1
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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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2
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Simsek B, Ozyuksel A, Saygi M. A rare coexistence: Hammock mitral valve and aortopulmonary window. Cardiol Young 2023; 33:1787-1789. [PMID: 37092647 DOI: 10.1017/s1047951123000914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Congenital mitral stenosis is a broad-spectrum pathology in which blood flow to the left ventricle is obstructed both functionally and anatomically. Hammock mitral valve, also known as anomalous mitral arcade, is a rare congenital anomaly particularly in infants and children. Hammock mitral valve may not be suitable for repair regarding the advanced dysplastic mitral valve structure. Aortopulmonary window is an unusual cardiac anomaly which is defined as a communication between the main pulmonary artery and the ascending aorta. As a result of the excessive left-to-right shunt, early intervention and surgical closure deemed mandatory to avoid development of severe pulmonary hypertension and its consequences. All patients with an aortopulmonary window necessitates prompt repair immediately. In this brief report, mitral valve replacement with a mechanical valve and repair of aortopulmonary window with a Dacron patch were performed simultaneously in a 5-month-old patient with a hammock mitral valve and accompanying aortopulmonary window.
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Affiliation(s)
- Baran Simsek
- Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey
| | - Arda Ozyuksel
- Department of Cardiovascular Surgery, Medicana International Hospital, Istanbul, Turkey
- Department of Cardiovascular Surgery, Biruni University School of Medicine, Istanbul, Turkey
| | - Murat Saygi
- Department of Pediatric Cardiology, Medicana International Hospital, Istanbul, Turkey
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3
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Aortopulmonary window and coronary anatomy - still a pre-operative diagnostic trouble! Cardiol Young 2022; 32:2027-2028. [PMID: 35538626 DOI: 10.1017/s1047951122000981] [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: 12/16/2022]
Abstract
We present a case of aortopulmonary window in which the diagnosis of anomalous left coronary artery originating from pulmonary artery was made intra-operatively even if the coronary arteries anatomy was correctly studied pre-operatively with echocardiography. No evidence of coronary anomalies or indirect sings of coronary anomalies has been noted. Should we improve our pre-operative diagnostic accuracy and how?
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4
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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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5
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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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6
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Minaev AV, Golubev EP, Danilov TY. Left coronary artery occlusion in an adult after the closure of aortopulmonary window. Asian J Surg 2021; 45:607-608. [PMID: 34801359 DOI: 10.1016/j.asjsur.2021.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 10/25/2021] [Indexed: 11/02/2022] Open
Affiliation(s)
- Anton Vladimirovich Minaev
- A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, Congenital Heart Diseases Department, Moscow, Russia.
| | - Eugene Pavlovich Golubev
- A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, Congenital Heart Diseases Department, Moscow, Russia
| | - Timur Yurievich Danilov
- A.N. Bakoulev National Medical Research Center of Cardiovascular Surgery, Congenital Heart Diseases Department, Moscow, Russia
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7
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Cui M, Xia B, Wang H, Liu H, Yin X. A Rare Case of Adult Aortopulmonary Window Combined with Anomalous Origin of the Right Pulmonary Artery from the Aorta Leading to Eisenmenger Syndrome. J Int Med Res 2021; 49:300060520984656. [PMID: 33472471 PMCID: PMC7829515 DOI: 10.1177/0300060520984656] [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: 11/17/2022] Open
Abstract
Aortopulmonary window is a rare congenital heart disease that can increase pulmonary
vascular resistance, exacerbate left-to-right shunt and lead to heart failure and
respiratory tract infections. Most patients die during childhood. We report a 53-year-old
male patient with a large aortopulmonary window combined with anomalous origin of the
right pulmonary artery from the aorta, with Eisenmenger syndrome and without surgery.
