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Qureshi AU, Kazmi T, Sadiq M. Device closure of residual aortopulmonary window using Konar-MF occluder device: an attractive new option. Cardiol Young 2024:1-3. [PMID: 38773806 DOI: 10.1017/s1047951124025010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2024]
Abstract
We report a case of a residual aortopulmonary window where a new Konar-MF occluder device was used to close the defect. This device has a low profile and conforms to the anatomy of aortopulmonary window very nicely without unnecessary protrusion on either side. This report highlights the advantage of Konar-MF occluder device for closure of such defects.
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Affiliation(s)
- Ahmad Usaid Qureshi
- The Children's Hospital, University of Child Health Sciences, Lahore, Pakistan
| | - Tehmina Kazmi
- The Children's Hospital, University of Child Health Sciences, Lahore, Pakistan
| | - Masood Sadiq
- The Children's Hospital, University of Child Health Sciences, Lahore, Pakistan
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2
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Transcatheter closure of a large aortopulmonary window with the novel device Multifunctional occluder (Konar) under TEE guidance (A case report). J Cardiol Cases 2022; 25:370-372. [DOI: 10.1016/j.jccase.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 11/04/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022] Open
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3
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Transcatheter closure of the aortopulmonary window in a three-month-old infant with a symmetric membranous ventricular septal defect occluder device. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:101-104. [PMID: 33768987 PMCID: PMC7970074 DOI: 10.5606/tgkdc.dergisi.2021.20988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 12/01/2020] [Indexed: 11/21/2022]
Abstract
Although most of aortopulmonary window cases are closed surgically, percutaneous closure can be also used in suitable patients. Defects which are far from the pulmonary and aortic valves, coronary artery, and pulmonary artery bifurcation, with adequate septal rims are considered suitable for percutaneous closure. A three-month-old male infant weighing 4 kg was referred to our pediatric cardiology department with the complaints of fatigue while breastfeeding, difficulty in weight gain, heart murmur, and respiratory distress. A large aortopulmonary window (5.3 mm) and left heart chamber dilatation were detected on echocardiography. The large aortopulmonary window was closed using a symmetric membranous ventricular septal defect occluder device. The closure procedure was performed via the antegrade route without forming an arteriovenous loop. In conclusion, the use of a symmetric membranous ventricular septal defect device for closure of large aortopulmonary window seems to be a safe and effective alternative to surgery in selected infants.
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Abstract
Aortopulmonary window is a rare cardiac defect, and early management with surgery or transcatheter closure is lifesaving. Here, a 9-month-old patient, who underwent a successful device closure with additional size-Amplatzer duct occlude, is presented to make emphasis that it may be considered as the device of choice for defects in close proximity to aortic valve and/or coronary ostium.
