RT Book, Section A1 Morell, Victor O. A1 Kocyildirim, Ergin A2 Yuh, David D. A2 Vricella, Luca A. A2 Yang, Stephen C. A2 Doty, John R. SR Print(0) ID 1104596084 T1 Aortopulmonary Window T2 Johns Hopkins Textbook of Cardiothoracic Surgery YR 2014 FD 2014 PB McGraw-Hill Education PP New York, NY SN 978-0-07-166350-2 LK accesssurgery.mhmedical.com/content.aspx?aid=1104596084 RD 2024/03/28 AB EpidemiologyAortopulmonary (AP) window is a rare congenital anomaly, representing 0.2 to 0.5 percent of all cases of congenital heart disease.PathophysiologyAn abnormal communication between the ascending aorta and main or branch pulmonary artery results in severe left-to-right shunting. The degree of pulmonary overcirculation, pulmonary hypertensive vascular changes, congestive heart failure, and failure to thrive depend on associated anomalies and the size of the defect, which is often large enough to allow equalization of pulmonary and aortic pressures. Associated malformations are present in 50 to 60 percent of cases and include interrupted aortic arch, tetralogy of Fallot and anomalous origin of the right pulmonary or coronary artery.DiagnosisTwo-dimensional echocardiography provides accurate identification and localization of AP window as well as definition of associated lesions.TreatmentSurgical closure of large defects is indicated at the time of diagnosis in order to avoid early development of fixed pulmonary hypertension. Patch repair using a transaortic, transpulmonary, or “sandwich” approach has excellent outcomes. Small defects can be ligated or approached by percutaneous techniques.Outcomes/prognosisOperative mortality is reported at less than 10 percent, with long-term prognosis largely dependent on the development of pulmonary hypertensive changes.