“…3,11,15 There is no uniform agreement regarding the superiority of either technique. 18,19 In 1 series of 14 patients aged more than 1 year, 18 adverse outcome was associated with transluminal repair. Others have likewise advocated a transwindow approach.…”
Complete correction of aortopulmonary window in the setting of interrupted aortic arch can be performed with low mortality in the neonatal period. Reinterventions for aortic arch obstruction are the most frequent complication after repair, but pulmonary artery stenosis also occurs. Use of patch augmentation may reduce the need for subsequent arch reintervention.
“…3,11,15 There is no uniform agreement regarding the superiority of either technique. 18,19 In 1 series of 14 patients aged more than 1 year, 18 adverse outcome was associated with transluminal repair. Others have likewise advocated a transwindow approach.…”
Complete correction of aortopulmonary window in the setting of interrupted aortic arch can be performed with low mortality in the neonatal period. Reinterventions for aortic arch obstruction are the most frequent complication after repair, but pulmonary artery stenosis also occurs. Use of patch augmentation may reduce the need for subsequent arch reintervention.
“…7,[12][13][14] Pulmonary vascular disease develops with the same rapidity as it does in patients with unrestrictive ventricular septal defect. [15][16][17] Pinto et al 16 described Eisenmenger physiology in one-third of patients in whom the diagnosis was made after 15 years of age.…”
Section: Discussionmentioning
confidence: 99%
“…5,9 A variety of materials and suture techniques have been used for closure by different operators without a clear influence on outcomes. 1,6,17,[28][29][30][31][32][33][34] Windows have been repaired without the use of cardiopulmonary bypass. 35 Suitable lesions have also been addressed by transcatheter closure.…”
An aortopulmonary window is a communication between the ascending aorta and pulmonary trunk in the presence of two separate arterial valves, and is often complicated by other associated defects. We sought to determine management and related outcomes in patients with this malformation. We identified those patients presenting between 1969 and 1999 from the databases held in our Departments of Cardiology, Pathology and Cardiovascular Surgery. We obtained data relating to issues concerning demography, clinical findings, imaging, management and outcome. The median age at presentation for the 42 patients identified, of whom 23 were female, was 62 days, with a range from birth to 6 years. Associated cardiac defects were present in 34 patients, including interruption of the aortic arch in 6 patients. The correct diagnosis was initially missed in 13 patients. Of the patients, six died without surgical repair, and 1 patient was lost-to-follow-up. Repair was performed in 35 patients, subsequent to repair of other defects in 4, in association with repair of other defects in 17, of whom 3 died, and as an isolated procedure in 14 patients, one of the latter being treated by transcatheter closure. Overall, there were 9 deaths, all in patients with complex associated defects, except 1 patient with a missed aortopulmonary window after repair of aortic coarctation. Kaplan-Meier estimates of survival were 81% at 3 months until 11.5 years, and 69% up to 21 years. Only the presence of interrupted aortic arch was independently associated with increased time-related mortality, the hazard ratio being 5.87 (p = 0.009). The outcome for an isolated lesion is excellent. Mortality occurs mainly before repair, mostly with complex associated lesions, particularly interruption of the aortic arch.
“…Once the lesions are defined, colour Doppler can be used to show low velocity bidirectional laminar flow even in unrestricted defects with pulmonary arterial hypertension. The spiral defects extending to incorporate the origin of the right pulmonary artery, or those large defects extending from the sinutubular junctions to the bifurcation of the pulmonary trunk, can be difficult to differentiate from persistent patency of the arterial ducts, 8 as was the case in our second patient in whom initially we failed to make the correct diagnosis.Figure 1Parasternal short axis view showing dropout in the area of the adjacent walls of the intrapericardial components of the aorta and the pulmonary trunk, suggestive of an aortopulmonary window.…”
Even meticulous echocardiography may result in a false negative diagnosis of an aortopulmonary window. A high index of suspicion for this lesion is warranted in cases of unexplained severe pulmonary arterial hypertension, and/or unexplained cardiac dilation.
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