*****AMERICAN JOURNAL OF CARDIOLOGY*****

(REFERENCE 1 OF 20) 98252601

McElhinney DB Reddy VM Tworetzky W Silverman NH Hanley FL Early and late results after repair of aortopulmonary septal defect and associated anomalies in infants <6 months of age.

In: Am J Cardiol (1998 Jan 15) 81(2):195-201

ISSN: 0002-9149

The Richardson classification system for aortopulmonary septal defect (APSD) includes simple defects between the ascending aorta and pulmonary trunk (type I), defects extending distally to include the origin of the right main pulmonary artery (type II), and anomalous origin of the right main pulmonary artery from the ascending aorta with no other aortopulmonary communication (type III). These are rare lesions that must be repaired in early infancy to avoid development of pulmonary vascular disease. Few reports have focused on patients with complex, associated lesions who underwent repair in early infancy. Between 1972 and 1995, 24 patients with Richardson type I (n = 11), II (n = 7), or III (n = 6) defects underwent repair at ages ranging from 2 to 172 days (median 34). Twelve patients had complex, associated anomalies, including interrupted or hypoplastic arch (n = 9), tetralogy of Fallot with (n = 1) or without (n = 1) pulmonary atresia, and transposition of the great arteries (n = 1). The most recent 7 patients were diagnosed by echocardiography without cardiac catheterization. There were no early or late deaths among the 12 patients with simple APSD. Four patients with complex, associated lesions died in the early postoperative period and another died 4 months after surgery. All 6 surviving patients with interrupted arch have had recurrent obstruction at the arch repair site, although reintervention for this reason has been performed in only 2 patients. Altogether, 6 early survivors have required reintervention, and all survivors are in New York Heart Association class I at follow-up ranging from 2 to 25 years. Thus, long-term survival after repair of APSD in early infancy is excellent. Late sequelae are likely to be related either to associated lesions or to obstruction at the APSD repair site. Almost all cases of APSD in young infants can be diagnosed and evaluated by echocardiography without catheterization.

Institutional address: Division of Cardiothoracic Surgery University of California San Francisco

USA.

(REFERENCE 2 OF 20) 98127604

Jureidini SB Spadaro JJ Rao PS Successful transcatheter closure with the buttoned device of aortopulmonary window in an adult.

In: Am J Cardiol (1998 Feb 1) 81(3):371-2

ISSN: 0002-9149

This case report describes a technique to close an intermediate aortopulmonary window with the use of the buttoned device in an adult.

Institutional address: Department of Pediatrics St. Louis University School of Medicine Cardinal Glennon Children's Hospital Missouri 63104 USA.

*****ANNALS OF THORACIC SURGERY*****

(REFERENCE 3 OF 20) 99015462

Morell VO Feccia M Cullen S Elliott MJ Anomalous coronary artery with tetralogy of Fallot and aortopulmonary window.

In: Ann Thorac Surg (1998 Oct) 66(4):1403-5

ISSN: 0003-4975

Anomalous origin of the left main coronary artery from the pulmonary artery is rarely associated with other conditions. We report the case of an infant born with tetralogy of Fallot and aortopulmonary window who at the time of surgical repair was found to have an anomalous left main coronary artery originating from the right pulmonary artery.

Institutional address: Cardiothoracic Unit Great Ormond Street Hospital for Children London England.

(REFERENCE 4 OF 20) 95070470

Chiu IS Wang JK Wang MJ Wang CC One-stage repair of aortopulmonary septal defect and interrupted aortic arch [see comments]

In: Ann Thorac Surg (1994 Nov) 58(5):1529-32

ISSN: 0003-4975

Surgical repair of an aortopulmonary septal defect, interrupted aortic arch and the duct that coexists in this setting usually includes closure of the aortopulmonary septal defect, reconstruction of the arch, and interruption of the duct. A 20-month-old girl underwent a successful one-stage repair of such anomalies in which an intraarterial baffle was used. A Gore-Tex baffle was used both to close the aortopulmonary septal defect and to conduct the ascending aortic blood flow through the duct into the descending aorta. We recommend use of this intraarterial baffle as an alternative to the repair of an aortopulmonary septal defect and an interrupted aortic arch with a widely patent duct.

Comment in: Ann Thorac Surg 1995 Apr;59(4):1045-6

Institutional address: Department of Surgery National Taiwan University Hospital Taipei.

