Tetralogy of Fallot with aortopulmonary window and interrupted aortic arch: multimodality imaging in a rare association

Tetralogy of Fallot with aortopulmonary window and interrupted aortic arch: multimodality imaging... Myocardial T1 and ECV with age and gender 621 24. Beltrami CA, Finato N, Rocco M, Feruglio GA, Puricelli C, Cigola E et al. The cel- 25. Piechnik SK, Chiarelli PA, Jezzard P. Modelling vascular reactivity to investigate lular basis of dilated cardiomyopathy in humans. J Mol Cell Cardiol 1995;27: . the basis of the relationship between cerebral blood volume and flow under 291–305. CO2 manipulation. NeuroImage 2008;39:107–18. IMAGE FOCUS doi:10.1093/ehjci/jey056 Online publish-ahead-of-print 30 March 2018 .................................................................................................................................................... Tetralogy of Fallot with aortopulmonary window and interrupted aortic arch: multimodality imaging in a rare association 1 2 1 1 1 Miarisoa Ratsimandresy *, Fabio Cuttone , Yves Dulac , Philippe Acar , and Khaled Hadeed 1 2 Department of Paediatric Cardiology, Toulouse University Hospital, Toulouse, France; and Department of Congenital Cardiac Surgery, Toulouse University Hospital, Toulouse, France * Corresponding author. Tel 133 (0)5 34 55 74 59. E-mail: mia.ratsi@gmail.com A newborn was referred for assessment of suspected complex congenital heart disease. Chromosomes were normal including fluorescent in situ hybridization analysis for 22q11 deletion. There was a saturation difference between right upper arm and lower limbs. The 2D echocardiogram (Epic, Philips) established the diagnosis of tet- ralogy of Fallot (TOF) with infundibular stenosis and hypoplasia of the pulmo- nary annulus. This was associated with a large aortopulmonary window (APW) between the ascending aorta (AA) and main pulmonary artery (MPA) (asterisk). The aortic arch appeared interrupted beyond the left carotid artery (Panel A and Supplementary data online, Videos S1 and S2) with a large ductus arteriosus (DA) supplying the left subclavian artery (LSA) and descending aorta. Computed tomogra- phy (CT) scan confirmed the echocar- diographic diagnosis and further allowed visualization of the APW between the left edge of the aorta and the right edge of the MPA. It further confirmed the type B interrupted aortic arch (IAA) between the left carotid and LSA. There was a large patent DA (Panel B). On the basis of CT images, 3D reconstruction was performed, and 3D model created (Mimics Materialise, Belgium). These allowed better understanding of the spatial relationships between the cardiac and vascular structures (Panel C). A full repair was performed in neonatal period including TOF repair, reconstruction of the aortic arch, and closure of APW. The association between TOF, APW, and IAA is a very unusual form of TOF. Multimodality imaging with 3D reconstructions can be help- ful for establishing an accurate diagnosis. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/6/621/4956824 by Ed 'DeepDyve' Gillespie user on 20 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png European Heart Journal – Cardiovascular Imaging Oxford University Press

Tetralogy of Fallot with aortopulmonary window and interrupted aortic arch: multimodality imaging in a rare association

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Oxford University Press
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: journals.permissions@oup.com.
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2047-2404
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10.1093/ehjci/jey056
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Abstract

Myocardial T1 and ECV with age and gender 621 24. Beltrami CA, Finato N, Rocco M, Feruglio GA, Puricelli C, Cigola E et al. The cel- 25. Piechnik SK, Chiarelli PA, Jezzard P. Modelling vascular reactivity to investigate lular basis of dilated cardiomyopathy in humans. J Mol Cell Cardiol 1995;27: . the basis of the relationship between cerebral blood volume and flow under 291–305. CO2 manipulation. NeuroImage 2008;39:107–18. IMAGE FOCUS doi:10.1093/ehjci/jey056 Online publish-ahead-of-print 30 March 2018 .................................................................................................................................................... Tetralogy of Fallot with aortopulmonary window and interrupted aortic arch: multimodality imaging in a rare association 1 2 1 1 1 Miarisoa Ratsimandresy *, Fabio Cuttone , Yves Dulac , Philippe Acar , and Khaled Hadeed 1 2 Department of Paediatric Cardiology, Toulouse University Hospital, Toulouse, France; and Department of Congenital Cardiac Surgery, Toulouse University Hospital, Toulouse, France * Corresponding author. Tel 133 (0)5 34 55 74 59. E-mail: mia.ratsi@gmail.com A newborn was referred for assessment of suspected complex congenital heart disease. Chromosomes were normal including fluorescent in situ hybridization analysis for 22q11 deletion. There was a saturation difference between right upper arm and lower limbs. The 2D echocardiogram (Epic, Philips) established the diagnosis of tet- ralogy of Fallot (TOF) with infundibular stenosis and hypoplasia of the pulmo- nary annulus. This was associated with a large aortopulmonary window (APW) between the ascending aorta (AA) and main pulmonary artery (MPA) (asterisk). The aortic arch appeared interrupted beyond the left carotid artery (Panel A and Supplementary data online, Videos S1 and S2) with a large ductus arteriosus (DA) supplying the left subclavian artery (LSA) and descending aorta. Computed tomogra- phy (CT) scan confirmed the echocar- diographic diagnosis and further allowed visualization of the APW between the left edge of the aorta and the right edge of the MPA. It further confirmed the type B interrupted aortic arch (IAA) between the left carotid and LSA. There was a large patent DA (Panel B). On the basis of CT images, 3D reconstruction was performed, and 3D model created (Mimics Materialise, Belgium). These allowed better understanding of the spatial relationships between the cardiac and vascular structures (Panel C). A full repair was performed in neonatal period including TOF repair, reconstruction of the aortic arch, and closure of APW. The association between TOF, APW, and IAA is a very unusual form of TOF. Multimodality imaging with 3D reconstructions can be help- ful for establishing an accurate diagnosis. Supplementary data are available at European Heart Journal – Cardiovascular Imaging online. V C Published on behalf of the European Society of Cardiology. All rights reserved. The Author(s) 2018. For permissions, please email: journals.permissions@oup.com. Downloaded from https://academic.oup.com/ehjcimaging/article-abstract/19/6/621/4956824 by Ed 'DeepDyve' Gillespie user on 20 June 2018

Journal

European Heart Journal – Cardiovascular ImagingOxford University Press

Published: Mar 30, 2018

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