PMC5864793_01
(a) Multi-detector computed tomography (MDCT) image of the chest with contrast showing a large aortopulmonary window (APW) (arrow mark). (b) Reconstructed MDCT images showing a large APW (arrow mark)
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F1
Multi-detector computed tomography (CT) with CT pulmonary angiography of the chest revealed no evidence of pulmonary thromboembolism, but showed the presence of a large APW with severe PAH (Fig. 1a, 1b, Fig. 2a).
(a) Reconstructed MDCT images showing a large APW (arrow mark). (b) Cardiac magnetic resonance imaging (CMRI) showing the presence of a large APW (arrow mark; 3-cm defect). (c) CMRI flow study image
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F2
Subsequent cardiac magnetic resonance imaging (CMRI) revealed a large APW (3 cm, type I Mori classification) with severe PAH and right ventricular dysfunction (Fig. 2b, 2c).
3-dimensional (3D) anatomical model (exact replica of the patient's heart) prepared using 3D printing technology, showing (a) the anterior and the posterior part of the model; (b) the aortopulmonary window (APW) (arrow mark); (c) the presence of APW (blue arrow mark) and the absence of an inner rim in the defect (black arrow mark), which led to avoiding an attempt at device closure of the defect
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F3
The solid 3D anatomical model of the patient's heart (Fig. 3a, 3b) revealed that the anatomical defect did not have an inner rim (Fig. 3c) and was not ideal for device closure.