Surgical Repair of Complex Aortopulmonary Window: A Case Study

Abstract

Aortopulmonary septal defect, also known as the aortopulmonary window, is a rare congenital macrovascular malformation. This case involves a 9-year-old boy with aortopulmonary septal defect (type I combined with type IV). Before surgery, milrinone and alprostadil were used to counteract high lung pressure. Surgery was performed under cardiopulmonary bypass, following which the pulmonary pressure decreased. The aorta was cut, and the right pulmonary artery opening was connected with the main pulmonary artery septal defect using polyester patch. An internal tunnel was made, and the deformity correction was completed. The child exhibited normal postoperative recovery with no discomfort. A complex aortopulmonary window is a rare condition that can be treated successfully with appropriate preoperative and surgical management.

Aortopulmonary Window: Classification, Associated Cardiac Anomalies, Treatment Options, and Clinical Outcome

“…Among patients with complex APW, topsy-turvy heart, atrial septal defect, and VSD were the most frequently observed associated conditions (50%). In the case reports we reviewed, rare cardiovascular abnormalities were identified in association with APW, including a right aortic arch with an aberrant origin of the left subclavian artery (15), an isolated origin of the left subclavian artery from the left pulmonary artery (16), total abnormal pulmonary venous return (17), a right pulmonary artery originating from the ascending aorta (8), and crisscross pulmonary arteries (18). We have not encountered such rare abnormalities in our patients.…”

“…Early closure is imperative given the potential for rapid onset of congestive heart failure owing to high pulmonary blood flow. The conventional approach to treating APW is surgical intervention, and several studies (4,5,6,8,13,20) have examined surgical outcomes in this context. However, transcatheter closure may serve as a viable alternative in cases with no associated cardiovascular lesions and adequate rims.…”

“…Hence, early closure of large APWs is imperative to avert heart failure or pulmonary vascular disease. While surgery remains the standard treatment of choice (6,8), transcatheter APW closure can be a suitable alternative for patients with adequate rims (9,10).…”