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Ultrasound in Obstetrics & Gynecology :... Dec 2004We report a case in which aortopulmonary window (APW) in combination with pulmonary atresia was diagnosed correctly in a neonate by echocardiography. Prenatal... (Review)
Review
We report a case in which aortopulmonary window (APW) in combination with pulmonary atresia was diagnosed correctly in a neonate by echocardiography. Prenatal echocardiography showed progression of tetralogy of Fallot to pulmonary atresia with retrograde pulmonary perfusion, concealing the concomitant APW in fetal life. Due to intractable heart failure, primary correction was successfully performed at the age of 4 weeks (weight 2280 g).
Topics: Adult; Aortopulmonary Septal Defect; Echocardiography; Female; Heart Septal Defects; Humans; Infant, Newborn; Pregnancy; Pulmonary Atresia; Ultrasonography, Prenatal
PubMed: 15586382
DOI: 10.1002/uog.1752 -
European Journal of Cardio-thoracic... Jun 2020In 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...
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.
Topics: Aorta; Aortopulmonary Septal Defect; Cardiac Surgical Procedures; Humans; Male; Middle Aged; Recurrence; Tricuspid Valve Insufficiency
PubMed: 31750891
DOI: 10.1093/ejcts/ezz322 -
Revista Portuguesa de Cardiologia :... Nov 2008Aortopulmonary window (APW) is a rare anomaly, accounting for 0.1% of congenital heart defects. It consists of a communication between the ascending aorta and the...
INTRODUCTION
Aortopulmonary window (APW) is a rare anomaly, accounting for 0.1% of congenital heart defects. It consists of a communication between the ascending aorta and the pulmonary artery in the presence of normal separate aortic and pulmonary valves. Early treatment is usually required in order to prevent the development of irreversible pulmonary hypertension.
OBJECTIVE
To assess the results of treatment in all patients diagnosed at our institution between January 1994 and November 2007, based on a retrospective longitudinal study.
RESULTS
Nine patients treated for APW were identified. Their ages at diagnosis ranged from two days to 23 years; eight were infants aged 2 +/- 2.9 months. In this group clinical presentation was congestive heart failure in all cases. Five patients had associated lesions (interrupted aortic arch: 2; coarctation of the aorta: 2; VSD: 1; ASD: 3). In seven cases the diagnosis was made on the basis of echocardiography only. In the other two it was by cardiac catheterization, one patient with coarctation of the aorta and the other an adult patient with a smaller lesion who was initially misdiagnosed as having ductus arteriosus. All patients had corrective surgery, via a transaortic approach, with implantation of an autologous pericardial patch. All patients are alive and only one case has a small residual shunt at the correction site.
CONCLUSION
A diagnosis of APW should always be kept in mind in the differential diagnosis of a child with congestive heart failure. Associated congenital heart anomalies should be excluded. Surgical repair appears to provide good short- and long-term results.
Topics: Aortopulmonary Septal Defect; Female; Heart Failure; Humans; Infant; Infant, Newborn; Longitudinal Studies; Male; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 19227811
DOI: No ID Found -
Journal of Clinical and Diagnostic... Aug 2016
PubMed: 27656504
DOI: 10.7860/JCDR/2016/19412.8244 -
World Journal For Pediatric &... Nov 2019Aortopulmonary window (APW) is a rare lesion, accounting for 0.2% to 0.6% of all congenital heart diseases. We report a rare case of an infant with APW, interrupted...
Aortopulmonary window (APW) is a rare lesion, accounting for 0.2% to 0.6% of all congenital heart diseases. We report a rare case of an infant with APW, interrupted aortic arch, and pulmonary atresia with intact interventricular septum and right ventricle-dependent coronary circulation. This report describes the anatomy of this lesion set, the complex surgical palliation that was required, and the management of postoperative complications.
Topics: Abnormalities, Multiple; Aorta, Thoracic; Aortopulmonary Septal Defect; Cardiac Surgical Procedures; Computed Tomography Angiography; Humans; Imaging, Three-Dimensional; Infant, Newborn; Male; Pulmonary Artery; Pulmonary Atresia
PubMed: 31701829
DOI: 10.1177/2150135119872199 -
Turk Gogus Kalp Damar Cerrahisi Dergisi Oct 2022The aim of this study is to present our experience regarding the creation of an aortopulmonary window as the initial palliative procedure.
BACKGROUND
The aim of this study is to present our experience regarding the creation of an aortopulmonary window as the initial palliative procedure.
METHODS
Between February 2016 and February 2021, a total of eight patients (3 males, 5 females; median age: 2 months; range, 0.7 to 6 months) who underwent aortopulmonary window creation were retrospectively analyzed. Data collection was performed by review from our institution.
RESULTS
There was no occurrence of early or late mortality in any patient. The median postoperative duration of mechanical ventilation and length of hospital stay were five and eight days, respectively. No postoperative reperfusion injury or severe pulmonary overcirculation was observed in any of the patients. Four patients achieved complete repair with unifocalization of the major aortopulmonary collateral arteries, one patient had a second procedure, and the remaining three patients waited for complete repair. The median right ventricle-toaortic pressure ratio after complete repair was 0.6 (range, 0.4 to 0.7). The median follow-up after complete repair was 1.4 (range, 0.9 to 2.8) years, and the median follow-up period for all survivors was 2.7 (range, 0.9-5.8) years.
CONCLUSION
Our study results suggest that aortopulmonary window operation can be safely performed in selected patients with good early and mid-term outcomes. Although the central pulmonary arteries are very small, half of the patients underwent complete repair and achieved acceptable right ventricle-to-aortic pressure ratios. Patient selection criteria and early postoperative interventions are of utmost importance to prevent postoperative pulmonary overcirculation.
