RESUMO
Congenital mitral stenosis is a broad-spectrum pathology in which blood flow to the left ventricle is obstructed both functionally and anatomically. Hammock mitral valve, also known as anomalous mitral arcade, is a rare congenital anomaly particularly in infants and children. Hammock mitral valve may not be suitable for repair regarding the advanced dysplastic mitral valve structure. Aortopulmonary window is an unusual cardiac anomaly which is defined as a communication between the main pulmonary artery and the ascending aorta. As a result of the excessive left-to-right shunt, early intervention and surgical closure deemed mandatory to avoid development of severe pulmonary hypertension and its consequences. All patients with an aortopulmonary window necessitates prompt repair immediately. In this brief report, mitral valve replacement with a mechanical valve and repair of aortopulmonary window with a Dacron patch were performed simultaneously in a 5-month-old patient with a hammock mitral valve and accompanying aortopulmonary window.
Assuntos
Defeito do Septo Aortopulmonar , Insuficiência da Valva Mitral , Estenose da Valva Mitral , Lactente , Criança , Humanos , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Valva Mitral/anormalidades , Defeito do Septo Aortopulmonar/diagnóstico , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Estenose da Valva Mitral/complicações , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Artéria Pulmonar/anormalidades , Insuficiência da Valva Mitral/complicações , Insuficiência da Valva Mitral/diagnóstico , Insuficiência da Valva Mitral/cirurgiaRESUMO
We report a case of a 2-day-old male with a diagnosis of interrupted aortic arch combined with aortopulmonary window suspected through echocardiography and confirmed by multidetector computer tomography (MDCT) angiography. Our case highlights how MDCT angiography was a key factor in planning surgical approach as it not only accurately defined aortic arch anatomy but also aortopulmonary window morphology.
Assuntos
Coartação Aórtica , Defeito do Septo Aortopulmonar , Masculino , Humanos , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Tomografia Computadorizada Multidetectores , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Defeito do Septo Aortopulmonar/cirurgia , Coartação Aórtica/complicações , Angiografia , Angiografia por Tomografia ComputadorizadaRESUMO
AIM: The present study sought to evaluate the morphology and associated cardiovascular anomalies in patients with aortopulmonary window on virtual dissection of multidetector computed tomography (CT) angiography data sets. MATERIAL AND METHODS: We conducted a retrospective search of our departmental database from January 2014 to September 2021 to identify patients with aortopulmonary window and relevant information was extracted from the electronic case records and from routine examination as well as virtual dissection of CT data sets. RESULTS: An aortopulmonary window was observed in 26 patients (20 males; 6 females). Based on location of the defect, a distal aortopulmonary window was the most common subtype, seen in 13/26 (50%) patients followed by a proximal, complete and intermediate subtypes seen in 7/26 (27%), 5/26 (19%) and 1/26 (4%) patients respectively. Associated ventricular septal defect was observed in 9/26 (34.6%) patients while an interrupted aortic arch was present in 5/26 (19.2%) patients. Tetralogy of Fallot was seen in 5/26 (19.2%) patients. Anomalous origin of right pulmonary artery from ascending aorta and crossed pulmonary arteries were seen in 2/26 (7.6%) patients each. An isolated aortopulmonary window without any simple/complex congenital anomaly was seen in 10/26 (38.5%) patients. CONCLUSION: Aortopulmonary window is associated with a wide gamut of cardiovascular lesions, with ventricular septal defect being the commonest associated anomaly followed by tetralogy of Fallot and interrupted aortic arch respectively. Virtual dissection of multidetector CT angiography allows detailed anatomical evaluation of aortopulmonary window, allowing a clear visualization of the defect and associated cardiovascular anomalies.
Assuntos
Coartação Aórtica , Defeito do Septo Aortopulmonar , Anormalidades Cardiovasculares , Comunicação Interventricular , Tetralogia de Fallot , Masculino , Feminino , Humanos , Tomografia Computadorizada Multidetectores , Estudos Retrospectivos , Tetralogia de Fallot/complicações , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Defeito do Septo Aortopulmonar/cirurgia , Defeito do Septo Aortopulmonar/complicações , Artéria Pulmonar/cirurgia , Coartação Aórtica/cirurgia , Anormalidades Cardiovasculares/complicações , Angiografia , Comunicação Interventricular/diagnóstico por imagem , Comunicação Interventricular/cirurgia , Comunicação Interventricular/complicaçõesRESUMO
Anomalous ascending aortic origin of left pulmonary artery in association with aortopulmonary window has not been reported so far in literature and is the main highlight of the present case.
Assuntos
Defeito do Septo Aortopulmonar , Artéria Pulmonar , Aorta/anormalidades , Aorta/diagnóstico por imagem , Aorta/cirurgia , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Defeito do Septo Aortopulmonar/cirurgia , Humanos , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgiaRESUMO
Aortopulmonary window (APW) seen in association with anomalous origin of left coronary artery from pulmonary artery (ALCAPA) is extremely uncommon. When faced with this combination, ALCAPA usually goes undetected since most of the clinical and echocardiographic features of ALCAPA, including ventricular dysfunction are absent due to co-existent pulmonary hypertension. Herein we report a 5-month-old child with a large APW in whom a preoperative computed tomography angiogram facilitated the diagnosis of ALCAPA. The case is described for its rarity and the challenges faced during management. Also, it is extremely crucial that this coronary anomaly is identified and corrected during surgery, since failure to do so results in unforeseen postoperative ventricular dysfunction.
