Diagnosis, management, and results of treatment for aortopulmonary window

Abstract

The aortopulmonary window is a communication between the ascending aorta and the pulmonary trunk in the presence of two separate arterial valves. This uncommon congenital anomaly is reported rarely in the literature. We present here our experience with 16 patients, emphasizing the importance of early closure of the defect by a transaortic approach. We performed surgery on 16 patients over a period of 13 years using a transaortic approach under cardiopulmonary bypass. The median age of the patients at the time of operation was 6.5 months, with a range from 1 month to 11 years. Preoperative pulmonary arterial systolic pressure ranged from 30 to 100 mmHg. Associated cardiac anomalies were present in 7 of the patients, and were repaired at the same stage. The defect was between the ascending aorta and the proximal pulmonary trunk in 13 patients, and between the ascending aorta and the distal pulmonary trunk, with overriding of the orifice of the right pulmonary artery, in 3 patients. For closure, we used a patch of 0.4 mm Gore-Tex in 11, and gluteraldehyde-treated autologous pericardium in 5 of the patients. One patient died during surgery. The mean follow-up period for the surviving 15 patients was 52.2 months, with a range from 12 to 130 months. All the patients were in good condition during the follow-up, and no residual defects have been detected. Aortopulmonary window is a rare congenital cardiac anomaly, which can be repaired with very good operative results if surgery is performed before the development of irreversible pulmonary hypertension. We advise early correction of the defect with a transaortic patch, repairing all associated cardiac anomalies at the time of diagnosis.

Diagnosis, Treatment and Outcomes of Patients with Aortopulmonary Window

“…We preferred the transaortic approach in our cases because coronary orifices are visualised better and reconstruction of both arteries is safer by this technique; we did not experience any complications. Similarly, Mert et al (21) reported that they did not document residual defects when they preferred the transaortic approach. For the patch, we use either glutaraldehyde-treated autologous pericardium, or Gore-Tex of 0.4 mm thickness.…”

Janela aortopulmonar: impacto das lesões associadas no resultado cirúrgico

“…Since [9][10][11] , in contrast with our experience, where five patients (71.4%) underwent repair through the transpulmonary approach, 1 patient (14.2%) through the transaortic approach and in another case (14.2%), the closing was accomplished through dissection and repair.…”

“…The closing through hemodynamic intervention is also reported for small defects and to close any residual defect 11,12 . According to Soares and cols., for this procedure, the type of APW must be characterized and it must be type I (proximal), of a small dimension (3 to 4 mm) and not associated with anomalous origin of the coronary arteries.…”

Echokardiografische Diagnose des aortopulmonalen Fensters

“…Alternativ besteht die Mçglichkeit des transpulmonalen bzw. des transaortalen Zugangsweges[5,24], welcher aber das potenzielle Risiko eines Restshunts beinhaltet. In Einzelfällen ist bei kleinen drucktrennenden Defekten ein katheterinterventioneller Verschluss mçglich.…”

“…Dies betrifft auch Restdefekte nach operativem Verschluss[25,26]. Assoziierte Herzfehler werden heutzutage in der Regel im Rahmen der Primäroperation korrigiert[5,24]. Die Prognose des operativ korrigierten aortopulmonalen Fensters ist bei frühzeitiger Diagnosestellung und bei Fehlen komplexer assoziierter Vitien exzellent, vergleichbar mit der Prognose beim Verschluss eines Ventrikelseptumdefektes [5].Unsere Ergebnisse zeigen, dass das aortopulmonale Fenster echokardiografisch zuverlässig diagnostiziert werden kann.…”