(REFERENCE 5 OF 20) 94346939

Burke RP Rosenfeld HM Primary repair of aortopulmonary septal defect, interrupted aortic arch, and anomalous origin of the right pulmonary artery.

In: Ann Thorac Surg (1994 Aug) 58(2):543-5

ISSN: 0003-4975

Aortopulmonary septal defect, interruption of the aortic arch, and anomalous origin of the right pulmonary artery from the aorta comprised a challenging constellation of defects in a 13-day-old neonate, who underwent complete repair without homograft tissue or synthetic graft. After the aorta was separated from the pulmonary artery, the descending aorta was anastomosed to the septal defect in the ascending aorta. The right pulmonary artery was anastomosed to the septal defect in the main pulmonary artery, anterior to the aorta. The postoperative course was uncomplicated, and the potential for growth of both great vessels was optimized.

Institutional address: Department of Cardiology Children's Hospital Boston MA 02115.

(REFERENCE 6 OF 20) 98355212

Codispoti M Mankad PS One-stage repair of interrupted aortic arch, aortopulmonary window, and anomalous origin of right pulmonary artery with autologous tissues.

In: Ann Thorac Surg (1998 Jul) 66(1):264-7

ISSN: 0003-4975

Interruption of the aortic arch, distal aortopulmonary septal defect, and aortic origin of the right pulmonary artery with intact interventricular septum were associated findings in a 4-month-old infant who underwent successful one-stage repair without the use of any synthetic material, thus allowing for a potential for growth of both the pulmonary artery and the aorta. The baby made an uneventful recovery and remains asymptomatic 36 months after repair.

Institutional address: Department of Cardiac Surgery Royal Hospital for Sick Children Edinburgh Scotland.

(REFERENCE 7 OF 20) 98186455

Hata H Shiono M Sezai Y Sumitomo N Otsuka M Harada K One-stage repair of interrupted aortic arch and aortopulmonary window.

In: Ann Thorac Surg (1998 Mar) 65(3):829-31

ISSN: 0003-4975

Interrupted aortic arch type A with aortopulmonary window was diagnosed in a 12-day-old neonate. A successful one-stage repair was undertaken through a midline sternotomy without circulatory arrest. The aortopulmonary window was closed through the anterior wall of communication between ascending aorta and main pulmonary artery with a patch. Position of the arterial cannula was changed during the repair, which made it possible to mobilize and expose the aortic arch for the completion of direct anastomosis.

Institutional address: Second Department of Surgery Nihon University Tokyo Japan.

(REFERENCE 8 OF 20) 98186440

Di Bella I Gladstone DJ Surgical management of aortopulmonary window.

In: Ann Thorac Surg (1998 Mar) 65(3):768-70

ISSN: 0003-4975

BACKGROUND: Aortopulmonary window is a rare anomaly, and a variety of surgical techniques have been described for its closure. METHODS: We treated 6 infants with aortopulmonary window between 1993 and 1995. Three had associated type A interrupted aortic arch, and another had a muscular ventricular septal defect. The diagnosis was made by echocardiography, confirmed by cardiac catheterization in 4 infants. In 1 very sick neonate with interrupted arch, diagnosis of the window was considerably delayed. In 4 patients, we closed the window by using a flap of pulmonary artery, which was reconstructed without using a patch. In 2 neonates with interrupted arch we anastomosed the mobilized descending aorta directly to the aortic defect of the aortopulmonary window, closing the pulmonary artery with a pericardial patch. RESULTS: There were no hospital deaths, and all patients are in New York Heart Association functional class I at a mean follow-up of 30 months. Echocardiography shows no significant distortion of the great vessels. CONCLUSIONS: The techniques described achieve excellent results using only autologous tissues with the potential for normal growth.

Institutional address: Department of Cardiac Surgery

Royal Group of Hospitals Belfast Northern Ireland.

(REFERENCE 9 OF 20) 97116314

Kawata H Kishimoto H Ueno T Nakajima T Inamura N Nakada T Repair of aortopulmonary window in an infant with extremely low birth weight.

In: Ann Thorac Surg (1996 Dec) 62(6):1843-5

ISSN: 0003-4975

Although transaortic patch repair under cardiopulmonary bypass is a suitable procedure for aortopulmonary window, another method without cardiopulmonary bypass may be the only one for an infant with extremely low birth weight. We describe a successful repair of an infant with extremely low birth weight (758 g) by closing the window with a clip through a left thoracotomy. Cardiac catheterization 7 months after the operation showed no residual shunt and no stenosis of ascending aorta, pulmonary artery, or coronary arteries in the patient, whom we believe to be one of the smallest with successful repair.

