Background

We present a case of aorticopulmonary window (APW) with aortic arch interruptions that developed giant pseudoaneurysm after surgery.

Objectives

Case

A 6-day-old baby was referred to hospital for surgery with the diagnosis of APW. The patient was intubated and mechanical ventilation was performed due to respiratory distress. The echocardiographic evaluation showed a wide APW, patent ductus arteriosus, transverse aortic hypoplasia, aortic arch interruption and pulmonary hypertension.

Methods

Prostaglandin infusion was started. At 12 days of age, the hypoplastic transverse arch and interrupted aortic arch were repaired with prosthetic material. APW was repaired, PDA was ligated. Candida albicans was produced in the blood culture in the preoperative period. Antifungal therapy was initiated. The echocardiogram on the 18th postoperative day revealed giant pseudo aneurysm in the aortic arch. CT angiography showed a pseudo aneurysm extending from the aortic isthmus to distal descending aorta with active bleeding and hematoma in posterior mediastinum. The patient underwent to urgent surgery on the same day. Control CT angiographic evaluation revealed no aneurysm in the transverse aorta and descending aorta.

Results

He was discharged 21th day after the second operation. Blood culture taken 1 month after the end of antifungal treatment was negative

Conclusion

Aortopulmonary window (APW) may be an isolated anomaly (simple) or associated with concomitant cardiovascular anomalies (complex). Mortality is almost always due to concomitant cardiovascular anomalies. One of the most common concomitant cardiovascular anomalies is an interrupted aortic arch. Our patient underwent re-operation because of fungal end arthritis after a successful adjustment surgery.