Aortopulmonary window and aortic isthmic hypoplasia. Operative management in newborn infants

Aortopulmonary window with aortic isthmic hypoplasia is an unusual combination of congenital heart lesions that usually causes severe heart failure, poor systemic perfusion, and death shortly after birth. In 21 previously reported cases, survival beyond infancy was uncommon, yet only one neonate survived operation. This report describes three cases of aortopulmonary window and aortic isthmic hypoplasia and a two-stage operative approach that proved successful in both infants in which it was tried. During the first step the isthmic obstruction is relieved, the ductus is ligated, and the aortopulmonary window is plicated via a left thoracotomy. The second stage consists of definitive closure of the aortopulmonary window using the technique of deep perfusion hypothermia.