Aortopulmonary window: factors associated with early and late success after surgical treatment.
Between 1953 and 1990, 19 patients, who were from 7 weeks to 27 years old, underwent surgical correction of aortopulmonary window at the Mayo Clinic. Associated cardiac anomalies were present in nine patients (47%). At operation, extracorporeal circulation was used in all except one patient. In seven patients, division and primary closure were done. In four patients, the defect was closed by direct suture through a transpulmonary approach. In eight patients, the defect was closed with a patch through a transpulmonary or transaortic approach. Four deaths (21%) occurred intraoperatively or immediately postoperatively. All four patients had undergone division of the aortopulmonary window before 1962, and three of them had a pulmonary vascular resistance (Rp) that was 7.3 U.m2 or more and a ratio of Rp to systemic vascular resistance (Rp/Rs) that exceeded 0.6. One patient with an Rp of 11.8 U.m2 and an Rp/Rs of 0.72 died 16 years postoperatively. Statistical analysis of risk factors indicated that early year of operation (P = 0.022), division of the aortopulmonary window versus transaortic or transpulmonary closure (P = 0.009), and a high Rp/Rs (P = 0.021) were significantly associated with perioperative death. All patients with a preoperative Rp of 8 U.m2 or less, an Rp/Rs of less than 0.4, and no major associated cardiac anomalies were in functional class I (New York Heart Association) postoperatively. Our study confirms that infants with aortopulmonary window should undergo operation early, before irreversible pulmonary vascular changes have developed. Patients with an Rp/Rs that exceeds 0.4 should be thoroughly assessed to determine their operability.
van Son
J A
JA
Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905.
Puga
F J
FJ
Danielson
G K
GK
Seward
J B
JB
Mair
D D
DD
Schaff
H V
HV
Ilstrup
D M
DM
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000790:Angiocardiography; D001027:Aortography; D001028:Aortopulmonary Septal Defect / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures / Q000379:methods / Q000401:mortality / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006770:Hospitals, Group Practice; D006801:Humans; D007223:Infant; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D011379:Prognosis; D011652:Pulmonary Circulation; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D014655:Vascular Resistance