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Campos-Quintero A, García-Montes JA, Zabal-Cerdeira C, Cervantes-Salazar JL, Calderón-Colmenero J, Sandoval JP. Cierre transcatéter de la ventana aortopulmonar. ¿Vale la pena un método de cierre alternativo a la cirugía? Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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6
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A rare complication of balloon pulmonary angioplasty: Aortopulmonary window and its treatment. Anatol J Cardiol 2018; 21:46-47. [PMID: 30587706 PMCID: PMC6382906 DOI: 10.14744/anatoljcardiol.2018.24704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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7
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Campos-Quintero A, García-Montes JA, Zabal-Cerdeira C, Cervantes-Salazar JL, Calderón-Colmenero J, Sandoval JP. Transcatheter Device Closure of Aortopulmonary Window. Is There a Need for an Alternative Strategy to Surgery? ACTA ACUST UNITED AC 2018; 72:349-351. [PMID: 29844004 DOI: 10.1016/j.rec.2018.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/16/2018] [Indexed: 10/16/2022]
Affiliation(s)
- Aldo Campos-Quintero
- Departamento de Cardiología Intervencionista en Cardiopatías Congénitas, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - José Antonio García-Montes
- Departamento de Cardiología Intervencionista en Cardiopatías Congénitas, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Carlos Zabal-Cerdeira
- Departamento de Cardiología Intervencionista en Cardiopatías Congénitas, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Jorge Luis Cervantes-Salazar
- Departamento de Cirugía Cardiovascular en Cardiopatías Congénitas, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Juan Calderón-Colmenero
- Departamento de Cardiología Intervencionista en Cardiopatías Congénitas, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Juan Pablo Sandoval
- Departamento de Cardiología Intervencionista en Cardiopatías Congénitas, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
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8
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Diagnosis and surgical treatment of aortopulmonary window: Our single-center experience. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:30-37. [PMID: 32082708 DOI: 10.5606/tgkdc.dergisi.2018.14772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 10/02/2017] [Indexed: 11/21/2022]
Abstract
Background In this study, we aimed to report our single-center experience in aortopulmonary window and review clinical signs, symptoms, surgical correction techniques, and long-term outcomes. Methods We retrospectively reviewed the medical records of a total of 30 patients who were followed with the diagnosis of aortopulmonary window in our hospital between May 1998 and June 2016. The clinical characteristics of the patients, echocardiographic and angiographic findings, surgical treatment outcomes, and medical problems during follow-up were reviewed. Results The most common signs and symptoms were murmur, dyspnea, tachypnea, growth retardation, and signs of congestive heart failure. The mean age at the time of surgery was 8.2±14.4 months (7 days to 60 months). Eighteen patients (60%) had additional congenital cardiac anomalies. Eleven patients had simple congenital heart diseases, and seven patients had complex congenital heart diseases. Four patients were unable to be operated due to Eisenmenger syndrome (n=3) and complex congenital heart disease (n=1). No early or late postoperative death was observed. The mean follow-up was 6.4±4.8 years (range, 5 months to 16 years). In addition to aortopulmonary window repair, an additional cardiac anomaly modifying surgical intervention was corrected in nine patients (34.6%). One patient was reoperated for residual aortopulmonary window and another patient for pulmonary stenosis (valvular, supravalvar) after three years. One of these patients underwent pulmonary balloon valvuloplasty after two years. The reoperation rate was 7.7% (n=2) during follow-up. Conclusion Aortopulmonary window is a rare cardiac anomaly which may be overlooked by echocardiographic study, and which is amenable for repair with low-surgical risk. It is, therefore, imperative to diagnose and treat this condition, before pulmonary vascular disease develops.
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Sabnis GR, Shah HC, Lanjewar CP, Malik S, Kerkar PG. Transcatheter closure of large aortopulmonary window in a neonate. Ann Pediatr Cardiol 2018; 11:228-230. [PMID: 29922030 PMCID: PMC5963247 DOI: 10.4103/apc.apc_158_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Girish R Sabnis
- Department of Cardiology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India. E-mail:
| | - Hetan C Shah
- Department of Cardiology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India. E-mail:
| | - Charan P Lanjewar
- Department of Cardiology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India. E-mail:
| | - Sushma Malik
- Department of Pediatrics, T. N. Medical College and B. Y. L. Nair Hospital, Mumbai, Maharashtra, India
| | - Prafulla G Kerkar
- Department of Cardiology, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India. E-mail:
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Xu HX, Zheng DD, Pan M, Li XF. Transcatheter Treatment of Aortopulmonary Window with a Symmetrical Membranous Ventricular Septal Occluder. Cardiology 2017; 138:76-79. [PMID: 28609765 DOI: 10.1159/000475706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 04/04/2017] [Indexed: 11/19/2022]
Abstract
Aortopulmonary window (APW), the presence of a communication between aorta and pulmonary artery, is a rare congenital heart disease, and surgical intervention is the standard for closure. Recently, several cases have been treated with transcatheter device occluders. Here, we report an APW patient treated successfully using a transcatheter closure with a symmetrical membranous ventricular septal occluder. We are the first to report on a case treated with this type of occluder for APW.
