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The Annals of Thoracic Surgery Jul 2022We report a patient with an acquired traumatic aortopulmonary window. The patient presented with an aortopulmonary fistula between the proximal ascending aorta and...
We report a patient with an acquired traumatic aortopulmonary window. The patient presented with an aortopulmonary fistula between the proximal ascending aorta and pulmonary trunk, which was missed on the initial hospital admission. The 26-year-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.
Topics: Adult; Aorta; Aortopulmonary Septal Defect; Arterio-Arterial Fistula; Humans; Pulmonary Artery
PubMed: 34637766
DOI: 10.1016/j.athoracsur.2021.09.010 -
Cardiology in the Young Sep 2023Congenital mitral stenosis is a broad-spectrum pathology in which blood flow to the left ventricle is obstructed both functionally and anatomically. Hammock mitral...
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.
Topics: Infant; Child; Humans; Mitral Valve; Aortopulmonary Septal Defect; Mitral Valve Stenosis; Pulmonary Artery; Mitral Valve Insufficiency
PubMed: 37092647
DOI: 10.1017/S1047951123000914 -
Echocardiography (Mount Kisco, N.Y.) Feb 2019Aortopulmonary window is a rare conotruncal defect that is often associated with other congenital heart defects. We present a patient with a previously unreported...
BACKGROUND
Aortopulmonary window is a rare conotruncal defect that is often associated with other congenital heart defects. We present a patient with a previously unreported combination of aortopulmonary window with tetralogy of Fallot with an absent conal septum.
CASE PRESENTATION
A term, 2.4 kg newborn male infant presented at a community hospital with cyanosis unresponsive to supplemental oxygen. Transthoracic echocardiography demonstrated a conotruncal defect with a large conoventricular ventricular septal defect and an over-riding, dysplastic aortic valve. The main pulmonary artery (MPA) appeared to arise from left facing sinus of the aortic valve, with confluent yet hypoplastic right and left branch pulmonary arteries. There was no evidence of prograde flow into the MPA in systole, though there did appear to be retrograde flow in diastole from the patent ductus. The patient underwent multiple advanced imaging studies, and the diagnosis was not fully elucidated. Postmortem examination demonstrated morphology consistent with Tetralogy of Fallot with the absence of the conal septum. There were two distinct semilunar valves in fibrous continuity with an aortopulmonary window immediately cephalad to the valve.
DISCUSSION
The rare combination of defects and the patient's size made the anatomic diagnosis by conventional imaging challenging. However, retrospective review of imaging studies did demonstrate anatomic features seen by direct examination of the specimen.
Topics: Animals; Aorta; Echocardiography; Fatal Outcome; Heart Septal Defects, Ventricular; Humans; Infant, Newborn; Male; Pulmonary Artery; Tetralogy of Fallot
PubMed: 30585348
DOI: 10.1111/echo.14243 -
Journal of Cardiac Surgery Feb 2017Aortopulmonary window (APW) is a rare congenital heart defect. We reviewed our experience with this condition over the last two decades.
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.
Topics: Aortopulmonary Septal Defect; Cardiac Surgical Procedures; Child, Preschool; Echocardiography; Follow-Up Studies; Hospital Mortality; Humans; Incidence; India; Infant; Infant, Newborn; Length of Stay; Postoperative Complications; Retrospective Studies; Survival Rate; Time Factors; Treatment Outcome
PubMed: 28139013
DOI: 10.1111/jocs.12936 -
Asian Cardiovascular & Thoracic Annals Mar 2014Aortopulmonary window is a rare cardiac anomaly. We report our experience with this rare lesion and highlight the criteria for treating this defect without the use of...
BACKGROUND
Aortopulmonary window is a rare cardiac anomaly. We report our experience with this rare lesion and highlight the criteria for treating this defect without the use of cardiopulmonary bypass.
METHODS
From May 2007 to April 2012, 10 patients, aged 1 to 10 months and weighing 3.4 to 5.5 kg, were operated on by a single surgeon using both off-pump and standard techniques. All patients underwent preoperative and postoperative echocardiographic assessment, and were followed up with clinical examinations and echocardiography.
RESULTS
There was no operative death and all patients were alive at the last follow-up. No major morbidities were noted. Two cases were operated on off-pump and they had shorter intensive care unit stays. All patients were in New York Heart Association class I on follow-up, with no residual shunt noted in follow-up echocardiograms.
CONCLUSIONS
The surgical closure of aortopulmonary window carries a low surgical risk. Early surgical closure prevents the development of pulmonary vascular disease and achieves good immediate and long-term outcomes. Off-pump repair techniques, when used judiciously, have a place in the treatment of this defect.
Topics: Aorta; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Female; Heart Defects, Congenital; Hemodynamics; Humans; India; Infant; Intensive Care Units, Pediatric; Length of Stay; Male; Pulmonary Artery; Time Factors; Treatment Outcome; Ultrasonography
PubMed: 24585901
DOI: 10.1177/0218492313481222 -
Journal of Cardiac Surgery Nov 2022Anomalous ascending aortic origin of left pulmonary artery in association with aortopulmonary window has not been reported so far in literature and is the main highlight...
Anomalous ascending aortic origin of left pulmonary artery in association with aortopulmonary window has not been reported so far in literature and is the main highlight of the present case.
Topics: Aorta; Aortopulmonary Septal Defect; Humans; Pulmonary Artery
PubMed: 36066047
DOI: 10.1111/jocs.16900 -
Anales de Pediatria (Barcelona, Spain :... Jun 2008
Topics: Aortopulmonary Septal Defect; Diuretics; Electrocardiography; Furosemide; Humans; Infant; Male; Ultrasonography
PubMed: 18559215
DOI: 10.1157/13123309 -
Journal of Cardiac Surgery Jun 2021Coronary artery anomalies may accompany the aortopulmonary window and, if not noticed, may cause catastrophic consequences. The repair of the aortopulmonary window is...
Coronary artery anomalies may accompany the aortopulmonary window and, if not noticed, may cause catastrophic consequences. The repair of the aortopulmonary window is quite straightforward; however, establishing a normal coronary pattern may challenge the repair. When the anomalous origin of the coronary artery is on the defect rim, right at the location where sutures are to be placed, it may interfere with proper suture placement. A technique to overcome such a technical obstacle and reroute the anomalous right coronary in such cases is described.
Topics: Aortopulmonary Septal Defect; Coronary Vessel Anomalies; Heart; Humans; Infant, Newborn; Pulmonary Artery
PubMed: 33738867
DOI: 10.1111/jocs.15499 -
Journal of Cardiac Surgery Feb 2022We report a case of a 4-year-old boy with a distal type of aortopulmonary window with crossed arrangement of the pulmonary arteries. This case highlights the potential...
We report a case of a 4-year-old boy with a distal type of aortopulmonary window with crossed arrangement of the pulmonary arteries. This case highlights the potential clinical implications of this variant pulmonary arterial anatomy in the setting of the aortopulmonary window and the role of computed tomography angiography in accurately defining vascular relationships in patients with complex congenital cardiac defects.
Topics: Angiography; Aortopulmonary Septal Defect; Child, Preschool; Humans; Male; Pulmonary Artery
PubMed: 34842305
DOI: 10.1111/jocs.16160 -
Current Cardiology Reviews 2020Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients...
BACKGROUND
Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum.
RESULTS
We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.
Topics: Adult; Aortopulmonary Septal Defect; Echocardiography; Humans; Male; Young Adult
PubMed: 31092183
DOI: 10.2174/1573403X15666190513105231