[Adult case of aortopulmonary window with aortic regurgitation: a case report]

Abstract

A 45-year-old woman was admitted to our hospital because of the evaluation of heart murmur. Her height was 152 cm and body weight was 46 kg. The physical examination showed a grade 4 continuous murmur widely audible on the anterior chest wall. The chest X-ray film was normal. The electrocardiogram showed premature ventricular contractions and left ventricular (LV) hypertrophy. The two dimensional echocardiogram demonstrated the presence of moderate aortic regurgitation (AR), however, aortopulmonary window could not be detected. The aortic valve showed neither atherosclerotic nor rheumatic changes. At cardiac catheterization, pulmonary artery (PA) pressure was 20/11 mmHg and aortic pressure was 133/60 mmHg, and a step-up of O2 saturation between right ventricule and pulmonary artery (PA) was demonstrated. The aortography revealed an aortopulmonary window between the proximal ascending aorta and the main PA, and grade 2 AR. The pulmonary to systemic flow ratio averaged 1.5:1. The coronary artery and the LV wall motion was normal. Aortopulmonary window is a very rare anomaly and often requires operation in childhood because of its large left-to-right shunt in most cases. Neither an asymptomatic adult case with this anomaly nor a case with AR has not been reported so far.