Objective: Distal aortopulmonary window (APW) are located away from aortic and pulmonary valves and may be amenable for catheter closures. We present our experience in transcatheter distal APW closure.
Methods: Patients with distal APW and good margin away from semilunar valves are selected on echocardiogram. Carefully chosen patients were taken for closure in catheterization laboratory after informed consent. After ascending aortogram and hemodynamic assessment under sedation with ketamine, APW is cannulated from pulmonary side with an internal mammary catheter and guidewire tip parked in right innominate artery. Through a long sheath from venous access, Amplatzer duct occluder device 2 mm more than the size of APW is deployed under angiographic control.
Results: 4 patients aged 8 months to 15 years had device closure of distal APW. The body weight ranged from 4.6-30 kg. Two of these patients were operated in past through left thoracotomy for diagnosis of patent ductus arteriosus, but continued to have continuous murmurs and left to right shunt through APW. The pulmonary artery hypertension was mild in two and moderate in rest. The shunt ratio was 2.9+/-1.1. The device used were 8x6 in one, 12x10 in two and 14x12 in one patient. Echocardiogram at 24 hours showed complete closure with no procedural complications. On a follow up ranging from 6 months to 5 years, there is no residual shunt, no pulmonary artery flow disturbance.
Conclusions: Transcatheter closure of distal APW is a safe and less morbid alternative to surgery in patients appropriately selected on echocardiogram.