Backer C L, Mavroudis C
Division of Cardiovascular-Thoracic Surgery, M/C #22, Children's Memorial Hospital, 2300 Children's Plaza, Northwestern University Medical School, Chicago, IL, USA.
Eur J Cardiothorac Surg. 2002 May;21(5):773-9. doi: 10.1016/s1010-7940(02)00056-8.
An aortopulmonary window (APW) is a communication between the pulmonary artery (PA) and the ascending aorta in the presence of two separate semilunar valves. The purpose of this review is to describe the evolution of surgical techniques and results of surgical correction of APW at a single center over a 40-year time period.
Between 1961 and 2001, 22 patients underwent repair of APW. Age ranged from 11 days to 13 years (median 0.3 years). Associated cardiac lesions included interrupted aortic arch (IAA) (four), right PA origin from the aorta (four), ventricular septal defect (three), atrial septal defect (one), tetralogy of Fallot (one), and transposition of the great arteries (one). Mean preoperative pulmonary vascular resistance was 5.4 U/m2 (n=17). Two patients had attempted ligation without cardiopulmonary bypass (CPB), one patient had division and oversewing of the APW between clamps on CPB. Ten patients had the APW divided on CPB with primary aortic closure. Three patients had circulatory arrest for APW division, IAA repair, and anastomosis right PA to main PA. Most recently, six patients have had open transaortic patch closure (one of these had simultaneous arterial switch, one had simultaneous IAA repair). Follow-up in operative survivors ranges from 1 month to 26 years (median 8 years).
There were five early deaths and one late death (pulmonary hypertension) in the first 16 patients where the primary strategy was APW division (37% mortality). There have been no deaths in the most recent six patients having transaortic patch closure. The patients with transaortic patch closure at a maximum of 8 years follow-up are demonstrating normal PA and aortic growth.
Early correction of APW with a transaortic patch and repair of all other associated cardiac anomalies at the time of diagnosis is advised.
主肺动脉窗（APW）是指在存在两个独立半月瓣的情况下，肺动脉（PA）与升主动脉之间的交通。本综述的目的是描述单一中心在40年时间里主肺动脉窗手术技术的演变及手术矫正结果。
1961年至2001年间，22例患者接受了主肺动脉窗修复术。年龄范围为11天至13岁（中位数0.3岁）。相关心脏病变包括主动脉弓中断（IAA）（4例）、右肺动脉起源于主动脉（4例）、室间隔缺损（3例）、房间隔缺损（1例）、法洛四联症（1例）和大动脉转位（1例）。术前平均肺血管阻力为5.4 U/m²（n = 17）。2例患者尝试在非体外循环（CPB）下结扎，1例患者在CPB下夹闭之间对主肺动脉窗进行分隔和缝合。10例患者在CPB下对主肺动脉窗进行分隔并直接关闭主动脉。3例患者在循环停止下进行主肺动脉窗分隔、IAA修复以及右肺动脉与主肺动脉吻合。最近，6例患者接受了经主动脉补片修补术（其中1例同时进行了动脉调转术，1例同时进行了IAA修复）。手术存活者的随访时间为1个月至26年（中位数8年）。
在前16例以主肺动脉窗分隔为主要策略的患者中，有5例早期死亡和1例晚期死亡（肺动脉高压）（死亡率37%）。最近6例接受经主动脉补片修补术的患者无死亡。经主动脉补片修补术的患者在最长8年的随访中显示肺动脉和主动脉生长正常。
建议在诊断时采用经主动脉补片对主肺动脉窗进行早期矫正，并修复所有其他相关心脏异常。