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Affiliation(s)
- Mingyue Cui
- Center for Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Binfeng Xia
- Center for Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Heru Wang
- Center for Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
| | - Haihui Liu
- Department of Cardiac Ultrasound, The First Hospital of Jilin University, Changchun, China
| | - Xia Yin
- Center for Cardiovascular Medicine, The First Hospital of Jilin University, Changchun, China
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8
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Márquez D, Chalela T, Sandoval N. Intraoperative Diagnosis of ALCAPA Complicating an Aortopulmonary Window Repair. World J Pediatr Congenit Heart Surg 2021; 13:92-94. [PMID: 33908835 DOI: 10.1177/2150135120975761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We present the case of transient left ventricular dysfunction secondary to impaired left coronary artery filling after aortopulmonary window repair, caused by intraoperative diagnosis of anomalous left coronary artery from pulmonary artery. Immediate recognition and repair allowed for uneventful recovery of the patient.
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Affiliation(s)
- Diego Márquez
- Fundacion Cardioinfantil Instituto de Cardiologia, Bogota, Colombia
| | - Tomás Chalela
- Fundacion Cardioinfantil Instituto de Cardiologia, Bogota, Colombia
| | - Nestor Sandoval
- Fundacion Cardioinfantil Instituto de Cardiologia, Bogota, Colombia
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9
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Roy A, Chavali P, Husain SM, Desai NB, Rao JN. Trans-pulmonary closure of an aorto-pulmonary window in a patient of tetralogy of Fallot: a case report. Indian J Thorac Cardiovasc Surg 2021; 37:421-426. [PMID: 34220024 DOI: 10.1007/s12055-020-01097-7] [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: 09/15/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022] Open
Abstract
We present a case of tetralogy of Fallot (TOF) accompanied by a type II aorto-pulmonary window with severe pulmonary arterial hypertension in a pediatric patient. A successful repair of tetralogy of Fallot with trans-pulmonary patch closure of aorto-pulmonary window was done.
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Affiliation(s)
- Arindam Roy
- Department of CTVS, Sri Sathya Sai Institute of Higher Medical Sciences, H001, Staff Quarters, SSSIHMS, Prasanthigram, Puttaparthi, Andhra Pradesh 515134 India
| | - Praveen Chavali
- Department of CTVS, Sri Sathya Sai Institute of Higher Medical Sciences, H001, Staff Quarters, SSSIHMS, Prasanthigram, Puttaparthi, Andhra Pradesh 515134 India
| | - Shaikh Mohammed Husain
- Department of CTVS, Sri Sathya Sai Institute of Higher Medical Sciences, H001, Staff Quarters, SSSIHMS, Prasanthigram, Puttaparthi, Andhra Pradesh 515134 India
| | - Neelam Bipinchandra Desai
- Department of CTVS, Sri Sathya Sai Institute of Higher Medical Sciences, H001, Staff Quarters, SSSIHMS, Prasanthigram, Puttaparthi, Andhra Pradesh 515134 India
| | - Jinaga Nageswar Rao
- Department of CTVS, Sri Sathya Sai Institute of Higher Medical Sciences, H001, Staff Quarters, SSSIHMS, Prasanthigram, Puttaparthi, Andhra Pradesh 515134 India
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10
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Bi WJ, Xiao YJ, Liu YJ, Hou Y, Ren WD. Berry syndrome: a case report and literature review. BMC Cardiovasc Disord 2021; 21:15. [PMID: 33407161 PMCID: PMC7788879 DOI: 10.1186/s12872-020-01837-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 12/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Berry syndrome, a rare combination of cardiac anomalies, consists of aortopulmonary window (APW); aortic origin of the right pulmonary artery; interrupted aortic arch (IAA) or hypoplastic aortic arch or coarctation of the aorta; and an intact ventricular septum. There is lack of review articles that elucidate the clinical features, diagnosis, treatment, and outcomes of Berry syndrome. This publication systematically reviews the 89 cases published since 1982 on Berry syndrome. CASE PRESENTATION A 38-year-old woman presented with a loud murmur and cyanosis. Transthoracic echocardiography demonstrated a severely dilated aorta and main pulmonary artery with a large intervening defect. Distal to the APW, the ascending aorta gave rise to the right pulmonary artery. Additionally, a type A IAA, an intact ventricular septum, and a large patent ductus arteriosus were revealed. Computed tomography angiography with 3-dimensional reconstruction confirmed above findings. This is the first report of a patient of this age with Berry syndrome who did not undergo surgery. CONCLUSIONS Berry syndrome is a rare but well-identified and surgically correctable anomaly. Patients with Berry syndrome should be followed up for longer periods to better characterize long-term outcomes.
