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Lessons learned from a series of patients with missed aortopulmonary windows

Published online by Cambridge University Press:  21 July 2008

Viralam S. Kiran ,
Mukesh Kumar Singh ,
Sejal Shah ,
Colin John  and
Sunita Maheshwari
Viralam S. Kiran
Affiliation:
Department of Paediatric Cardiology, Anekal Taluk, Bangalore, Karnataka, India
Mukesh Kumar Singh
Affiliation:
Department of Paediatric Cardiology, Anekal Taluk, Bangalore, Karnataka, India
Sejal Shah
Affiliation:
Department of Paediatric Cardiology, Anekal Taluk, Bangalore, Karnataka, India
Colin John
Affiliation:
Department of Paediatric Cardiac Surgery, Narayana Hrudayalaya Institute of Cardiac Sciences, Anekal Taluk, Bangalore, Karnataka, India
Sunita Maheshwari*
Affiliation:
Department of Paediatric Cardiology, Anekal Taluk, Bangalore, Karnataka, India
*
Correspondence to: Dr Sunita Maheshwari, ABP, ABPC, Head of the Department, Department of Paediatric Cardiology, Narayana Hrudayalaya Institute of Cardiac Sciences, No 258/A, Bommasandra Industrial Area, Anekal Taluk, Bangalore-560099, Karnataka, India. Tel: +91 80 2783 5000; Fax: +91 80 2783 2648; E-mail: [email protected]
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Abstract

Objectives

To identify factors contributing to missed diagnosis of aortopulmonary windows on initial echocardiographic examination; and to analyze lesions associated with these malformations.

Design

Retrospective study where echocardiographic findings and per-operative findings of patients were correlated by reviewing records.

Setting

Tertiary-care paediatric cardiac centre.

Patients

From May 2002 to September 2007, we diagnosed 50 patients with aortopulmonary windows. The group included 31 boys and 19 girls. Mean age at intervention was 1.7 years, with a range from 3 months to 17 years.

Results

The diagnosis of aortopulmonary window was made correctly by echocardiography during initial evaluation in 46 of 50 patients (92%). The remaining 4 patients were diagnosed either during repeat echocardiographic evaluation, cardiac catheterization, or per-operatively. We describe the details of these patients. Of the 50 patients, 23 had associated malformations, including ventricular septal defects in 10 patients, patent arterial ducts in 9, atrial septal defects or patent oval foramens in 5, 3 of whom also had patent arterial ducts, interruption of the aortic arch at the isthmus in 4, or between the left subclavian and common carotid arteries in 2, tetralogy of Fallot in 2, double-outlet right ventricle in 2, discordant ventriculo-arterial connections in 2, 1 of whom also had anomalous origin of the left coronary artery from the pulmonary trunk, and superior-inferior ventricles in 1 patient.

Conclusions

Even meticulous echocardiography may result in a false negative diagnosis of an aortopulmonary window. A high index of suspicion for this lesion is warranted in cases of unexplained severe pulmonary arterial hypertension, and/or unexplained cardiac dilation.

Keywords

Echocardiographydiagnostic errorcongenital heart disease
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 5 , October 2008 , pp. 480 - 484
Copyright
Copyright © Cambridge University Press 2008

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