PubMed: 36605316
DOI: 10.5606/tgkdc.dergisi.2022.23161 -
Indian Journal of Thoracic and... Jul 2022We report a case of a 1-year-old patient with aortopulmonary window, anomalous right coronary artery arising from the pulmonary artery, and a large perimembranous...
We report a case of a 1-year-old patient with aortopulmonary window, anomalous right coronary artery arising from the pulmonary artery, and a large perimembranous ventricular septal defect. Computed tomography was successful in diagnosing the coronary anomaly and the case was managed surgically with an intrapulmonary baffle, rerouting the right coronary ostium to the aortic root and a fenestrated patch closure of the ventricular septal defect. Pre-operative diagnosis and thorough planning were essential for the successful outcome of this case.
PubMed: 35756565
DOI: 10.1007/s12055-022-01334-1 -
Congenital Heart Disease 2008Aortopulmonary window is an uncommon condition, particularly so in adulthood because it is usually fatal in infancy or childhood if untreated. Very few cases of those...
OBJECTIVES
Aortopulmonary window is an uncommon condition, particularly so in adulthood because it is usually fatal in infancy or childhood if untreated. Very few cases of those who have survived to adulthood and been operated on successfully have been described. Our study aimed to provide clinical, investigative, surgical, and outcome details of such patients.
DESIGN AND SETTING
Retrospective study of consecutive adult patients with aortopulmonary window treated at a tertiary charitable cardiovascular institute in South India between 1996 and 2006.
RESULTS
Six adult patients successfully underwent aortopulmonary window closure. Five of the six patients had been correctly diagnosed on echocardiography, while one was only diagnosed after cardiac catheterization for unexplained pulmonary arterial hypertension. Four of the patients had large defects with severe pulmonary arterial hypertension, with pulmonary vascular resistance index (PVRI) ranging from 5.2 to 15.9 at baseline. All showed significant reversibility with oxygen administration, with PVRI on oxygen falling to between 0.6 and 2.2. These patients successfully underwent cardiopulmonary bypass. The other two patients with small lesions underwent ligation off-pump. There was no early or late mortality among these patients. All were in New York Heart Association class I, on follow-up ranging from 3 months to 8 years.
CONCLUSIONS
Aortopulmonary window may rarely present in adulthood. The diagnosis can usually be made by careful echocardiography alone. Even in the presence of severe pulmonary arterial hypertension, if a significant reversibility in pulmonary vascular resistance can be demonstrated with oxygen, the condition can be successfully corrected with good long-term outcomes.
Topics: Adolescent; Adult; Aortopulmonary Septal Defect; Cardiac Catheterization; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Echocardiography; Female; Follow-Up Studies; Humans; Hypertension, Pulmonary; Male; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 18837813
DOI: 10.1111/j.1747-0803.2008.00210.x -
Cardiology in the Young Mar 2022Tetralogy of Fallot with pulmonary atresia is a group of congenital cardiac malformations, which is defined by the absence of luminal continuity between both ventricles...
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.
Topics: Aortopulmonary Septal Defect; Collateral Circulation; Humans; Pulmonary Artery; Pulmonary Atresia; Tetralogy of Fallot; Truncus Arteriosus, Persistent
PubMed: 34134806
DOI: 10.1017/S1047951121002298 -
Outcomes After Aortopulmonary Window for Hypoplastic Pulmonary Arteries and Dual-Supply Collaterals.The Annals of Thoracic Surgery Sep 2019Our institutional approach to tetralogy of Fallot with major aortopulmonary collateral arteries (MAPCAs) emphasizes early unifocalization and complete repair (CR). In...
BACKGROUND
Our institutional approach to tetralogy of Fallot with major aortopulmonary collateral arteries (MAPCAs) emphasizes early unifocalization and complete repair (CR). In the small subset of patients with dual-supply MAPCAs and confluent but hypoplastic central pulmonary arteries (PAs), our surgical approach is early creation of an aortopulmonary window (APW) to promote PA growth. Factors associated with successful progression to CR and mid-term outcomes have not been assessed.
METHODS
Clinical data were reviewed. PA diameters were measured offline from angiograms prior to APW and on follow-up catheterization >1 month after APW but prior to any additional surgical interventions.
RESULTS
From November 2001 to March 2018, 352 patients with tetralogy of Fallot/MAPCAs underwent initial surgery at our center, 40 of whom had a simple APW with or without ligation of MAPCAs as the first procedure (median age, 1.4 months). All PA diameters increased significantly on follow-up angiography. Ultimately, 35 patients underwent CR after APW. Nine of these patients (26%) underwent intermediate palliative operation between 5 and 39 months (median, 8 months) after APW. There were no early deaths. The cumulative incidence of CR was 65% 1 year post-APW and 87% at 3 years. Repaired patients were followed for a median of 4.2 years after repair; the median PA:aortic pressure ratio was 0.39 (range, 0.22 to 0.74).
CONCLUSIONS
Most patients with tetralogy of Fallot/MAPCAs and hypoplastic but normally arborizing PAs and dual-supply MAPCAs are able to undergo CR with low right ventricular pressure after APW early in life. Long-term outcomes were good, with acceptable PA pressures in most patients.
Topics: Abnormalities, Multiple; Aortopulmonary Septal Defect; Cardiac Surgical Procedures; Cohort Studies; Collateral Circulation; Computed Tomography Angiography; Databases, Factual; Female; Follow-Up Studies; Hospitals, Pediatric; Humans; Imaging, Three-Dimensional; Infant, Newborn; Male; Pulmonary Atresia; Retrospective Studies; Risk Assessment; Survival Analysis; Tetralogy of Fallot; Time Factors; Treatment Outcome
PubMed: 30980823
DOI: 10.1016/j.athoracsur.2019.03.022