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Year : 2006  |  Volume : 16  |  Issue : 4  |  Page : 847-849
Helical CT evaluation of aortopulmonary window


Teleradiology Solutions, Bangalore, India

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Date of Submission05-Aug-2005
Date of Acceptance10-Jun-2006
 

   Abstract 

Aortopulmonary window is an opening between the aorta and the pulmonary trunk. Two distinct separated semilunar valves must exist to establish the diagnosis of aortopulmonary window, and this defect should be differentiated from truncus arteriosus. Aortopulmonary window is generally diagnosed by echocardiography or Angiocardiography. The authors present two cases of Aortopulmonary window diagnosed by helical CT.

Keywords: Aortopulmonary window, Helical CT

How to cite this article:
Sridhar P G, Kalyanpur A, Suresh P V, Sharma R, Maheshwari S, Hrudayalaya N. Helical CT evaluation of aortopulmonary window. Indian J Radiol Imaging 2006;16:847-9

How to cite this URL:
Sridhar P G, Kalyanpur A, Suresh P V, Sharma R, Maheshwari S, Hrudayalaya N. Helical CT evaluation of aortopulmonary window. Indian J Radiol Imaging [serial online] 2006 [cited 2019 Aug 24];16:847-9. Available from: http://www.ijri.org/text.asp?2006/16/4/847/32364

   Introduction Top


Aortopulmonary window (APW) is a rare form of congenital heart disease. Although echocardiography can provide a diagnosis in most cases, at times echo visualization is inadequate. In these situations, angiography has been utilized to delineate the anatomy. Angiography, however, has its own attendant risks especially in sick neonates in whom this is more often necessitated. Computed tomography (CT) is a non-invasive but under-utilized modality for the diagnosis of this anomaly. We report on the use of helical CT in the evaluation of APW in 2 children.


   Methods and Materials Top


Two patients with APW, provisionally diagnosed by echocardiography, were evaluated with CT. Helical CT (GE High speed Advantage) was performed with 2mm sections at a pitch of 1:1 and rapid bolus hand injections with 2ml/ kg body weight of non-ionic intravenous contrast. A delay of 30 seconds was given between the beginning of the contrast injection and the start of the scan. The patient was scanned from the apex of the lungs to the iliac crests. CT findings were correlated with echocardiographic and angiocardiographic findings.

Case 1: A 3 year old female child presented with exertional dyspnoea. On echocardiography an APW was noted. Additionally, the aortic arch was not well visualized leading to suspicion of arch interruption. A helical CT was performed [Figure - 1] which demonstrated a type- I APW with type- A interruption of the aortic arch, large PDA connecting ascending Aorta and the main pulmonary artery and origin of the right pulmonary artery from the aorta. Both the pulmonary arteries were dilated with associated mild main stem bronchus compression bilaterally. These findings were further confirmed at cardiac catheterization to assess operability and at surgical repair.

Case 2: A 1 month old baby was referred to our institution with a diagnosis of a patent ductus arteriosus. On echo a large APW was found. However, as there was a discrepancy in the diagnosis, the surgical team requested further confirmation. A helical CT clearly demonstrated the communication between the pulmonary trunk and the ascending aorta [Figure - 2]. There were no other associated anomalies. The lung fields were plethoric with prominence of pulmonary arteries. Angiography was not performed; however the findings were confirmed at surgery.


   Discussion Top


APW, also known as Aortopulmonary septal defect, is a deficiency in the septum between the aorta and pulmonary artery resulting in a communication between the two. It has been classified into 3 types: type I (proximal) defects which occur in the proximal part of the aortopulmonary septum between the aorta and the main pulmonary artery; type- II (distal) defects which occur in the distal part of the aortopulmonary septum extending into the right pulmonary artery; and type- III which is a combination of types- I and II [1]. Type- I is the most common and type- III the rarest [1]. Approximately half of the cases of APW are not associated with other cardiovascular anomalies [2]. The most common lesions associated with APW are aortic origin of the right pulmonary artery, type- A interruption of the aortic arch, anomalous origin of the right coronary artery from the pulmonary artery [2] and tetralogy of Fallot [3]. Aortopulmonary window should be considered in the differential diagnosis of a left to right shunt such as large patent ductus arteriosus or ventricular septal defect or a truncus arteriosus. In contrast to truncus arteriosus, both aortic and pulmonary valves are present and normally related.

APW's are generally diagnosed provisionally by echocardiography and confirmed by cardiac angiography, surgical follow up or at autopsy. Cardiac angiography is an invasive procedure, has certain inherent risks and at times, cannot be performed. There are a few case reports of noninvasive diagnosis of an APW by MRI [4]. However it remains expensive and not all cardiac centers have such a facility. To date only one case has been reported on CT angiography [5]. We report two cases of APW diagnosed on single slice helical CT with 3D reconstructions. Computed tomography clearly demonstrated the location, type and size of the window. In addition it also demonstrated the other associated anomalies and changes in the lungs, including bronchial compression by the dilated pulmonary arteries which cannot be demonstrated by echocardiography or angiocardiography. The accurate delineation of an aortopulmonary window by helical CT scanning makes the use of angiography in this situation redundant. However one has to be very careful while interpreting the images, as artifacts due to cardiac motion some time may give rise to the false positive results. Helical CT is a non-invasive, safe and potentially superior modality to angiography in the anatomic assessment of an APW.

 
   References Top

1.Brook Michael M and Heymann Michael A. Aortopulmonary window. In: Moss and Adams: Heart Disease in Infants, Children and Adolescents Including the Fetus and Young Adults. 5th. Ed. Baltimore, Williams & Wilkins, 1995:764-769.   Back to cited text no. 1    
2.Kutsche LM, Van Mierop LH: Anatomy and pathogenesis of aorticopulmonary septal defect. American Journal of Cardiology. 59(5): 443-7, 1987 Feb 15.  Back to cited text no. 2    
3.Alborino D, Guccione P, Di Donato R and Marino Brown: Aortopulmonary window coexisting with tetralogy of Fallot. J Cardiovasc Surg (Torino) 2001 Apr; 42(2): 97-9  Back to cited text no. 3    
4.Kimberly A. Garver, MD; Ramiro J. Hernandez, MD; Roger P. Vermilion, MD; Monica Martin Goble, MD. Images in cardiovascular medicine. Correlative imaging of aortopulmonary window: demonstration with echocardiography, angiography, and MRI. Circulation 1997 Aug 5; 96(3): 1036-7  Back to cited text no. 4    
5.Hyun Woo Goo, MD, In-Sook Park, MD, Jae Kon Ko, MD, Yong Hwue Kim, MD, Dong-Man Seo, MD, Tae-Jin Yun, MD, Jeong-Jun Park, MD and Chong Hyun Yoon, MD. CT of Congenital Heart Disease: Normal Anatomy and Typical Pathologic Conditions. Radiographics. 2003;23:S147-S165   Back to cited text no. 5    

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Correspondence Address:
P G Sridhar
No. 2, Regent place, Whitefield Main Road, Bangalore- 560066
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-3026.32364

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    Figures

  [Figure - 1], [Figure - 2]

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    Abstract
    Introduction
    Methods and Mate...
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    References
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