Surgical management of aortopulmonary window: 24 years of experience and lessons learned

Gowda, Deepak; Gajjar, Trushar; Rao, Jinaga Nageswar; Chavali, Praveen; Sirohi, Aaditya; Pandarinathan, Naveen; Desai, Nisarg

doi:10.1093/icvts/ivx099

Cited by 26 publications

(25 citation statements)

References 18 publications

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“…Although anomalous origin of the coronary artery (right or left) from the pulmonary trunk has been reported in APW, coronary artery anomalies were unlikely to be diagnosed prenatally and should be looked for postnatally prior to surgery . Nowadays, the “sandwich” repair described by Johansson and colleagues entailing a transwindow approach and defect closure is the most widely used technique . In general, surgery involves separation of the great arteries with either suture division or patch closure of the aorta and PA.…”

Section: Discussionmentioning

confidence: 99%

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

Geng

et al. 2018

J of Ultrasound Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

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

Geng

et al. 2018

J of Ultrasound Medicine

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“…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.…”

Section: Discussionmentioning

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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“…The major decision factors in the treatment of children presenting with defects beyond infancy are the assessment of operability, the postoperative management of pulmonary hypertension, and long-term outcomes [4] . Previous reports demonstrated favorable early and long-term outcomes after surgical correction, regardless of age or pulmonary vascular resistance [2,3] . Based on these reports, we decided to proceed with the surgical repair of the defect in the subject.…”

Section: Discussionmentioning

confidence: 99%

“…According to Stansel et al [1] , only less than 100 cases have been reported to date. The defect is located between the ascending aorta and the common pulmonary artery and is associated with a rapid progression of pulmonary arterial hypertension, unless it is corrected surgically [2] . Its pathophysiology and clinical manifestations resemble those of patent ductus arteriosus.…”

Section: Introductionmentioning

confidence: 99%

Surgical Repair of Complex Aortopulmonary Window: A Case Study

He¹,

Yan²,

Li³

et al. 2018

Braz J Cardiovasc Surg

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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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Surgical management of aortopulmonary window: 24 years of experience and lessons learned

Cited by 26 publications

References 18 publications

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

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

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

Surgical Repair of Complex Aortopulmonary Window: A Case Study

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