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Affiliation(s)
- Jeffrey P Jacobs
- Congenital Heart Center, UF Health Shands Hospital, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida, United States of America
| | - Rodney C G Franklin
- Paediatric Cardiology Department, Royal Brompton & Harefield NHS Trust, London, United Kingdom
| | - Marie J Béland
- Division of Paediatric Cardiology, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Québec, Canada
| | - Diane E Spicer
- Congenital Heart Center, UF Health Shands Hospital, Division of Cardiovascular Surgery, Departments of Surgery and Pediatrics, University of Florida, Gainesville, Florida, United States of America.,Johns Hopkins All Children's Hospital, Johns Hopkins University, Saint Petersburg, Florida, United States of America
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, Harvard University, Boston, Massachusetts, United States of America
| | - Henry L Walters
- Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Frédérique Bailliard
- Bailliard Henry Pediatric Cardiology, Raleigh, North Carolina, United States of America.,Duke University, Durham, North Carolina, United States of America
| | - Lucile Houyel
- Congenital and Pediatric Medico-Surgical Unit, Necker Hospital-M3C, Paris, France
| | - James D St Louis
- Department of Surgery and Pediatrics, Children Hospital of Georgia, Augusta University, Augusta, Georgia
| | - Leo Lopez
- Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Vera D Aiello
- Heart Institute (InCor), University of São Paulo School of Medicine, São Paulo, Brazil
| | - J William Gaynor
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Otto N Krogmann
- Pediatric Cardiology-Congenital Heart Disease, Heart Center Duisburg, Duisburg, Germany
| | - Hiromi Kurosawa
- Cardiovascular Surgery, Tokyo Women's Medical University, Tokyo, Japan
| | - Bohdan J Maruszewski
- Department for Pediatric and Congenital Heart Surgery, Children's Memorial Health Institute, Warsaw, Poland
| | - Giovanni Stellin
- Pediatric and Congenital Cardiac Surgical Unit, Department of Cardiothoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Paul Morris Weinberg
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | | | - Jeffrey R Boris
- Jeffrey R. Boris, MD LLC, Moylan, Pennsylvania, United States of America
| | - Meryl S Cohen
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Allen D Everett
- Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Jorge M Giroud
- All Children's Hospital, Saint Petersburg, Florida, United States of America
| | - Kristine J Guleserian
- Congenital Heart Surgery, Medical City Children's Hospital, Dallas, Texas, United States of America
| | - Marina L Hughes
- Cardiology Department, Norfolk and Norwich University Hospital NHS Trust, United Kingdom
| | - Amy L Juraszek
- Terry Heart Institute, Wolfson Children's Hospital, Jacksonville, Florida, United States of America
| | - Stephen P Seslar
- Department of Pediatrics, Division of Pediatric Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington, United States of America
| | - Charles W Shepard
- Children's Heart Clinic of Minneapolis, Minneapolis, Minnesota, United States of America
| | - Shubhika Srivastava
- Division of Cardiology, Department of Cardiovascular Medicine, Nemours Cardiac Center at the Alfred I. duPont Hospital for Children, Wilmington, Delaware, United States of America
| | - Andrew C Cook
- Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Adrian Crucean
- Congenital Heart Surgery, Birmingham Women's and Children's Foundation Trust Hospital, University of Birmingham, Birmingham, United Kingdom
| | - Lazaro E Hernandez
- Joe DiMaggio Children's Hospital Heart Institute, Hollywood, Florida, United States of America
| | - Rohit S Loomba
- Advocate Children's Heart Institute, Advocate Children's Hospital, Oak Lawn, Illinois, United States of America
| | - Lindsay S Rogers
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Stephen P Sanders
- Cardiovascular Surgery, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan, United States of America
| | - Jill J Savla
- Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
| | - Elif Seda Selamet Tierney
- Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Justin T Tretter
- Department of Pediatrics, Heart Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States of America
| | - Lianyi Wang
- Heart Centre, First Hospital of Tsinghua University, Beijing, China
| | | | - Constantine Mavroudis
- Johns Hopkins University, Baltimore, Maryland, United States of America.,Peyton Manning Children's Hospital, Indianapolis, Indiana, United States of America
| | - Christo I Tchervenkov
- Division of Cardiovascular Surgery, The Montreal Children's Hospital of the McGill University Health Centre, Montréal, Québec, Canada
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17
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Thirunavukkarasu B, Kithan LS, Kumar N, Jain A, Bal A. Fatal outcome of congenital aortopulmonary window with patent ductus arteriosus complicating pregnancy. AUTOPSY AND CASE REPORTS 2021; 11:e2021265. [PMID: 33968832 PMCID: PMC8087394 DOI: 10.4322/acr.2021.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Aortopulmonary window (APW) is a rare congenital heart defect with abnormal communication between the ascending aorta and the pulmonary trunk with two separate semilunar valves. We present an autopsy case report wherein a young primigravida woman presented with progressive breathlessness and central cyanosis at 21 weeks of gestation. Echocardiography performed in the emergency room revealed elevated right-sided cardiac pressures suggestive of severe pulmonary hypertension; however, no structural cardiac defect was discernible. The patient succumbed to congestive cardiac failure and progressive hypoxia within 5 days of hospitalization. The autopsy revealed a Type I aortopulmonary window (2 cm) with patent ductus arteriosus. The lungs showed changes of severe pulmonary hypertension with superadded bronchopneumonia. This report underscores a rare presentation of APW, undiagnosed until pregnancy, leading to the Eisenmenger syndrome and death.
