Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-28T13:37:54.862Z Has data issue: false hasContentIssue false
  • English
  • Français

Diagnosis, management, and results of treatment for aortopulmonary window

Published online by Cambridge University Press:  21 January 2005

Murat Mert ,
Tufan Paker ,
Atif Akcevin ,
Gurkan Cetin ,
Ahmet Ozkara ,
Levent Saltik ,
Ihsan Bakir  and
Cenk Eray Yildiz
Murat Mert
Affiliation:
Department of Cardiovascular Surgery, Institute of Cardiology, Istanbul University, Istanbul, Turkey
Tufan Paker
Affiliation:
Department of Cardiovascular Surgery, Istanbul American Hospital, Istanbul, Turkey
Atif Akcevin
Affiliation:
Department of Cardiovascular Surgery, Istanbul American Hospital, Istanbul, Turkey
Gurkan Cetin
Affiliation:
Department of Cardiovascular Surgery, Institute of Cardiology, Istanbul University, Istanbul, Turkey
Ahmet Ozkara
Affiliation:
Department of Cardiovascular Surgery, Institute of Cardiology, Istanbul University, Istanbul, Turkey
Levent Saltik
Affiliation:
Department of Pediatric Cardiology, Institute of Cardiology, Istanbul University, Istanbul, Turkey
Ihsan Bakir
Affiliation:
Department of Cardiovascular Surgery, Institute of Cardiology, Istanbul University, Istanbul, Turkey
Cenk Eray Yildiz
Affiliation:
Department of Cardiovascular Surgery, Institute of Cardiology, Istanbul University, Istanbul, Turkey
Get access Rights & Permissions [Opens in a new 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.

Keywords

Aortopulmonary fenestrationpulmonary hypertensiontransthoracic echocardiography
Type
Original Article
Information
Cardiology in the Young , Volume 14 , Issue 5 , October 2004 , pp. 506 - 511
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Tirado AM, De Soto JS, Montero JG, Camacho JLG, Madrid AA, Fournier MG, Senorans AD. Aortopulmonary window: clinical assessment and surgical results. Rev Esp Cardiol 2002; 55: 266–702.Google Scholar
Tkebuchava T, Von Segesser LK, Vogt PR, Bauersfeld U, Jenni R, Kunzli A, Lachat M, Turina M. Congenital aortopulmonary window: diagnosis, surgical technique and long-term results. Eur J Cardiothorac Surg 1997; 11: 293–297.Google Scholar
Di Bella I, Gladstone DJ. Surgical management of aortopulmonary window. Ann Thorac Surg 1998; 65: 768–770.Google Scholar
Van Son JA, Kaan GL, Van Oort A, Van De Wal HJ, Vincent JG, Lacquet LK. Aortopulmonary window: the need for early surgical correction. Tijdschr Kindergeneeskd 1991; 59: 32–36.Google Scholar
Backer CL, Mavroudis C. Surgical management of aortopulmonary window: a 40-year experience. Eur J Cardiothorac Surg 2002; 21: 773–779.Google Scholar
Soares AM, Atik E, Martins Cortez T, Albuquerque AM, Castro CP, Barbero-Marcial M, Ebaid M. Aortopulmonary window: clinical assessment of 18 cases. Arq Bras Cardiol 1999; 73: 59–74.Google Scholar
Elliotson J. Case of malformation of the pulmonary artery and aorta. Lancet 1830; 1: 247–251.Google Scholar
Richardson JV, Doty DB, Rossi NP, Ehrenhaft J. The spectrum of anomalies of aortopulmonary septation. J Thorac Cardiovasc Surg 1979; 78: 21–27.Google Scholar
Ho SY, Gerlis LM, Anderson C, Devine WA, Smith A. The morphology of aortopulmonary windows with regard to their classification and morphogenesis. Cardiol Young 1994; 4: 146–155.Google Scholar
Anderson RH, Webb S, Brown NA, Lamers W, Moorman A. Development of the heart: (3) Formation of the ventricular outflow tracts, arterial valves, and intrapericardial arterial trunks. Heart 2003; 89: 1110–1118.Google Scholar
Faulkner LS, Olhan RR, Atwood GF, Graham TP. Aortopulmonary window, ventricular septal defect and membranous pulmonary atresia with a diagnosis of truncus arteriosus. Chest 1974; 65: 351–353.Google Scholar
Muller AM, Schulz F, Muller KM. Complex pulmonary vessel alterations in aortopulmonary window in adulthood. Pathologe 2001; 22: 349–353.Google Scholar
Gross RE. Surgical closure of an aortic septal defect. Circulation 1952; 5: 858–863.Google Scholar
Doty DB, Richardson JV, Falkovsky GE, Gordonova MI, Burakovsky VI. Aortopulmonary septal defect: hemodynamics, angiography and operation. Ann Thorac Surg 1981; 32: 244–250.Google Scholar
Hew CC, Bacha EA, Zurakowski D, Del Nido Jr PJ, Jonas RA. Optimal surgical approach for repair of aortopulmonary window. Cardiol Young 2001; 11: 385–390.Google Scholar
Matsuki O, Yagihara T, Yamamoto F, Nishigaki K, Uemura H, Kawashima Y. New surgical technique for total-defect aortopulmonary window. Ann Thorac Surg 1992; 54: 991–992.Google Scholar
Matsuki O, Yagihara T. As originally published in 1992: new surgical technique for total-defect aortopulmonary window – updated in 1999. Ann Thorac Surg 1999; 67: 891.Google Scholar
Tulloh RM, Rigby ML. Transcatheter umbrella closure of aorto-pulmonary window. Heart 1997; 77: 479–480.Google Scholar