Aortopulmonary window: Types, associated cardiovascular anomalies, and surgical outcome. Retrospective analysis of a single center experience

Late Identification of a Stealthy Aorto-Pulmonary Window: A Case Report

The term "aortopulmonary window" (APW), often referred to as "aortopulmonary septal defect," refers to a rare congenital medical disorder where there is an improper direct link between the main pulmonary artery and the ascending aorta. It can be combined with other cardiac congenital conditions or be an isolated lesion. Herein, we report the incidental discovery of a minor, restrictive aortopulmonary septal defect in a 60-year-old male who denied having any clinical symptoms. Incidentally detected APW in adulthood is uncommon and, hence, can be readily overlooked, a fortiori, in asymptomatic patients.

Berry syndrome; a successful one-stage repair in neonate periods, evaluation result after 9 years, a case report

Backgroud

IAA with an intact ventricular septum is distinctly unusual. Combination with an Aortopulmonary Window (APW), ascending aortic origin of the right pulmonary artery and PDA may be present which is called as Berry syndrome, a rare combination of cardiac anomalies, reported to be 0.046%, lethal combination and die shortly after birth.

Case Report

We report a 9 days-old male neonates weighing 3.85 kg was referred by local hospital to our center and was ventilated with history of respiratory distress and severe infection since he was born. Admitted to our PCICU, 2D echo showed an IAA type A associated with a huge APW type II and restrictif PDA. A PGE1 infusion was started, during the following days the baby experienced several epileptic episodes. After improvement of the clinical condition, surgery was performed on the 20th days of life on year 2011. A successful one-stage repair of such anomalies in which cutting of PDA that arised from PA trunk and distally becoming into descending aorta, extended end to end anastomosis to conduct the ascending aortic blood flow into the descending aorta and intra arterial baffle was used. A 4-0 Gore-Tex baffle was used both to close the APW and separated the RPA from aortic origin with a good result, as his recently grown up as a cheerful 9 year old child who is growing actively and has entered elementary school in grade 2.

Conclusion

Berry syndrome is a rare but well‐identified and surgically correctable anomaly. Early diagnosis and surgical treatment to avoid irreversible pulmonary hypertension is mandatory.

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Berry syndrome, a rare combination of cardiac anomalies, reported to be 0.046%, lethal combination and die shortly after birth. But well‐identified and surgically correctable anomaly.

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Early diagnosis and surgical treatment to avoid irreversible pulmonary hypertension is mandatory.

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Successful one-stage repair was done in a 20-days-old neonate using an alternative technique without circulatory arrest (performed on year 2011).

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Currently on year 2021, (after 9 years of evaluation) the patient has grown up as a cheerful 9 year old child who is growing actively and has entered elementary school in grade 2.

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During this patient last follow up on March 2019 at NCHHK Pediatric Cardiology clinic, echo result showed no residual AP Window, minimal pressure gradient of 18 mmHg across the aortic reconstruction with good LV function of 70%, good RV function, intact inter atrial & ventricular septum with TVG 20 mmHg. The latest echo follow up with the pediatric cardiologist showed good LV function with EF of 70%, no residual pumnonary hypertension was detected.