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Affiliation(s)
- Balamurugan Thirunavukkarasu
- Post Graduate Institute of Medical Education & Research (PGIMER), Departments of Histopathology, Chandigarh, India
| | - Lijanthung S Kithan
- Post Graduate Institute of Medical Education & Research (PGIMER), Departments of Histopathology, Chandigarh, India
| | - Nikhil Kumar
- Post Graduate Institute of Medical Education & Research (PGIMER), Departments of Internal Medicine, Chandigarh, India
| | - Arihant Jain
- Post Graduate Institute of Medical Education & Research (PGIMER), Departments of Internal Medicine, Chandigarh, India
| | - Amanjit Bal
- Post Graduate Institute of Medical Education & Research (PGIMER), Departments of Histopathology, Chandigarh, India
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18
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Chikkabyrappa S, Mahadevaiah G, Doshi AR, Lee J, Sagiv E, Buddhe S. Uncommon Association of Aortopulmonary Window in a Patient with Complex Univentricular Heart and CHARGE Syndrome. Kans J Med 2021; 14:48-50. [PMID: 33654544 PMCID: PMC7889068 DOI: 10.17161/kjm.vol1414591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/27/2020] [Indexed: 11/20/2022] Open
Affiliation(s)
- Sathish Chikkabyrappa
- Seattle Children's Hospital, Division of Pediatric Cardiology, Seattle, WA.,University of Washington School of Medicine, Seattle, WA
| | | | - Arpan R Doshi
- Children's Cardiology Associates, Pediatrix Medical Services, Inc., Houston, TX.,University of Houston College of Medicine, Houston, TX
| | - Joan Lee
- Seattle Children's Hospital, Division of Pediatric Cardiology, Seattle, WA.,University of Washington School of Medicine, Seattle, WA
| | - Eyal Sagiv
- Seattle Children's Hospital, Division of Pediatric Cardiology, Seattle, WA.,University of Washington School of Medicine, Seattle, WA
| | - Sujatha Buddhe
- Seattle Children's Hospital, Division of Pediatric Cardiology, Seattle, WA.,University of Washington School of Medicine, Seattle, WA
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19
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Transcatheter closure of the aortopulmonary window in a three-month-old infant with a symmetric membranous ventricular septal defect occluder device. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:101-104. [PMID: 33768987 PMCID: PMC7970074 DOI: 10.5606/tgkdc.dergisi.2021.20988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/01/2020] [Indexed: 11/21/2022]
Abstract
Although most of aortopulmonary window cases are closed surgically, percutaneous closure can be also used in suitable patients. Defects which are far from the pulmonary and aortic valves, coronary artery, and pulmonary artery bifurcation, with adequate septal rims are considered suitable for percutaneous closure. A three-month-old male infant weighing 4 kg was referred to our pediatric cardiology department with the complaints of fatigue while breastfeeding, difficulty in weight gain, heart murmur, and respiratory distress. A large aortopulmonary window (5.3 mm) and left heart chamber dilatation were detected on echocardiography. The large aortopulmonary window was closed using a symmetric membranous ventricular septal defect occluder device. The closure procedure was performed via the antegrade route without forming an arteriovenous loop. In conclusion, the use of a symmetric membranous ventricular septal defect device for closure of large aortopulmonary window seems to be a safe and effective alternative to surgery in selected infants.
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20
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Anomalous Left-to-Right Shunting Vessel between the Ascending Aorta and Right Pulmonary Artery and Concurrent Left Peripheral Pulmonary Artery Stenosis in a Dog. CASE 2020; 4:534-539. [PMID: 33376849 PMCID: PMC7756180 DOI: 10.1016/j.case.2020.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Atypical appearance of continuous shunting vessel warrants further characterization. A type III PFAA has not been previously suspected in dogs. Unilateral pulmonary artery stenosis may not impose significant pressure overload.
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21
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Fukumoto Y, Hosoba S, Takagi S, Goto Y. Relapse of aortopulmonary window 41 years after patch closure. Eur J Cardiothorac Surg 2020; 57:1218-1220. [PMID: 31750891 DOI: 10.1093/ejcts/ezz322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 11/13/2022] Open
Abstract
In this study, we describe a rare case of a 45-year-old man with a recurrence of aortopulmonary window (APW) 41 years after the initial patch closure for an APW at the age of 4. He presented with persistent cough and exertional dyspnoea. Imagings revealed a recurrence of APW, ascending aorta saccular aneurysm, and severe mitral and tricuspid regurgitation. Re-patch closure, ascending aortic replacement, and mitral and tricuspid annuloplasties were performed, followed by an uneventful postoperative course. The relapse of APW in the remote postoperative period is extremely rare.
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Affiliation(s)
- Yuichiro Fukumoto
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Soh Hosoba
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Sho Takagi
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
| | - Yoshihiro Goto
- Department of Cardiovascular Surgery, Toyohashi Heart Center, Toyohashi, Japan
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22
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Bin-Moallim M, Hamadah HK, Alhabshan F, Alghamdi AA, Kabbani MS. Aortopulmonary window: Types, associated cardiovascular anomalies, and surgical outcome. Retrospective analysis of a single center experience. J Saudi Heart Assoc 2020; 32:127-133. [PMID: 33154906 PMCID: PMC7640542 DOI: 10.37616/2212-5043.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/03/2020] [Accepted: 03/27/2020] [Indexed: 11/20/2022] Open
Abstract
Objective Aortopulmonary window (APW) is a rare congenital heart defect. It occurs as an isolated cardiac lesion or in association with other cardiac anomalies and rarely with abnormal coronary arteries. The spectrum of cardiovascular anomalies associated with APW and overall management and outcome in the current era were reviewed. Methods Between 2001 and 2018, all patients diagnosed with APW were included. Based on associated cardiovascular anomalies, those patients were divided into 2 groups: simple APW group and complex APW group (APW with associated other cardiovascular anomalies). All cases were followed longitudinally. The outcomes are described. Result Twenty patients underwent APW repair including 2 (10%) in simple APW group and 18 (90%) in complex APW group. Their mean age and weight were 4.8 ± 1.8 months and 4 ± 0.4 kg, respectively. APW Type I was confirmed in 65% followed by Type III in 20% and then Type II in 15% of the patients. In the complex APW group, atrial septal defect was the commonest associated cardiac lesion occurring in 8/20 (40%), followed by ventricular septal defect, interrupted aortic arch, and pulmonary artery anomalies in 25% of each. The presence of patent ductus arteriosus (PDA) was found in 40% of APW cases with 2/3rd of them in association with interrupted aortic arch. Two patients (10%) had unusual coronary anomalies that required repair, both with APW Type I. Associated non-cardiac anomalies were found in 30% of cases. Risk Adjustment for Congenital Heart Surgery (RACHS-1) score frequencies were between 2 and 4. Only one patient had reactive pulmonary hypertension related to chronic lung disease. All patients underwent surgical correction with median age of 2 month at the time of repair (interquartile range, 2 weeks to 4.5 months). Mean duration of mechanical ventilation, pediatric cardiac ICU and hospital length of stay were 2.8 ± 0.5, 9 ± 3 and 26 ± 6 days, respectively. All patients survived with no residual APW with mean follow-up duration of 4.5 years. Conclusion Majority of APW are associated with other cardiovascular anomalies (90%) including coronary abnormalities (10%). Early surgical repair of APW and associated lesions showed excellent survival rate, freedom from re-intervention need within an average of 4.5 years of follow up and no evidence of persistent pulmonary hypertension post repair.
