Aortopulmonary window: Factors associated with early and late success after surgical treatment

J. A M Van Son, F. J. Puga, G. K. Danielson, J. B. Seward, D. D. Mair, Hartzell V Schaff, D. M. Ilstrup

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

Between 1953 and 1990, 19 patients, who were from 7 weeks to 27 years old, underwent surgical correction of aortopulmonary window at the Mayo Clinic. Associated cardiac anomalies were present in nine patients (47%). At operation, extracorporeal circulation was used in all except one patient. In seven patients, division and primary closure were done. In four patients, the defect was closed by direct suture through a transpulmonary approach. In eight patients, the defect was closed with a patch through a transpulmonary or transaortic approach. Four deaths (21%) occurred intraoperatively or immediately postoperatively. All four patients had undergone division of the aortopulmonary window before 1962, and three of them had a pulmonary vascular resistance (Rp) that was 7.3 U · m2 or more and a ratio of Rp to systemic vascular resistance (Rp/Rs) that exceeded 0.6. One patient with an Rp of 11.8 U · m2 and an Rp/Rs of 0.72 died 16 years postoperatively. Statistical analysis of risk factors indicated that early year of operation (P = 0.022), division of the aortopulmonary window versus transaortic or transpulmonary closure (P = 0.009), and a high Rp/Rs (P = 0.021) were significantly associated with perioperative death. All patients with a preoperative Rp of 8 U · m2 or less, an Rp/Rs of less than 0.4, and no major associated cardiac anomalies were in functional class I (New York Heart Association) postoperatively. Our study confirms that infants with aortopulmonary window should undergo operation early, before irreversible pulmonary vascular changes have developed. Patients with an Rp/Rs that exceeds 0.4 should be thoroughly assessed to determine their operability.

Original languageEnglish (US)
Pages (from-to)128-133
Number of pages6
JournalMayo Clinic Proceedings
Volume68
Issue number2
StatePublished - 1993

ASJC Scopus subject areas

  • Medicine(all)

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    Van Son, J. A. M., Puga, F. J., Danielson, G. K., Seward, J. B., Mair, D. D., Schaff, H. V., & Ilstrup, D. M. (1993). Aortopulmonary window: Factors associated with early and late success after surgical treatment. Mayo Clinic Proceedings, 68(2), 128-133.