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.