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Affiliation(s)
- Mohammed Bin-Moallim
- Pediatric Cardiac Section, Cardiac Science Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hussam K Hamadah
- Pediatric Cardiac Intensive Care Division, Department of Cardiac Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Fahad Alhabshan
- Pediatric Cardiac Section, Cardiac Science Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah A Alghamdi
- Division of Cardiac Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohamed S Kabbani
- Pediatric Cardiac Intensive Care Division, Department of Cardiac Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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23
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Khanna S, Mahajan S, Halder V, Gowda N. Incidental diagnosis of a large aortopulmonary window with reversible pulmonary arterial hypertension in adult age and its surgical management. J Card Surg 2020; 35:1364-1367. [PMID: 32306468 DOI: 10.1111/jocs.14569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/09/2020] [Indexed: 11/30/2022]
Abstract
Aortopulmonary window (APW) is a rare congenital cardiac condition. A large number of patients with a large APW usually die within 1 year of age. It is extremely rare to find cases of APW surviving till adult age and it is still rare to surgically treat such patients who are incidentally detected in adult age because such subsets of patients invariably have associated pulmonary vascular obstructive disease in advanced stage and thus there is therapeutic dilemma to surgically correct these patients. Although cases of uncorrected AP window presenting in adulthood have been reported but literature on surgically treated AP window in adult populations is limited. We describe case of APW in a 26-year-old male patient who was diagnosed incidentally while suspecting infective endocarditis and was subsequently surgically closed successfully with polytetrafluoroethylene patch after confirming reversibility of pulmonary arterial hypertension which is the key for successful outcome.
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Affiliation(s)
- Sudhansoo Khanna
- Department of Cardiovascular and Thoracic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sachin Mahajan
- Department of Cardiovascular and Thoracic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vikram Halder
- Department of Cardiovascular and Thoracic Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Nischitha Gowda
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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24
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Saxena A, Relan J, Agarwal R, Awasthy N, Azad S, Chakrabarty M, Dagar KS, Devagourou V, Dharan BS, Gupta SK, Iyer KS, Jayranganath M, Joshi R, Kannan BRJ, Katewa A, Kohli V, Kothari SS, Krishnamoorthy KM, Kulkarni S, Kumar RM, Kumar RK, Maheshwari S, Manohar K, Marwah A, Mishra S, Mohanty SR, Murthy KS, Rao KN, Suresh PV, Radhakrishnan S, Rajashekar P, Ramakrishnan S, Rao N, Rao SG, Chinnaswamy Reddy HM, Sharma R, Shivaprakash K, Subramanyan R, Kumar RS, Talwar S, Tomar M, Verma S, Vijaykumar R. Indian guidelines for indications and timing of intervention for common congenital heart diseases: Revised and updated consensus statement of the Working group on management of congenital heart diseases. Ann Pediatr Cardiol 2019; 12:254-286. [PMID: 31516283 PMCID: PMC6716301 DOI: 10.4103/apc.apc_32_19] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A number of guidelines are available for the management of congenital heart diseases (CHD) from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for CHD, as often these patients present late in the course of the disease and may have coexisting morbidities and malnutrition. Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on August 10 and 11, 2018, at the All India Institute of Medical Sciences. The meeting was supported by Children's HeartLink, a nongovernmental organization based in Minnesota, USA. The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common CHD; (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for CHD; and (iii) indications for use of pacemakers in children. Evidence-based recommendations are provided for indications and timing of intervention in common CHD, including left-to-right shunts (atrial septal defect, ventricular septal defect, atrioventricular septal defect, patent ductus arteriosus, and others), obstructive lesions (pulmonary stenosis, aortic stenosis, and coarctation of aorta), and cyanotic CHD (tetralogy of Fallot, transposition of great arteries, univentricular hearts, total anomalous pulmonary venous connection, Ebstein's anomaly, and others). In addition, protocols for follow-up of postsurgical patients are also described, disease wise. Guidelines are also given on indications for implantation of permanent pacemakers in children.
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Affiliation(s)
- Anita Saxena
- Convener, All India Institute of Medical Sciences, New Delhi, India
| | - Jay Relan
- Writing Committee, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Sushil Azad
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | | | - Baiju S Dharan
- Sree Chitra Tirunal Institute for Medical sciences and Technology, Trivandrum, Kerala, India
| | | | | | - M Jayranganath
- Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Raja Joshi
- Sir Ganga Ram Hospital, New Delhi, India
| | - BRJ Kannan
- Vadamalayan Hospitals, Madurai, Tamil Nadu, India
| | - Ashish Katewa
- Sri Sathya Sai Sanjeevani Hospital, Raipur, Chhattisgarh, India
| | | | | | - KM Krishnamoorthy
- Sree Chitra Tirunal Institute for Medical sciences and Technology, Trivandrum, Kerala, India
| | - Snehal Kulkarni
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - R Manoj Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Krishna Manohar
- Sri Sathya Sai Sanjeevani International Centre for Child Heart Care and Research, Palwal, Haryana, India
| | | | | | | | - K Samba Murthy
- Innova Children's Heart Hospital, Hyderabad, Telangana, India
| | | | - PV Suresh
- Narayana Hrudayalaya, Bangalore, Karnataka, India
| | | | | | - S Ramakrishnan
- All India Institute of Medical Sciences, New Delhi, India
| | - Nitin Rao
- Star Hospital, Hyderabad, Telangana, India
| | - Suresh G Rao
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | | | | | | | | | - R Suresh Kumar
- Believers International Heart Centre, Thiruvalla, Kerala, India
| | - Sachin Talwar
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sudeep Verma
- Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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25
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Shin HJ, Jung Y, Shin JS. Aortic Reconstruction Using a Main Pulmonary Artery Flap in an Isolated Aortopulmonary Window. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 52:236-238. [PMID: 31404434 PMCID: PMC6687049 DOI: 10.5090/kjtcs.2019.52.4.236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 02/26/2019] [Accepted: 03/07/2019] [Indexed: 11/16/2022]
Abstract
Aortopulmonary window (APW) is a rare cardiac anomaly that was reported to occur in only 43 cases over 33 years at a large-volume cardiac center. It can present as an isolated anomaly or in combination with another cardiac anomaly. The surgical technique for APW has evolved from simple ligation to separation of the 2 great arteries. However, because of the rarity of APW, there is no standard surgical treatment for this disease entity. Herein, we present successful aortic reconstruction using a main pulmonary artery flap after separation of the 2 great arteries in a neonate with isolated APW.
