Beyond Childhood: Percutaneous Closure of an Aortopulmonary Window with Severe Pulmonary Hypertension in an Adult Woman - A Case Report.

Abstract

Aortopulmonary window (APW) is a rare congenital heart defect that may progress to pulmonary hypertension if untreated. Presented here is the case of a 25-year-old woman with type 1 APW diagnosed in childhood who presented with chest pain, headache, dyspnoea, and transient loss of consciousness. Imaging confirmed severe pulmonary hypertension (mean pulmonary artery pressure 50 mmHg) and a positive vasoreactivity test, allowing for percutaneous closure. A 14 mm Amplatzer Septal Occluder was implanted under transoesophageal echocardiographic and fluoroscopic guidance. Postoperative complications comprised non-immune haemolytic anaemia and haematuria, likely due to minimal residual shunting, both managed conservatively. At 3-month follow-up, echocardiography showed stable device position, no residual shunt, pulmonary pressure reduction (36 mmHg), and mildly decreased systolic function with persistent left-sided dilation. This case supports the feasibility of percutaneous APW closure in selected adults with reversible pulmonary hypertension and highlights the need for structured echocardiographic and haemodynamic follow-up.