Aorto-Pulmonary Window (APW)

What is Aorto-Pulmonary window (APW)?

APW is a hole at the level of great vessels (aorta and pulmonary artery). This is a congenital heart disease, i.e. child born with a hole.

What are the types of AP Window?

APW can be proximal/distal and may be in entire length of great vessels.

Clinical presentation of AP Window?

It depends on size of AP Window.
If size of APW is small, child is generally asymptomatic, and only systolic murmur will be there on examination by a pediatrician.
If size of APW is moderate (neither small nor big), child generally have history of poor weight gain, cough and cold etc.
In large sized APW, child generally presents at 1-2 months of age with complaints of cough, cold, difficulty in breathing, poor weight gain, sweating over forehead during feeding.

Diagnosis of AP Window?

For diagnosing APW, Echocardiography of child needs to be done. Echo is a non-invasive test that is without pain. Echo is done from chest.Generally in small child, echo needs to be done when child sleeps.

Timing of closure of AP window as well as procedure of choice for closure of AP window?

After confirming the size of APW and degree of dilatation of left heart chambers on Echocardiography, we can plan further treatment.

If size of APW is small, then we can close this hole by 6 months-1 year of age by device technique instead of open heart surgery.

If moderate sized APW,then it generally associated with left heart dilatation, then we should close the hole between 6 months. This is generally suitable for surgical closure but in few cases where anatomy is favorable then device closure technique also can be done.

In large sized APW: we close between 3-6 months of age by open heart surgery.

Can we close AP Window by medications?

No. Medicine is not available for closing the APW. Medicines are used for controlling symptoms due to heart failure, LRTI etc.

What are the options for closure of AP Window?

Either angiographically (without surgery) or by surgery.

Advantages of closure of AP Window by using a device (Non-surgical method)?
  1. Short hospital stay (2-3 days)
  2. No surgical scar on the body
  3. No medicine is required after the procedure.
  4. Can attend school from next day of discharge
  5. Can participate in all outdoor activities from very next day
  6. Very less risk as compared to surgery, although very safe procedure
  7. No requirement  of ventilator in most cases
Surgical options?
Only by open heart surgery on bypass machine.
How we should do follow-up after device closure or after surgery?

After Device closure by angiographically: After one month then 3, 6, 12 months after the procedure.

After surgery: after 3 days for wound dressing, then 1,3,6,12 months after surgery.

How AP window is closed in the cath lab?

By cardiac angiography from thigh blood vessels that are connected with the heart. We close APWin a beating heart.
This procedure is generally done under conscious sedation. Within six months, device become endothelized and become a part of heart for life long.