Institutional address: Department of Cardiovascular Surgery Osaka Medical Center Japan.

(REFERENCE 10 OF 20) 94145264

Messmer BJ Pulmonary artery flap for closure of aortopulmonary window.

In: Ann Thorac Surg (1994 Feb) 57(2):498-501

ISSN: 0003-4975

A simple technique for closure of aortopulmonary windows using an inverted pulmonary artery flap is described. Long-term results up to 4 years demonstrate normal growth of the great arteries reconstructed with autologous material only.

Institutional address: Department of Thoracic and Cardiovascular Surgery Klinikum RWTH Aachen Germany.

(REFERENCE 11 OF 20) 93393277

Gargiulo G Zannini L Albanese SB Frascaroli G Santorelli MC Rossi C Bonvicini M Pierangeli A

Interrupted aortic arch and aortopulmonary window: one-stage repair in the first week of life.

In: Ann Thorac Surg (1993 Sep) 56(3):554-6

ISSN: 0003-4975

Aortic arch interruption associated with an aortopulmonary window is a rare congenital malformation that needs an early diagnosis and surgical treatment to avoid irreversible pulmonary lesions. Here we describe a case of a successful one-stage surgical repair in a 3-day- old neonate, without the use of prosthetic material, for the correction of the aortic arch interruption.

Institutional address: Department of Cardiovascular Surgery University of Bologna Italy.

*****BRITISH HEART JOURNAL*****

(REFERENCE 12 OF 20) 93207879

Redington AN Rigby ML Novel uses of the Rashkind ductal umbrella in adults and children with congenital heart disease.

In: Br Heart J (1993 Jan) 69(1):47-51

ISSN: 0007-0769

OBJECTIVE--To show possible alternative uses of the Rashkind ductal umbrella. DESIGN--Descriptive study of selected, non-randomised patients; with specific congenital heart lesions other than an arterial duct. SETTING--A tertiary referral centre. PATIENTS--Nine patients with congenital heart lesions; four with interatrial communications after a fenestrated Fontan procedure two with large aortopulmonary collaterals, three with an unoperated ventricular septal defect. INTERVENTIONS--Placement of a Rashkind umbrella occluder as treatment for a haemodynamically important lesion. RESULTS--Successful placement with symptomatic and haemodynamic improvement in all. CONCLUSIONS--The Rashkind ductal umbrella may be used successfully to treat some patients with aortopulmonary collateral vessels, ventricular septal defects, and interatrial communications after the fenestrated Fontan procedure.

Institutional address: Department of Paediatric Cardiology Royal Brompton National Heart and Lung Hospital London.

*****CHEST*****

(REFERENCE 13 OF 20) 95079847

Chopra PS Reed WH Wilson AD Rao PS Delayed presentation of anomalous circumflex coronary artery arising from pulmonary artery following repair of aortopulmonary window in infancy.

In: Chest (1994 Dec) 106(6):1920-2

ISSN: 0012-3692

Anomalous origin of the circumflex coronary artery is extremely rare and may cause serious perioperative myocardial injury associated with correction of coexisting congenital malformations. We describe a 15- year-old female patient who underwent surgical correction of an aortopulmonary window at 13 months. Fourteen years later, she presented with dyspnea on exertion associated with angina. On cardiac catheterization, she was noted to have a step-up in oxygen saturation in the pulmonary artery and retrograde filling of the circumflex coronary artery from the left anterior descending coronary artery, with drainage into the pulmonary artery. The patient underwent surgical bypass of the anomalous circumflex coronary artery and ligation of its anomalous origin in the pulmonary artery. Her postoperative course was uneventful, with complete relief of symptoms. We have reviewed this rare congenital anomaly and its therapeutic options.

Institutional address: Department of Surgery University of Wisconsin Medical School Madison.

*****HEART*****

(REFERENCE 14 OF 20) 97339868

Tulloh RM Rigby ML Transcatheter umbrella closure of aorto-pulmonary window.

