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Bronshtein M, Gover A, Bachar G, Beloosesky R, Asaad K, Khatib N. 'Red eye' in main pulmonary artery: new sonographic sign for diagnosing aortopulmonary window. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023. [PMID: 38147439 DOI: 10.1002/uog.27565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/25/2023] [Accepted: 12/09/2023] [Indexed: 12/28/2023]
Affiliation(s)
- M Bronshtein
- Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - A Gover
- Neonatal Intensive Care Unit, Carmel Medical Center, Haifa, Israel
| | - G Bachar
- Department of Obstetrics and Gynecology, Rambam Health Care Campus, Haifa, Israel
| | - R Beloosesky
- Department of Obstetrics and Gynecology, Rambam Health Care Campus affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - K Asaad
- Department of Pediatric Cardiology, Rambam Health Care Campus affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - N Khatib
- Department of Obstetrics and Gynecology, Rambam Health Care Campus affiliated with Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Yu J, Liu K, Xu W, Xiong J, Zhong X, Hu S, Li W. Prenatal ultrasound diagnosis and management of fetal aortopulmonary septal defects: a case series. Transl Pediatr 2021; 10:3068-3074. [PMID: 34976772 PMCID: PMC8649606 DOI: 10.21037/tp-21-488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/16/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To investigate the prenatal ultrasound diagnosis and management of patients with aortopulmonary septal defects (APSDs). METHODS A total of 8 fetuses with APSDs who underwent fetal echocardiography at our hospital from January 2015 to January 2019 were retrospectively included in this study. RESULTS Among the 8 fetuses, there were 4 cases of type I APSD, 3 cases were type II, and 1 case was type III. Among the 8 cases, there were 2 cases of simple APSD. There were echocardiographic characteristics that were common to all 3 types of APSD. This included defects between the ascending aorta and the trunk of the pulmonary artery in the short-axis section of the aorta, and in the three vessels and the three-vessel trachea section. Furthermore, the "V"-shaped structure confluence point of all APSD cases was positioned more forward than normal in the three-vessel trachea section. Type I APSD can be better characterized by the cross-section of the double outflow tract of the aorta and the pulmonary artery, which is close to the aortic valve and pulmonary valve. Type II APSD can be clearly diagnosed by the short-axis view of the aorta. Since the defect between the aorta and the pulmonary artery is distant from the aortic valve and pulmonary valve, the defect does not involve the bifurcation of the pulmonary artery and may be associated with an ectopic origin of the right pulmonary artery. Type III APSD is similar to a permanent arterial trunk, and the space between the ascending aorta and the trunk of the pulmonary artery is completely missing. Color and pulse Doppler showed shunt flow in the defects. CONCLUSIONS APSD can be diagnosed and classified by fetal echocardiography. This, together with the presence or absence of fetal intracardiac and extracardiac deformities, can provide valuable prenatal information to pregnant women and their families, which may facilitate timely diagnosis and timely surgical treatment after birth.
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Affiliation(s)
- Junjian Yu
- Department of Cardiovascular and Thoracis Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Kang Liu
- Department of Cardiovascular and Thoracis Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Weichang Xu
- Department of Cardiovascular and Thoracis Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Jianxian Xiong
- Department of Cardiovascular and Thoracis Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Xuehong Zhong
- Department of Cardiovascular and Thoracis Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Shuo Hu
- Department of Cardiovascular and Thoracis Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
| | - Wentong Li
- Department of Cardiovascular and Thoracis Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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Bhalgat PS, Nabi F, Ray S. Aortopulmonary window: Clues to fetal diagnosis. Ann Pediatr Cardiol 2021; 14:247-248. [PMID: 34103873 PMCID: PMC8174642 DOI: 10.4103/apc.apc_42_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/08/2020] [Accepted: 11/28/2020] [Indexed: 11/25/2022] Open
Abstract
Being a planar structure, fetal diagnosis of aorto-pulmonary window poses great challenge. A few echocardiographic signs can help to clinch the diagnosis.
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Affiliation(s)
| | - Fazal Nabi
- Department of Pediatric, Jaslok Hospital, Mumbai, Maharashtra, India
| | - Sudeshna Ray
- Department of Gynecology, Jaslok Hospital, Mumbai, Maharashtra, India
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Pelzek C, Kellihan HB, Sheehan N, Powers A, Peek SF. Aortopulmonary window, left coronary artery aneurysm, and redundant aortic valve leaflet in a calf: the use of multimodal imaging to diagnose congenital heart disease. J Vet Cardiol 2021; 34:48-54. [PMID: 33561812 DOI: 10.1016/j.jvc.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 12/20/2020] [Accepted: 01/07/2021] [Indexed: 11/29/2022]
Abstract
A 2-month-old male Holstein calf was presented for evaluation of a continuous systolic murmur. A grade V/VI left basilar continuous murmur and a grade IV/VI right basilar continuous murmur was auscultated upon evaluation with increased respiratory effort, wheezes, and crackles. Multimodality diagnostics were performed on this patient for further workup and included transthoracic and transesophageal echocardiography, fluoroscopy guided angiography, and gross necropsy with histopathology. An aortopulmonary window with continuous left-to-right shunting was identified at the level of the left aortic sinus of Valsalva with a severely dilated left coronary artery and left-sided congestive heart failure. This case report outlines the diagnostic workup of a rare congenital heart defect and secondary cardiac abnormalities not previously identified in veterinary literature.
