The authors present a novel operative technique for an aortopulmonary window. The patient was a two-month-old boy, the product of a full-term pregnancy, who presented with an incidental finding of a murmur during examination.
An echocardiogram showed a Type 1 aortopulmonary window with no associated pathology. The color Doppler showed continuous high-velocity flow between the ascending aorta and the main pulmonary artery.
After a median sternotomy, bicaval and aortic cannulation were performed. A patent ductus arteriosus was identified, ligated, and divided. The branches of the pulmonary artery were identified and controlled with a vessel loop. Careful dissection was performed around the aortopulmonary window.
Cardiopulmonary bypass was initiated, and both pulmonary arteries were snared. The pulmonary window was controlled with a vessel loop. Then, the aortopulmonary window was clamped at the aortic side. The window was then divided. Primary closure of the aortic side of the window was closed with Prolene suture. The clamp was removed, and hemostasis was secured. An autologous pericardial patch was harvested and prepared as a patch for the pulmonary side of the window. The pulmonary side was patched, and hemostasis was secured.
The patient was decannulated successfully, completing the procedure. The patient was discharged home on postoperative day four.
Several techniques have been described for the repair of an aortopulmonary window, including historical off-pump approaches and conventional repair using cardiopulmonary bypass with cardioplegic arrest. In this case, the repair was performed using cardiopulmonary bypass while maintaining a beating heart. This approach provided a controlled operative field, while maintaining continuous coronary perfusion and avoided the need for aortic cross-clamping and cardioplegic arrest. Given the relatively straightforward anatomy and the ability to obtain adequate exposure and control of the defect, this technique is considered a safe and reproducible alternative to conventional arrested-heart repair.
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1 Comment
Thank you for the nice, straight forward technique. What are the pitfalls and best practices for this technique. How do you choose patients? which one to do on X clamp and who to favor this? Do you need imaging other than echo?
what was the weight? and how did the ICU course go?