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.
APW can be proximal/distal and may be in entire length of great vessels.
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.
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.
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.
No. Medicine is not available for closing the APW. Medicines are used for controlling symptoms due to heart failure, LRTI etc.
Either angiographically (without surgery) or by surgery.
- Short hospital stay (2-3 days)
- No surgical scar on the body
- No medicine is required after the procedure.
- Can attend school from next day of discharge
- Can participate in all outdoor activities from very next day
- Very less risk as compared to surgery, although very safe procedure
- No requirement of ventilator in most cases
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.
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.