Transcatheter closure of aortopulmonary window

Aortopulmonary window is an uncommon congenital cardiac defect. Most infants presenting with aortopulmonary window will require conventional surgical repair. Experience with transcatheter closure of aortopulmonary window is limited. We report the case of a 9-year-old girl with aortopulmonary window, in whom transcatheter closure was performed successfully using Amplatzer ductal occluder device.     

Aortic valve regurgitation following percutaneous closure of patent ductus arteriosus

Objectives : To determine the incidence and outcome of aortic valve regurgitation (AR) following the percutaneous closure of patent ductus arteriosus (PDA). Background : Aortic valve regurgitation is an overlooked consequence of percutaneous PDA closure. Methods : Between December 2000 and May 2009, 51 children underwent percutaneous closure of PDA using Amplatzer Duct Occluders. Their median age at the time of the procedure was 2.6 years (range: 0.6–18.0 years), and median weight was 14.0 kg (range: 7.6–75.0 kg). Follow‐up echocardiograms were performed a day after the procedure and at 1, 3, 12 months, and yearly thereafter. Results : A day after the procedure, AR was detected for the first time in 13 of 48 patients (27.0%). A group of patients with newly developed AR was significantly different from a group of patients with competent aortic valves with respect to their age, weight, and minimal PDA diameter indexed to the body weight. The follow‐up period ranged from 0.2 to 8.5 years (median 3.3 years) and at the latest follow‐up evaluation, AR persisted in a single patient (2.0%) 6 years after the procedure. Conclusions : The aortic valve regurgitation following percutaneous PDA closure is trivial to mild and transient. It develops in approximately a quarter of children after percutaneous closure of PDA with a minimal diameter ≥1.5 mm and is more likely to develop in infants and small children having significant left‐to‐right shunts. © 2010 Wiley‐Liss, Inc.     

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.     

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. © 2008 Wiley‐Liss, Inc.     

Amplatzer device closure of a residual aortopulmonary window.

Significant residual defects after surgical closure of aortopulmonary windows have previously required re-operation. In this paper, we describe the use of a custom made Amplatzer closure device to occlude a hemodynamically significant defect in a 5-year-old child. The device was successfully deployed without complication, and resulted in a major reduction in aorto-pulmonary flow.     

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.     

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. © 1995 Wiley-Liss, Inc.     

Transcatheter closure of aortopulmonary window in children:Case reports and literature review

INTRODUCTION Aortopulmonary(AP) window is an uncommon congenital anomaly,accounting for approximately 0.2 % of all congenital heart abnormalities 1.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 this lesion,it is restrictive and case reports of its percutaneous closure are mostly limited to these patients.     

Current treatment of aortopulmonary window

Aortopulmonary window is a rare abnormal congenital communication between the pulmonary artery and the ascending aorta with intact aortic and pulmonary valves. Because pulmonary hypertension and premature death are the natural history of the uncorrected left-to-right shunt physiology that occurs with aortopulmonary window, surgical correction, which is the gold standard of treatment, should be offered to patients at the time of diagnosis, before the development of lung injury and irreversible pulmonary hypertension.     

Cardiac perforation following transcatheter PFO closure.

From December 1998 to August 2001, transcatheter closure of patent foramen ovale (PFO) with an Amplatzer PFO occluder has been successfully performed in our center in 102 patients without severe complications. We are reporting the first known case of cardiac perforation by an Amplatzer PFO occluder.     

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.     

The surgical treatment of aortopulmonary window

From 1956 through July 1981, 15 patients, ranging in age from 9 days to 20 years, underwent surgical correction of aortopulmonary (AP) window. Surface hypothermia and venous inflow occlusion were used in the first patient. In four patients, the technique for closure of AP window was similar to that for patent ductus arteriosus: in one, the AP window was ligated; and in three, clamping, division and suture were performed. Cardiopulmonary bypass was used in ten patients. In five patients, division and primary closure were done. In five, a patch was used to close the defect by using the transaortic and/or pulmonary approach. Associated cardiovascular anomalies were repaired concomitantly in four of seven patients. Two patients died during the immediate postoperative period; both were infants and had serious associated cardiovascular anomalies. One patient died from increased pulmonary vascular resistance and right heart failure 1 year after replacement of the tricuspid valve. Of 12 patients who survived the operation, 11 had excellent results. For the surgical treatment of patients with AP window, we stress the safety and ease afforded by extracorporeal circulation and a preference for the transaortic approach and fabric patch closure.     

Aortopulmonary window or aortopulmonary communication?

Two patients had a vessel-like aortopulmonary "window" which could be ligated without the institution of cardiopulmonary bypass. While embryologically and functionally these communications are identical to the classic aortopulmonary "window," it is suggested that the term "aortopulmonary communication" is more appropriate.     

Tetralogy of Fallot with aortopulmonary window

A patient with tetralogy of Fallot associated with aortopulmonary window has been documented. The association was found in one case out of 350 consecutive cases of Fallot's tetralogy evaluated cineangiographically. Since tetralogy of Fallot may be completely masked by the aortopulmonary window it is suggested that a right ventricular angiogram should be obtained in all patients with an aortopulmonary window.