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Affiliation(s)
- Hai-Xia Xu
- Department of Cardiology, Affiliated Hospital of Nantong University, Nantong, China
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11
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Percutaneous closure of an aortopulmonary window using Amplatzer Duct Occluder II: Additional Sizes: the first reported case. Cardiol Young 2017; 27:812-815. [PMID: 27869054 DOI: 10.1017/s1047951116002134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
To date, there are no reported cases of the Amplatzer Duct Occluder II: Additional Sizes' use in percutaneous closure of an aortopulmonary window. We report a case of percutaneous closure of an aortopulmonary window in a 4.5-month-old, 6 kg child. Owing to the patient's low weight, high risk of damage to the pulmonary valve, as well as the possibility of aortic and pulmonary artery obstruction, classic implants were deemed unsuitable and a decision was made to use the Amplatzer Duct Occluder II: Additional Sizes. The implant performed very well - the soft waist filled the aortopulmonary connection and both retention discs were properly shaped and pressed against vessel walls. Echocardiogram performed 12 hours after the procedure confirmed a correct occluder position. Low-profile retention discs had no impact on pulmonary valve function, despite the defect's proximity to the valve. No obstruction of the aortic or pulmonary artery lumen was noted. The Amplatzer Duct Occluder II: Additional Size implant is a safe and useful device for percutaneous closure of an aortopulmonary window in a carefully selected group of patients.
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12
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Talwar S, Agarwal P, Choudhary SK, Kothari SS, Juneja R, Saxena A, Airan B. Aortopulmonary window: Morphology, diagnosis, and long-term results. J Card Surg 2017; 32:138-144. [PMID: 28139013 DOI: 10.1111/jocs.12936] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Palkesh Agarwal
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shiv Kumar Choudhary
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Shyam Sunder Kothari
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rajnish Juneja
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Anita Saxena
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Balram Airan
- Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India
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Awasthy N, Tomar M, Radhakrishnan S, Shrivastava S. Unconventional uses of septal occluder devices: Our experience reviewed. Indian Heart J 2015; 67:128-35. [PMID: 26071291 DOI: 10.1016/j.ihj.2015.02.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 02/18/2015] [Indexed: 10/23/2022] Open
Abstract
UNLABELLED Device closure is now an accepted modality of treatment for cardiac septal defects such as fossa ovalis Atrial Septal Defect (ASD), Ventricular Septal Defect (VSD) and Patent Ductus Arteriosus (PDA) and have well-accepted indication and long term results. Devices used for these defects have been specifically designed for use in closing these defects. In this manuscript, we are reporting the efficacy of closure of nonseptal defects with devices conventionally used for septal cardiac defects although they have not been prototyped for use in such conditions. AIM To study use of occluder devices in nonseptal defects/malformation. MATERIAL & METHODS 39 patients, in the age group 2-67 yrs, were treated percutaneously with occluder devices for various conditions. These included: coronary arteriovenous (CAV) fistula (n = 6), pulmonary AV fistula (n = 4), systemic AV fistula (vascular plug; n = 1), closure of AP window (duct occluder; n = 3), closure of ascending aorta perforation (septal occluder; n = 2), ruptured sinus of Valsalva (RSOV) (duct occluder; n = 13), Fontan fenestration closure (ASD septal occluder, patent foramen ovale device, vascular plug n = 3,1 each), splenic artery (duct occluder; n = 1), Balock Taussig shunt (duct occlude; n = 1)and closure of mitral paravalvular leak (n = 3; duct occlude devices = 2, VSD device: n = 1) and aortic paravalvular leak n = 2 (duct occluder; n = 2 additional vascular plug = 2). RESULTS Procedural success: Successful closure as signified by no residual shunt was achieved in all coronary AV fistula (immediately n = 2, at 3 months in all), ruptured sinus of Valsalva (immediate in all), fenestrated Fontan (immediately in all), and ascending aorta perforations (immediate), mitral paravalvular leak (immediate in none, and late in 2/3). The aortic paravalvular leak closed at 3 months follow-up in one and small residual persisted after 1 month in another. COMPLICATIONS Local site Hematoma was observed in 4 patients. 