Assuntos
Defeito do Septo Aortopulmonar , Síndrome de Bland-White-Garland , Anomalias dos Vasos Coronários , Disfunção Ventricular , Defeito do Septo Aortopulmonar/complicações , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Defeito do Septo Aortopulmonar/cirurgia , Síndrome de Bland-White-Garland/diagnóstico , Síndrome de Bland-White-Garland/diagnóstico por imagem , Criança , Anomalias dos Vasos Coronários/complicações , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Humanos , Lactente , Artéria Pulmonar/anormalidades , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgiaRESUMO
We report a case of a 4-year-old boy with a distal type of aortopulmonary window with crossed arrangement of the pulmonary arteries. This case highlights the potential clinical implications of this variant pulmonary arterial anatomy in the setting of the aortopulmonary window and the role of computed tomography angiography in accurately defining vascular relationships in patients with complex congenital cardiac defects.
Assuntos
Defeito do Septo Aortopulmonar , Artéria Pulmonar , Angiografia , Defeito do Septo Aortopulmonar/complicações , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Defeito do Septo Aortopulmonar/cirurgia , Pré-Escolar , Humanos , Masculino , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgiaRESUMO
We report a case of advanced age at presentation of interrupted aortic arch with aortopulmonary window. Although the association between these two defects is well established, their overall prevalence is extremely low. This case presents us with an excellent opportunity to discuss decision making regarding aortic arch repair techniques according to age at which primary surgical correction is intended.
Assuntos
Coartação Aórtica , Defeito do Septo Aortopulmonar , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico por imagem , Coartação Aórtica/cirurgia , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Defeito do Septo Aortopulmonar/cirurgia , HumanosRESUMO
The association of total anomalous pulmonary venous connection (TAPVC) with aortopulmonary window (APW) is extremely rare. The coexistence of these two anomalies will have implications on clinical presentation, diagnosis, and pathophysiology. The lungs are exposed to pulmonary venous hypertension due to obstructed TAPVC as well as pulmonary arterial hypertension due to unrestrictive APW. We describe successful management of this unusual association in a three-month-old child.
Assuntos
Defeito do Septo Aortopulmonar , Hipertensão Arterial Pulmonar , Veias Pulmonares , Síndrome de Cimitarra , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Defeito do Septo Aortopulmonar/cirurgia , Humanos , Lactente , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/cirurgia , Síndrome de Cimitarra/diagnóstico por imagem , Síndrome de Cimitarra/cirurgiaRESUMO
Coronary artery anomalies may accompany the aortopulmonary window and, if not noticed, may cause catastrophic consequences. The repair of the aortopulmonary window is quite straightforward; however, establishing a normal coronary pattern may challenge the repair. When the anomalous origin of the coronary artery is on the defect rim, right at the location where sutures are to be placed, it may interfere with proper suture placement. A technique to overcome such a technical obstacle and reroute the anomalous right coronary in such cases is described.
Assuntos
Defeito do Septo Aortopulmonar , Anomalias dos Vasos Coronários , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Defeito do Septo Aortopulmonar/cirurgia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Coração , Humanos , Recém-Nascido , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgiaRESUMO
Aortopulmonary window is a rare congenital heart disease that can increase pulmonary vascular resistance, exacerbate left-to-right shunt and lead to heart failure and respiratory tract infections. Most patients die during childhood. We report a 53-year-old male patient with a large aortopulmonary window combined with anomalous origin of the right pulmonary artery from the aorta, with Eisenmenger syndrome and without surgery.
Assuntos
Defeito do Septo Aortopulmonar , Complexo de Eisenmenger , Adulto , Aorta/diagnóstico por imagem , Aorta/cirurgia , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Defeito do Septo Aortopulmonar/cirurgia , Complexo de Eisenmenger/complicações , Complexo de Eisenmenger/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Resistência VascularRESUMO
Anomalous origin of coronary artery originating from the pulmonary artery in conjunction with the aorticopulmonary window (APW) is a rare but a significant anomaly in the era of congenital cardiac diseases. The occurrence of anomalous origin of the right coronary artery from the pulmonary artery among the associated anomalies is less than 5%. The severity of the clinical condition of these patients depends on the degree of left-right shunt and compromise of the pulmonary blood flow. We report surgical management of a case of a 45-day-old infant with APW, ventricular septal defect, and anomalous origin of coronary artery originated from the pulmonary artery.
