A 3-year-old child, referred for pre-operative echocardiogaphy of a persistently patent arterial duct (Fig 1), had no continuous diastolic flow on continuous wave Doppler (Fig 2). This caused us to search for additional anomalies, and, in a supra-aortic window, a 15-millimetre aortopulmonary window (Fig 3) was visualised, with left-to-right shunting (Fig 4). A trans-aortic view (Fig 5) additionally disclosed a non-obstructive, two-leaflet aortic valve. With this information, the child underwent successful closure of both the aortopulmonary window and arterial duct at operation. This case emphasises the importance of a thorough and complete pre-operative echocardiographic examination in all cases of congenital cardiac disease.
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Figure 5