The Annals of Thoracic Surgery, Vol 32, 244-250, Copyright © 1981 by The Society of Thoracic Surgeons
Aortopulmonary septal defect: hemodynamics, angiography, and operation
DB Doty, JV Richardson, GE Falkovsky, MI Gordonova and VI Burakovsky
Twenty-five patients with malseptation of the aortopulmonary trunk
resulting in aortopulmonary septal defect (window) were evaluated in a
unique combined surgical series assembled from two institutions
participating in the USA-USSR Health Exchange Program. Typical
aortopulmonary septal defect or window (type I) with the connection between
the ascending aorta and main pulmonary artery was found in 21 patients.
Four had a more cephalad defect (type II) between the ascending aorta and
the origin of the right pulmonary artery. Hemodynamics were the consequence
of a large left-to-right shunt (mean ratio of pulmonary to systemic flow,
3.0) with right ventricular hypertension (mean right ventricular pressure,
86 mm Hg) and increased pulmonary vascular resistance (mean, 7.4 U) (mean
ratio of pulmonary to systemic vascular resistance, 0.33). Angiography may
provide patterns that allow preoperative distinction between the two types
of aortopulmonary septal defect and provide information important in
planning the details of corrective operation. Operative techniques included
ligation, direct suture, and patch closure of the aortopulmonary septal
defect. The best method appeared to be patch closure by the transaortic
approach; real and potential problems were associated with other
techniques.
