Aortopulmonary window
-0,1-0,2% of congenital heart defects.
-More than half of patients with associated defects.
-Arch anomalies, TOF, coronary anomalies, VSD, aortic origin of RPA.
-Types
-Type I(proximal) – in the middle of the semilunar valves to the PA bifurcation.
Most common
-Type II(distal) – at the lateral wall of the asc. Ao. and the bifurcation.
Associated with aortic origin of the RPA.
-Type III(total defect) – from the semilunar valves to the level of the
bifurcation, including the proximal RPA.
-All types typically influenced by large left to right shunts.
-Initial treatment might be pharmacological reduction of pulmonary overcirculation.
-May also be smaller and restrictive.
Imaging
-Atrial communication?
-LA enlargement as sign of large left to right shunt?
-VSD?
-Obstructive lesion in outflow tract? Conal septal deviation?
-Coronary anatomy. Distance from the AP window.
-Pulmonary artery anatomy.
-Aortic arch anatomy.
-Presence of ductus arteriosus – uncommon except for aortic hypoplasia.
-Associated anomalies.
-Postoperative – No residual shunt and unobstructed flow.
-Parasternal short axis.
-Consequences: Increased flow from the pulmonary veins, LA and LV dilated.
Increased flow in the MV and AV.
-PAs distal to defect is dilated.
-Due to diastolic runoff there is less pulsatility in the thoracic aorta.
-In large defects – continuous flow in PA and retrograde flow in diastole of the
AoA, arch and AoD (not seen in PDA, but in AI, aorto-LV tunnel and ruptured sinus Valsalva
aneurysm.