2 of them required post procedure transfusion for the same. Hematuria was observed in 2 of the 4 patients of mitral paravalvular leak and 2 patients of RSOV device closure. Hematuria subsided with conservative management before discharge from hospital in all the 4 cases. One patient with residual mitral regurgitation required surgical management for continuing hematuria, anemia and hyperbilirubenemia. There was one mortality observed on table during the attempted closure of a very large RSOV who presented to us in severe congestive heart failure and shock. On follow up ranging from 2 months to 6 years, all the patients are asymptomatic. There was no late complication related to device in any patient. CONCLUSION It is feasible in selected nonseptal defects, which traditionally have been subjected to surgical interventions, to treat successfully, non surgically with the use of non prototype occluder devices without significant complications. Conventionally these devices have not been recommended for closure of nonseptal defects but show good early outcome. Adequate sample size with good follow up data is necessary before concluding that it can be safe alternative to surgery on long term.
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Affiliation(s)
- Neeraj Awasthy
- Consultant, Department of Pediatric Cardiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi 110025, India.
| | - Munesh Tomar
- Consultant, Pediatric Cardiology, Medanta Medicity, Gurgaon, Haryana, India
| | - S Radhakrishnan
- Director and HOD, Department of Pediatric Cardiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi 110025, India
| | - Savitri Shrivastava
- Director, Department of Pediatric Cardiology, Fortis Escorts Heart Institute, Okhla Road, New Delhi 110025, India
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Li X, Zhu D, Feng Y. Transcatheter Closure of Late-Onset Residual Aortopulmonary Septal Defect Using a Muscular Ventricular Septal Occluder. Int Heart J 2014; 55:89-91. [DOI: 10.1536/ihj.13-201] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- Xiao Li
- Department of Cardiology, West China Hospital, Sichuan University
| | - Da Zhu
- Department of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University
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Noonan PME, Desai T, Degiovanni JV. Closure of an aortopulmonary window using the Amplatzer Duct Occluder II. Pediatr Cardiol 2013; 34:712-4. [PMID: 22864674 DOI: 10.1007/s00246-012-0325-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 04/17/2012] [Indexed: 11/26/2022]
Abstract
We report two cases of transcatheter-device closure of aortopulmonary windows, a residual defect occurring after previous surgical closure, and a native lesion. The postsurgical defect was closed with an Amplatzer Duct Occluder II (AGA Medical Corporation, MN). The native lesion was not suitable for an Amplatzer Duct Occluder II device; thus, it was closed using an Amplatzer Duct Occluder (AGA Medical Corporation, MN). The Amplatzer Duct Occluder II provides an additional device for aortopulmonary window closure, but anatomy and defect characteristics dictate the most appropriate device.
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Affiliation(s)
- Patrick M E Noonan
- Birmingham Children's Hospital, Steel House Lane, Birmingham, B4 6NH, UK
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Caspi J, Pettitt TW, Ascuito RJ. Double Aortic Arch and Aortopulmonary Window. World J Pediatr Congenit Heart Surg 2012; 3:504-7. [DOI: 10.1177/2150135112445520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We describe a rare association of aortopulmonary window and double aortic arch in a 1.7-kg newborn who presented with severe respiratory distress. A staged surgical approach was used because of the size of the patient and significant comorbidity. This approach resulted in excellent outcome.