In: Heart (1997 May) 77(5):479-80

ISSN: 1355-6037

Aorto-pulmonary window (aorto-pulmonary septal defect) is an uncommon congenital cardiac malformation which is repaired using cardiopulmonary bypass. A case is described of an infant with a small aorto-pulmonary window which was closed by transcatheter insertion of a double umbrella device. Complete occlusion of the defect was achieved without complications. Transcatheter umbrella closure of a small aorto-pulmonary window is feasible in infancy and the technique is likely to be applicable in a few cases.

Institutional address: Department of Paediatric Cardiology Royal Brompton Hospital London.

(REFERENCE 15 OF 20) 98199114

Hofbeck M Rauch A Buheitel G Leipold G von der Emde J Pfeiffer R Singer H Monosomy 22q11 in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries.

In: Heart (1998 Feb) 79(2):180-5

ISSN: 1355-6037

OBJECTIVE: To describe the morphology of the pulmonary arteries in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries with and without monosomy 22q11. DESIGN: A retrospective analysis of all patients with this congenital heart defect who are being followed at the University Children's Hospital Erlangen. SETTING: A tertiary referral centre for paediatric cardiology and paediatric cardiac surgery. PATIENTS: 21 patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries. Monosomy 22q11 was diagnosed by fluorescent in situ hybridisation using the D22S75 probe (Oncor). The

morphology of the pulmonary arteries was assessed on the basis of selective angiograms. RESULTS: 10 patients (48%) were shown to have a microdeletion in 22q11 (group I). There was no difference with respect to the presence of confluent central pulmonary arteries between these patients (80%) and the remaining 11 patients (group II) without monosomy 22q11 (91%). Patients of group I, however, more often had arborisation anomalies of the pulmonary vascular bed (90% in group I v 27% in group II). Because of the more severe abnormalities of the pulmonary arteries, a biventricular repair had not been possible in any of the children with monosomy 22q11, though repair had been carried out in 64% of the children in group II. CONCLUSION: The developmental disturbance caused by the monosomy 22q11 seems to impair the connection of the peripheral pulmonary artery segments to the central pulmonary arteries in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries, resulting in a lower probability of biventricular repair.

Institutional address: Department of Paediatric Cardiology University Children's Hospital Erlangen Germany.

*****JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY*****

(REFERENCE 16 OF 20) 99054773

Carotti A Di Donato RM Squitieri C Guccione P Catena G Total repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals: an integrated approach.

In: J Thorac Cardiovasc Surg (1998 Dec) 116(6):914-23

ISSN: 0022-5223

OBJECTIVE: Rapid reperfusion may be injurious to the ischemic lung. Our aim was to confirm that slow reperfusion improves postischemic pulmonary function and to elucidate the ultrastructural changes associated with slow versus rapid reperfusion. METHODS: We used an ex vivo perfused rat lung transplant model to study the effect of slow versus rapid reperfusion on subsequent lung function and morphologic condition. Functional assessment was performed in (1) fresh lung, slowly reperfused; (2) fresh lung, rapidly reperfused; (3) ischemic lung (4 hours at 22 degreesC), slowly reperfused; and (4) ischemic lung, rapidly reperfused. RESULTS: In group 4, the shunt fraction (P =.001), airway pressure (P =.001), and wet/dry ratio (P =.01) were significantly higher than in groups 1 through 3. Light and electron microscopy of slowly reperfused ischemic lungs (n = 4) appeared normal. Rapidly reperfused ischemic lungs (n = 4) demonstrated massive alveolar edema, hemorrhage, and epithelial "blebbing" by light microscopy. Electron microscopy identified the blebbing as separation of the epithelial layer from an intact basement membrane by edema fluid. The epithelial layer was disrupted in numerous locations. Complete disruption of all layers of the blood-gas barrier was occasionally present. CONCLUSION: Rapid reperfusion of the ischemic lung is an important contributing factor to reperfusion lung injury resulting in mechanical stress failure of the alveolar/capillary barrier. Gradual reintroduction of blood flow to the ischemic lung improves oxygenation.

Institutional address: Division of Pediatric Cardiac Surgery Department of Pediatric Cardiology and Cardiac Surgery Bambino Gesu Hospital Rome Italy.

(REFERENCE 17 OF 20) 95257598

Reddy VM Liddicoat JR Hanley FL Midline one-stage complete unifocalization and repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals.

