Transposition of Great Arteries With Aortopulmonary Window: Our Surgical Experience

Transposition of the great arteries: When echocardiography does not match the clinical picture

“…As the PVR falls, shunting at the APW becomes systemic‐to‐pulmonary and improved mixing occurs at this large lesion resulting in improved oxygen saturations. Depending on the size and type of APW, failure to make a timely diagnosis can result in the pulmonary vascular system experiencing significant over‐circulation leading to congestive heart failure, increased pulmonary arterial pressures, and eventual irreversible pulmonary vascular changes . Depending on the size and location of an APW with the associated complex congenital heart lesion, early surgical repair may be prudent.…”

“…Depending on the size and location of an APW with the associated complex congenital heart lesion, early surgical repair may be prudent. Numerous studies have documented lower mortality with early closure of an APW, while mortality after late closure is generally higher and dependent on the pulmonary vascular resistance and presence of complex associated lesions …”

“…Numerous studies have documented lower mortality with early closure of an APW, while mortality after late closure is generally higher and dependent on the pulmonary vascular resistance and presence of complex associated lesions. 3,4,7,10,19 As the systemic and pulmonary circulations are in parallel in TGA, mixing of the two circulations is necessary to allow for oxygenated pulmonary venous blood to mix with deoxygenated systemic venous blood to provide adequate oxygen delivery to the systemic circulation. 24 .…”

“…1,3,4 These associated cardiac anomalies include: tetralogy of Fallot, coarctation of the aorta, interrupted aortic arch (commonly type A), coronary artery anomalies, and in the rarest of cases an APW can be seen with transposition of the great arteries (TGA). 1,5,6 On review of the current literature, there have been 18 reported cases of TGA with APW documented between 1988-2016 [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] (Table 1). Given its rare occurrence, diagnosing an APW in association with other cardiac anomalies can be challenging.…”

Arterial switch operation for complex d-transposition of the great arteries with aortopulmonary window

“…Aortopulmonary (AP) window rarely occurs with d-TGA, and only 20 cases have been formally published. 1 In this case report, we describe a neonate at our institution diagnosed with d-TGA, AP window, and outlet VSD who underwent the arterial switch operation and patch closure of the VSD. Institutional review board approval was waived, and informed consent for publication of study data was obtained.…”