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Affiliation(s)
- Wen-Jing Bi
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36# of Sanhao St. Heping District, Shenyang, 110004, China
| | - Yang-Jie Xiao
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36# of Sanhao St. Heping District, Shenyang, 110004, China
| | - Yue-Jia Liu
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36# of Sanhao St. Heping District, Shenyang, 110004, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, 36# of Sanhao St. Heping District, Shenyang, 110004, China
| | - Wei-Dong Ren
- Department of Ultrasound, Shengjing Hospital of China Medical University, 36# of Sanhao St. Heping District, Shenyang, 110004, China.
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11
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Gupta A, Agstam S. Aortopulmonary window: a rare presentation with left ventricular outflow tract obstruction. J Echocardiogr 2020; 19:258-259. [PMID: 32451756 DOI: 10.1007/s12574-020-00475-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/12/2020] [Accepted: 05/16/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Ankur Gupta
- Postgraduate Institute of Medical Edu-cation and Research (PGIMER), Chandigarh, India
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12
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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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13
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Aortopulmonary window with anomalous right coronary artery from the pulmonary artery. Case report and literature review. Cardiol Young 2020; 30:47-49. [PMID: 31854282 DOI: 10.1017/s1047951119002543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Aortopulmonary window is a rare congenital heart lesion. It might be associated with other CHDs, as well as with anomalous origin of the coronary arteries. Anomalous origin of the right coronary artery from the pulmonary artery (ARCAPA) is the most commonly described coronary artery anomaly in association with aortopulmonary window. We are describing a premature neonate who was diagnosed to have aortopulmonary window and ARCAPA immediately after birth, and had a successful operation at the age of 4 months. This report highlights the importance of very careful assessment of the coronary arteries in patients with aortopulmonary window.
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14
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Zucker EJ. Cross-sectional imaging of congenital pulmonary artery anomalies. Int J Cardiovasc Imaging 2019; 35:1535-1548. [PMID: 31175525 DOI: 10.1007/s10554-019-01643-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/31/2019] [Indexed: 02/06/2023]
Abstract
Congenital pulmonary artery (PA) anomalies comprise a rare and heterogeneous spectrum of disease, ranging from abnormal origins to complete atresia. They may present in early infancy or more insidiously in adulthood, often in association with congenital heart disease such as tetralogy of Fallot or other syndromes. In recent years, cross-sectional imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), has become widely utilized for the noninvasive assessment of congenital PA diseases, supplementing echocardiography and at times supplanting invasive angiography. In this article, modern CT and MRI techniques for imaging congenital PA disorders are summarized. The key clinical features, cross-sectional imaging findings, and treatment options for the most commonly encountered entities are then reviewed. Emphasis is placed on the ever-growing role of cross-sectional imaging options in facilitating early and accurate diagnosis and tailored treatment.
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Affiliation(s)
- Evan J Zucker
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Stanford, CA, 94305, USA.
