Surgical clipping of an aortopulmonary window: a valid strategy?-case report

An aortopulmonary window is a rare congenital anomaly causing pulmonary overflow and respiratory problems. Various techniques have been propagated for these children. In most instances, complete reconstruction using cardiopulmonary bypass and patch reconstruction is advocated. In this report, we describe a less invasive technique with an optimal result six months later.

An eight-day-old, 3.5 kg neonate presented with shortness of breath. His gestational age was 38 weeks. Echocardiography revealed an aortopulmonary window, with high pulmonary artery pressures. The lesion was not picked up at the structural echo at 21 weeks. Because of favorable anatomy, the shunt was clipped through a median sternotomy, thus excluding the need for cardiopulmonary bypass. The procedure took 90 minutes, and a 6 mm titanium vascular clip was used. This resulted in a complete occlusion of the shunt and preserved anatomy and function of the great vessels. The patient was extubated one day later and could be dismissed from the intensive care unit on the fourth postoperative day. The echocardiography six months later shows favorable anatomy of the great vessels and complete occlusion of the window.

External clipping through a median sternotomy could be a valid option to occlude an aortopulmonary window in neonates. It omits the need for cardiopulmonary bypass in neonates with this pathology. However, more cases and long-term results are needed to support this as a valid strategy.