Aortopulmonary Window  (AP Window)

The aorta is a large blood vessel carrying oxygen-rich blood away from the body's left side heart. The pulmonary artery is a large blood vessel carrying oxygen-poor blood away from the heart's right side to the lungs, where it picks up oxygen. An AP Window is when there is a connection between the two vessels. This connection allows oxygen-rich blood that should be going to the body to go to the lungs instead. The lungs can get overworked, often seen a few weeks after birth. Additionally, if this connection is not fixed, the lungs can become permanently injured, and the child can develop pulmonary hypertension with may prevent any future repair.

Symptoms

Infants may show signs and symptoms of congestive heart failure such as:

• breathing fast
• difficulty breathing
• elevated heart rate
• not taking feedings and other babies
• not growing well for their age
• tiredness or sleeping more often than other babies

Surgical Techniques

Surgical treatment to close an AP Window involves making an incision through the breastbone (sternotomy). A machine that allows the heart and lungs to rest (cardiopulmonary bypass) allows the surgery team to work on the blood vessels and the abnormal connection. A patch (a piece of synthetic material) is placed, which closes the connection. If present, any additional cardiac defects are repaired at this time.

Post-Operative Care

After an aortopulmonary window repair, monitoring in the post-operative period will include invasive lines, such as an arterial line and central venous line, to monitor blood pressure and deliver medications. Medications may be needed to control hemodynamics, provide sedation and maintain hydration during recovery. Perfusion is monitored by pulse oximetry and NIRS (near-infrared spectroscopy) probes. Depending on various factors specific to each individual, the breathing tube (endotracheal tube) may or may not still be present after surgery. Chest tubes will be present to remove air, blood, and/or fluid from around the heart or lungs. These tubes will be removed in the ICU as soon as possible, typically the next day or so.

The average length of hospital stay is around 7-10 days.