This could present with features of Eisenmenger syndrome, including cyanosis and clubbing. Rarely, an AP window diagnosis is not made until later in childhood or even adult life. In this scenario, a continuous heart murmur could be noted. Occasionally the AP window can be restrictive and present with less significant symptoms of over circulation. When the AP window occurs with an interrupted aortic arch, the neonate can present with shock as the ductus arteriosus constricts. In the tetralogy of Fallot, a pulmonary ejection murmur and pulmonary valve click can be noted. Rarely, there is a continuous murmur noted as the connection between the aorta, and the pulmonary artery is usually large, not allowing for a significant pressure gradient (restriction) to develop.Īs noted above, an AP window can be associated with other types of congenital heart defects, and the associated defect can alter the presentation. The pulses are often bounding as the systemic diastolic blood pressure is decreased secondary to aortic flow reversal in diastole. The precordium is often hyperdynamic, and a mitral valve rumble can be appreciated. This usually results in a large left to right shunt, and the symptoms would include diaphoresis (especially with feeding), tachypnea, tachycardia, poor weight gain, and increased respiratory symptoms with viral infections. The typical signs and symptoms associated with an AP window are pulmonary over-circulation occurring as the pulmonary vascular resistance falls over the first few weeks of life. While it is conceivable to diagnose an isolated AP window in utero by fetal echocardiography, the more typical presentation is in the neonatal period or early infancy. In less than 10% of the cases, the AP window is small and pressure restrictive. The size of the connection is variable but is usually large, unrestrictive, and hemodynamically significant. Type I is the most common type of AP window. Three types of AP window are identified: type I (proximal), occurring between the posterior wall of the ascending aorta and lateral wall of the main pulmonary artery type II (distal), occurring between the posterior wall of the ascending aorta and the anterior wall of the origin of the right pulmonary artery and type III, which is a combination of type I and II. The location of the window defect is between the semilunar valves and the branch pulmonary arteries. In an isolated AP window, the two separate semilunar valves (aortic and pulmonary) are typically formed normally. An AP window occurs during embryonic life when there is incomplete septation of the common arterial trunk, allowing an abnormal connection between the ascending aorta and the main pulmonary artery.
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