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Affiliation(s)
- Joseph Caspi
- Louisiana State University Health Science Center and Children’s Hospital, New Orleans, LA, USA
| | - Timothy W. Pettitt
- Louisiana State University Health Science Center and Children’s Hospital, New Orleans, LA, USA
| | - Robert J. Ascuito
- Louisiana State University Health Science Center and Children’s Hospital, New Orleans, LA, USA
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17
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Prem Sekar R, Bhima Shankar PR, Cherian KM. Transcatheter closure of a residual aortopulmonary window through internal jugular vein access. Indian Heart J 2012; 64:521-3. [PMID: 23102395 DOI: 10.1016/j.ihj.2012.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/09/2012] [Accepted: 07/17/2012] [Indexed: 11/15/2022] Open
Abstract
The use of Amplatzer septal occluder for closing a residual aortopulmonary defect has been described. This is usually performed by femoral access. We report closure of a residual aortopulmonary defect using right internal jugular vein access in a patient who had no femoral access as a result of previous cannulation for surgical repair. The 1 cm defect was closed successfully using a 10 mm Amplatzer septal occluder. Technical difficulty anticipated was unfounded although it was more cumbersome than femoral access. Left to right cardiac defects including PDA and AP window are amenable to transcatheter closure through internal jugular vein access.
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Affiliation(s)
- R Prem Sekar
- Frontier Lifeline & Dr K M Cherian Heart Foundation, Mogappair, Tamilnadu, India
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18
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Pan J, Li QG, Zhou Q, Zhang J, Wang Q, Wu Z, Wang DJ. Aortopulmonary window with subaortic fibrous stenosis and septal defect: surgery through a minimal right vertical infra-axillary thoracotomy. Heart Surg Forum 2012; 14:E264-6. [PMID: 21859650 DOI: 10.1532/hsf98.20111002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Aortopulmonary window with subaortic stenosis and ventricular septal defect is an uncommon congenital cardiac malformation that is repaired using cardiopulmonary bypass. The authors describe a 3-year-old patient on whom we performed surgery through a minimal right vertical infra-axillary thoracotomy. This minimally invasive surgery is likely to be applicable in a few cases.
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Affiliation(s)
- Jun Pan
- Department of Cardiothoracic Surgery, Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 East Zhong Shan Road, Nanjing, Jiangsu Province, China
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Hijazi ZM, Awad SM. Pediatric cardiac interventions. JACC Cardiovasc Interv 2009; 1:603-11. [PMID: 19463373 DOI: 10.1016/j.jcin.2008.07.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2008] [Revised: 06/24/2008] [Accepted: 07/27/2008] [Indexed: 11/18/2022]
Abstract
The field of pediatric cardiac interventions has witnessed a dramatic increase in the number and type of procedures performed. We review the most common procedures performed in the catheter laboratory. Lesions are divided according to their physiological characteristics into left-to-right shunting lesions (atrial septal defect, patent ductus arteriosus, ventricular septal defect), right-to-left shunting lesions (pulmonary stenosis, pulmonary atresia/intact ventricular septum), right heart obstructive lesions (peripheral arterial pulmonic stenosis, right ventricular outflow tract obstruction), and left heart obstructive lesions (aortic valve stenosis, coarctation of the aorta). In addition, a miscellaneous group of lesions is discussed.
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Affiliation(s)
- Ziyad M Hijazi
- Department of Pediatrics, Section of Cardiology, Rush University Medical Center, Rush Center for Congenital and Structural Heart Disease, Chicago, Illinois 60637, USA.