In: J Thorac Cardiovasc Surg (1995 May) 109(5):832-44; discussion 844-5

ISSN: 0022-5223

Traditionally patients with pulmonary atresia, ventricular septal defect, diminutive or absent central pulmonary arteries, and multiple aortopulmonary collaterals have been managed by staged procedures necessitating multiple operations. We have taken a different approach to this lesion. Between August 1992 and March 1994, ten patients aged 1.43 months to 37.34 years (median 2.08 years) at the severe end of the morphologic spectrum of this lesion underwent a one-stage complete unifocalization and repair from a midline sternotomy approach. The median Nakata index of true pulmonary arteries was 50.0 (range 0 to 103.13) and they provided vascular supply to up to nine lung segments (median 5 segments). The number of collaterals per patient ranged from two to five with a median of four. The collaterals provided vascular supply to a median of 15 lung segments per patient (range 11 to 20). Complete unifocalization was achieved in all patients with emphasis on native tissue-to-tissue connections via anastomosis of collaterals to other collaterals and to the native pulmonary arteries. In only one patient (37.34 years old) was it necessary to use a non-native conduit for peripheral pulmonary artery reconstruction. The ventricular septal defect was left open in one patient (5 years old) because of diffuse distal hypoplasia and stenosis of the pulmonary arteries and the collaterals. The postrepair peak systolic right ventricular/left ventricular pressure ratio ranged from 0.31 to 0.58 (median 0.47). There were no early deaths. Complications were bleeding necessitating reexploration in one patient, phrenic nerve palsy in three patients, and severe bronchospasm in three patients. Follow-up (median 8 months, range 2 to 19 months) was complete in all patients. One patient was reoperated on for pseudoaneurysm of the central homograft conduit and

then again for stenosis of the left lower lobe collateral. After this last operation at 13 months after the initial repair she died of a preventable cardiac arrest caused by pneumothorax. The patient with open ventricular septal defect underwent balloon dilation of the unifocalized pulmonary arteries, with a current pulmonary/systemic flow ratio of 1.4 to 1.8:1, and is awaiting ventricular septal defect closure. One other patient underwent balloon dilation of the reconstructed right pulmonary artery, with a good result. All survivors (9/10) are clinically doing well. This approach establishes normal cardiovascular physiology early in life, eliminates the need for multiple systemic-pulmonary artery shunts and use of prosthetic material, and minimizes the number of operations required.(ABSTRACT TRUNCATED AT 400 WORDS)

Institutional address: Division of Cardiothoracic Surgery University of California at San Francisco USA.

(REFERENCE 18 OF 20) 96350090

Yagihara T Yamamoto F Nishigaki K Matsuki O Uemura H Isizaka T Takahashi O Kamiya T Kawashima Y Unifocalization for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries.

In: J Thorac Cardiovasc Surg (1996 Aug) 112(2):392-402

ISSN: 0022-5223

To extend the indications for corrective operation in patients with pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries, surgical procedures were done to unify the blood sources for pulmonary perfusion. Since December 1985, 50 patients have undergone unifocalization at ages from 2 months to 26 years with a mean of 6 +/- 7 years. In total, 84 staged unifocalization procedures and 5 other palliative procedures were done in 49 patients. These included several operative procedures: simple ligation of major aortopulmonary collateral arteries in 8; pulmonary angioplasty in 29 including reconstruction of the pulmonary arterial tree by direct anastomosis or interposition between the central pulmonary arteries and the intrapulmonary arteries; construction of artificial central pulmonary arteries with use of a xenograft pericardial tube graft in 36 with no native central pulmonary arteries detected; and construction of supplemental central pulmonary arteries also with use of a pericardial tube graft in 10. The pericardial tube graft, if used, was anastomosed to the intrapulmonary arteries on one end and connected to a prosthetic tube on the other end so as to perfuse the reconstructed pulmonary arteries. The anastomosis was made inside the lung through the divided interlobar fissure. Five patients died after operation among those undergoing these 89 preparative operative procedures. Deaths were related either to bleeding caused by anticoagulation therapy administered to prevent thrombosis within the xenograft pericardial tube graft used or to progressive congestive heart failure as a result of an excessive amount of pulmonary blood flow. Twenty-six patients have undergone intracardiac repair after previous unifocalization. In 16 patients the artificial central pulmonary arteries surgically constructed were connected to each other and then an external conduit was placed. In another patient, intracardiac repair and unifocalization could be concomitantly achieved via a median sternotomy. The right ventricle to left ventricle systolic pressure ratio immediately after intracardiac repair in 27 patients ranged from 0.24 to 0.91 with a mean of 0.54 +/- 0.17. One patient (4%) died shortly after intracardiac repair because of thrombosis within the pulmonary arteries. Postoperative catheterization showed that pulmonary vascular resistance was correlated significantly with the number of pulmonary vascular segments functioning rather than with the condition of the central pulmonary arteries. We conclude that surgical unifocalization is a feasible procedure before subsequent intracardiac repair, even in patients with critically hypoplastic or absent central pulmonary arteries.

