Repair of Aortopulmonary Window in a Newborn
A 2-week-old, 3.5 kg neonate presented with tachypnea and a murmur was heard. Echocardiogram showed a type I aortopulmonary window and patent foramen ovale. Computed tomography scan confirmed the diagnosis and a mild distal aortic arch hypoplasia was present. No coronary arterial anomalies were identified.
Through a standard median sternotomy, and with indirect innominate artery and right atrial cannulation, cardiopulmonary bypass was initiated at normothermia. Both branch pulmonary arteries were temporary controlled with vessel loops. Antegrade cardioplegic arrest was achieved. A trans-window approach was utilized and an incision was made through the aortopulmonary window being careful of the location of the coronary arteries. The aorta and main pulmonary artery were separated. The ascending aorta was further dissected and separated from the branch pulmonary artery.
An appropriately sized bovine pericardial patch was used to repair the defect in the aortic wall and a similar patch was used for the main pulmonary artery. The heart was then de-aired and the aortic cross clamp was removed. The patient regained here normal sinus rhythm and was weaned off cardiopulmonary bypass in the standard fashion.
The aortic cross clamp and cardiopulmonary bypass times were 25 and 37 minutes respectively.
The postoperative course was uneventful and she was discharged 5 days after the procedure. Pre-discharge echocardiogram confirmed good biventricular function with competent aortic and pulmonary valves and normal caliber of both the ascending aorta and main pulmonary artery.
References
1. Jacobs JP, Quintessenza JA, Gaynor JW, Burke RP, Mavroudis C. Congenital Heart Surgery Nomenclature and Database Project: aortopulmonary window. Ann Thorac Surg. 2000 Apr;69(4 Suppl):S44-9
2. Talwar S, Agarwal P, Choudhary SK, Kothari SS, Juneja R, Saxena A, Airan B. Aortopulmonary window: Morphology, diagnosis, and long-term results. J Card Surg. 2017 Feb;32(2):138-144
3. Backer CL, Mavroudis C. Surgical management of aortopulmonary window: a 40-year experience. Eur J Cardiothorac Surg. 2002 May;21(5):773-9
