Surgical management of aortopulmonary window and associated lesions.
BACKGROUND
Aortopulmonary window is a rare congenital heart defect commonly associated with other cardiac anomalies. Although single institutional experience is low, several surgical techniques have been reported. The purpose of this study is to describe our approach to the management of aortopulmonary window and its associated lesions.


METHODS
Between February 1996 and November 2002, 13 patients underwent repair of aortopulmonary window. The age range went from 4 days to 5.5 months (mean 42 +/- 52 days), with 9 patients younger than 1 month old. The weight range was from 1.9 to 6.7 kg (mean 3.5 +/- 1.2 kg). Concomitant cardiac anomalies were present in 11 patients. The major additional anomalies were interruption of aortic arch in 4 patients and tracheal stenosis in 1 patient. Initial diagnoses were made using two-dimensional echocardiography only.


RESULTS
There was one postoperative death. In general, patients with aortopulmonary window and additional major defects had a prolonged intensive care unit and hospital stay when compared with the other patients. Follow-up time ranged from 2 months to 6.8 years (mean of 2.5 +/- 2.2 years). There were no reoperations and no late deaths. Transcatheter balloon dilatation of the repaired aortic arch was required in 1 patient and of the right pulmonary artery in another. All other patients had good flow to both pulmonary arteries. No residual shunts were detected at the aortopulmonary window site, and pulmonary pressures were normal.


CONCLUSIONS
Aortopulmonary window may be effectively diagnosed with echocardiography. Early surgical treatment (neonatal period, if possible) is safe and associated with the best long-term results, even in the presence of other cardiac anomalies. Complete separation and reconstruction of both aorta and pulmonary arteries under direct vision may prevent recurrence and distortion of adjacent structures.
Erez
Eldad
E
Department of Cardiothoracic Surgery, Anesthesiology and Heart Institute, Schneider Children's Medical Center of Israel, Rabin Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Petach Tikva, Israel. eldade@clalit.org.it
Dagan
Ovadia
O
Georghiou
Georgios P
GP
Gelber
Oscar
O
Vidne
Bernardo A
BA
Birk
Einat
E
D001017:Aortic Coarctation / Q000000981:diagnostic imaging / Q000601:surgery; D001028:Aortopulmonary Septal Defect / Q000000981:diagnostic imaging / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate; D014135:Tracheal Stenosis / Q000000981:diagnostic imaging / Q000601:surgery; D014463:Ultrasonography