Navigating aortopulmonary window repair beyond infancy: a case report on perioperative management
Main Article Content
Keywords
aortopulmonary window, case report, congenital heart disease, perioperative management, pulmonary hypertension
Abstract
Background: Aortopulmonary window (APW) represents one of the most uncommon congenital heart anomalies. Prompt surgical correction is essential once the diagnosis is established, independent of patient age. Without intervention, there is a high risk of developing severe pulmonary hypertension (PH). Delayed diagnosis and treatment remain a major obstacle, particularly in regions with limited healthcare resources. This study aims to highlight the clinical presentation, surgical management, and outcomes of a late-diagnosed APW case, emphasizing the feasibility of successful intervention beyond infancy.
Case Presentation: A two-year-old boy who was diagnosed late with type 3 APW, presenting with repeated episodes of breathlessness and poor growth. Echocardiography revealed a significant defect in the aortopulmonary septum. Surgical closure was performed successfully using a patch through a transaortic approach. Intensive postoperative care—including administration of pulmonary vasodilators, inotropic support, and regular monitoring—was provided, and the patient did not experience any PH crises. Before discharge, echocardiography confirmed complete closure of the APW with no remaining defect.
Conclusion: APW is a rare congenital heart defect that carries a notable risk of pulmonary hypertension. Although timely intervention is ideal, this case demonstrates that surgical repair can still be effective in selected patients with late-presenting APW beyond infancy. Careful perioperative management is crucial to minimize the risk of PH crises and to achieve the best possible outcomes.
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