Reversing the irreversible? A case of successful surgical repair in a late-presenting aortopulmonary window with severe pulmonary hypertension

This case suggests that operability in APW may not be irrevocably lost beyond infancy in carefully selected adolescents. It underscores the importance of individualized assessment, medical preconditioning and serial haemodynamic reassessment to unmask latent pulmonary vasoreactivity. Larger series are needed to define which late-presenting patients with APW and PH may safely benefit from definitive surgical repair.