Aortopulmonary window: results of repair beyond infancy

• Published in: Interactive cardiovascular and thoracic surgery 2017-11, Vol.25 (5), p.740-744
• Main Authors: Talwar, Sachin, Siddharth, Bharat, Gupta, Saurabh Kumar, Choudhary, Shiv Kumar, Kothari, Shyam Sunder, Juneja, Rajnish, Saxena, Anita, Airan, Balram
• Format: Article
• Language: English
• Subjects: Aortopulmonary Septal Defect - complications; Aortopulmonary Septal Defect - diagnosis; Aortopulmonary Septal Defect - surgery; Cardiac Surgical Procedures - methods; Child; Child, Preschool; Echocardiography; Female; Follow-Up Studies; Hemodynamics; Humans; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - physiopathology; Hypertension, Pulmonary - surgery; Infant; Ligation; Male; Postoperative Period; Reoperation; Retrospective Studies
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivx158

Abstract OBJECTIVES To study the anatomic and haemodynamic data and results of surgery in patients undergoing surgical repair of aortopulmonary window beyond infancy. METHODS Between July 2005 and December 2015, 23 patients, older than 1 year undergoing surgery for aortopulmonary window were analysed retrospectively. Postoperative clinical and echocardiography follow-up were performed. RESULTS Median age and weight at repair was 4 years (range 14 months–12 years) and 12 kg (range 3.5–22 kg), respectively. Fifteen patients had Richardson’s Type I, 6 patients had Type II and 2 patients had Type III aortopulmonary window. Six patients had associated defects. Baseline mean systolic pulmonary artery pressure was 101 ± 14.9 mmHg (range 80–130, median 100 mmHg) and pulmonary vascular resistance index was 9.6 ± 5.9 (median 7.7 Wood units/m2, range 3.7–23.5 Wood units/m2). Patch repair of aortopulmonary window was performed using the sandwich method (transwindow) (n = 15), transaortic (n = 3) and transpulmonary artery (n = 2) approaches; 2 patients underwent double ligation and 1 underwent division and suturing. Two patients underwent valved patch closure of aortopulmonary window and 1 patient underwent valved patch closure of associated ventricular septal defect. There were 2 in-hospital deaths: one due to intractable pulmonary hypertension and the other due to low cardiac output. Mean follow-up was 36 months (range 2–119 months). Eighteen patients were in NYHA Class I at last follow-up. There were no late deaths or reoperation. CONCLUSIONS Surgery can be safely undertaken beyond infancy in carefully selected patients of aortopulmonary window with acceptable early and mid-term outcomes.