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1/4. Transesophageal echocardiography in aortopulmonary communications.

    The assessment of congenital aortopulmonary communications by transthoracic echocardiography may be suboptimal, particularly postoperatively, due to limited acoustic windows. We performed intraoperative transesophageal echocardiograms in six patients with eight proven systemic-pulmonary communications. diagnosis included truncus arteriosus (1), aortopulmonary window (1), Waterston anastomosis (3), central Gore-Tex shunt (1), and modified left Blalock-Taussig shunt (2). All communications were accurately demonstrated by transesophageal echocardiography (TEE). The transesophageal technique also provided an assessment of the size of the aortopulmonary communications and the proximal pulmonary arteries. In addition, the gradient across some of the communications could be accurately estimated utilizing the high pulse repetition frequency Doppler. On the other hand, only two of the seven aortopulmonary communications were detected by transthoracic echocardiography. Postoperatively, transesophageal imaging demonstrated unobstructed conduit in five of five patients who underwent conduit repair, as well as intact closure of aortopulmonary communications and concomitant closure of ventricular septal defects.
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2/4. Novel uses of the Rashkind ductal umbrella in adults and children with congenital heart disease.

    OBJECTIVE--To show possible alternative uses of the Rashkind ductal umbrella. DESIGN--Descriptive study of selected, non-randomised patients; with specific congenital heart lesions other than an arterial duct. SETTING--A tertiary referral centre. patients--Nine patients with congenital heart lesions; four with interatrial communications after a fenestrated fontan procedure two with large aortopulmonary collaterals, three with an unoperated ventricular septal defect. INTERVENTIONS--Placement of a Rashkind umbrella occluder as treatment for a haemodynamically important lesion. RESULTS--Successful placement with symptomatic and haemodynamic improvement in all. CONCLUSIONS--The Rashkind ductal umbrella may be used successfully to treat some patients with aortopulmonary collateral vessels, ventricular septal defects, and interatrial communications after the fenestrated fontan procedure.
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3/4. magnetic resonance imaging of proximal aortopulmonary window.

    Aortopulmonary window was prospectively diagnosed by magnetic resonance imaging in a 9-month-old boy. The diagnosis was confirmed by cardiac catheterization, angiocardiography, two-dimensional and color doppler echocardiography. Spin-echo T1-weighted axial and coronal magnetic resonance images show a large windowlike communication between left ascending aorta and right wall of the main pulmonary arterial trunk. To our knowledge, this is the first time that the diagnosis of the aorticopulmonary window was achieved by magnetic resonance imaging.
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4/4. One-stage repair of interrupted aortic arch and aortopulmonary window.

    Interrupted aortic arch type A with aortopulmonary window was diagnosed in a 12-day-old neonate. A successful one-stage repair was undertaken through a midline sternotomy without circulatory arrest. The aortopulmonary window was closed through the anterior wall of communication between ascending aorta and main pulmonary artery with a patch. Position of the arterial cannula was changed during the repair, which made it possible to mobilize and expose the aortic arch for the completion of direct anastomosis.
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