Aortopulmonary window (APW) is a communication between the ascending aorta and the pulmonary artery in the presence of two separate semilunar valves and is the rarest of septal defects. To present our experience with the diagnosis and outcome of APW cases. Retrospective cohort study. Between June 2003 and October 2011, thirteen patients were diagnosed with APW. Clinical features of patients, findings of echocardiographic and angiographic examination, results of surgical intervention and follow-up were reviewed retrospectively. Eleven children (10 days to 16 years), underwent surgical correction of APW. In a 12-month-old boy, the defect was repaired by the transcatheter approach. In addition to APW repair, closure of VSD was performed in 2 patients. APW were associated with interruption in two patients; one also had a complex pathology. None of the patients died due to complications of surgical or transcatheter procedures. After a median follow-up period of 40 months, the patients were asymptomatic and none of them required additional medication, except for the patient with complex pathology including an interrupted aortic arch, who underwent balloon angioplasty for recoarctation. In any infant with the findings of congestive heart failure and failure to thrive, APW must be kept in mind as a differential diagnosis. In isolated APW cases before 6 months of age, echocardiography is often sufficient for diagnosis. In complex cases, cardiac catheterisation is performed for the comprehensive evaluation of associated defects. After 6 months, cardiac catheterisation could be utilised to perform vasoreactivity testing and, if possible, to close the defect.
1 April 2022 in The Anatolian Journal of Cardiology
Introduction: Although amiodarone is traditionally used in the treatment of postoperative junctional ectopic tachycardia (JET), the search for new treatments is ongoing. We present our experience with ivabradine at two medical centers.Materials and Methods: Between January 2022 and January 2023, patients who developed JET after pediatric cardiac surgery were prospectively followed up and documented. The diagnosis of JET was made with the support of the electrophysiology team and treatment was based primarily on whether JET disrupted hemodynamics.Results: This study was conducted at two high‐volume centers, which record a total of 1130 pediatric cardiac surgeries within a year. The study recruited 26 patients with median heart rate 180 beats per minute, and 10 (38%) patients had impaired hemodynamics. Out of the 26 study participants, 14 (54%) cases were treated with ivabradine alone, 10 (38%) cases were treated with amiodarone + ivabradine, and 2 patients (8%) with high heart rates and prolonged junctional arrhythmia were treated with ivabradine and flecainide. The median time to ventricular rate control was 12 h, and the median time to sinus rhythm conversion was 55.5 h. No ivabradine‐related side effects were observed in any of the patients, and no patient experienced JET recurrence after discontinuing treatment.Conclusion: Ivabradine seems to be a safe and effective medical treatment that can be used as the primary treatment in patients with stable hemodynamics, as an adjunctive therapy to amiodarone in patients with impaired hemodynamics.