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20
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Marini D, Calcagni G, Ou P, Bonnet D, Agnoletti G. Percutaneous treatment of aorto-pulmonary window in a one year old child. Int J Cardiol 2008; 129:e91-3. [PMID: 17869356 DOI: 10.1016/j.ijcard.2007.06.135] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Accepted: 06/30/2007] [Indexed: 10/22/2022]
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21
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Trehan V, Nigam A, Tyagi S. Percutaneous closure of nonrestrictive aortopulmonary window in three infants. Catheter Cardiovasc Interv 2008; 71:405-11. [DOI: 10.1002/ccd.21366] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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22
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Sivakumar K, Francis E. Transcatheter Closure of Distal Aortopulmonary Window Using Amplatzer Device. CONGENIT HEART DIS 2006; 1:321-3. [DOI: 10.1111/j.1747-0803.2006.00055.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Abstract
The Cardioseal/Starflex septal occluder is usually deployed through a long transvenous sheath for closure of atrial septal defects, persistent foramen ovale, and, less commonly, ventricular septal defects. We describe two patients with residual left-to-right shunting after surgical palliation of congenital heart defects and illustrate the successful use of the double-umbrella device in these situations using a retrograde transarterial approach. This is exemplified by two previously not described interventions: retrograde closure of a large muscular ventricular septal defect in a patient after a palliative Mustard operation and a transcatheter closure of a Waterston-Cooley anastomosis. Effective and safe closure of left-to-right shunting can be achieved by retrograde use of the Cardioseal/Starflex device in selected adolescents and grown-ups with congenital heart disease.
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Affiliation(s)
- Christian Jux
- Department of Pediatric Cardiology and Pediatric Intensive Care Medicine, Georg-August University Goettingen, Germany.
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Bagtharia R, Trivedi KR, Burkhart HM, Williams WG, Freedom RM, Van Arsdell GS, McCrindle BW. Outcomes for patients with an aortopulmonary window, and the impact of associated cardiovascular lesions. Cardiol Young 2004; 14:473-80. [PMID: 15680067 DOI: 10.1017/s1047951104005025] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
An aortopulmonary window is a communication between the ascending aorta and pulmonary trunk in the presence of two separate arterial valves, and is often complicated by other associated defects. We sought to determine management and related outcomes in patients with this malformation. We identified those patients presenting between 1969 and 1999 from the databases held in our Departments of Cardiology, Pathology and Cardiovascular Surgery. We obtained data relating to issues concerning demography, clinical findings, imaging, management and outcome. The median age at presentation for the 42 patients identified, of whom 23 were female, was 62 days, with a range from birth to 6 years. Associated cardiac defects were present in 34 patients, including interruption of the aortic arch in 6 patients. The correct diagnosis was initially missed in 13 patients. Of the patients, six died without surgical repair, and 1 patient was lost-to-follow-up. Repair was performed in 35 patients, subsequent to repair of other defects in 4, in association with repair of other defects in 17, of whom 3 died, and as an isolated procedure in 14 patients, one of the latter being treated by transcatheter closure. Overall, there were 9 deaths, all in patients with complex associated defects, except 1 patient with a missed aortopulmonary window after repair of aortic coarctation. Kaplan-Meier estimates of survival were 81% at 3 months until 11.5 years, and 69% up to 21 years. Only the presence of interrupted aortic arch was independently associated with increased time-related mortality, the hazard ratio being 5.87 (p = 0.009). The outcome for an isolated lesion is excellent. Mortality occurs mainly before repair, mostly with complex associated lesions, particularly interruption of the aortic arch.