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Affiliation(s)
- Hong Ju Shin
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Younggi Jung
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jae Seung Shin
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
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26
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Saxena A, Relan J, Agarwal R, Awasthy N, Azad S, Chakrabarty M, Dagar KS, Devagourou V, Dharan BS, Gupta SK, Iyer KS, Jayranganath M, Joshi R, Kannan BRJ, Katewa A, Kohli V, Kothari SS, Krishnamoorthy KM, Kulkarni S, Kumar RM, Kumar RK, Maheshwari S, Manohar K, Marwah A, Mishra S, Mohanty SR, Murthy KS, Koneti NR, Suresh PV, Radhakrishnan S, Rajashekar P, Ramakrishnan S, Rao N, Rao SG, Reddy CHM, Sharma R, Shivaprakasha K, Subramanyan R, Suresh Kumar R, Talwar S, Tomar M, Verma S, Raju V. Guidelines for the management of common congenital heart diseases in India: A consensus statement on indications and timing of intervention. Indian Heart J 2019; 71:207-223. [PMID: 31543193 PMCID: PMC6796629 DOI: 10.1016/j.ihj.2019.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 07/19/2019] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION A number of guidelines are available for management of congenital heart diseases from infancy to adult life. However, these guidelines are for patients living in high-income countries. Separate guidelines, applicable to Indian children, are required when recommending an intervention for congenital heart diseases, as often these patients present late in the course of the disease and may have co-existing morbidities and malnutrition. PROCESS Guidelines emerged following expert deliberations at the National Consensus Meeting on Management of Congenital Heart Diseases in India, held on the 10th and 11th of August, 2018 at the All India Institute of Medical Sciences. OBJECTIVES The aim of the study was to frame evidence-based guidelines for (i) indications and optimal timing of intervention in common congenital heart diseases and (ii) follow-up protocols for patients who have undergone cardiac surgery/catheter interventions for congenital heart diseases. RECOMMENDATIONS Evidence-based recommendations are provided for indications and timing of intervention in common congenital heart diseases, including left-to-right shunts, obstructive lesions, and cyanotic congenital heart diseases. In addition, protocols for follow-up of postsurgical patients are also described.
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Affiliation(s)
- Anita Saxena
- Convener, All India Institute of Medical Sciences, New Delhi, India.
| | - Jay Relan
- Writing Committee, All India Institute of Medical Sciences, New Delhi, India
| | | | | | - Sushil Azad
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | | | - Baiju S Dharan
- Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | | | | | - M Jayranganath
- Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India
| | - Raja Joshi
- Sir Ganga Ram Hospital, New Delhi, India
| | - B R J Kannan
- Vadamalayan Hospitals, Madurai, Tamil Nadu, India
| | - Ashish Katewa
- Sri Sathya Sai Sanjeevani Hospital, Raipur, Chhattisgarh, India
| | | | | | - K M Krishnamoorthy
- Sree Chitra Tirunal Institute for Medical Sciences & Technology, Trivandrum, Kerala, India
| | - Snehal Kulkarni
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Rohit Manoj Kumar
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Krishna Manohar
- Sri Sathya Sai Sanjeevani International Centre for Child Heart Care and Research, Palwal, Haryana, India
| | | | | | | | | | | | - P V Suresh
- Narayana Hrudayalaya, Bangalore, Karnataka, India
| | | | | | | | - Nitin Rao
- Star Hospital, Hyderabad, Telangana, India
| | - Suresh G Rao
- Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | | | | | | | | | - R Suresh Kumar
- Believers International Heart Centre, Thiruvalla, Kerala, India
| | - Sachin Talwar
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Sudeep Verma
- Krishna Institute of Medical Sciences, Secunderabad, Telangana, India
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Kumar V, Singh RS, Thingnam SKS, Mishra AK, Jaswal V. Surgical outcome in aortopulmonary window beyond the neonatal period. J Card Surg 2019; 34:300-304. [DOI: 10.1111/jocs.14023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 02/26/2019] [Accepted: 03/04/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Vikas Kumar
- Department of Cardiothoracic and Vascular SurgeryPost Graduate Institute of Medical Education and ResearchChandigarh India
| | - Rana S. Singh
- Department of Cardiothoracic and Vascular SurgeryPost Graduate Institute of Medical Education and ResearchChandigarh India
| | - Shyam K. S. Thingnam
- Department of Cardiothoracic and Vascular SurgeryPost Graduate Institute of Medical Education and ResearchChandigarh India
| | - Anand K. Mishra
- Department of Cardiothoracic and Vascular SurgeryPost Graduate Institute of Medical Education and ResearchChandigarh India
| | - Vivek Jaswal
- Department of Cardiothoracic and Vascular SurgeryPost Graduate Institute of Medical Education and ResearchChandigarh India
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Li W, Bin G, Jiang W, Shuang Y. Prenatal Diagnosis of Aortopulmonary Window by 2-Dimensional Echocardiography: Summary of 8 Cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:795-803. [PMID: 30312989 DOI: 10.1002/jum.14756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 06/08/2023]
Abstract
Aortopulmonary window (APW) is a rare congenital heart anomaly. A total of 8 cases with APW confirmed by echocardiography and surgery were retrospectively reviewed and the echocardiographic features analyzed. Among the 8 APW cases, 5 were type II and 3 were type III, the latter of which includes 2 cases complicated with Berry syndrome. Prenatal echocardiography can provide accurate information for the diagnosis of fetal APW. The prognosis depends on the timing of surgery and the nature of the associated cardiac anomalies.
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Affiliation(s)
- Wenxiu Li
- Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Geng Bin
- Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wu Jiang
- Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Shuang
- Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Poor oral intake in a late preterm twin - usual symptom with an unusual diagnosis. Heart Lung 2018; 47:162-165. [PMID: 29331441 DOI: 10.1016/j.hrtlng.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 10/30/2017] [Accepted: 11/12/2017] [Indexed: 11/21/2022]
Abstract
BACKGROUND At three weeks of age, a previous 34 weeks' gestation male infant (twin A) was transferred to our regional perinatal center (RPC) with complaints of poor oral feeding and intermittent tachypnea. Twin B was discharged at 37 weeks with an uneventful course. CASE Twin A briefly required respiratory support but continued to have difficulty transitioning from gavage to oral feeding. Initially, his inability to feed orally was thought to be secondary to nasal congestion and prematurity, but with worsening respiratory distress he was transferred for further evaluation and management. DIAGNOSIS & CONCLUSION On admission to RPC, the examination prompted a cardiac assessment which revealed a large aortic-pulmonary window type II. After surgery, the infant quickly improved and went home on-demand oral feeds. Cardiac lesions are more common in monochorionic twins but should be suspected in dichorionic twins especially if one twin has a normal course.
