Transcatheter Treatment of Aortopulmonary Window with a Symmetrical Membranous Ventricular Septal Occluder.

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.

Transcatheter closure of late-onset residual aortopulmonary septal defect using a muscular ventricular septal occluder.

Late-onset residual shunt after surgical repair of aortopulmonary septal defect (APSD) is a rare event complicating the management strategy. Surgical reoperation was the treatment of choice traditionally, while associated with increased risk and suffering. We report a case of successful treatment of this type of residual shunt using a transcatheter closure technique with an infrequently used muscular ventricular septal device.

Closure of an aortopulmonary window using the Amplatzer Duct Occluder II.

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.

Transcatheter closure of a residual aortopulmonary window through internal jugular vein access.

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.

Hybrid therapy for interrupted aortic arch with aortopulmonary window in a low birth weight infant.

Interrupted aortic arch (IAA) is rarely associated with aortopulmonary window. Single-stage total correction is the preferred therapeutic option. When total correction is unfeasible, staged repair could be the therapeutic choice. Here, we presented a low birth weight infant who underwent bilateral pulmonary arteries banding and stenting ductus arteriosus by hybrid procedure. Hybrid procedure avoids long-term central line insertion and guarantees ductal flow. It also avoids the side effects from prostaglandin infusion.

Percutaneous closure of nonrestrictive aortopulmonary window in three infants.

Aortopulmonary (AP) window, a communication between ascending aorta and pulmonary artery, is usually nonrestrictive and causes severe pulmonary vascular obstructive disease early in life. Only in 10% of the cases it is restrictive. There are sporadic case reports [1-8] of device closure of AP window which are mostly confined to these restrictive AP windows, that too in adults or relatively older children. Till date there is a single case report of device closure of nonrestirctive AP window in an infant [8]. We report our single experience of device closure of large, nonrestrictive AP windows in 3 infants. Percutaneous closure of AP window in each of the three patients was done by a different type of device i.e. duct occluder, muscular VSD occluder and perimembranous VSD occluder.

Percutaneous device closure of nonrestrictive aortopulmonary window in a 4 months' infant.

Aortopulmonary window is a rare congenital heart disease occurring in 0.2-0.6% of all patients with congenital heart disease. It is usually nonrestrictive and is conventionally treated surgically at an early age to prevent the development of pulmonary vascular obstructive disease. In 10% of the patients, it is restrictive and case reports of its percutaneous closure are mostly limited to these patients. We report percutaneous device closure of nonrestrictive AP window in a 4 months old, 4 kg child. To the best of our knowledge this is the youngest child to have undergone percutaneous device closure of an AP window.

Management of aortopulmonary collateral arteries in Fontan patients: routine occlusion is not warranted.

Aortopulmonary collaterals (APCs) are common in patients undergoing a Fontan operation and are typically identified at cardiac catheterization. However, this is a qualitative approach and has important limitations. Previous catheterization-based studies of the effects of APCs have produced conflicting results. We have recently carried out a study directly measuring APC flow at the time of Fontan operation. This study showed that patients undergoing a Fontan operation have APC flow many-fold higher than controls, the extent of APC flow varies widely from patient to patient, APC flow does not increase in a linear fashion over time, and that APC flow has no detectable effect on the outcome of the Fontan operation. Thus, routine preoperative APC identification and occlusion does not appear indicated. A randomized study of preoperative coil occlusion could clarify this issue further. Aortopulmonary collaterals may exert a "threshold" effect, increasing risk in patients who also have other risk factors. Preoperative coil occlusion may decrease overall risk in such patients. Postoperative APC occlusion is a reasonable option in the patient with prolonged effusions after a Fontan operation, with no other correctable anatomic defects.

Management of aortopulmonary collateral arteries in Fontan patients: occlusion improves clinical outcome.

