Prenatal Diagnosis of Aortopulmonary Window by 2‐Dimensional Echocardiography: Summary of 8 Cases

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.

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

“…Note that the abnormal spatial relationship of the great arteries only presents in APW fetuses with distal defect while it remains unchanged for fetuses with proximal defects. It is also interesting that the ductus is absent in all the 6 distal APW fetuses in the current study, which is consistent with previous report 2 . In addition, the size of aortopulmonary communication is apparently larger in distal type than that in the proximal type, though statistical analysis was not performed to make comparisons due to the very small number of cases involving this rare malformation.…”

“…Color Doppler is crucial in showing the abnormal communication between the two great arteries. Previous report indicated a unidirectional flow from the pulmonary artery to the aorta across the defect, 4 or in other reports a bidirectional shunt between the two great arteries 2,12 . As featured in the current study, the shunt is unidirectional in the case of proximal APW, while bidirectional unrestrictive flow was found in distal APW cases with large unrestrictive defects.…”

“…In addition, they indicated the use of sagittal plane in the diagnosis of APW coexisting with transposition of the great arteries. Recently, Bin et al proposed the using of coronal plane of double outflow tracts in the diagnosis of APW besides the planes mentioned above 2 . To our points, the short‐axis view is not good at the recognition of APW as the beam is perpendicular to the shunt.…”

“…APW infants can be an indication for immediate surgery to prevent congestive heart failure and irreversible pulmonary vascular changes. Without surgery, 40% to 50% of infants will die within one year after birth 2,14,15 . The prognosis is usually associated with other cardiac malformations.…”

“…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 . 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 .…”