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Affiliation(s)
- Rajesh Bagtharia
- Division of Cardiology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Erez E, Dagan O, Georghiou GP, Gelber O, Vidne BA, Birk E. Surgical management of aortopulmonary window and associated lesions. Ann Thorac Surg 2004; 77:484-7. [PMID: 14759423 DOI: 10.1016/s0003-4975(03)01603-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Aortopulmonary window is a rare congenital heart defect commonly associated with other cardiac anomalies. Although single institutional experience is low, several surgical techniques have been reported. The purpose of this study is to describe our approach to the management of aortopulmonary window and its associated lesions. METHODS Between February 1996 and November 2002, 13 patients underwent repair of aortopulmonary window. The age range went from 4 days to 5.5 months (mean 42 +/- 52 days), with 9 patients younger than 1 month old. The weight range was from 1.9 to 6.7 kg (mean 3.5 +/- 1.2 kg). Concomitant cardiac anomalies were present in 11 patients. The major additional anomalies were interruption of aortic arch in 4 patients and tracheal stenosis in 1 patient. Initial diagnoses were made using two-dimensional echocardiography only. RESULTS There was one postoperative death. In general, patients with aortopulmonary window and additional major defects had a prolonged intensive care unit and hospital stay when compared with the other patients. Follow-up time ranged from 2 months to 6.8 years (mean of 2.5 +/- 2.2 years). There were no reoperations and no late deaths. Transcatheter balloon dilatation of the repaired aortic arch was required in 1 patient and of the right pulmonary artery in another. All other patients had good flow to both pulmonary arteries. No residual shunts were detected at the aortopulmonary window site, and pulmonary pressures were normal. CONCLUSIONS Aortopulmonary window may be effectively diagnosed with echocardiography. Early surgical treatment (neonatal period, if possible) is safe and associated with the best long-term results, even in the presence of other cardiac anomalies. Complete separation and reconstruction of both aorta and pulmonary arteries under direct vision may prevent recurrence and distortion of adjacent structures.
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Affiliation(s)
- Eldad Erez
- Department of Cardiothoracic Surgery, Anesthesiology and Heart Institute, Schneider Children's Medical Center of Israel, Rabin Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Petach Tikva, Israel.
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26
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Naik GD, Chandra VS, Shenoy A, Isaac BC, Shetty GG, Padmakumar P, Jayranganath M. Transcatheter closure of aortopulmonary window using Amplatzer device. Catheter Cardiovasc Interv 2003; 59:402-5. [PMID: 12822171 DOI: 10.1002/ccd.10535] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Two cases of transcatheter closure of aortopulmonary window (APW) using an Amplatzer duct occluder in one and a septal occluder device in the second are described. Transcatheter device closure of APW should be considered when anatomy is favorable in terms of location and size of the defect with absence of associated anomalies.
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Moruno Tirado A, Santos De Soto J, Grueso Montero J, Gavilán Camacho JL, Alvarez Madrid A, Gil Fournier M, Descalzo Señorans A. [Aortopulmonary window: clinical assessment and surgical results]. Rev Esp Cardiol 2002; 55:266-70. [PMID: 11893318 DOI: 10.1016/s0300-8932(02)76595-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND OBJECTIVES Aortopulmonary septal defect is an uncommon congenital cardiac anomaly. To date, approximately 300 cases have been reported. We present our experience, emphasizing the importance of early correction to avoid irreversible pulmonary hypertension. PATIENTS AND METHOD Between 1979 and 2000, seven patients underwent surgical repair of this heart defect in our hospital. Two had type I (proximal), 4 had type II (distal) and 1 had type III (complete). Complex associated cardiac anomalies were present in 4 cases: type A interruption of the aortic arch in 2 cases, hypoplastic aortic arch in 1 and transposition of great arteries with ventricular septal defect in 1. Four cases (57%) were diagnosed by echocardiography. In all patients diagnoses were confirmed by cardiac catheterization. Patient records were reviewed retrospectively, with special attention to clinical, echocardiographic and hemodynamic data as well as surgical characteristics. RESULTS No intraoperative deaths occurred. The patient with associated transposition of great arteries died 22 days after surgery as a result of severe pulmonary hypertension. The remaining patients are asymptomatic without treatment after a mean follow-up period of 69 months. CONCLUSIONS Even though aortopulmonary septal defect is a rare anomaly, it should be considered whenever the course of complex congenital heart disease includes early cardiac failure and pulmonary hypertension. Repair before 6 months will prevent irreversible damage of pulmonary vessels.
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Affiliation(s)
- Antonio Moruno Tirado
- Secciones de Cardiología y Hemodinámica, Hospital Infantil Virgen del Rocío, Sevilla.