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Affiliation(s)
- C Pelzek
- University of Wisconsin Veterinary Medical Teaching Hospital, Madison, WI 53706, USA
| | - H B Kellihan
- University of Wisconsin Veterinary Medical Teaching Hospital, Madison, WI 53706, USA.
| | - N Sheehan
- University of Wisconsin Veterinary Medical Teaching Hospital, Madison, WI 53706, USA
| | - A Powers
- University of Wisconsin Veterinary Medical Teaching Hospital, Madison, WI 53706, USA
| | - S F Peek
- University of Wisconsin Veterinary Medical Teaching Hospital, Madison, WI 53706, USA
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Bin-Moallim M, Hamadah HK, Alhabshan F, Alghamdi AA, Kabbani MS. Aortopulmonary window: Types, associated cardiovascular anomalies, and surgical outcome. Retrospective analysis of a single center experience. J Saudi Heart Assoc 2020; 32:127-133. [PMID: 33154906 PMCID: PMC7640542 DOI: 10.37616/2212-5043.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/03/2020] [Accepted: 03/27/2020] [Indexed: 11/20/2022] Open
Abstract
Objective Aortopulmonary window (APW) is a rare congenital heart defect. It occurs as an isolated cardiac lesion or in association with other cardiac anomalies and rarely with abnormal coronary arteries. The spectrum of cardiovascular anomalies associated with APW and overall management and outcome in the current era were reviewed. Methods Between 2001 and 2018, all patients diagnosed with APW were included. Based on associated cardiovascular anomalies, those patients were divided into 2 groups: simple APW group and complex APW group (APW with associated other cardiovascular anomalies). All cases were followed longitudinally. The outcomes are described. Result Twenty patients underwent APW repair including 2 (10%) in simple APW group and 18 (90%) in complex APW group. Their mean age and weight were 4.8 ± 1.8 months and 4 ± 0.4 kg, respectively. APW Type I was confirmed in 65% followed by Type III in 20% and then Type II in 15% of the patients. In the complex APW group, atrial septal defect was the commonest associated cardiac lesion occurring in 8/20 (40%), followed by ventricular septal defect, interrupted aortic arch, and pulmonary artery anomalies in 25% of each. The presence of patent ductus arteriosus (PDA) was found in 40% of APW cases with 2/3rd of them in association with interrupted aortic arch. Two patients (10%) had unusual coronary anomalies that required repair, both with APW Type I. Associated non-cardiac anomalies were found in 30% of cases. Risk Adjustment for Congenital Heart Surgery (RACHS-1) score frequencies were between 2 and 4. Only one patient had reactive pulmonary hypertension related to chronic lung disease. All patients underwent surgical correction with median age of 2 month at the time of repair (interquartile range, 2 weeks to 4.5 months). Mean duration of mechanical ventilation, pediatric cardiac ICU and hospital length of stay were 2.8 ± 0.5, 9 ± 3 and 26 ± 6 days, respectively. All patients survived with no residual APW with mean follow-up duration of 4.5 years. Conclusion Majority of APW are associated with other cardiovascular anomalies (90%) including coronary abnormalities (10%). Early surgical repair of APW and associated lesions showed excellent survival rate, freedom from re-intervention need within an average of 4.5 years of follow up and no evidence of persistent pulmonary hypertension post repair.
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Affiliation(s)
- Mohammed Bin-Moallim
- Pediatric Cardiac Section, Cardiac Science Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Hussam K Hamadah
- Pediatric Cardiac Intensive Care Division, Department of Cardiac Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Fahad Alhabshan
- Pediatric Cardiac Section, Cardiac Science Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Abdullah A Alghamdi
- Division of Cardiac Surgery, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohamed S Kabbani
- Pediatric Cardiac Intensive Care Division, Department of Cardiac Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia.,King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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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 2020; 37:732-737. [PMID: 32347569 DOI: 10.1111/echo.14666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 03/22/2020] [Accepted: 03/31/2020] [Indexed: 11/30/2022] Open
Abstract
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.