Children with chronic cyanotic heart disease often develop systemic-to-pulmonary artery collateral vessels that can be deleterious at the time of a Fontan procedure because of excessive pulmonary blood flow with resultant ventricular volume overload. We therefore occlude all significant collateral arteries during preoperative cardiac catheterization. From June 1993 to September 2001, 137 children ranging from 1.5 to 18.3 years old (median, 2.4 years), underwent a fenestrated lateral tunnel Fontan procedure. Of these, 130 (95%) had a previous bidirectional Glenn anastomosis, including 43 (31%) with a Norwood procedure. Preoperatively, 52 children (38%) required occlusion of collateral vessels. Two of five perioperative deaths (operative survival, 96%) resulted from excessive pulmonary blood flow; one from unrecognized collateral arteries and one from uncontrollable collateral arteries. Postoperatively, 29 children (22%) required coil occlusion of collateral vessels for elevated pulmonary artery pressures, heart failure, or prolonged chest tube drainage. At follow-up of 1.5 months to 8.3 years (mean, 4.1 years), there have been four late deaths (two from pneumonia, two secondary to heart failure); nine patients underwent cardiac transplantation for refractory heart failure. Ten of 11 patients with ventricular failure required occlusion of significant collateral vessels postoperatively. Hemodynamically significant collateral arteries are common in Fontan candidates. Aggressive control can result in good early and medium-term survival. After the Fontan operation, the presence of significant collateral vessels may be a marker for eventual cardiac failure; 11 of the 29 patients who required postoperative coil placement went on to transplantation or died of heart failure.

Transcatheter closure of a large aortopulmonary window with severe pulmonary arterial hypertension beyond infancy.

A patient presented with a large aortopulmonary window and significant pulmonary hypertension, and underwent successful closure with muscular ventricular septal occluder (Shen-Zhen Lifetech Scientific Inc.) without complications in short-term follow-up.

Aortic regurgitation following transcatheter closure of aortopulmonary window.

Natural history of aortic regurgitation (AR) following transcatheter closure (TCC) of intracardiac or aortopulmonary shunt needs to be explored. AR can appear immediately or later after TCC and may increase or regress. We describe a previously unreported AR development following successful TCC of aortopulmonary window.

Successful use of a new Amplatzer Vascular plug for percutaneous closure of a large aortopulmonary collateral artery in a pulmonary atresia with ventricular septal defect prior to complete repair.

We report the case of a 14 year-old girl with a pulmonary atresia with VSD and multiple aortopulmonary collaterals who underwent a successful complementary occlusion of a large collateral vessel using an Amplatzer vascular plug after a previously failed attempt of occlusion with a coil. The percutaneous procedure, performed from the femoral artery before the complete surgical repair, provided an immediate closure of the vessel. This new device is safe and effective for the occlusion of aortopulmonary collaterals, specifically if of large dimensions.

Transcatheter closure of an aortopulmonary window with a modified double umbrella occluder system.

Transcatheter occlusion of a small aortopulmonary window was successfully performed in a child using a double umbrella occluding device. The delivery system was adapted for use through a small sheath from a transvenous approach. Transcatheter closure is feasible in appropriately selected aortopulmonary windows.

Closure of aortopulmonary window with amplatzer duct occluder device.

Aortopulmonary window is a relatively uncommon congenital heart defect. We report on a patient with a small aortopulmonary window, who presented with an asymptomatic murmur and in whom catheter closure was successfully performed with an Amplatzer Duct Occluder.

New device for percutaneous closure of aortopulmonary collaterals.

A 4.5-month-old infant with tetralogy of Fallot, pulmonary atresia, and multiple aortopulmonary collaterals underwent successful occlusion of the collaterals using a new device. This new plug (Amplatzer vascular plug) is a self-expandable cylindrical device made of nitinol wire mesh. The device is available in sizes from 4 to 16 mm in 2 mm increment. The device can be used in patients with aortopulmonary collaterals, pulmonary arteriovenous malformations, venovenous collaterals, shunts, coronary fistulas, and certain type of patent ductus arteriosus.

Transcatheter closure of aortopulmonary window using Amplatzer device.

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.