A Rare Case of Dissection Originating at an Aortopulmonary Window

Abstract

A 17-year-old male patient was referred to our center with acute onset of chest pain and resting dyspnea. Transthoracic echocardiography showed enlargement of the aorta with possible dissection, dilated left heart chambers, and moderate pericardial effusion. Computerized tomography demonstrated a large aortopulmonary communication between the posteromedial part of the ascending aorta and the anterolateral part of the pulmonary trunk (Fig 1, Ao aorta; PA pulmonary artery; FL false lumen; arrow aortopulmonary window). Right subclavian arterial cannulation and selective bicaval cannulation were performed, and the patient was cooled down to 19°C. Longitudinal aortotomy revealed a type I aortopulmonary window 1 cm above the coronary ostia and separated semilunar valves. The defect size was 2.5 3 cm. In addition, an intimal tear at the posterior wall of the window and a false lumen extending toward both the aorta and the pulmonary artery were noticed (Fig 2, Ao aorta; PA pulmonary artery; black arrow intimal tear; transparent arrow posterior rim of aortopulmonary window). No other anatomic malformation was observed. The dissection was localized only at the ascending aorta, which was repaired with supracoronary Fig 1.