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2013-01-30-09 Case of the week #347 © Bronshtein www.TheFetus.net 

Answer to the case of the week #347

June 20, 2013 - July 04, 2013


Moshe Bronshtein, MD*; Frantisek Grochal, MD**

*   Haifa, Israel;
**  Femicare, Center of prenatal ultrasonographic diagnostics, Martin, Slovak republic.


Case report

This was a low risk pregnancy and the mother presented to our facility for the first time at 15 weeks of her pregnancy. She fought off a viral infection at the beginning of the gestation. Our ultrasound examination discovered an isolated cardiac anomaly - aortopulmonary window (type I according to Kattsuhiko Mori classification [1]). The newborn was delivered at 40 weeks of pregnancy and the diagnosis was confirmed. Surgical operation was done without complication and the newborn is doing well. 


Drawing 1: Aortopulmonary window (type I - proximal type, Mori classification [1]) - drawing.

According to Mori et. al. [1] three types of the aortopulmonary window exist. The most common type is the type I (proximal defect) - the defect is usually between the ascending aorta and the pulmonary trunk, and may take the form of a fenestration or a narrow channel. Anatomically, type II (distal defect) is a communication between the left posterolateral wall of the ascending aorta and the junctional portion of the right pulmonary artery and the pulmonary trunk. A total defect (type III) involves the entire length of the pulmonary trunk from immediately above both semilunar valves to the level of the pulmonary bifurcation and the proximal portion of the right pulmonary artery. In this type the aortic and pulmonary valves are separated hemodynamically and anatomically, a crucial distinguishing feature from persistent truncus arteriosus.




Images 1, 2, 3, 4, 5, and 6: 15 weeks (Image 1) and 24 weeks (Images 2, 3, 4, 5, 6) of pregnancy. The images show gray scale and color Doppler transverse scans of the fetal chest at the level of pulmonary trunk and ascending aorta showing communication between the vessels - aortopulmonary window (the images 4 and 6 also show drawings and arrows pointed to the place of the aortopulmonary window). 

 

 

 

Videos 1, 2
15 weeks (Video 1) and 24 weeks (Video 2) of pregnancy. The video show transverse scans of the fetal chest at the level of pulmonary trunk and ascending aorta showing communication between the vessels (arrowheads point at the place of the aortopulmonary window). 

 

References

1. Mori K, Ando M, Takao A, Ishikawa S, Imai Y. Distal type of aortopulmonary window. Report of 4 cases. Br Heart J. 1978 Jun;40(6):681-9.
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