Device closing AP window on X-ray chest PA view

Device closing AP window on X-ray chest PA view

Device closing AP windowDevice closing AP window on X-ray chest PA view

Device closing aortopulmonary window is seen on chest X-ray PA view in different styles. Upper left panel shows a standard PA view with device faintly seen to the left of the spine, medial to the upper left cardiac border. The upper left panel shows a darkened image of the X-ray which makes the device a little more prominent. The lower middle panel is a magnified view of the device, which clearly shows two discs of the device, with left disc being smaller than the right one. Shape of the device is suggestive of an Amplatzer device. It is easy to miss the device on the routine chest X-ray unless one is aware of the presence of the device. The radio opaque markers are barely visible. Close scrutiny near the markers makes the presence of the discs of the device more evident. On a film, it will be better seen if it is a penetrated view. With the availability of post processing on digital X-rays, it is easy to make the device appear more prominent as we have done here. The device will be much better seen on cine X-ray fluoroscopy.

Echocardiogram showing a device closing AP window is seen here.

Technique of transcatheter closure of symptomatic AP window in an infant has been reported by F Pillekamp et al [1]. The defect was initially crossed using a Judkin’s right coronary catheter and Terumo guide wire. Terumo guide wire was then exchanged for a 300 cm long guide wire, which was snared in the right pulmonary artery by a snare passed through the femoral vein and later exteriorized, creating and arteriovenous loop. Amplatzer delivery system was advanced through the femoral vein over this guide wire. Amplatzer septal occluder was delivered and distal disk opened in the aorta. Device was retracted and the proximal disk opened in the pulmonary arterial side. Device position was confirmed by echocardiography and aortography prior to release.

Updated 3rd May 2020

Reference

  1. Pillekamp F, Hannes T, Koch D, Brockmeier K, Sreeram N. Transcatheter closure of symptomatic aortopulmonary window in an infant. Images Paediatr Cardiol. 2008 Apr;10(2):11-7.