AORTOPULMONARY SEPTAL-DEFECTS - A REVIEW OF THE LITERATURE AND REPORTOF 10 CASES

From 1981 to 1992, 10 infants with aortopulmonary septal defect (APSD) underwent surgical repair. The mean age at operation was 5.6 +/- 5.5 months, and the mean weight 4.6 +/- 2 kg. Intracardiac associated anom alies were as follows; ventricular septal defects (7 cases), tetralogy of Fallot (2 cases), aortic valve stenosis (2 cases), atrial septal d efect (3 cases), patent ductus arteriosus (3 cases), pulmonary valve s tenosis (1 case). Cardiac catheterization was performed in 8 out of 10 patients. Eight patients had type I (proximal) defect, 1 had type II (distal) defect and 1 had type III (absent aortopulmonary septation) d efect. A variety of surgical procedure was employed. APSD closure with hemoclip was feasible in 3 cases with small window. In 6 patients, du ring a period of cardiopulmonary by-pass, a side biting clamp was posi tioned on the ascending aorta close the defect; the border of the wind ow was divided leaving a flap of pulmonary wall on the left side to cl ose the aortic defect; the pulmonary artery was repaired by an autolog ous pericardial patch. In the patient with type III APSD, aortopulmona ry septation was carried out through a trans-window approach. Associat ed anomalies were repaired in all infants except one. Hospital mortali ty was 10% (1 case). No late deaths occurred. At a mean follow-up of 4 7 +/- 3 5 months 8 patients are asymptomatic and 1 is awaiting for rep air of associated anomalies. Conclusions. APSD is a rare but nonethele ss well identifiable anomaly. Surgery is indicated as soon as the diag nosis is established, regardless of the patient's age. The choice of t he technique is based upon the type and size of the APSD. Associated c ardiac anomalies should be repaired simultaneously. Data of the litera ture regarding surgical techniques and age at operation are discussed.