INTRODUCTION
Aortopulmonary window(APW) is a rare congenital cardiac anomaly,
occurring due to incomplete separation of conotruncus by the
aorticopulmonary septum with separate semilunar valves. The usual
presentation is in early infancy and childhood due to congestive heart
failure.1 Early surgical closure is required before
progression to irreversible pulmonary hypertension beyond infancy, which
contradicts closure. Recently, attempts have been made for transcatheter
device closure of this anomaly, but it is not possible in all cases,
particularly for large proximal and distal types. Surgical closure is
feasible for all types with excellent long-term
outcomes.2 Here we present the case of a 14-year-old
boy, with a large type-I APW who developed severe pulmonary artery
hypertension causing the dilated pulmonary artery to cause compression
of the left main coronary artery. He underwent a successful anterior
sandwich repair after a failed attempt at device closure.