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Percutaneous closure of an aortopulmonary window using Amplatzer Duct Occluder II: Additional Sizes: the first reported case. Cardiol Young 2017; 27:812-815. [PMID: 27869054 DOI: 10.1017/s1047951116002134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
To date, there are no reported cases of the Amplatzer Duct Occluder II: Additional Sizes' use in percutaneous closure of an aortopulmonary window. We report a case of percutaneous closure of an aortopulmonary window in a 4.5-month-old, 6 kg child. Owing to the patient's low weight, high risk of damage to the pulmonary valve, as well as the possibility of aortic and pulmonary artery obstruction, classic implants were deemed unsuitable and a decision was made to use the Amplatzer Duct Occluder II: Additional Sizes. The implant performed very well - the soft waist filled the aortopulmonary connection and both retention discs were properly shaped and pressed against vessel walls. Echocardiogram performed 12 hours after the procedure confirmed a correct occluder position. Low-profile retention discs had no impact on pulmonary valve function, despite the defect's proximity to the valve. No obstruction of the aortic or pulmonary artery lumen was noted. The Amplatzer Duct Occluder II: Additional Size implant is a safe and useful device for percutaneous closure of an aortopulmonary window in a carefully selected group of patients.
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Abstract
The association of tricuspid atresia with aortopulmonary window is exceptionally rare. We report a patient with tricuspid atresia, normally related great arteries, non-restrictive ventricular septal defect, and no pulmonary stenosis (type IC) with an aortopulmonary window who underwent successful initial surgical palliation. The unique anatomical feature of this case, other than the presence of the aortopulmonary window, was the absence of pulmonary stenosis at the level of either the ventricular septal defect or the pulmonary valve. All other reported cases have described some degree of restriction of anterograde pulmonary flow due to pulmonary stenosis or atresia.
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Talwar S, Agarwal P, Choudhary SK, Kothari SS, Juneja R, Saxena A, Airan B. Aortopulmonary window: Morphology, diagnosis, and long-term results. J Card Surg 2017; 32:138-144. [PMID: 28139013 DOI: 10.1111/jocs.12936] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Aortopulmonary window (APW) is a rare congenital heart defect. We reviewed our experience with this condition over the last two decades. METHODS Between September 1993 and December 2013, 62 patients underwent surgery for APW. Depending on the associated lesions, they were divided into two groups: Simple (Group 1) or complex (Group 2). In the complex group, six patients had a ventricular septal defect, five patients had interrupted aortic arch, three patients had tetralogy of Fallot, two patients had double outlet right ventricle, and one patient had the right pulmonary artery arising from the ascending aorta. RESULTS Mean age at repair was 21.6 ± 32.02 months (median = 6, range 0.1-144 months). By preoperative echocardiographic assessment 27 out of 62 patients had severe pulmonary artery hypertension (52% of the cohort). Patch repair of APW was performed using the sandwich method (transwindow) (n = 27; 43.5%), transaortic (n = 18; 29%), and transpulmonary artery (n = 5; 8.1%) approaches; 10 patients (16.1%) underwent double ligation and two (3.2%) underwent division and suturing. Overall hospital mortality in group 1 was 6.97% (3/43) and in group 2 it was 21% (4/19), p = 0.085. Mean hospital stay in group 1 was 6.9 ± 2.4 days (median = 7 days) and in group 2 was 12 ± 6.1 days (median = 13 days), p = 0.0001. Follow-up in group 1 was 1.6-9.8 years (median = 6 years); in group 2, it was 1.8-8.9 years (median = 6.5 years). There were no late deaths. Two patients needed reintervention for distortion of the right pulmonary artery origin. All patients were in New York Heart Association Class I/II at last follow up. CONCLUSION There are multiple acceptable surgical strategies for the treatment of aortopulmonary window. Despite a relatively advanced age and substantial number of patients with severe pulmonary hypertension the outcomes can still be good. Associated anomalies complicate the repair. Patients in the complex group had a protracted hospital course and a higher early mortality but similar late survival.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Palkesh Agarwal
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Sunder Kothari
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rajnish Juneja
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Balram Airan
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Current Outcomes of Surgical Management of Aortopulmonary Window and Associated Cardiac Lesions. Ann Thorac Surg 2016; 102:608-14. [PMID: 27207392 DOI: 10.1016/j.athoracsur.2016.02.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/01/2016] [Accepted: 02/09/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND Aortopulmonary window (APW) is a rare congenital defect that is often associated with other cardiac lesions. We analyzed our operative strategy to determine whether this had any relationship with outcomes. METHODS Early and late outcomes of 40 children who underwent APW repair at our institution during a 20-year period (1994 to 2013) were analyzed. RESULTS Median age at time of the operation was 22 days (interquartile range, 9 to 63 days), and median weight was 3.2 kg (interquartile range, 2.5 to 3.8 kg). Eleven patients (28%) were born prematurely at or before 36 weeks' gestation, and 10 (25%) had genetic/extracardiac malformations. Mean APW size was 0.84 ± 0.28 cm, and by the Mori classification was type I in 17 patients (43%), type II in 18 (45%), and type III in 5 (13%). Twenty-five patients (63%) had simple APW, with no associated cardiac lesions other than atrial septal defect or patent ductus arteriosus, whereas 15 (38%) had complex APW with one or more associated lesions, including interrupted aortic arch (n = 6), ventricular septal defect (n = 6), or other (n = 5). There were no hospital or late deaths. Four patients required cardiac reoperations, 3 of whom had interrupted aortic arch. The 10-year freedom from cardiac reoperation was 100% for simple APW vs 73% for complex APW (p = 0.008), with 75% of reoperations related to aortic obstruction. Age, weight, prematurity, extracardiac anomalies, APW size and type, and APW repair technique were not associated with reoperation risk. CONCLUSIONS Current outcomes of early repair of APW are excellent, including infants with complex associated cardiac lesions. Compared with historic results, contemporary outcomes are favorable, supporting early and complete repair of APW and associated lesions. Cardiac reoperation can be required in complex APW, mainly with concomitant arch repair, and is usually related to aortic obstruction.
