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Direct Re-implantation of Left Coronary Artery into the Aorta in Adults with Anomalous Origin of Left Coronary Artery from the Pulmonary Artery ALCAPA
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Surgical Management of Aortopulmonary Window and its Associated Cardiac Lesions

Chinnaswamy Reddy1, Ameya Kaskar1, Eswara Karthick1

  • 1Department of Cardiothoracic Surgery, 501944Narayana Institute of Cardiac Sciences, Narayana Health, Bangalore, Karnataka, India.

World Journal for Pediatric & Congenital Heart Surgery
|April 21, 2022
PubMed

Insights

Surgical repair of aortopulmonary window shows excellent outcomes when it is an isolated defect. Outcomes are less favorable but still good for patients with associated cardiac anomalies, with pulmonary artery hypertensive crisis being a key predictor of early mortality.

Area of Science:

  • Cardiology
  • Pediatric Cardiac Surgery
  • Congenital Heart Disease

Background:

  • Aortopulmonary window is a rare congenital heart defect.
  • Surgical repair is the standard treatment.
  • Outcomes can vary based on the presence of associated cardiac anomalies.

Purpose of the Study:

  • To review institutional experience with surgical repair of aortopulmonary window.
  • To compare outcomes between isolated aortopulmonary window and those with associated lesions.
  • To identify predictors of early mortality and long-term outcomes.

Main Methods:

  • Retrospective review of 183 patients undergoing surgical repair of aortopulmonary window from 2006-2020.
  • Patients were divided into two groups: isolated aortopulmonary window (n=120) and associated lesions (n=63).
  • Analysis of early mortality, long-term survival, and freedom from reintervention.

Main Results:

  • Early mortality was significantly higher in patients with associated lesions (12.7%) compared to isolated aortopulmonary window (0.8%).
  • Pulmonary artery hypertensive crisis was the only independent predictor of early mortality on multivariable analysis.
  • Five- and 8-year survival rates were 77% ± 6.5% for associated lesions and 98.8% ± 1.2% for isolated lesions.

Conclusions:

  • Surgical repair of isolated aortopulmonary window yields excellent early and long-term outcomes.
  • Patients with associated lesions have higher early mortality, but still achieve good long-term survival and freedom from reoperation.
  • Pulmonary artery hypertensive crisis is a critical factor influencing early mortality in this patient population.

Keywords:
aortopulmonary window repaircongenital heart disease (CHD)

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