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Affiliation(s)
- Huiyu Tang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xue Sun
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ying Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
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Fetal aortopulmonary window associated with urorectal malformation and common cloaca. Clin Dysmorphol 2020; 29:38-41. [PMID: 30925528 DOI: 10.1097/mcd.0000000000000265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kaya B, Ekiz A, Acar DK, Sezer S, Bornaun H, Yildirim G, Aslan H. Prenatal diagnosis of aortopulmonary window by foetal echocardiography: 'U or reversed U sign'. J OBSTET GYNAECOL 2019; 39:712-713. [PMID: 30856023 DOI: 10.1080/01443615.2018.1534817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Başak Kaya
- a Department of Maternal Fetal Medicine , Kanuni Sultan Süleyman Education and Research Hospital , İstanbul , Turkey
| | - Ali Ekiz
- a Department of Maternal Fetal Medicine , Kanuni Sultan Süleyman Education and Research Hospital , İstanbul , Turkey
| | - Deniz Kanber Acar
- a Department of Maternal Fetal Medicine , Kanuni Sultan Süleyman Education and Research Hospital , İstanbul , Turkey
| | - Salim Sezer
- a Department of Maternal Fetal Medicine , Kanuni Sultan Süleyman Education and Research Hospital , İstanbul , Turkey
| | - Helen Bornaun
- b Department of Pediatric Cardiology , Kanuni Sultan Süleyman Education and Research Hospital , İstanbul , Turkey
| | - Gökhan Yildirim
- a Department of Maternal Fetal Medicine , Kanuni Sultan Süleyman Education and Research Hospital , İstanbul , Turkey
| | - Halil Aslan
- a Department of Maternal Fetal Medicine , Kanuni Sultan Süleyman Education and Research Hospital , İstanbul , Turkey
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Li W, Bin G, Jiang W, Shuang Y. Prenatal Diagnosis of Aortopulmonary Window by 2-Dimensional Echocardiography: Summary of 8 Cases. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:795-803. [PMID: 30312989 DOI: 10.1002/jum.14756] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Indexed: 06/08/2023]
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.
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Affiliation(s)
- Wenxiu Li
- Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Geng Bin
- Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wu Jiang
- Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yang Shuang
- Pediatric Cardiovascular Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Dhillon GS, Fernandes CJ, Khan A, Heinle JS, Lopez KN. Transposition of the great arteries: When echocardiography does not match the clinical picture. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:617-622. [PMID: 30160304 PMCID: PMC6710829 DOI: 10.1002/jcu.22615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 06/01/2018] [Accepted: 06/10/2018] [Indexed: 06/08/2023]
Abstract
Aortopulmonary window (APW) is a rare form of congenital heart disease seen in isolation or with complex cardiac lesions. APW has been associated with other cardiac defects such as interrupted aortic arch and Tetralogy of Fallot, but few cases have been reported of APW associated with transposition of the great arteries (TGA). In a newborn with TGA and intact ventricular septum, diagnosis of APW requires a high index of suspicion. This article reviews the literature on TGA with APW and illustrates the importance of additional evaluation in neonates with TGA when oxygen saturation and PaO2 do not match predicted clinical values.
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Affiliation(s)
- Gurpreet S. Dhillon
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Caraciolo J. Fernandes
- Section of Neonatology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Asra Khan
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Jeffrey S. Heinle
- Division of Congenital Heart Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Keila N. Lopez
- Lillie Frank Abercrombie Section of Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
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Yu S, Han J, Gao S, Liu X, Gu X, Zhang Y, Sun L, He Y. The prenatal diagnosis of aortopulmonary window by fetal echocardiography. Echocardiography 2018; 35:1835-1840. [PMID: 30192407 DOI: 10.1111/echo.14131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 08/07/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The purpose of this study was to analyze the fetal echocardiographic features and the associated anomalies of prenatal aortopulmonary window (APW). METHODS We retrospectively reviewed the fetal echocardiographic database (n = 24 000) in our hospital between May 2012 and December 2017. The general clinical information, fetal echocardiographic features, and the associated anomalies in patients with APW were analyzed. Four patients had undergone whole genome sequencing using fetal tissues. RESULTS Six cases of APW confirmed by autopsy were identified in our fetal echocardiographic database. On the three-vessel view, a communication between the pulmonary artery trunk and ascending aorta was noted above the two semilunar valves in all cases. The most frequent type of APW among the cases was type II, and all cases were associated with other cardiac anomalies. No pathogenic or suspected pathogenic copy number variation or insertion-deletions were detected in this series. CONCLUSION Prenatal diagnosis of APW is feasible, which is helpful during prenatal consultations, so that parents can make better decisions regarding postpartum treatment options and pregnancy outcomes.
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Affiliation(s)
- Shaomei Yu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiancheng Han
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuang Gao
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaowei Liu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Gu
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ye Zhang
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lin Sun
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yihua He
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Tongprasert F, Sittiwangkul R, Jatavan P, Tongsong T. Prenatal Diagnosis of Aortopulmonary Window: A Case Series and Literature Review. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1733-1738. [PMID: 28393388 DOI: 10.7863/ultra.16.08025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 10/11/2016] [Indexed: 06/07/2023]
Abstract
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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Affiliation(s)
| | - Rekwan Sittiwangkul
- Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Thailand
| | - Phudit Jatavan
- Departments of Obstetrics and Gynecology, Chiang Mai University, Thailand
| | - Theera Tongsong
- Departments of Obstetrics and Gynecology, Chiang Mai University, Thailand
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