Institutional address: Department of Cardiovascular Surgery National Cardiovascular Center Osaka

Japan.

*****MAYO CLINIC PROCEEDINGS*****

(REFERENCE 19 OF 20) 93140399

van Son JA Puga FJ Danielson GK Seward JB Mair DD Schaff HV Ilstrup DM Aortopulmonary window: factors associated with early and late success after surgical treatment.

In: Mayo Clin Proc (1993 Feb) 68(2):128-33

ISSN: 0025-6196

Between 1953 and 1990, 19 patients, who were from 7 weeks to 27 years old, underwent surgical correction of aortopulmonary window at the Mayo Clinic. Associated cardiac anomalies were present in nine patients (47%). At operation, extracorporeal circulation was used in all except one patient. In seven patients, division and primary closure were done. In four patients, the defect was closed by direct suture through a transpulmonary approach. In eight patients, the defect was closed with a patch through a transpulmonary or transaortic approach. Four deaths (21%) occurred intraoperatively or immediately postoperatively. All four patients had undergone division of the aortopulmonary window before 1962, and three of them had a pulmonary vascular resistance (Rp) that was 7.3 U.m2 or more and a ratio of Rp to systemic vascular resistance (Rp/Rs) that exceeded 0.6. One patient with an Rp of 11.8 U.m2 and an Rp/Rs of 0.72 died 16 years postoperatively. Statistical analysis of risk factors indicated that early year of operation (P = 0.022), division of the aortopulmonary window versus transaortic or transpulmonary closure (P = 0.009), and a high Rp/Rs (P = 0.021) were significantly associated with perioperative death. All patients with a preoperative Rp of 8 U.m2 or less, an Rp/Rs of less than 0.4, and no major associated cardiac anomalies were in functional class I (New York Heart Association) postoperatively. Our study confirms that infants with aortopulmonary window should undergo operation early, before irreversible pulmonary vascular changes have developed. Patients with an Rp/Rs that exceeds 0.4 should be thoroughly assessed to determine their operability.

Institutional address: Division of Thoracic and Cardiovascular Surgery Mayo Clinic Rochester MN 55905.

*****RADIOLOGY*****

(REFERENCE 20 OF 20) 97043042

Doppman JL Skarulis MC Chen CC Chang R Pass HI Fraker DL Alexander HR Niederle B Marx SJ Norton JA Wells SA Spiegel AM Parathyroid adenomas in the aortopulmonary window [see comments]

In: Radiology (1996 Nov) 201(2):456-62

ISSN: 0033-8419

PURPOSE: To describe localization studies in nine patients with ectopic parathyroid adenomas in the aortopulmonary window. MATERIALS AND METHODS: Nine patients with ectopic parathyroid tissue (eight adenomas, one hyperplastic gland) in the aortopulmonary window were examined with ultrasound (US), computed tomography (CT), magnetic resonance (MR) imaging, and scintigraphy. Diagnostic arteriography (n = 4) and venous sampling (n = 3) were performed in the first four patients; arteriography for the purpose of staining was attempted in the last five patients. RESULTS: The results of CT and MR imaging studies were positive in eight of nine patients (89%) and five of eight patients (63%), respectively. The results of thallium/technetium scintigraphy were negative in three patients scanned (0%), but the results of a repeat study in one patient were positive (33%). Sestamibi scans were positive in six of six patients (100%). Single photon emission CT was performed in all six patients and enabled distinction between adenomas in the aortopulmonary window and those in the thymus. CONCLUSION: Ectopic parathyroid glands in the aortopulmonary window are usually detected at sestamibi scintigraphy, and SPECT is helpful in distinguishing these adenomas from more common adenomas in the anterior mediastinum. CT and MR imaging studies can also enable this distinction, but imaging must extend below the aortic arch.

Comment in: Radiology 1996 Nov;201(2):317-8

Institutional address: Diagnostic Radiology Department Warren Grant Magnuson Clinical Center National Institutes of Health Bethesda MD 20892-1182 USA.