AP Window can be diagnosed even before delivery of the baby by doing Fetal Echocardiogram test but sometimes, it can be missed as well.
“Echocardiography of child” is essential for making the diagnosis of AP window in children.
Sometimes, when echo is inconclusive, then CT angiography can also be done for confirming size of AP window as well as for assessing adjacent structures near AP window.
Supportive tests that can be done are chest x ray and ECG.
Occasionally, “pediatric cardiac catheterization’’ needs to be done for determining whether child is operable or not when AP window is not treated on time.
Treatment of AP window
If AP window is large in size, then only option for treatment is by doing open heart surgery as early as possible (preferably by before 6 months of age). For controlling heart failure, we can give anti-failure medications.
If size of AP window is small, then we can follow up for few months and if suitable then we can close AP window by “device closure of AP window” in cath lab (instead of open heart surgery) preferably before first birthday of the child.
In moderate size AP window, then depending on size and location of AP window, we can plan either device closure or open heart surgery by before one year of age or even early if medical therapy fails.
AP window surgery:
This is done by open heart surgery by opening of the chest in midline.
AP Window device closure in cath lab:
It is done in selected cases which are suitable for device closure. Angiographic closure is done by using thigh vessels and with the help of wire, catheters etc, we deploy device across the hole and hole can be closed without open heart surgery.
Prognosis of AP window:
If AP window is treated on time, then it is having a very good prognosis. AP window once occur, cannot be close spontaneously, it needs to be closed either by surgery or by angiography. Late closure is associated with Eisenmenger’s like situation which is having a poor prognosis.
Pregnancy and AP window
Pregnant women with repaired AP window with no signs of pulmonary arterial hypertension (PAH) pose no significant problems during pregnancy either to herself or to the baby.
Pregnancy is contraindicated with established Eisenmenger complex like situation as it poses risk both to the mother and child.
Dr Gaurav Agrawal is a Pediatric Cardiologist (Child and Fetal heart Specialist). Dr Agrawal is a pediatrician who has specialized training in the treatment of various child heart related problems (neonates to 18 years of age). He is also having a vast experience in fetal echocardiography.
He is one of the very few pediatricians in India who practices pediatric cardiology exclusively. Cardiac problems in children are common in children, sometimes life threating and often not diagnosed properly. Early diagnosis and timely treatment is very important. Areas of specific interest include child echocardiography including fetal echocardiography, diagnostic and therapeutic cardiac catheterization (pediatric cardiac holes closure by device, opening of obstructed cardiac valves by balloons etc).