Repair of Type 2 Aortopulmonary Window in an Infant with Right Aortic Arch

A two-month-old female presented with failure to thrive and shortness of breath during feedings. Echo images show ed type 2 aortopulmonary window, left ventricular enlargement, and systemic pulmonary hypertension. After a median sternotomy, the mean, right, and left pulmonary arteries, and ascending aorta were dissected. There was no patent ductus arteriosus. The AP window was visualized. The ascending aorta was then cannulated distally. Next, the right atrium was cannulated. Then the left heart was vented via right superior pulmonary vein. Next, the aortic cross-clamp was applied, and the heart was arrested with the Del Nido cardioplegic solution.  

The aortotomy was then performed, and the AP window was visualized between the posteromedial wall of the ascending aorta and pulmonary bifurcation. It was quite close to the right aortic arch. The AP window was closed with glutaraldehyde-treated autologous pericardium and 7-0 Prolene sutures. Then we checked the patch for any residual shunt by removing the pulmonary arterial snares.  

To finish the procedure, the aortotomy was closed after de-airing and the patient was weaned from cardiopulmonary bypass easily. The pulmonary arterial pressure was measured. The postoperative echo demonstrated an intact wall between the aorta and pulmonary arteries. The patient was extubated on postoperative day four and discharged on postoperative day eight. 

References

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