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Manuel V, Sousa-Uva M, Morais H, Magalhães MP, Pedro A, Miguel G, Nunes MAS, Gamboa S, Júnior APF. Anomalous Origin of One Pulmonary Artery From the Ascending Aorta: From Diagnosis to Treatment in Angola. World J Pediatr Congenit Heart Surg 2015; 6:521-5. [PMID: 26467865 DOI: 10.1177/2150135115601832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Anomalous origin of one pulmonary artery is a rare congenital heart disease in which one pulmonary artery branch originates from the ascending aorta. OBJECTIVE To describe the experience of a cardiothoracic center in an African country to repair anomalous origin of one pulmonary artery in the context of Portugal-Angola collaboration. METHODS Between March 2011 and March 2015, four consecutive patients with anomalous origin of pulmonary artery branch underwent surgical correction. The mean age was 1.6 months. The mean weight was 4 kg. All had right pulmonary artery branch originating from the ascending aorta. All patients underwent direct implantation of right pulmonary branch to main pulmonary artery. Two patents had patent ductus arteriosus and one had atrial septal defect. Two patients had pulmonary hypertension. RESULTS There was no registration of death. The mean cardiopulmonary bypass time was 75.5 ± 4.5 minutes, mean aortic cross-clamping time was 40 ± 5.6 minutes, and mean duration of the postoperative intensive care unit stay was 6.8 ± 5.7 days. At discharge, one patient had residual gradient of 25 mm Hg, the remainder had no significant gradient. The mean follow-up time was 11 months (5-28 months). One week after discharge, one patient presented operative wound dehiscence. At the last follow-up, all patients were alive, and no significant residual gradient or stenosis at site of anastomosis was observed. No reintervention was required. CONCLUSION Anomalous origin of one pulmonary artery is a rare but potentially treatable lesion if operated early in life. Direct implantation was a good technique with good short-term results.
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Affiliation(s)
- Valdano Manuel
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
| | - Miguel Sousa-Uva
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola Hospital Cruz Vermelha, Lisbon, Portugal
| | - Humberto Morais
- Cardiology Department, Hospital Militar Principal/Instituto Superior, Luanda, Angola
| | - Manuel P Magalhães
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola Hospital Cruz Vermelha, Lisbon, Portugal
| | - Albino Pedro
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola Hospital Cruz Vermelha, Lisbon, Portugal
| | - Gade Miguel
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola
| | - Maria A S Nunes
- Cardio-Thoracic Center, Clínica Girassol, Luanda, Angola Hospital Cruz Vermelha, Lisbon, Portugal
| | - Sebastiana Gamboa
- Service of Pediatric Cardiology, Hospital Pediátrico David Bernardino, Luanda, Angola
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Cho S, Kim WH, Choi ES, Lee JR, Kim YJ. Surgical Results of Anomalous Origin of One Pulmonary Artery Branch from the Ascending Aorta. Pediatr Cardiol 2015; 36:1532-8. [PMID: 26008763 DOI: 10.1007/s00246-015-1197-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 05/06/2015] [Indexed: 12/20/2022]
Abstract
We reviewed our surgical experience with anomalous origin of one pulmonary artery from the ascending aorta (AOPA). From 1989 to 2012, 12 children (five neonates) aged 3-734 days (mean 152 ± 222) with AOPA underwent operations. Eight patients had right AOPA, and four patients had left AOPA. The majority of the patients had elevated right ventricular pressure, with 58 % (7 of 12) demonstrating suprasystemic right ventricular pressure. Surgery was performed by direct anastomosis (group 1) in seven patients and by employing an autologous patch (group 2) in five patients. There were two postoperative mortalities caused by heart failure and pulmonary hypertensive crisis. The mean follow-up duration was 12.6 ± 8 years. Catheterization showed that the right ventricle-to-systemic pressure ratio decreased following operation (preoperative vs. postoperative; 1.13 ± 0.19 vs. 0.48 ± 0.03, p = 0.043). There was no difference in the perfusion of the affected lung as measured by the final lung perfusion scan, between the two groups (group 1 vs. group 2; 50.0 ± 10.3 vs. 42.7 ± 28.7 %, p = 0.158). Two patients required reoperations for pulmonary regurgitation and pulmonary artery stenosis. There were two catheter-based interventions. At 20 years, survival by the Kaplan-Meier was 91.7 ± 8.0 %, freedom from reoperation was 80.0 ± 17.9 %, and freedom from catheter intervention was 80.8 ± 12.2 %. Early repair of AOPA improves right ventricular pressure and overall hemodynamics with excellent survival and low risk of reintervention. The type of surgical repair did not significantly affect the long-term outcomes (measured via lung perfusion scan).
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Affiliation(s)
- Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea.
| | - Eun Seok Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Jeong Ryul Lee
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
| | - Yong Jin Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 110-744, South Korea
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36
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Agarwala BN, Varga P, Hijazi ZM, Ziemer G. Rare Case of Aortopulmonary Window With Anomalous Origin of Right Coronary Artery. Ann Thorac Surg 2015; 99:1803-5. [PMID: 25952213 DOI: 10.1016/j.athoracsur.2014.06.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/20/2014] [Accepted: 06/24/2014] [Indexed: 11/17/2022]
Abstract
A 5-month-old infant presented with a rare, congenital heart disease: aortopulmonary window with an anomalous origin of the right coronary artery from the aortopulmonary window. Using echocardiography and computed tomography, the exact diagnosis could only be ascertained retrospectively; however, cardiac catheterization and angiography confirmed the diagnosis, which led to elective open-heart surgery. The infant made a full recovery.
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Affiliation(s)
| | - Peter Varga
- Department of Pediatric Cardiology, University of Chicago, Chicago, Illinois
| | - Ziyad M Hijazi
- Departments of Pediatrics and Medicine, Rush University, Chicago, Illinois; Department of Pediatrics, Sidra Medical & Research Center, Doha, Qatar
| | - Gerhard Ziemer
- Departments of Pediatrics and Surgery, University of Chicago, Chicago, Illinois
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Aortopulmonary Window and the Interrupted Aortic Arch: Midterm Results With Use of the Single-Patch Technique. Ann Thorac Surg 2015; 99:186-91. [DOI: 10.1016/j.athoracsur.2014.08.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 07/24/2014] [Accepted: 08/07/2014] [Indexed: 11/23/2022]
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38
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Naimo PS, Yong MS, d’Udekem Y, Brizard CP, Kelly A, Weintraub R, Konstantinov IE. Outcomes of Aortopulmonary Window Repair in Children: 33 Years of Experience. Ann Thorac Surg 2014; 98:1674-9. [DOI: 10.1016/j.athoracsur.2014.06.043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/02/2014] [Accepted: 06/09/2014] [Indexed: 10/24/2022]
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Anselmi A, Langanay T, Laurent M, Leguerrier A, Flecher E. Transpulmonary correction of an isolated aortopulmonary window in an adult. J Card Surg 2013; 28:663-5. [PMID: 24118138 DOI: 10.1111/jocs.12224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We describe the operative management of a 65-year-old patient with a congenital type I aortopulmonary window. At surgery, heavy calcifications on the aortic side of the defect, and close proximity with the left coronary ostium, prevented patch repair from the transaortic access. Patch closure through a combined transpulmonary approach was therefore required. This case illustrates unique features of a late-presenting aortopulmonary window.
