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J Thorac Cardiovasc Surg 2009;138:1433-1435
© 2009 The American Association for Thoracic Surgery

Brief Technique Report

An alternative technique for septation of the aortopulmonary window using a fenestrated, unidirectional valved fabric patch

Ujjwal K. Chowdhury, MCh, Diplomate NB*, Chander Mohan Mittal, MS, Anand K. Mishra, MCh, Srikrishna M. Reddy, MS, Avneesh Sheil, MS, Ganapathy K. Subramaniam, MCh

Department of Cardiothoracic Surgery, AIIMS, New Delhi, India

Received for publication June 7, 2008; accepted for publication September 17, 2008.

* Address for reprints: Ujjwal K. Chowdhury, MCh, Diplomate NB, Additional Professor, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi-110029, India. (Email: ujjwalchow@rediffmail.com; ujjwalchowdhury@gmail.com).

The first 20% of the full text of this article appears below.


   Introduction
 
Postoperative pulmonary hypertensive crises and right-sided heart failure remain the predominant cause of death in patients undergoing septation of the aortopulmonary window with moderate-to-severe pulmonary arterial hypertension (PAH).1,2Go Although a unidirectional, fenestrated valved patch has been used in the setting of hypertensive atrial and ventricular septal defects to decompress the right-sided chambers in the event of pulmonary hypertensive crisis, there is no published report of aortopulmonary septation using this technique so far.3,4Go We report the technique and results in 7 patients with a large aortopulmonary window with severe PAH using a fenestrated, unidirectional, valved polytetrafluoroethylene patch.


   Clinical Summary
 
Between January 1999 and December 2007, 7 patients underwent aortopulmonary window repair by a single surgeon using the surgical technique described after informed written consent and institutional ethics committee approval were obtained.

The demographic characteristics of all 7 patients are presented in Table 1 . The diagnosis was established preoperatively by echocardiography, cardiac catheterization, and angiocardiography in all patients. Reversal of pulmonary vascular resistance (PVR) to 2.6 to 8.5 woods units/m2 after oxygen (100%) and nitric oxide (80 PPM) administration for 10 minutes suggested operability in all patients.


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  		Table 1 Demographic data, cardiac anatomy, type of operation, and results of patients under study
 
We used a transwindow approach to repair the aortopulmonary window by sandwich patch closure technique in these patients. On moderately hypothermic cardiopulmonary bypass, the right and left pulmonary arteries were temporarily snared . . . [Full Text of this Article]






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