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15
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Goel D, Gupta P, Cooper S, Klimek J. A literature review of systemic to pulmonary collaterals in preterm infants to emphasise their existence and clinical importance. Acta Paediatr 2018; 107:1867-1878. [PMID: 29869341 DOI: 10.1111/apa.14434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/18/2018] [Accepted: 06/01/2018] [Indexed: 11/30/2022]
Abstract
AIM Cardiorespiratory physiology plays an important role in neonatal care with increasing utility of point-of-care ultrasound. This review is to bring to light the importance of systemic to pulmonary collaterals (SPCs) in the preterm population without congenital heart disease (CHD) and provide a useful diagnostic tool to the neonatologist performing a cardiac ultrasound. METHODS Medline, PubMed, EMBASE and the Internet were searched up to November 2017 for articles in English which included SPCs in preterm infants without CHD. This comprised title, abstract and full-text screening of relevant data. RESULTS A total of 10 studies which included case reports, retrospective observational studies and one small prospective cohort study were identified and analysed in detail. The studies had varying focus such as variable incidence, clinical presentation, association with chronic lung disease, pathophysiology and clinical importance of SPCs. SPCs were overall thought to be prevalent, underdiagnosed and of clinical significance in preterm infants. CONCLUSION Systemic to pulmonary collaterals are a potential left-to-right shunt in preterm infants and may contribute to worsening chronic lung disease (CLD) or heart failure. They should be carefully looked for when performing bedside cardiac ultrasound as the findings can mimic those seen in patent ductus arteriosus (PDA).
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Affiliation(s)
- Dimple Goel
- Westmead Hospital; Sydney Australia
- University of Sydney; Sydney Australia
- Children's Hospital at Westmead; Sydney Australia
| | - Pankaj Gupta
- Children's Hospital at Westmead; Sydney Australia
| | | | - Jan Klimek
- Westmead Hospital; Sydney Australia
- University of Sydney; Sydney Australia
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16
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Nakamura R, Honda K, Yuzaki M, Nakai T, Kunimoto H, Nishimura Y. Repair of an adult aorto-pulmonary artery fistula associated with a ruptured aortic arch aneurysm using a frozen elephant trunk technique. J Card Surg 2018; 33:676-678. [PMID: 30239034 DOI: 10.1111/jocs.13814] [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: 11/29/2022]
Abstract
We describe the repair of an acute aorto-pulmonary artery fistula in a 82-year-old patient with a ruptured aortic arch aneurysm using a frozen elephant trunk technique.
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Affiliation(s)
- Ryo Nakamura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Kentaro Honda
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Mitsuru Yuzaki
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Takeo Nakai
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Hideki Kunimoto
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Yoshiharu Nishimura
- Department of Thoracic and Cardiovascular Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
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17
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Yu S, Han J, Gao S, Liu X, Gu X, Zhang Y, Sun L, He Y. The prenatal diagnosis of aortopulmonary window by fetal echocardiography. Echocardiography 2018; 35:1835-1840. [PMID: 30192407 DOI: 10.1111/echo.14131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 08/07/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The purpose of this study was to analyze the fetal echocardiographic features and the associated anomalies of prenatal aortopulmonary window (APW). METHODS We retrospectively reviewed the fetal echocardiographic database (n = 24 000) in our hospital between May 2012 and December 2017. The general clinical information, fetal echocardiographic features, and the associated anomalies in patients with APW were analyzed. Four patients had undergone whole genome sequencing using fetal tissues. RESULTS Six cases of APW confirmed by autopsy were identified in our fetal echocardiographic database. On the three-vessel view, a communication between the pulmonary artery trunk and ascending aorta was noted above the two semilunar valves in all cases. The most frequent type of APW among the cases was type II, and all cases were associated with other cardiac anomalies. No pathogenic or suspected pathogenic copy number variation or insertion-deletions were detected in this series. CONCLUSION Prenatal diagnosis of APW is feasible, which is helpful during prenatal consultations, so that parents can make better decisions regarding postpartum treatment options and pregnancy outcomes.