Assuntos
Defeito do Septo Aortopulmonar , Anomalias dos Vasos Coronários , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Defeito do Septo Aortopulmonar/cirurgia , Anomalias dos Vasos Coronários/diagnóstico por imagem , Anomalias dos Vasos Coronários/cirurgia , Humanos , Lactente , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Circulação PulmonarRESUMO
Aortopulmonary window (APW) is a rare but serious congenital cardiac malformation, most patients with APW will die from congestive heart failure within one year after birth. In fact, patients with large APW is rarely seen in childhood or adult life. However, we report an older child with a large anomalous "window" on the ascending aorta, with discontinuous pulmonary arteries, and the left pulmonary artery (LPA) arising via a left-sided arterial duct in the presence of a right aortic arch. Preoperative diagnosis made by echocardiography and chest computerized tomography revealed anatomical futures clearly. Cardiac catheterization indicated that the pulmonary resistances indices were 2.92 Wood unit/m2 in LPA and 3.35 Wood unit/m2 in RPA, Q p : Q s was 3.26. This patient underwent surgical correction at the age of 10 and successfully survived.
Assuntos
Defeito do Septo Aortopulmonar , Artéria Pulmonar , Adolescente , Adulto , Aorta , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Defeito do Septo Aortopulmonar/cirurgia , Criança , Ecocardiografia , Humanos , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgiaRESUMO
Aorto-pulmonary window (APW) is a rare congenital heart defect characterized by the connection between the ascending aorta and the pulmonary trunk before its bifurcation, just above the semilunar valves, due to the abnormal development of spiral septum. The short-axis echocardiographic view of the right ventricular outflow track, the three-vessel-view, and the three-vessel-trachea view are the key planes for prenatal diagnosis. We report a case of APW with absent ductus arteriosus in a monochorionic twin, detected by prenatal echocardiography. The diagnosis was confirmed postnatally and corrective surgery was performed at the age of 1 week. Prenatal diagnosis of APW is essential, since surgical correction early after birth is required to prevent congestive heart failure secondary to high pulmonary blood flow.
Assuntos
Defeito do Septo Aortopulmonar/diagnóstico por imagem , Canal Arterial/diagnóstico por imagem , Ecocardiografia , Ultrassonografia Pré-Natal , Adulto , Aorta/diagnóstico por imagem , Defeito do Septo Aortopulmonar/cirurgia , Feminino , Humanos , GravidezRESUMO
Type II Aortopulmonary window (APW) accounts for only 10% of total cases of APW, which by itself is a rare congenital anomaly. Various cardiac malformations have been reported to be associated with this rare anomaly. We report one such association of origin of left subclavian artery (LSCA) from left pulmonary artery (LPA) via ductus arteriosus that was surgically repaired.
Assuntos
Defeito do Septo Aortopulmonar , Artéria Subclávia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Defeito do Septo Aortopulmonar/complicações , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Defeito do Septo Aortopulmonar/cirurgia , Humanos , Pulmão , Artéria Pulmonar/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Artéria Subclávia/diagnóstico por imagem , Artéria Subclávia/cirurgiaRESUMO
Abstract Type II Aortopulmonary window (APW) accounts for only 10% of total cases of APW, which by itself is a rare congenital anomaly. Various cardiac malformations have been reported to be associated with this rare anomaly. We report one such association of origin of left subclavian artery (LSCA) from left pulmonary artery (LPA) via ductus arteriosus that was surgically repaired.
Assuntos
Humanos , Defeito do Septo Aortopulmonar/cirurgia , Defeito do Septo Aortopulmonar/complicações , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Artéria Subclávia/cirurgia , Artéria Subclávia/diagnóstico por imagem , Aorta Torácica/cirurgia , Aorta Torácica/diagnóstico por imagem , Artéria Pulmonar/cirurgia , Artéria Pulmonar/diagnóstico por imagem , PulmãoRESUMO
Aortopulmonary window (APW) is a rare congenital cardiac condition. A large number of patients with a large APW usually die within 1 year of age. It is extremely rare to find cases of APW surviving till adult age and it is still rare to surgically treat such patients who are incidentally detected in adult age because such subsets of patients invariably have associated pulmonary vascular obstructive disease in advanced stage and thus there is therapeutic dilemma to surgically correct these patients. Although cases of uncorrected AP window presenting in adulthood have been reported but literature on surgically treated AP window in adult populations is limited. We describe case of APW in a 26-year-old male patient who was diagnosed incidentally while suspecting infective endocarditis and was subsequently surgically closed successfully with polytetrafluoroethylene patch after confirming reversibility of pulmonary arterial hypertension which is the key for successful outcome.
Assuntos
Defeito do Septo Aortopulmonar/cirurgia , Procedimentos Cirúrgicos Cardiovasculares/métodos , Achados Incidentais , Hipertensão Arterial Pulmonar/etiologia , Hipertensão Arterial Pulmonar/cirurgia , Adulto , Defeito do Septo Aortopulmonar/complicações , Defeito do Septo Aortopulmonar/diagnóstico por imagem , Ecocardiografia Transesofagiana , Humanos , Masculino , Politetrafluoretileno , Doenças Raras , Resultado do TratamentoRESUMO
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.