title: Aortopulmonary window: Morphology, diagnosis, and long-term results.
abstract: OBJECTIVE
  Aortopulmonary window (APW) is a rare congenital heart defect. We reviewed our experience with this condition over the last two decades.
  
  
  METHODS
  Between September 1993 and December 2013, 62 patients underwent surgery for APW. Depending on the associated lesions, they were divided into two groups: Simple (Group 1) or complex (Group 2). In the complex group, six patients had a ventricular septal defect, five patients had interrupted aortic arch, three patients had tetralogy of Fallot, two patients had double outlet right ventricle, and one patient had the right pulmonary artery arising from the ascending aorta.
  
  
  RESULTS
  Mean age at repair was 21.6 ± 32.02 months (median = 6, range 0.1-144 months). By preoperative echocardiographic assessment 27 out of 62 patients had severe pulmonary artery hypertension (52% of the cohort). Patch repair of APW was performed using the sandwich method (transwindow) (n = 27; 43.5%), transaortic (n = 18; 29%), and transpulmonary artery (n = 5; 8.1%) approaches; 10 patients (16.1%) underwent double ligation and two (3.2%) underwent division and suturing. Overall hospital mortality in group 1 was 6.97% (3/43) and in group 2 it was 21% (4/19), p = 0.085. Mean hospital stay in group 1 was 6.9 ± 2.4 days (median = 7 days) and in group 2 was 12 ± 6.1 days (median = 13 days), p = 0.0001. Follow-up in group 1 was 1.6-9.8 years (median = 6 years); in group 2, it was 1.8-8.9 years (median = 6.5 years). There were no late deaths. Two patients needed reintervention for distortion of the right pulmonary artery origin. All patients were in New York Heart Association Class I/II at last follow up.
  
  
  CONCLUSIONS
  There are multiple acceptable surgical strategies for the treatment of aortopulmonary window. Despite a relatively advanced age and substantial number of patients with severe pulmonary hypertension the outcomes can still be good. Associated anomalies complicate the repair. Patients in the complex group had a protracted hospital course and a higher early mortality but similar late survival.
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Sachin
authors.initials: S
authors.lastname: Talwar
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Palkesh
authors.initials: P
authors.lastname: Agarwal
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Choudhary
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Shyam Sunder
authors.initials: SS
authors.lastname: Kothari
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Juneja
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Saxena
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Balram
authors.initials: B
authors.lastname: Airan
mesh_terms: D001028:Aortopulmonary Septal Defect / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002675:Child, Preschool; D004452:Echocardiography; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000639:trends; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome