Tetralogy of Fallot with Coexistmg Type I1 Aortopulmonary Window

An infant had a coexisting tetralogy of Fallot and type I1 aortopulmonary window between the ascending aorta and the right pulmonary artery in which the communication acted as a palliative systemic-pulmonary shunt. Surgical repair is de- scribed, and the appropriate literature is reviewed. Aortopulmonary windows are unusual cardiac defects, which usually consist of a communica- tion between the ascending aorta and the main pulmonary artery (5, 10, 193. They have been reported to occasionally coexist with other de- fects such as ventricular septal defect, patent ductus arteriosus, and more rarely with tetral- ogy of Fallot (3, 6, 10, 171. A different type of aortopulmonary window between the ascend- ing aorta and the right pulmonary artery at its origin has recently been described in several patients (3, 14, 191. This case report describes a patient with tetralogy of Fallot and such an aortopulmonary window which in location and effect was identical to a palliative Waterston- Cooley shunt. A 3-month-old girl was referred to the Univer- sity of Mississippi Medical Center in January, 1977, for evaluation of a heart murmur and con- gestive heart failure. An older brother had re- cently undergone successful repair of tetralogy of Fallot. Physical examination revealed a small acyanotic infant with a grade 4/6 holosystolic murmur heard along the left sternal border. The liver was 7 cm below the right costal mar- gin. Electrocardiogram demonstrated combined ventricular hypertrophy with right atrial en- largement. Chest roentgenogram showed a moderately enlarged heart with increased pul- From the Divisions of Pediatric Cardiology and Cardiac Surgery, University of Mississippi Medical Center, Jackson, MI.