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Affiliation(s)
- Shaomei Yu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiancheng Han
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuang Gao
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaowei Liu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Gu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ye Zhang
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lin Sun
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yihua He
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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18
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He J, Yan D, Li B, Li H. Surgical Repair of Complex Aortopulmonary Window: A Case Study. Braz J Cardiovasc Surg 2018; 33:424-427. [PMID: 30184041 PMCID: PMC6122751 DOI: 10.21470/1678-9741-2017-0231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/26/2018] [Indexed: 11/04/2022] Open
Abstract
Aortopulmonary septal defect, also known as the aortopulmonary window, is a rare congenital macrovascular malformation. This case involves a 9-year-old boy with aortopulmonary septal defect (type I combined with type IV). Before surgery, milrinone and alprostadil were used to counteract high lung pressure. Surgery was performed under cardiopulmonary bypass, following which the pulmonary pressure decreased. The aorta was cut, and the right pulmonary artery opening was connected with the main pulmonary artery septal defect using polyester patch. An internal tunnel was made, and the deformity correction was completed. The child exhibited normal postoperative recovery with no discomfort. A complex aortopulmonary window is a rare condition that can be treated successfully with appropriate preoperative and surgical management.
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Affiliation(s)
- Jigang He
- Cardiovascular Surgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Dan Yan
- Cardiovascular Surgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Beibei Li
- Cardiovascular Surgery, The First People's Hospital of Yunnan Province, Kunming, China
| | - Hongrong Li
- Cardiovascular Surgery, The First People's Hospital of Yunnan Province, Kunming, China
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19
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Binsalamah ZM, Greenleaf CE, Heinle JS. Type A interrupted aortic arch and type III aortopulmonary window with anomalous origin of the right pulmonary artery from the aorta. J Card Surg 2018; 33:344-347. [PMID: 29749109 DOI: 10.1111/jocs.13717] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Interruption of the aortic arch, aortopulmonary window, and anomalous origin of the right pulmonary artery from the ascending aorta are very rare congenital anomalies. It is even rarer to have all three anomalies in the same setting. We present a case of a newborn who was diagnosed with these lesions and describe the primary repair of these anomalies.
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Affiliation(s)
- Ziyad M Binsalamah
- Congenital Heart Surgery, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
| | - Christopher E Greenleaf
- Congenital Heart Surgery, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
| | - Jeffrey S Heinle
- Congenital Heart Surgery, Texas Children's Hospital-Baylor College of Medicine, Houston, Texas
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20
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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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21
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Samaddar S, Bhatt D, Guleria M, Yadav DK, Gupta A. Total anomalous pulmonary venous connection masking an aortopulmonary window: A rare combination of defects. Ann Pediatr Cardiol 2018; 11:322-324. [PMID: 30271027 PMCID: PMC6146854 DOI: 10.4103/apc.apc_45_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The association of aortopulmonary (AP) window with total anomalous pulmonary venous connection (TAPVC) has so far not been reported. We report a unique case of an 8-month-old child who presented with congestive cardiac failure and severe pulmonary arterial hypertension. Initial echocardiography revealed supracardiac TAPVC. Cardiac computed tomography showed the presence of Type I AP window along with the TAPVC. In the presence of severe pulmonary hypertension and dilated right ventricle, AP window may easily be missed if not actively looked for.
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Affiliation(s)
- Shyamajit Samaddar
- Department of Pediatrics, Division of Pediatric Cardiology, Dr RML Hospital and PGIMER, New Delhi, India
| | - Dheeraj Bhatt
- Department of Pediatrics, Division of Pediatric Cardiology, Dr RML Hospital and PGIMER, New Delhi, India
| | - Munish Guleria
- Department of Radiology, Dr RML Hospital and PGIMER, New Delhi, India
| | - Dinesh Kumar Yadav
- Department of Pediatrics, Division of Pediatric Cardiology, Dr RML Hospital and PGIMER, New Delhi, India
| | - Anubhav Gupta
- Department of CTVS, Dr RML Hospital and PGIMER, New Delhi, India
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