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28
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Alekyan BG, Boukharin VA, Podzolkov VP, Poursanov MG. Residual Aortopulmonary Window Closure with Amplatzer Septal Occluder. Asian Cardiovasc Thorac Ann 2001. [DOI: 10.1177/021849230100900319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 15-year-old female presented with fatigue and dyspnea on exertion due to a residual left-to-right shunt across an aortopulmonary window that had been surgically closed 11 years earlier. The residual opening was located distal to the coronary ostia, the semilunar valves, and the pulmonary artery bifurcation. An Amplatzer septal occluder was used to completely close the residual defect, thereby avoiding reoperation.
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Affiliation(s)
- Bagrat G Alekyan
- Department of Interventional Cardiology and Angiology Bakoulev Scientific Center for Cardiovascular Surgery Russian Academy of Medical Sciences Moscow, Russia
| | - Vitaly A Boukharin
- Department of Interventional Cardiology and Angiology Bakoulev Scientific Center for Cardiovascular Surgery Russian Academy of Medical Sciences Moscow, Russia
| | - Vladimir P Podzolkov
- Department of Interventional Cardiology and Angiology Bakoulev Scientific Center for Cardiovascular Surgery Russian Academy of Medical Sciences Moscow, Russia
| | - Manolis G Poursanov
- Department of Interventional Cardiology and Angiology Bakoulev Scientific Center for Cardiovascular Surgery Russian Academy of Medical Sciences Moscow, Russia
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Jacobs JP, Quintessenza JA, Gaynor JW, Burke RP, Mavroudis C. Congenital Heart Surgery Nomenclature and Database Project: aortopulmonary window. Ann Thorac Surg 2000; 69:S44-9. [PMID: 10798415 DOI: 10.1016/s0003-4975(99)01236-9] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The extant nomenclature for aortopulmonary window (AP window) and pulmonary artery origin from ascending aorta (hemitruncus) is reviewed for the purpose of establishing a unified reporting system. The subject was debated and reviewed by members of the STS-Congenital Heart Surgery Database Committee and representatives from the European Association for Cardiothoracic Surgery. All efforts were made to include all relevant nomenclature categories using synonyms where appropriate. A comprehensive database set is presented that is based on a hierarchical scheme. Data are entered at various levels of complexity and detail that can be determined by the clinician. These data can lay the foundation for comprehensive risk stratification analyses. A minimum database set is also presented that will allow for data sharing and would lend itself to basic interpretation of trends. Outcome tables relating diagnoses, procedures, and various risk factors are presented.
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Affiliation(s)
- J P Jacobs
- Division of Thoracic and Cardiovascular Surgery, All Children's Hospital, University of South Florida School of Medicine, St. Petersburg 33701, USA.
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Jureidini SB, Spadaro JJ, Rao PS. Successful transcatheter closure with the buttoned device of aortopulmonary window in an adult. Am J Cardiol 1998; 81:371-2. [PMID: 9468090 DOI: 10.1016/s0002-9149(97)00917-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This case report describes a technique to close an intermediate aortopulmonary window with the use of the buttoned device in an adult.
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Affiliation(s)
- S B Jureidini
- Department of Pediatrics, St. Louis University School of Medicine, Cardinal Glennon Children's Hospital, Missouri 63104, USA
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31
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Abstract
Aorto-pulmonary window (aorto-pulmonary septal defect) is an uncommon congenital cardiac malformation which is repaired using cardiopulmonary bypass. A case is described of an infant with a small aorto-pulmonary window which was closed by transcatheter insertion of a double umbrella device. Complete occlusion of the defect was achieved without complications. Transcatheter umbrella closure of a small aorto-pulmonary window is feasible in infancy and the technique is likely to be applicable in a few cases.
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Affiliation(s)
- R M Tulloh
- Department of Paediatric Cardiology, Royal Brompton Hospital, London
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