Aortopulmonary Window with Atrial Septal Defect: Prenatal Diagnosis, Management and Outcome

Álvarez, Rosario; García‐Díaz, Lutgardo; Coserria, Félix; Hosseinpour, Reza; Antiñolo, Guillermo

doi:10.1159/000324173

Cited by 13 publications

(19 citation statements)

References 20 publications

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“…Just a careful inspection can usually detect it. Based on our series and literature review, the prenatal sonographic clues that are helpful in diagnosis of APW are as follows: The window or connection between the pulmonary artery and the aorta is found just above the two semilunar valves in nearly all cases; The window is best seen in the typical three‐vessel view, located below the bifurcation of the right pulmonary artery and high short‐axis view of great arteries (doughnut view) with fine cephalad angulation. The window must be visualized on at least two perpendicular views; With proper ultrasound beam angulation, bright border (T‐sign) of the window should be demonstrated to avoid false drop‐out, which is common in this area.…”

Section: Discussionmentioning

confidence: 99%

“…Just a careful inspection can usually detect it. Based on our series and literature review, [3][4][5][6][7][8][9][10][11][12][13][14][15] the prenatal sonographic clues that are helpful in diagnosis of APW are as follows: 1. The window or connection between the pulmonary artery and the aorta is found just above the two semilunar valves in nearly all cases; 2.…”

Section: Discussionmentioning

confidence: 99%

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Prenatal Diagnosis of Aortopulmonary Window: A Case Series and Literature Review

Tongprasert

Sittiwangkul

Jatavan

et al. 2017

J of Ultrasound Medicine

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Aortopulmonary window (APW) is a rare congenital heart defect, characterized by a connection between the ascending aorta and the pulmonary trunk before bifurcation. Prenatal diagnosis of APW is essential, as a surgical correction early after birth is required in most cases to prevent congestive heart failure secondary to high pulmonary blood flow. We report a series of three cases of APW that were detected by prenatal echocardiography. The key feature of diagnosis is demonstration of connection between the pulmonary artery and the aorta above the level of the two semilunar valves. Based on our cases and literature review, diagnostic clues for prenatal diagnosis of APW are summarized and proposed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prenatal Diagnosis of Aortopulmonary Window: A Case Series and Literature Review

Tongprasert

Sittiwangkul

Jatavan

et al. 2017

J of Ultrasound Medicine

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show abstract

“…The clinical outcome depends on the size of the defect and the presence of associated malformations. Early recognition and surgical repair of APSD is needed, as it results in heart failure due to high pulmonary blood flow [12]. Surgical treatment within the first postnatal 6 months using the transaortic or transpulmonary approach for patch closure is needed for optimal long-term outcome [11].…”

Section: Discussionmentioning

confidence: 99%

Aortopulmonary septal defect with interrupted aortic arch in a monochorionic diamniotic twin pregnancy

et al. 2012

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We report a monochorionic diamniotic twin pregnancy with prenatal diagnosis of aortopulmonary septal defect combined with type B interrupted aortic arch in one of the fetuses. The mother was referred for fetal echocardiography at 24 weeks' gestation due to suspected congenital heart disease. Prenatal echocardiography revealed a defect of 2.8 mm between the main pulmonary artery and the ascending aorta. The course of the ascending aorta was straight to the neck and head, and there was no continuity of the aortic arch after the origin of innominate and left common carotid arteries. Thus, aortopulmonary septal defect with type B interrupted aortic arch was suspected. Postnatal echocardiography confirmed the diagnosis, and surgical repair was performed on the 10th day after birth. The combination of aortopulmonary septal defect with type B interrupted aortic arch is a very rare condition that can be diagnosed by fetal echocardiographic examination in the second trimester of gestation. Prenatal diagnosis is important for the prognosis, since early surgical intervention is needed to prevent development of severe heart failure in the neonate.

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“…Aortopulmonary window (APW), also called aortopulmonary septal defect, is a rare, severe cardiac abnormality characterized by an abnormal communication between ascending aorta and the main pulmonary artery 1,2 . The defect is generally located above two semilunar valves and before the bifurcation of pulmonary artery 2 .…”

Section: Introductionmentioning

confidence: 99%

“…The defect is generally located above two semilunar valves and before the bifurcation of pulmonary artery 2 . The incidence rate is about 0.1% ~ 0.2% of all congenital heart diseases (CHDs), 1,3,4 with a sex ratio of 1 female for every 3 male fetuses 1,5 . Three main structural types have been described according to the site of the defect 6 : proximal defects or type Ⅰ, distal defects or type Ⅱ, and total defects or type Ⅲ, of which type Ⅰ is the most common.…”

Section: Introductionmentioning

confidence: 99%

Prenatal diagnosis of fetal aortopulmonary window by two‐ and four‐dimensional echocardiography with spatiotemporal image correlation

et al. 2020

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Background: Aortopulmonary window (APW) is a rare congenital heart disease which challenges most screening sonographers. The current study aims to summarize the two-dimensional (2D) and four-dimensional (4D) sonographic features in the fetal diagnosis.Methods: Ten cases of fetal APW were retrospectively reviewed, including 6 and 4 fetuses with distal and proximal defects, respectively. In addition, 40 normal fetuses with similar gestational age were also enrolled. The angle (α) between the pulmonary artery and aorta, and the length (D) of the ductus/pulmonary artery before its convergence with aorta were measured and compared between the normal and APW fetuses, respectively. Cardiac volumes of APW fetuses were acquired with spatial temporal image correlation (STIC) technique and post-analyzed to obtain 4D rendered images. Results:The D and the α were smaller and greater in distal APW fetuses than those in the normal fetuses, respectively (both P < .01), while no difference presented between the proximal APW fetuses and the normal fetuses. The ductus was absent for all distal APW fetuses, while it was normal for proximal APW fetuses. In 9 of 10 fetuses (90%), the 4D rendered image could be successfully obtained, which clearly showed the abnormal blood communication between the two great arteries in space. Conclusion:It is essential to scan around the three-vessel view and three-vessel trachea view to identify fetal APW using grayscale and color Doppler echocardiography.Distal APW is always with an increasing angulation between aorta and the pulmonary artery, and without the presence of normal ductus. 4D STIC technique may provide additional spatial relationships of the great arteries and thus help the diagnosis and consultation. K E Y W O R D S aortopulmonary window, echocardiography, fetus, prenatal diagnosis, spatial temporal image correlation technique, STIC | 733 TANG eT Al. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section. Movie S1. Detection of fetal proximal APW at the three-vessel trachea view by conventional echocardiogram. Movie S2. Detection of fetal distal APW at the three-vessel trachea view by conventional echocardiogram. Movie S3. 4D cineloops showing the abnormal communication in a case of fetal proximal APW. Movie S4. 4D cineloops showing the abnormal communication in a case of fetal distal APW. How to cite this article: Tang H, Wang Y, Sun X, Zhang Y. Prenatal diagnosis of fetal aortopulmonary window by two-and four-dimensional echocardiography with spatiotemporal image correlation. Echocardiography.

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Aortopulmonary Window with Atrial Septal Defect: Prenatal Diagnosis, Management and Outcome

Cited by 13 publications

References 20 publications

Prenatal Diagnosis of Aortopulmonary Window: A Case Series and Literature Review

Prenatal Diagnosis of Aortopulmonary Window: A Case Series and Literature Review

Aortopulmonary septal defect with interrupted aortic arch in a monochorionic diamniotic twin pregnancy

Prenatal diagnosis of fetal aortopulmonary window by two‐ and four‐dimensional echocardiography with spatiotemporal image correlation

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