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Aortopulmonary window: results of repair beyond infancy
Sachin Talwar1, Bharat Siddharth1, Saurabh Kumar Gupta1
1Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India.
Insights
Surgical repair of aortopulmonary window beyond infancy is safe and effective. This study shows acceptable early and mid-term outcomes in carefully selected patients, with no late deaths or reoperations.
Area of Science:
- Cardiovascular Surgery
- Pediatric Cardiology
- Congenital Heart Disease
Background:
- Aortopulmonary window is a rare congenital heart defect.
- Surgical repair is typically performed in infancy.
- Outcomes of repair beyond infancy are less well-documented.
Purpose of the Study:
- To evaluate the safety and efficacy of surgical repair of aortopulmonary window in patients older than one year.
- To analyze the anatomic and hemodynamic data and surgical outcomes in this patient group.
Main Methods:
- Retrospective analysis of 23 patients older than 1 year undergoing aortopulmonary window repair between July 2005 and December 2015.
- Review of pre-operative, intra-operative, and post-operative data, including clinical and echocardiographic follow-up.
- Classification of aortopulmonary window types (Richardson's) and assessment of associated defects.
Main Results:
- Median age at repair was 4 years. Fifteen patients had Type I, 6 had Type II, and 2 had Type III aortopulmonary windows. Six patients had associated defects.
- Baseline pulmonary artery pressure was significantly elevated (median 100 mmHg).
- Patch repair using the sandwich method was most common. Two in-hospital deaths occurred due to pulmonary hypertension and low cardiac output. Mean follow-up was 36 months, with 18 patients in NYHA Class I. No late deaths or reoperations were reported.
Conclusions:
- Surgical repair of aortopulmonary window beyond infancy is feasible and associated with acceptable early and mid-term outcomes in carefully selected patients.
- The study highlights the importance of patient selection for successful surgical outcomes.
- Further research may focus on long-term results and specific surgical techniques.
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.