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Affiliation(s)
- Amedeo Anselmi
- Division of Thoracic, Cardiac and Vascular Surgery, Rennes University Hospital, Rennes, France
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40
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Cardiac magnetic resonance imaging in a premature baby with interrupted aortic arch and aortopulmonary window. Cardiol Young 2013; 23:742-5. [PMID: 23137589 DOI: 10.1017/s1047951112001461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Aortopulmonary window is a communication between the main pulmonary artery and the ascending aorta in the presence of two separate semilunar valves. The combination of an aortopulmonary window with interrupted aortic arch is rare. We discuss the unique case of an extremely premature infant weighing 1.7 kilograms who underwent cardiovascular magnetic resonance imaging as a pre-operative assessment in a high-field open 1.0 Tesla magnetic resonance imaging system as a one-stop investigation before complete repair.
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41
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Asano M, Ukai T, Nomura N, Mishima A. Anatomical Repair of Aortopulmonary Window with Anomalous Origin of the Right Coronary Artery from the Pulmonary Artery. J Card Surg 2013; 28:767-9. [DOI: 10.1111/jocs.12205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Miki Asano
- Department of Cardiovascular Surgery; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Tomohiko Ukai
- Department of Cardiovascular Surgery; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Norikazu Nomura
- Department of Cardiovascular Surgery; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Akira Mishima
- Department of Cardiovascular Surgery; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
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Kosmač B, Eicken A, Kühn A, Heinrich M, Ewert P. Percutaneous device closure of an aortopulmonary window in a small infant. Int J Cardiol 2013; 168:e102-3. [PMID: 23953630 DOI: 10.1016/j.ijcard.2013.07.218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 07/20/2013] [Indexed: 11/18/2022]
Affiliation(s)
- Blaž Kosmač
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Centre Munich, Germany; Pediatric Cardiology Unit, University Medical Centre Ljubljana, Slovenia
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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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Caspi J, Pettitt TW, Ascuito RJ. Double Aortic Arch and Aortopulmonary Window. World J Pediatr Congenit Heart Surg 2012; 3:504-7. [DOI: 10.1177/2150135112445520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe a rare association of aortopulmonary window and double aortic arch in a 1.7-kg newborn who presented with severe respiratory distress. A staged surgical approach was used because of the size of the patient and significant comorbidity. This approach resulted in excellent outcome.
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Affiliation(s)
- Joseph Caspi
- Louisiana State University Health Science Center and Children’s Hospital, New Orleans, LA, USA
| | - Timothy W. Pettitt
- Louisiana State University Health Science Center and Children’s Hospital, New Orleans, LA, USA
| | - Robert J. Ascuito
- Louisiana State University Health Science Center and Children’s Hospital, New Orleans, LA, USA
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45
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Restrepo CS, Melendez-Ramirez G, Kimura-Hayama E. Multidetector Computed Tomography of Congenital Anomalies of the Thoracic Aorta. Semin Ultrasound CT MR 2012; 33:191-206. [DOI: 10.1053/j.sult.2011.11.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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46
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Abstract
Aortopulmonary window is a rare defect caused by failure of fusion of the two opposing conotruncal ridges that are responsible for separating the truncus arteriosus into the aorta and pulmonary artery. Aortopulmonary window may occur as an isolated lesion or it can be associated with other cardiac abnormalities in one third to one half of cases. The most common associated lesions are arch abnormalities, specifically interrupted aortic arch and coarctation of the aorta. Antenatal diagnosis is rare. In the current era, early mortality following repair of simple aortopulmonary window approaches zero and depends on the presence of associated lesions, especially interrupted aortic arch. Long-term outcome should be excellent. Early morbidity includes pulmonary artery stenosis and residual aortopulmonary septal defects. Long-term follow-up is indicated to look for recurrent lesions such as the development of branch pulmonary artery stenosis and arch obstruction.
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Affiliation(s)
- Michael E Barnes
- Department of Cardiothoracic Surgery, Herma Heart Center at the Children's Hospital of Wisconsin, USA
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47
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Successful surgical treatment of congenital aortopulmonary window in an adult patient. Case Rep Cardiol 2011; 2011:505216. [PMID: 24826220 PMCID: PMC4008504 DOI: 10.1155/2011/505216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2011] [Accepted: 07/20/2011] [Indexed: 11/18/2022] Open
Abstract
Congenital aortopulmonary window is a rare inborn cardiac malformation that should be surgically treated as soon as the diagnosis is made usually during infancy. We report a successful surgical treatment of a 23-year-old male patient with a big type III aortopulmonary window.
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48
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Pulmonary atresia and ventricular septal defect with collaterals to right lung associated with anomalous left pulmonary artery from the ascending aorta. Pediatr Radiol 2010; 40 Suppl 1:S72-6. [PMID: 20865412 DOI: 10.1007/s00247-010-1832-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Revised: 07/05/2010] [Accepted: 08/06/2010] [Indexed: 10/19/2022]
Abstract
We present a 10-month-old boy with cyanosis. This is a rare case of pulmonary atresia, ventricular septal defect (VSD), major aorto-pulmonary collateral arteries (MAPCAs) to the right lung with absent native right pulmonary artery (RPA) in association with anomalous left pulmonary artery (LPA) from the ascending aorta (AAo). Echocardiography was unable to identify all of the cardiovascular abnormalities. Multidetector CT demonstrated all of these abnormalities and is the investigation of choice instead of cardiac catheterization.
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49
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Giroud JM, Jacobs JP, Spicer D, Backer C, Martin GR, Franklin RCG, Béland MJ, Krogmann ON, Aiello VD, Colan SD, Everett AD, William Gaynor J, Kurosawa H, Maruszewski B, Stellin G, Tchervenkov CI, Walters HL, Weinberg P, Anderson RH, Elliott MJ. Report From The International Society for Nomenclature of Paediatric and Congenital Heart Disease. World J Pediatr Congenit Heart Surg 2010; 1:300-13. [PMID: 23804886 DOI: 10.1177/2150135110379622] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tremendous progress has been made in the field of pediatric heart disease over the past 30 years. Although survival after heart surgery in children has improved dramatically, complications still occur, and optimization of outcomes for all patients remains a challenge. To improve outcomes, collaborative efforts are required and ultimately depend on the possibility of using a common language when discussing pediatric and congenital heart disease. Such a universal language has been developed and named the International Pediatric and Congenital Cardiac Code (IPCCC). To make the IPCCC more universally understood, efforts are under way to link the IPCCC to pictures and videos. The Archiving Working Group is an organization composed of leaders within the international pediatric cardiac medical community and part of the International Society for Nomenclature of Paediatric and Congenital Heart Disease ( www.ipccc.net ). Its purpose is to illustrate, with representative images of all types and formats, the pertinent aspects of cardiac diseases that affect neonates, infants, children, and adults with congenital heart disease, using the codes and definitions associated with the IPCCC as the organizational backbone. The Archiving Working Group certifies and links images and videos to the appropriate term and definition in the IPCCC. These images and videos are then displayed in an electronic format on the Internet. The purpose of this publication is to report the recent progress made by the Archiving Working Group in establishing an Internet-based, image encyclopedia that is based on the standards of the IPCCC.
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Affiliation(s)
- Jorge M. Giroud
- The Congenital Heart Institute of Florida (CHIF), Division of Pediatric Cardiology, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Pediatric Cardiology Associates/Pediatrix Medical Group, Saint Petersburg and Tampa, FL, USA
| | - Jeffrey P. Jacobs
- The Congenital Heart Institute of Florida (CHIF), Division of Thoracic and Cardiovascular Surgery, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates of Florida (CSSofF), Saint Petersburg and Tampa, FL, USA
| | - Diane Spicer
- The Congenital Heart Institute of Florida (CHIF), Division of Pediatric Cardiology, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Pediatric Cardiology Associates/Pediatrix Medical Group, Saint Petersburg and Tampa, FL, USA
- The Congenital Heart Institute of Florida (CHIF), Division of Thoracic and Cardiovascular Surgery, All Children’s Hospital and Children’s Hospital of Tampa, University of South Florida College of Medicine, Cardiac Surgical Associates of Florida (CSSofF), Saint Petersburg and Tampa, FL, USA
| | - Carl Backer
- Children’s Memorial Hospital, Chicago, IL, USA
| | - Gerard R. Martin
- Center for Heart, Lung and Kidney Disease, Children’s National Medical Center, Washington, DC, USA
| | | | - Marie J. Béland
- Division of Pediatric Cardiology, The Montreal Children’s Hospital of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Otto N. Krogmann
- Paediatric Cardiology–CHD, Heart Center Duisburg, Duisburg, Germany
| | - Vera D. Aiello
- Heart Institute (InCor), Sao Paulo University, School of Medicine, Sao Paulo, Brazil
| | - Steven D. Colan
- Department of Cardiology, Children’s Hospital, Boston, MA, USA
| | - Allen D. Everett
- Pediatric Cardiology, Johns Hopkins University, Baltimore, MD, USA
| | - J. William Gaynor
- Cardiac Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hiromi Kurosawa
- Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women’s Medical University, Tokyo, Japan
| | - Bohdan Maruszewski
- The Children’s Memorial Health Institute, Department of Cardiothoracic Surgery, Warsaw, Poland
| | - Giovanni Stellin
- Pediatric Cardiac Surgery Unit, University of Padova Medical School, Padova, Italy
| | - Christo I. Tchervenkov
- Division of Pediatric Cardiovascular Surgery, The Montreal Children’s Hospital of the McGill University Health Centre, Montréal, Quebec, Canada
| | - Henry L. Walters
- Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA
| | - Paul Weinberg
- Division of Pediatric Cardiology, The Children’s Hospital of Philadelphia, PA, USA
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50
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Jacobs JP, Maruszewski B, Kurosawa H, Jacobs ML, Mavroudis C, Lacour-Gayet FG, Tchervenkov CI, Walters H, Stellin G, Ebels T, Tsang VT, Elliott MJ, Murakami A, Sano S, Mayer JE, Edwards FH, Quintessenza JA. Congenital heart surgery databases around the world: do we need a global database? Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2010; 13:3-19. [PMID: 20307856 DOI: 10.1053/j.pcsu.2010.02.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The question posed in the title of this article is: "Congenital Heart Surgery Databases Around the World: Do We Need a Global Database?" The answer to this question is "Yes and No"! Yes--we need to create a global database to track the outcomes of patients with pediatric and congenital heart disease. No--we do not need to create a new "global database." Instead, we need to create a platform that allows for the linkage of currently existing continental subspecialty databases (and continental subspecialty databases that might be created in the future) that will allow for the seamless sharing of multi-institutional longitudinal data across temporal, geographical, and subspecialty boundaries. This review article will achieve the following objectives: (A) Consider the current state of analysis of outcomes of treatments for patients with congenitally malformed hearts. (B) Present some principles that might make it possible to achieve life-long longitudinal monitoring and follow-up. (C) Describe the rationale for the creation of a Global Federated Multispecialty Congenital Heart Disease Database. (D) Propose a methodology for the creation of a Global Federated Multispecialty Congenital Heart Disease Database that is based on linking together currently existing databases without creating a new database. To perform meaningful multi-institutional analyses, any database must incorporate the following six essential elements: (1) Use of a common language and nomenclature. (2) Use of a database with an established uniform core dataset for collection of information. (3) Incorporation of a mechanism to evaluate the complexity of cases. (4) Implementation of a mechanism to assure and verify the completeness and accuracy of the data collected. (5) Collaboration between medical and surgical subspecialties. (6) Standardization of protocols for life-long longitudinal follow-up. Analysis of outcomes must move beyond recording 30-day or hospital mortality, and encompass longer-term follow-up, including cardiac and non-cardiac morbidities, and importantly, those morbidities impacting health-related quality of life. Methodologies must be implemented in our databases to allow uniform, protocol-driven, and meaningful long-term follow-up. We need to create a platform that allows for the linkage of currently existing continental subspecialty databases (and continental subspecialty databases that might be created in the future) that will allow for the seamless sharing of multi-institutional longitudinal data across temporal, geographical, and subspecialty boundaries. This "Global Federated Multispecialty Congenital Heart Disease Database" will not be a new database, but will be a platform that effortlessly links multiple databases and maintains the integrity of these extant databases. Description of outcomes requires true multi-disciplinary involvement, and should include surgeons, cardiologists, anesthesiologists, intensivists, perfusionists, neurologists, educators, primary care physicians, nurses, and physical therapists. Outcomes should determine primary therapy, and as such must be monitored life-long. The relatively small numbers of patients with congenitally malformed hearts requires multi-institutional cooperation to accomplish these goals. The creation of a Global Federated Multispecialty Congenital Heart Disease Database that links extant databases from pediatric cardiology, pediatric cardiac surgery, pediatric cardiac anesthesia, and pediatric critical care will create a platform for improving patient care, research, and teaching related to patients with congenital and pediatric cardiac disease.
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Affiliation(s)
- Jeffrey Phillip Jacobs
- The Congenital Heart Institute of Florida, All Children's Hospital and Children's Hospital of Tampa, and Department of Surgery, University of South Florida College of Medicine, 625 Sixth Ave. South, St Petersburg, FL 33701, USA.
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