Repair of Aortopulmonary Window in a Newborn

A two-week-old, 3.5 kg newborn presented with tachypnea and a heart murmur. An echocardiogram showed a type I aortopulmonary window and patent foramen ovale. A computed tomography scan confirmed the diagnosis and showed a mild distal aortic arch hypoplasia. No coronary arterial anomalies were identified. 

Through a standard median sternotomy, and with indirect innominate artery and right atrial cannulation, cardiopulmonary bypass was initiated at normothermia. Both branch pulmonary arteries were temporary controlled with vessel loops, and antegrade cardioplegic arrest was achieved. Next, a trans-window approach was used, and an incision was made through the aortopulmonary window while being careful of the location of the coronary arteries. After this, the aorta and main pulmonary artery were separated. The ascending aorta was further dissected and separated from the branch pulmonary artery. 

An appropriately sized bovine pericardial patch was used to repair the defect in the aortic wall, and a similar patch was used for the main pulmonary artery. The heart was then de-aired, and the aortic cross-clamp was removed. Here, the patient regained normal sinus rhythm and was weaned off cardiopulmonary bypass in the standard fashion. 

The aortic cross-clamp and cardiopulmonary bypass times were 25 and 37 minutes respectively. 

The postoperative course was uneventful, and the patient was discharged five days after the procedure. A predischarge echocardiogram confirmed good biventricular function with competent aortic and pulmonary valves and normal caliber of both the ascending aorta and main pulmonary artery. 

References

1. Jacobs JP, Quintessenza JA, Gaynor JW, Burke RP, Mavroudis C. Congenital Heart Surgery Nomenclature and Database Project: aortopulmonary window. Ann Thorac Surg. 2000 Apr;69(4 Suppl):S44-9
2. Talwar S, Agarwal P, Choudhary SK, Kothari SS, Juneja R, Saxena A, Airan B. Aortopulmonary window: Morphology, diagnosis, and long-term results. J Card Surg. 2017 Feb;32(2):138-144
3. Backer CL, Mavroudis C. Surgical management of aortopulmonary window: a 40-year experience. Eur J Cardiothorac Surg. 2002 May;21(5):773-9

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