Patent Arterial Duct and Aortopulmonary Window

Persistent arterial duct, also known as patent ductus arteriosus (PDA), is a common form of congenital heart disease. The clinical implications and management of a PDA varies quite broadly based on multiple factors that partially include the age of presentation, prematurity (including degree of prematurity), and size of the ductus arteriosus. Management of the PDA can vary from clinical observation for children with a “silent” PDA to surgical ligation or transcatheter closure for extremely premature infants. Medical management may include anticongestive therapy for symptomatic relief but also pharmacologic interventions such as indomethacin or acetaminophen to attempt closure in premature infants. Fortunately, less invasive forms of definitive management including transcatheter closure are becoming more widely available including for extremely preterm infants. Aortopulmonary window is a much rarer form of congenital heart disease. The clinical presentation and course of patients with an aortopulmonary window is that of congestive heart failure from a left-to-right shunt, similar to a large PDA or ventricular septal defect. Intervention for patients with an aortopulmonary window is primarily surgical closure, but transcatheter approaches have been reported in smaller lesions. Accurate diagnosis and appropriate management are essential to reduce the risk of long-term sequelae such as pulmonary vascular disease secondary to pulmonary hypertension. With prompt identification and proper management, outcomes for both of these lesions are excellent in the long term.