Case 5/2015 Late Outcome of Corrected Aortopulmonary Window in A 23-Year-Old Female Patient Who Underwent Surgery in Childhood

DOI: 10.5935/abc.20150062 Clinical data: At 10 months of age, the patient underwent correction of a large aortopulmonary window and mitral valve regurgitation secondary to volume overload, which caused severe heart failure. The post-operative clinical outcome was favorable. Prior to operation, her clinical picture was of concern because of severe malnutrition (weight of 5,500 g), congestive heart failure (tachypnea of 60 bpm), hepatomegaly (liver palpable at 4 cm of the right costal margin), severe cardiomegaly, and increased pulmonary vasculature. Cardiovascular examination showed left ventricular (LV) enlargement; thrill and systolic murmur in the mitral area; accentuated S2; marked LV overload on electrocardiogram (ECG); mitral regurgitation due to incomplete leaflet coaptation; and pulmonary systolic pressure of 60 mmHg. At surgery, the 2-cm-diameter window between the pulmonary trunk and ascending aorta (Ao) was closed, and plication of the posterior ring of the mitral valve was performed. There was an immediate clinical response with hemodynamic stabilization, resolution of the heart murmur and heart failure, and subsequent normal weight gain. Medication for congestive heart failure was discontinued at 4 years of age, when the cardiac silhouette had returned to normal. To date, the patient tolerates routine exercises well and does not report any symptoms.