Iatrogenic aortopulmonary window after balloon dilation of left pulmonary artery stenosis following arterial switch operation
Branch pulmonary artery stenosis may occur in 4%-28% of patients after an arterial switch operation. Balloon dilation can be attempted with variable results, while stenting is a more definitive option when balloon dilation fails. We report the case of a young boy who underwent balloon dilation of a stenosed left pulmonary artery 9 years after an arterial switch operation and was noted to have an aortopulmonary window about a year later. This was treated with covered stent implantation, which dealt both with the aortopulmonary window and the residual stenosis. The diagnostic process with cardiac magnetic resonance imaging and cardiac catheterization of such an unusual entity as well as the transcatheter management are discussed in detail.
[Show abstract] [Hide abstract] ABSTRACT: We present a case of iatrogenic aortopulmonary fistula following pulmonary artery (PA) stenting late after arterial switch operation (ASO) for D-transposition of the great arteries (D-TGA), an unusual complication that may be encountered more frequently in contemporary adult cardiology clinics. The diagnosis should be sought in the face of unexplained heart failure in patients who underwent ASO and subsequent PA angioplasty. Treatment should be instituted in a timely fashion, and options include surgical correction or implantation of a duct occluder or covered stent.
- "The diagnosis of aortopulmonary window was made at multimodality imaging involving echocardiography, CMR, and cardiac catheterization one year later when the patient presented with signs and symptoms of congestive heart failure. A covered stent then successfully treated the fistula and the residual left PA stenosis . Given the relatively high incidence of supravalvular pulmonary stenosis after ASO and the increasing survival into adulthood of this population, iatrogenic aortopulmonary fistulae may be encountered more frequently in contemporary adult cardiology practice. "
- [Show abstract] [Hide abstract] ABSTRACT: We present a case of an iatrogenic aortopulmonary (AP) fistula in a 9-year-old patient with a history of repaired truncus arteriosus without the use of a right ventricle to pulmonary artery conduit and subsequent transcatheter placement of a right ventricular outflow tract (RVOT) stent. Redilation of the stent resulted in a defect in the aortic wall and the creation of an AP fistula with an associated hemodynamically significant left to right shunt. This case demonstrates a previously unreported adverse event of transcatheter RVOT reintervention after truncus arteriosus repair.
- [Show abstract] [Hide abstract] ABSTRACT: Objectives. To investigate the spectrum, etiology, and management of traumatic aortopulmonary (AP) communications after transcatheter interventions on the pulmonary circulation. Background. An iatrogenic AP communication is an unusual complication after balloon pulmonary artery (PA) angioplasty or stenting, or transcatheter pulmonary valve replacement (TPVR). However, with the increasing application of transcatheter therapies for postoperative PA stenosis and right ventricular outflow tract (RVOT) dysfunction, including percutaneous pulmonary valve replacement, consideration of the etiology, diagnosis, and management of this problem is important for interventional cardiologists performing such procedures. Methods and Results. We present 3 new cases, as well as gross anatomy and histopathology data, related to AP communications after PA interventions. We also review the literature relevant to this topic. Including these new cases, iatrogenic AP communications after transcatheter interventions on the PAs or RVOT have been reported in 18 patients, primarily with transposition of the great arteries who underwent pulmonary artery angioplasty after an arterial switch operation, or after TPVR in patients who had undergone a Ross procedure. The likely cause of such defects is PA trauma plus distortion of the neo-aortic anastomosis resulting from angioplasty or stenting of the RVOT or central PAs, with subsequent dissection through the extravascular connective tissue and into the closely adjacent vessel through the devitalized tissue at the anastomosis. Conclusions. Cardiologists performing PA or RVOT interventions should be aware of the possibility of a traumatic AP communication and consider this diagnosis when confronted with suggestive signs and symptoms. This article is protected by copyright. All rights reserved. Copyright © 2015 Wiley Periodicals, Inc., a Wiley company.